Effect of β-blocker therapy in diabetic patients with stable coronary heart disease: a meta-analysis

Background β-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD).The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce.This meta-analysis summarizes the evidence relating to the BB therapy in diabetic patients with stable CHD.Methods A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies.PubMed,Embase,and Cochrane central were searched and two authors independently screened studies for eligibility.The quality of studies was assessed with the Newcastle Ottawa scale.The primary outcome of interest was all-cause mortality,cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy.A generic inverse variance model was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate.The significance threshold was set at P-value < 0.05.Heterogeneity was assessed by I2.Results Four non-randomized studies with 9515 participants were selected for the analyses.Four studies were post-hoc analyses of randomized controlled trials,and one article was an analysis of a nationally representative survey.In a fixed effects model,BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality,and MACE (27% and 32% respectively;P-value < 0.05) and was not associated with a reduction in all-cause mortality (HR 1.12;95% CI: 0.94–1.33;P-value = 0.22).Conclusion BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality.Large randomized trials are needed in this population to confirm these findings.

Mental health impact of the Middle East respiratory syndrome,SARS,and COVID-19:A comparative systematic review and metaanalysis

BACKGROUND Over the last few decades,3 pathogenic pandemics have impacted the global population;severe acute respiratory syndrome coronavirus(SARS-CoV),Middle East respiratory syndrome coronavirus(MERS-CoV)and SARS-CoV-2.The global disease burden has attributed to millions of deaths and morbidities,with the majority being attributed to SARS-CoV-2.As such,the evaluation of the mental health(MH)impact across healthcare professionals(HCPs),patients and the general public would be an important facet to evaluate to better understand short,medium and long-term exposures.AIM To identify and report:(1)MH conditions commonly observed across all 3 pandemics;(2)Impact of MH outcomes across HCPs,patients and the general public associated with all 3 pandemics;and(3)The prevalence of the MH impact and clinical epidemiological significance.METHODS A systematic methodology was developed and published on PROSPERO(CRD42021228697).The databases PubMed,EMBASE,ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process,and publications from January 1,1990 to August 1,2021 were searched.MeSH terms and keywords used included Mood disorders,PTSD,Anxiety,Depression,Psychological stress,Psychosis,Bipolar,Mental Health,Unipolar,Self-harm,BAME,Psychiatry disorders and Psychological distress.The terms were expanded with a‘snowballing’method.Cox-regression and the Monte-Carlo simulation method was used in addition to I2 and Egger’s tests to determine heterogeneity and publication bias.RESULTS In comparison to MERS and SARS-CoV,it is evident SAR-CoV-2 has an ongoing MH impact,with emphasis on depression,anxiety and post-traumatic stress disorder.CONCLUSION It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2,with much emphasis on reporting symptoms of depression,anxiety,stress and sleep disturbances.The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the“know-how”for clinicians and researchers to better support patients and deliver care with limited healthcare resources.