IntroductionSerum Soluble Interleukin-2 Receptor (sIL-2R) levels are used clinically as a disease activity marker for systemic sarcoidosis. Studies have investigated the diagnostic role of serum soluble interleukin-2 receptor (sIL-2R) level for sarcoidosis relative to biopsy. We performed a systematic review and meta-analysis of studies evaluating the diagnostic utility of sIL-2R.MethodsWe carried out an electronic search in Medline, Embase, Google Scholar, and Cochrane databases using keyword and Medical Subject Heading (MeSH) terms: sarcoidosis and sIL-2R. Studies evaluating the sIL-2R levels as a diagnostic tool in clinically diagnosed or biopsy-proven sarcoidosis patients compared to control groups with non-sarcoidosis patients were included. Forest plots were constructed using a random effect model depicting pooled sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy.ResultsWe selected ten studies comprising 1477 patients, with 592 in the sarcoidosis group and 885 in the non-sarcoidosis group. Pooled sensitivity and specificity of sIL-2R levels were 0.88 (95% CI: 0.75-0.95) and 0.87 (95% CI 0.73-0.94) respectively. Pooled negative predictive value and positive predictive value were 0.91 (95% CI 0.77-0.97) and 0.85 (95% CI 0.59-0.96) respectively with diagnostic accuracy of 0.86 (95% CI 0.71-0.93).ConclusionIn addition to its utility as a marker of sarcoidosis disease activity, sIL-2R has high diagnostic accuracy. Despite the limitations of the heterogenous sarcoidosis population and different sIL-2R cutoffs, our results suggest that sIL-2R is an important biomarker that can be used to confirm sarcoidosis diagnosis in unconfirmed or unclear cases.
The second hit hypothesis in pulmonary hypertension refers to the development of pulmonary vascular disease in individuals at risk, after an additional exposure or “hit” to factors with potential injury to the pulmonary circulation, such as drugs or toxins. We here present a case of severe pulmonary hypertension diagnosed during the third trimester of pregnancy, in a patient with familial history of pulmonary hypertension, found to have a heterozygous mutation in the BMPR2 gene, who also had chronic exposure to prescription amphetamines. We hypothesize that exposure to prescription amphetamines could act as a second hit of pulmonary vascular injury in individuals at risk of pulmonary vascular disease.
Anterior-lateral Vs Anterior-posterior Electrode Positioning for Cardioversion of Atrial Fibrillation and Atrial Arrhythmias: A Systematic Review and Meta-analysis
Introduction:
Multiple randomized controlled trials (RCTs) have compared the efficacy of anterolateral (AL) and anteroposterior (AP) electrode positioning for cardioversion of atrial fibrillation and other atrial arrhythmias with conflicting results. We hypothesized that AP electrode positioning will have a superior efficacy for cardioversion due to better alignment of the energy vector with the atria.
Methods:
A systematic search was conducted in the MEDLINE and Embase databases utilizing the Ovid interface. Results were screened to identify RCTs comparing AL and AP position of electrodes for cardioversion for atrial arrhythmias. Studied outcomes included the success of cardioversion, number of shocks, and mean shock energy required for successful cardioversion to sinus rhythm. Mantel-Haenszel aggregated risk ratios (RR) with 95% CIs were calculated.
Results:
A total of 14 RCTs were included comprising 2445 patients (1329 AL, 1116 AP). There was no statistically significant difference between the two groups with respect to successful cardioversion (RR 1.02 [0.97-1.06]; p = 0.43), first shock success (RR 1.14 [0.99-1.32]; p = 0.06), second shock success (RR1.08 [0.94-1.23]; p = 0.29), mean shock energies (mean difference 6.49 [17.33-30.31]; p = 0.59). We additionally compared success at high; >150 J (RR 1.02 [0.92-1.14] and low; <150 J (RR 1.09 [0.97-1.22]; p = 0.64) cardioversion energies which also did not show any significant difference.
Conclusions:
There is no significant difference in the efficacy between AL vs. AP electrode position for cardioversion of atrial arrhythmias.
Introduction: Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure.Methods: A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated.Results: A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA
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