Background: Nigella sativa or Habbatus Sauda is known to have beneficial effect to reduce blood pressure and other cardiovascular markers. But antihypertensive effect of N. sativa in hypertensive population remains controversial.Objective: We aim to assess the latest evidence of antihypertensive effect of N. sativa in patients with cardiometabolic risk factors.Method: A systematic review and meta-analysis was conducted according to the PRISMA statement. We systematically searched relevant studies in Pubmed, Cochrane, and Scopus from the date of inception until January 2022. Outcomes of interest were reduction of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate.Results: A total of 974 patients from 13 randomized controlled trials were included. Mean duration of treatment was 7.15 weeks. Pooled analysis showed that N. sativa supplementation significantly reduce both SBP (MD -3.93 [-5.72, -2.14], p<0.0001; I2: 39%, p=0.07) and DBP (MD -3.26 [-4.76, -1.75], p<0.0001; I2: 54%, p=0.01) compared to placebo group. Subgroup analysis showed that BP was reduced significantly in both hypertensive and non-hypertensive group, although non-hypertensive group had greater SBP and DBP reduction. NS powder showed greater SBP reduction compared to NS oil (MD -5.22 vs -2.77). Heart rate was also significantly reduced in NS group (MD -2.25 [-2.25, -0.54], p<0.001; I2: 0%, p=0.86).Conclusion: This meta-analysis suggests short-term treatment with N. sativa is associated with significant reduction of SBP, DBP, and heart rate in hypertensive and non-hypertensive patients with cardiometabolic risk factors. Future trials are needed to strengthen the evidence of long-term antihypertensive effect of N. sativa.
Aims Right ventricular outflow tract (RVOT) stenting is emerging as an effective alternative to surgical palliation in selected patients. We aim to assess the outcome of RVOT stenting in patients suffered from RVOT obstruction with ventricular shunt physiology such as tetralogy of Fallot (ToF) and other type of lesions, also to compare its clinical outcomes with modified Blalock-Taussig shunt (mBTS) procedure. Method and Results A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We systematically searched the relevant studies from date of inception to June 2021. Outcomes of interest were pulmonary artery (PA) growth and oxygen saturation after palliation. Eleven retrospective studies (384 patients) were included for qualitative analysis, and four studies (193 patients) were eligible for meta-analysis. From our study, RVOT stenting can be accomplished safely and effectively in severe cyanosis or high risk patients with ToF physiology. Right PA z-score and oxygen saturation post RVOT stenting was significantly higher compared with post mBTS (MD 0.50; 95% CI 0.06 – 0.93, p = 0.03 and MD 3.46; 95% CI 1.42 – 5.49, p = 0.0009 respectively). Our analysis shows no significant difference of left PA z-score after palliation between two groups (MD -0.05; 95% CI -0.89 – 0.79, p = 0.90). Conclusion RVOT stenting effectively improves oxygen saturation and promotes proper pulmonary artery growth in patients with ToF physiology. The larger and randomized-controlled studies are required to better evaluate the efficacy of RVOT stenting and its superiority compared to mBTS.
Background and Aims The use of brain natriuretic peptide (BNP), a common cardiac biomarker, has traditionally been limited to adult populations for heart failure assessment. In children, less is known about the diagnostic value of BNP. Emerging evidence suggests they might be useful in diagnosis of children with cardiovascular disease. We aim to evaluate the use of BNP in children with cardiovascular disease. Methods and Results We performed a systematic review of literatures on online databases for studies evaluating level of BNP in children with cardiovascular disease from inception to July 26, 2021. A total number of 8 studies comprising 1304 patients were included in the meta-analysis. All articles included in the meta-analysis had high quality according to the GRADE approach. From our analysis, higher BNP was found in patients with congenital heart disease (CHD) compared with healthy subjects (SMD 2.88 [0.21-5.56], p = 0.03; I2 99%). Higher BNP was also found in children with heart failure (HF) compared with patients without HF (SMD 1.21 [0.73-1.69], p < 0.0001; I2 0%), and higher in CHD patients with pulmonary hypertension (PH) compared with CHD patients without PH (SMD 1.76 [0.02-3.51], p = 0.05; I2 95%). Conclusion Significantly higher level of BNP was found in CHD patients, CHD-PH, and HF patients. Therefore, BNP measurement might be used for screening of CHD, PH in CHD populations and HF in pediatric populations. Further study is required to determine diagnostic accuracies and cut-offs within age groups.
Aims Acute coronary syndrome (ACS) is responsible for high rates of hospital admission with high cost burden. Knowing patients with projected prolonged length of stay (LOS) could enable clinicians to do early interventions and better preparations. This study aims to identify factors associated with prolonged LOS in ACS patients at the time of admission. Method and Result We included 237 ACS patients admitted to Kediri General Hospital and Bogor General Hospital between January and June 2020. Patients who died during hospitalization or discharged by their own will were excluded. Data were collected retrospectively and analyzed using SPSS v25. Prolonged LOS was defined as LOS more than 6 days. The mean age was 57.5±0.7 years, majority was male (65.8%) and had diagnosis of NSTE-ACS (56.5%). The median LOS was 5 days (2-23), and the prevalence of prolonged LOS was 18.1%. On bivariate analysis, factors associated with prolonged LOS were high risk age (men > 40 years and women > 50 years) (p = 0.01), hypotension (p < 0.01), decreased consciousness (p = 0.004), sign of shock (p = 0.002), tachycardia (p = 0.001), and higher Killip class (p = 0.002). After multivariable adjustment and stepwise elimination, hypotension was found to be significant independent predictor for prolonged LOS (OR 38.512 [95% CI 4.5-328], p = 0.001). The area under the receiver operating characteristic curve (AUC) was 0,704 (95% CI 0.614-0.794) which showed acceptable discrimination, and calibration was good (Hosmer-Lemeshow test: p = 0.96). Conclusion Hypotension was found to be strong independent predictor for prolonged LOS in ACS patients.
Background: In patients with acute coronary syndrome (ACS), the role of admission blood pressure (BP) on outcomes remains inconclusive.Objective: This study aimed to investigate the association between admission BP and various outcomes in patients hospitalized for ACS. Method:In this cross-sectional study, 279 patients who admitted with ACS to Kediri District Hospital and Bogor General Hospital between January and June 2020 were included. Data were analyzed using SPSS software v25.Result: There was association between hypertension status on admission and diagnosis; there were more hypertensive patients with non-ST segment elevation (NSTE) ACS compared to ST segment elevation (STE) ACS diagnosis (p=0.002); and signifi cant difference on admission systolic BP between STE-ACS and NSTE-ACS patients (p<0.00001). Patients who died during hospitalization had signifi cantly lower admission systolic BP compared to survived patients (p=0.001). Patients with reduced ejection fraction (EF) on follow-up echocardiography had signifi cantly lower admission systolic BP compared to patients with normal EF (p=0.014). Patients with diastolic dysfunction on follow-up echocardiography had signifi cantly higher admission systolic BP compared to patients without diastolic dysfunction (p=0.009). No signifi cant difference on length of stay between hypertensive and non-hypertensive patients (p=0.416). Conclusion:Lower admission systolic BP was associated with increased inhospital mortality and reduced EF, while higher systolic BP was associated with diastolic dysfunction.
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