8 research outputs found
Continued versus discontinued oxytocin in the active phase of induced labor in term pregnancies: an updated systematic review and meta-analysis of randomized controlled trials
No full textIntroduction: Oxytocin has long been used for the induction of labor, but it can be associated with fetal and maternal complications that could potentially be reduced by dis continuing the treatment during labor. We performed this meta-analysis to determine whether discontinuation of oxytocin, once the active phase of induced labor is achieved, affects the second stage of labor and the rate of various maternal and fetal outcomes. Methods: We searched for randomized controlled trials (RCTs) comparing discontinuing oxytocin after the active stage of labor is established versus continuing to give oxytocin throughout the labor process using databases like PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from the inception till February 1, 2025. Results were pooled using RevMan 5.4, and the effect metric was the risk ratio (RR). Our systematic review and meta-analysis was registered with PROSPERO (CRD42024534076). Results: Pooled analysis of fifteen RCTs included in our review showed that discontinuation of oxytocin, once the active stage of labor is established, did not reduce the primary outcome of incidence of cesarean delivery (RR = 0.91; 95% CI, 0.77-1.07; p = 0.21). The inci dence of uterine tachysystole, postpartum hemorrhage, and non-reassuring fetal heart rate was significantly lower in the oxytocin discontinuation group compared to oxytocin continuation. The rates of uterine rupture, vaginal instrument use, epidural use, and neonatal intensive care unit admission did not differ among both groups. The duration of the active stage of labor was significantly prolonged in the oxytocin-discontinued group; however, the duration of the second stage of labor and total delivery time remained comparable between the two groups. Conclusions: Discontinuation of oxytocin during the active phase of labor did not reduce the incidence of cesarean section or neonatal morbidity. We therefore rec ommend an individualized approach regarding oxytocin discontinuation while factoring in patient-specific factors. Newlarge-scale RCTsfocusing on identifying subgroups that might benefit from one approach over the other are required to provide more reliable results
Prolonged activated partial thromboplastin time secondary to factor XII deficiency in two surgical patients
No full textFactor XII (FXII) plays a pivotal role in hemostasis, inflammation and complement system. Its deficiency is usually an incidental finding in an otherwise asymptomatic patient who is identified during his/her routine preoperative blood work. This study aimed in evaluating the clinical course of the surgical patients having FXII deficiency. Information regarding demographics, laboratory tests and management of patients was obtained through medical chart and in-house integrated laboratory management system whereas the medical literature was searched through PubMed®. During the study period, two patients were consulted for FXII deficiency prior to the various surgical procedures. Both patients had uneventful surgeries without any thrombotic events while hemorrhage observed in one patient was secondary to obstetric complications. With the limited evidence today, it is concluded that patients having FXII deficiency are not at increased risk of bleeding, thrombosis or infections during surgery, but a personalized approach is needed for planning an appropriate perioperative management
Influence of Government Effectiveness, Health Expenditure, and Sustainable Development Goals on Life Expectancy: Evidence from Time Series Data
No full textThis study investigates the influence of government effectiveness, health expenditure, and sustainable development goals (SDGs) on life expectancy in Pakistan. To accomplish this, a systematic analysis was conducted on time series data spanning from 2000 to 2020. Cointegration analysis was utilized to evaluate the long-term integration of all variables, while a comprehensive causality test was performed to investigate the short-term links among government effectiveness, health expenditure, SDGs, and life expectancy. The findings of the Johansen Cointegration test definitively confirmed the presence of long-term cointegration among all variables. In addition, the results of the Granger causality test show that there is a one-way causal relationship between government performance, health spending, and SDGs to life expectancy in the short term. The validation of both enduring and immediate connections among these factors emphasizes the crucial significance of healthcare services in Pakistan. Therefore, it is important to push for more healthcare investments and increased national budget allocations by the Pakistani government. Prioritizing the allocation of resources towards healthcare, bolstering the efficiency of the administration, and attaining SDG targets are all crucial for enhancing life expectancy in Pakistan. The study’s results also carry significant policy implications, underscoring the necessity of strategically implementing health expenditure and SDG targets to enhance human capital and population well-being, as demonstrated by the increased life expectancy
Comparison of percutaneous coronary intervention vs coronary artery bypass graft for left main coronary artery disease in patients with prior cerebrovascular disease: A systematic review, meta-analysis and meta-regression
No full textBackground: Previous studies suggest similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD). Thus, we aim to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG. Methods: A comprehensive search from (January 2000 to August 2024) identified three relevant studies. Outcomes analyzed included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data analysis employed a random effects model and presented hazard ratios (HR) along with their 95 % confidence intervals (CI). Results: Three studies involving 760 patients (361 PCI, 399 CABG) were included. PCI was associated with a significantly higher risk of MACCE (HR = 2.56; 95 % CI = 1.23–5.37; p = 0.01; I2 = 86 %) and MI (HR = 2.97; 95 % CI = 1.72–5.13; p < 0.0001; I2 = 0 %) compared to CABG. No significant differences were observed in all-cause mortality (HR = 1.35; 95 % CI = 0.92–1.98; p = 0.12; I2 = 0 %) or recurrent stroke (HR = 0.83; 95 % CI = 0.40–1.70; p = 0.60; I2 = 1 %). The risk of repeat revascularization was higher in PCI, though not statistically significant (HR = 3.44; 95 % CI = 0.50–23.60; p = 0.21; I2 = 70 %). Conclusion: PCI significantly elevates the risk of MACCE and MI in patients with LMCAD and prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were non-significant. Comorbidities may drive the elevated risk, underscoring the need for tailored strategies in this population
Outcomes and survival of patients undergoing percutaneous vegetectomy for right heart endocarditis
No full textBACKGROUNDS: AngioVac is used for the percutaneous removal of vegetations and for debulking of large vegetations in patients who are not surgical candidates.This study aims to identify the demographics, echocardiographic features, indications, improvement of the tricuspid valve regurgitation, and survival outcomes of patients who have undergone AngioVac vegetectomy reported in the literature.
METHODS: A systematic review was performed to identify articles reporting suction thromectomy or vegetation removal using the AngioVac system for RSIE (right sided infective endocarditis). Survival on discharge was our primary outcome. Additionally, we evaluated indications for suction thrombectomy and TR improvement. Categorical variables were expressed as percentages and ratios.
RESULTS: A total of 49 studies were identified. The most common risk factor was intravenous drug abuse seen in 45% (20/49) and cardiovascular implantable electronic device (CIED) in 45% (20/49). Circulatory shock was seen in 35% of patients. The causative organism was gram positive cocci (86%). Moderate to severe TR was present in 74% of cases with documented echocardiograms. Indications for AngioVac were poor surgical candidacy (81%) or to reduce septic emboli risk (19%). Survival at discharge was 93%. TR improvement was reported only in 16% cases and remained unchanged/worsened in 84%.
CONCLUSION: AngioVac procedure is an alternative treatment for critically ill patients who cannot undergo surgery. To understand the survival, safety and candidacy of patients undergoing this procedure, further randomized control studies and literature reviews are needed. The improvement or worsening of tricuspid regurgitation in patients with TR valve involvement is another factor to be investigated
Outcomes and survival of patients undergoing percutaneous vegetectomy for right heart endocarditis
No full textBackgrounds: AngioVac is used for the percutaneous removal of vegetations and for debulking of large vegetations in patients who are not surgical candidates.This study aims to identify the demographics, echocardiographic features, indications, improvement of the tricuspid valve regurgitation, and survival outcomes of patients who have undergone AngioVac vegetectomy reported in the literature. Methods: A systematic review was performed to identify articles reporting suction thromectomy or vegetation removal using the AngioVac system for RSIE (right sided infective endocarditis). Survival on discharge was our primary outcome. Additionally, we evaluated indications for suction thrombectomy and TR improvement. Categorical variables were expressed as percentages and ratios. Results: A total of 49 studies were identified. The most common risk factor was intravenous drug abuse seen in 45% (20/49) and cardiovascular implantable electronic device (CIED) in 45% (20/49). Circulatory shock was seen in 35% of patients. The causative organism was gram positive cocci (86%). Moderate to severe TR was present in 74% of cases with documented echocardiograms. Indications for AngioVac were poor surgical candidacy (81%) or to reduce septic emboli risk (19%). Survival at discharge was 93%. TR improvement was reported only in 16% cases and remained unchanged/worsened in 84%. Conclusion: AngioVac procedure is an alternative treatment for critically ill patients who cannot undergo surgery. To understand the survival, safety and candidacy of patients undergoing this procedure, further randomized control studies and literature reviews are needed. The improvement or worsening of tricuspid regurgitation in patients with TR valve involvement is another factor to be investigated
Trends and Disparities in Acute Coronary Syndrome-Related Mortality in the United States: Implications for Healthcare
No full textAcute coronary syndrome (ACS) is a major cause of morbidity and mortality in the United States (US). However, the trends and disparities in ACS mortality are not well understood. This study aimed to analyze the ACS mortality in the US from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. The age-adjusted mortality rates (AAMR) due to ACS were calculated for each year from 1999 to 2020, stratified by sex, race, urbanization, and state. The trends and disparities in AAMR were examined using descriptive statistics and graphical methods. The AAMR due to ACS decreased from 1999 to 2010 and for some variables till 2018, but then increased from 2018 to 2020. The AAMR due to ACS was higher in men than in women, non-Hispanic black adults than in non-Hispanic white adults and rural than in urban populations. The AAMR due to ACS varied widely among different states, with New York having the highest AAMR and Minnesota having the lowest AAMR. This study revealed the trends and disparities in ACS mortality in the US from 1999 to 2020. The study showed an increase in AAMR due to ACS in the recent years. The study also found significant disparities in AAMR due to ACS by sex, race, urbanization, and state. Further research is needed to explore the factors that contribute to the variation and inequality in ACS mortality
Pan-cancer analysis of whole genomes
No full textCancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale1,2,3. Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4–5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter4; identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation5,6; analyses timings and patterns of tumour evolution7; describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity8,9; and evaluates a range of more-specialized features of cancer genomes8,10,11,12,13,14,15,16,17,18
