Ivabradine in the treatment of systolic heart failure- A systematic review and meta-analysis

AIM To perform a systematic-review and meta-analysis to compare outcomes of ivabradine combined with betablocker to beta-blocker alone in heart failure with reduced ejection fraction(HFr EF).METHODS We searched PubM ed, Cochrane, EMBASE, CINAHL and Web of Science for trials comparing ivabradine + betablocker to beta-blocker alone in HFr EF. We performed a systematic-review and meta-analysis of published literature. Primary end-point was combined end point of cardiac death and hospitalization for heart failure.RESULTS Six studies with 17671 patients were included. Mean follow-up was 8.7 ± 7.9 mo. Combined end-point of heart failure readmission and cardiovascular death was better in ivabradine + beta-blocker group compared to beta-blocker alone(RR: 0.93, 95%CI: 0.79-1.09, P = 0.354). Mean difference(MD) in heart rate was higher in the ivabradine + beta-blocker group(MD: 6.14, 95%CI: 3.80-8.48, P < 0.001). There was no difference in all cause mortality(RR: 0.98, 95%CI: 0.89-1.07, P = 0.609), cardiovascular mortality(RR: 0.99, 95%CI: 0.86-1.15, P = 0.908) or heart failure hospitalization(RR: 0.87, 95%CI: 0.68-1.11, P = 0.271). CONCLUSION From the available clinical trials, ivabradine + betablocker resulted in a significantly greater reduction in HRcoupled with improvement in combined end-point of heart failure readmission and cardiovascular death but with no improvement in all cause or cardiovascular mortality. Given the limited evidence, further randomized controlled trials are essential before widespread clinical application of ivabradine + beta-blocker is advocated for HFrEF.

Review of X-ray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic

As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management,it is critical to examine the role of different modalities currently in use,such as baseline X-rays and computed tomography scans carefully.In this article,we will draw attention to the critical findings for the radiologist.Further,we will look at point of care ultrasound,an increasingly a popular tool in diagnostic medicine,as a component of COVID-19 management.

Diagnosis and management strategy of syncope

Syncope is a common symptom due to various causes, ranging from benign to life-threatening conditions.According to the evaluation and management of patients with syncope, they can be classified as being at short- or long-term risk.Risk stratification during initial evaluation is important for guiding the treatment, and reducing long-term morbidity and mortality.This paper introduces the new progress in the etiology, risk stratification, diagnostic methods and treatment strategies of syncope, and elaborates on the selection of initial assessment tools for syncope patients.In order to elevate the diagnostic accuracy rate of syncope, a systematic and holistic analysis of syncope patients was proposed, including the initial assessment of outpatients and emergency services as well as the observation and treatment during subsequent hospitalization.This paper suggests the management of syncope be considered as a focus, such as establishing syncope management units, taking structured care pathways,etc.Finally, it is suggested to make more efforts in aspects of randomized controlled trials, treatment and collaborative research in the future.

克罗恩性结肠炎:手术患者不典型增生与腺癌的发生率

PURPOSE:Data supporting an increased risk of colorectal cancer in patients with Crohn’s colitis are inconsistent.Despite this,clinical recommendations regarding colonoscopic screening and surveillance for patients with Crohn’s colitis are extrapolated from chronic ulcerative colitis protocols.The primary aim of our study was to determine the incidence of dysplasia and carcinoma in pathology specimens of patients undergoing segmental or total colectomy for Crohn’s disease of the large bowel.In addition,we sought to identify risk factors associated with the development of dysplasia and carcinoma.METHODS:We performed a retrospective review of all patients operated on at our institution for Crohn’ s colitis between January 1992 and May 2004.Data were retrieved from patient charts,operative notes,and pathology reports.Logistic regression was used to model the probability of having dysplasia or adenocarcinoma.RESULTS:Two hundred twenty-two patients(138 females) who underwent surgical resection for the treatment of Crohn’s colitis were included in the study.Mean age at surgery was 41(range,15-82) years and the mean duration of disease was 10(range,0-53) years.There were five cases of dysplasia(2.3 percent) and six cases of adenocarcinoma(2.7 percent) .Three patients with dysplasia and one with adenocarcinoma were diagnosed on preoperative colonoscopy;while the other cases were discovered incidentally on pathologic examination of resected specimens.Factors associated with the presence of dysplasia or adenocarcinoma included older age at diagnosis(38.2 vs.30.3 years,P = 0.02) ,longer disease duration(16.0 vs.10.1 years,P = 0.05) ,and disease extent(90 percent extensive vs.59 percent limited,P = 0.05) .CONCLUSIONS:Patients with severe Crohn’s colitis requiring surgery are at significant risk for developing dysplasia and adenocarcinoma,particularly when diagnosed at an older age,after longer disease duration,and with more extensive colon involvement.

Effect of an educational intervention and parental vaccine refusal forms on childhood vaccination rates in a clinic with a large Somali population

Objective:The purpose of this study is to improve vaccination rates at a clinic with a large Somali population,and many vaccine hesitant parents.The study evaluated the effectiveness of some new materials for vaccine hesitant parents.Methods:Educational sessions were given to providers and staff to give“talking points”and to introduce a vaccine refusal form.Chart reviews were done for notes from 50 random well child visits per month of children less than six years old for 7 months before and after the intervention.Results:Before the intervention,44% of Somali children who needed shots did not get them at their well child visit.Afterwards,34% of the Somali children did not get their needed shots.Of non-Somali children,16.8% did not get needed shots before the intervention,and 12.7% did not get needed shots after the intervention(P=0.07).The MMR was the most frequent vaccine omitted.After the intervention,29 parents signed the vaccine refusal form.Conclusion:The“talking points”and vaccine refusal form were associated with improve-ments in immunization rates in this challenging patient population that were not statistically signifi-cant.Refusal form use was not well documented,so its true value requires further study.