40 research outputs found
Efficacy and Safety of Pulsed-Field versus High-Power Short Duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-analysis with Reconstructed Time-to-Event Data
No full textConflict of law and the methodology of Tarjīẖ : a study in Islamic legal theory
No full textIslamic law never achieved unity but expressed itself in, at least, four surviving schools. More interestingly, contemporary Muslim communities are still divided among themselves on a number of issues related to their laws. This work describes how problem of legal conflicts have been tackled by Muslim jurists. It is an attempt to examine closely the phenomenon of conflict in Islamic law from the standpoint of usūl-al-fiqh or Islamic legal theory. In fact, much is heard nowadays of the contradiction in the body of Islamic law. Whilst in contrast, little is presented in terms of the methodology of removing this conflict. The present work therefore, attempts to redress this balance. The emphasis of the work will be concerned primarily with tarjīh methodology ; how to give preference to one piece of evidence or argument over the other when they conflict. Nevertheless, considerable concern is given to investigating the background to the conflict of law in the Shari'ah.
This study of a neglected area in Islamic legal scholarship will be an important source of reference to students, both practising and theoretical jurists or to anyone who merely wishes to increase his knowledge of legal themes, particularly legal conflict. The very aim of the work is to argue that conflict is a natural and unavoidable consequence of legal study because legal conflict is only conflicting principles and arguments adduced by both the classical and modern jurists to reach what is actually intended by God in the target case. Therefore, conflicts are inevitable in most of the cases in fiqh owing to the variety of principles set out to deal with one piece of legal evidence, let alone with all the pieces of legal evidence in question.
Tarjīh is therefore, an important and workable instrument in the re-examination of these conflicts and in arriving at the most accurate principle for establishing the law for as long as this is possible. It is hoped that the discovery of new facts and the increase of knowledge which results from the broadening and deepening of the research will positively contribute to the process of unification of Islamic law
Refugee Perspectives on Migration Policy: Lessons from the Middle East
No full textIn a world with over 70 million people registered as forcibly displaced, governing migration has long been high on the European Union's agenda. However, rather than emerging from evidence-based perspectives, policy responses have often been built on simplistic premises regarding how refugees' mobility and decision-making work. Findings from the research project SYRMAGINE can contribute to the revising of these views:
While many Syrian refugees in Lebanon and Turkey strongly long for a return to their native country should the conflict end, returning under current conditions is perceived as unsafe - with individuals fearing military conscription or political persecution upon return, especially those opposed to al-Assad's regime.
Often moderate aspirations to stay in the host country exist, even should the war end. Among refugees in Turkey, strong resistance to the idea of migrating to Europe is also prevalent. The consideration to settle down is based on a preference to remain geographically close to Syria, to live in a culturally familiar context, feelings of relative safety compared to Syria, family ties, and the notion that building a life worth living might be possible where one currently lives.
Factors which influence refugees' decisions to move on to another third country are a combination of insufficient legal safety, financial vulnerability, and inadequate access to health and education services within the host country; views within families about onwards migration; and, refugees' current life satisfaction and future imaginations.
With ongoing violence in Syria alongside the legal and economic vulnerabilities faced by refugees in the Middle East, safe pathways to reaching third countries need to be expanded. In the Middle East itself, policies should focus on improving legal and educational conditions for refugees and supporting anti-discrimination measures. Return campaigns and refoulement have to stop immediately
Safety and efficacy of glucagon-like peptide-1 receptor agonists in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials
No full textBackground Obstructive sleep apnea (OSA) is a common condition affecting around one billion people worldwide. Emerging evidence from recent studies suggests that Glucagon-like peptide 1 receptor (GLP-1) agonists may reduce OSA severity. Hence, this meta-analysis aims to evaluate the efficacy and safety of GLP-1 agonists in patients with OSA.Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to 24 June 2024. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). The protocol for this review has been registered and published in PROSPERO with the ID (CRD42024562853).Results The meta-analysis included three randomized controlled trials with 828 patients. Pooled analysis of patients administered GLP-1 agonists or tirzepatide showed improvement in Apnea/Hypopnea Index (MD −16.57 events per hour, 95% CI [−27.41, −5.73], p = 0.003), weight reduction (MD −12.71%, 95% CI [−21.38, −4.03], p = 0.004), and systolic blood pressure (MD −4.93 mmHg,95% CI [−7.67, −2.19], p = 0.0004). Tirzepatide showed a reduction in high-sensitivity C-reactive protein (MD −0.89 mg/dl, 95% CI [−1.25, −0.54], p < 0.0001) and sleep apnea-specific hypoxic burden (MD −66.21%/min, 95% CI [−81.75, −50.67], p < 0.0001). Despite the heterogeneity observed in the AHI and weight, it was resolved, and the results were consistent. GLP-1 agonists/tirzepatide showed comparable outcomes concerning diastolic blood pressure (MD −1.34 mmHg, 95% CI [−2.80, 0.12], p = 0.07). No significant serious adverse events were observed for GLP-1 agonists/tirzepatide, but it was associated with a higher incidence of gastrointestinal adverse events.Conclusion GLP-1 agonists, including tirzepatide, improved Apnea/Hypopnea Index, weight, and systolic blood pressure in adults with moderate-to-severe OSA. However, the evidence remains limited to two published studies comprising three randomized controlled trials using different pharmacological agents. Consequently, further research is needed before firm conclusions can be drawn
Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome.
No full textCONTEXT: Bilateral pediatric cataracts are important cause of visual impairment in children. AIM: To study the outcome of bilateral pediatric cataract surgery in young children. SETTING AND DESIGN: Retrospective case series in a tertiary center. MATERIALS AND METHODS: Records of pediatric cataracts operated between January 2001 and December 2003, with a minimum follow-up of 3 months, were reviewed retrospectively. STATISTICAL METHODS: Independent sample t-test, Fisher's exact test, and logistic regression using SPSS (Statistical Package for Social Science, Chicago, USA) version 12. RESULTS: 215/257 (83.7%) patients had a minimum follow-up of 3 months. The mean age of presentation to the hospital was 53 months (range: 0-168 months). Congenital cataract was present in 107 patients (58.2%) and developmental cataract in 77 patients (41.8%). The mean age at surgery was 55.2 months (range: 1-168 months). Out of 430 eyes, 269 (62.6%) had an intraocular lens implanted. The mean duration of follow-up was 13.1 months (range: 3-38 months). Pre-operatively, 102 patients (47.3%) had visual acuity 6/18. The most common early post-operative complication was fibrinous uveitis in 57 eyes (13.3%) and the most common delayed post-operative complication was posterior capsular opacification in 118 eyes (27.4%). The most important prognostic factor for poor outcome was congenital cataract (odds ratio [OR]: 26.3; 95% confidence interval [CI], 4.4-158.5) and total cataract (OR: 4.8; 95% CI, 1.3-17). CONCLUSION: Nearly half of the eyes had visual acuity >6/18. The outcome was poorer in congenital cataracts, especially those operated after >1 year of age
TCT-252 Medical Management Compared to Per Cutaneous Intervention (PCI) in Treatment of Stable Angina: A Systematic Review and Meta-Analysis
No full textIntravenous Versus Oral Iron After Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
No full textBACKGROUND & OBJECTIVE: Few trials have compared the efficacy of intravenous (IV) iron repletion to oral repletion for patients with gastrointestinal bleeding (GIB). We aim to guide clinical decision-making and optimize treatment strategies through the findings from these studies to provide a step closer to a consensus on the most effective approach to iron supplementation for patients with GIB.
METHODS: A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase, CENTRAL, Scopus, and Web of Science from inception to April 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). PROSPERO ID: CRD42024542759.
RESULTS: Three RCTs that included 254 patients were included. IV iron was significantly associated with increased complete response (RR: 1.60 with 95% CI [1.24, 2.07], p \u3c 0.01) compared to oral iron, with no significant difference between IV iron and oral iron in partial response (RR: 2.13 with 95% CI [0.60, 7.50], p = 0.24). IV iron was significantly associated with increased Hb concentration (MD: 1.45 g/dL with 95% CI [0.50, 2.40], p \u3c 0.01) and ferritin change (MD: 220.02 μg/L with 95% CI [22.31, 417.73], p = 0.03) compared to oral iron. However, there was no significant difference between IV and oral iron in transferrin saturation (MD: 4.71% with 95% CI [-5.96, 15.38], p = 0.39).
CONCLUSION: With uncertain evidence, IV iron demonstrated increased hemoglobin and ferritin concentrations and achieved complete response rates in patients with GIB
The efficacy and safety of new potassium binders on renin–angiotensin–aldosterone system inhibitor optimization in heart failure patients: a systematic review and meta‐analysis
No full textAbstract Guideline‐directed medical therapy (GDMT) has improved outcomes in patients with heart failure, including the use of renin–angiotensin–aldosterone system inhibitors, which can hinder the excretion of potassium, resulting in hyperkalaemia. New potassium binders (NPBs) can prevent this adverse effect; however, the efficacy and safety of NPB for this indication have not been fully established. We conducted a systematic review and meta‐analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, Scopus, and Cochrane through 26 April 2023. The risk of bias assessment was conducted, following Cochrane's updated Risk of Bias 2 assessment tool. We used the fixed‐effects model to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI) (PROSPERO ID: CRD42023426113). We included six RCTs with a total of 1432 patients. NPB was significantly associated with successful mineralocorticoid receptor antagonist (MRA) optimization [RR: 1.13 with 95% CI (1.02–1.25), P = 0.02], decreased patients with MRA at less than the target dose [RR: 0.72 with 95% CI (0.57–0.90), P = 0.004], and decreased hyperkalaemic episodes [RR: 0.42 with 95% CI (0.24–0.72), P = 0.002]. However, there was no difference between NPB and placebo regarding angiotensin‐converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin receptor/neprilysin inhibitor (ANRi) optimization [RR: 1.02 with 95% CI (0.89–1.17), P = 0.76] and serum potassium change [MD: −0.31 with 95% CI (−0.61 to 0.00), P = 0.05], with an acceptable safety profile except for the increased incidence of hypokalaemia with NPB [RR: 1.57 with 95% CI (1.12–2.21), P = 0.009]. NPB has been shown to improve GDMT outcomes by enhancing MRA optimization and reducing hyperkalaemic episodes. However, there are limited data on the effects of NPB on ACEi/ARB/ANRi optimization. Future RCTs should investigate ACEi/ARB/ANRi optimization and conduct head‐to‐head comparisons of NPB (patiromer and sodium zirconium cyclosilicate)
TCT-819 Impact of Sodium-Glucose Co-Transporter Inhibitors on Cardiovascular Outcomes in Patients With Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
No full textOnce‐Weekly Insulin Versus Once‐Daily Insulin for Type 1 Diabetes Treatment: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials
No full textABSTRACT Background Type 1 diabetes mellitus (T1DM) represents a considerable global health burden, affecting approximately 5%–10% of individuals with diabetes. Once‐weekly basal insulin could substantially reduce the number of injections for T1DM patients from 365 daily to 52 weekly doses annually. Therefore, this meta‐analysis compares the safety and efficacy of once‐weekly insulin formulations. Methods The systematic review and meta‐analysis included the relevant randomised controlled trials (RCTs) retrieved from PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS databases until September 2024. The meta‐analysis was performed using (RevMan 5.4.1). The study protocol was registered on PROSPERO (CRD42024603022). Results Three RCTs comprising 1724 participants were included. Once‐daily insulin significantly decreased glycated haemoglobin (HbA1c) compared to once‐weekly insulin (estimated treatment difference: 0.09%, 95% CI [0.07, 0.11], p < 0.00001). Fasting blood glucose levels were comparable between the once‐weekly and once‐daily insulin groups (estimated treatment difference: 0.44 mg/dL, 95% CI [−0.64, 1.52], p = 0.42). Once‐weekly insulin was associated with a significant increase in the incidence of injection site reactions (RR: 3.48 with 95% CI [1.30, 9.31], p = 0.01), serious adverse events (RR: 1.55 with 95% CI [1.09, 2.19], p = 0.01), and treatment‐emergent adverse events (RR: 1.12 with 95% CI [1.02, 1.23], p = 0.02), while no significant difference was observed in hypersensitivity reactions (RR: 1.04 with 95% CI [0.78, 1.38], p = 0.79). Conclusion Once‐daily insulin has demonstrated slightly superior HbA1c reduction, while once‐weekly insulin offers potential advantages in patient adherence. However, these benefits must be weighed against an increased risk of injection site reactions and nocturnal hypoglycemia. Although once‐weekly insulin is more convenient, treatment decisions should consider individual patient factors such as hypoglycemia risk and tolerance to injection reactions
