The global use of kidney replacement therapy (KRT) has increased, mirroring the incidence of acute kidney injury and chronic kidney disease. Despite its growing clinical usage, patient outcomes with ...KRT modalities remain controversial. In this meta-analysis, we sought to compare the mortality outcomes of patients with any kidney disease requiring peritoneal dialysis (PD), hemodialysis (HD), or continuous renal replacement therapy (CRRT).
The investigation was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed (MEDLINE), Cochrane Library, and Embase databases were screened for randomized trials and observational studies comparing mortality rates with different KRT modalities in patients with acute or chronic kidney failure. A random-effects model was applied to compute the risk ratio (RR) and 95% confidence intervals (95%CI) with CRRT vs. HD, CRRT vs. PD, and HD vs. PD. Heterogeneity was assessed using I
statistics, and sensitivity using leave-one-out analysis.
Fifteen eligible studies were identified, allowing comparisons of mortality risk with different dialytic modalities. The relative risk was non-significant in CRRT vs. PD RR = 0.95, (95%CI 0.53, 1.73), p = 0.92 from 4 studies and HD vs. CRRT RR = 1.10, (95%CI 0.95, 1.27), p = 0.21 from five studies comparisons. The findings remained unchanged in the leave-one-out sensitivity analysis. Although PD was associated with lower mortality risk than HD RR = 0.78, (95%CI 0.62, 0.97), p = 0.03, the significance was lost with the exclusion of 4 out of 5 included studies.
The current evidence indicates that while patients receiving CRRT may have similar mortality risks compared to those receiving HD or PD, PD may be associated with lower mortality risk compared to HD. However, high heterogeneity among the included studies limits the generalizability of our findings. High-quality studies comparing mortality outcomes with different dialytic modalities in CKD are necessary for a more robust safety and efficacy evaluation.
Background
Females and ethnic minorities are underrepresented in the first and senior authorships positions of academic publications. This stems from various structural and systemic inequalities and ...discrimination in the journal peer-review process, as well as educational, institutional, and organizational cultures.
Methods
A retrospective bibliometric study design was used to investigate the representation of gender and racial/ethnic groups in the authorship of critical care randomized controlled trials in 12 high-impact journals from 2000 to 2022.
Results
In the 1398 randomized controlled trials included in this study, only 24.61% of the first authors and 16.6% of the senior authors were female. Although female authorship increased during the study period, authorship was significantly higher for males throughout (Chi-square for trend,
p
< 0.0001). The educational attainment
χ
2
(4) = 99.2,
p
< 0.0001 and the country of the author's affiliated institution
χ
2
(42) = 70.3,
p
= 0.0029 were significantly associated with gender. Male authorship was significantly more prevalent in 10 out of 12 journals analyzed in this study
χ
2
(11) = 110.1,
p
< 0.0001. The most common race/ethnic group in our study population was White (85.1% women, 85.4% males), followed by Asians (14.3% females, 14.3% males). Although there was a significant increase in the number of non-White authors between 2000 and 2022
χ
2
(22) = 77.3,
p
< 0.0001, the trend was driven by an increase in non-White male and not non-White female authors. Race/ethnicity was significantly associated with the country of the author’s affiliated institution
χ
2
(41) = 1107,
p
< 0.0001 but not with gender or educational attainment.
Conclusions
Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.
Abstract Background Catheter ablation and antiarrhythmic drug therapy are utilized for rhythm control in atrial fibrillation (AF), but their comparative effectiveness, especially with contemporary ...treatment modalities, remains undefined. We conducted a systematic review and meta-analysis contrasting current ablation techniques against antiarrhythmic medications for AF. Methods We searched PubMed, SCOPUS, Cochrane CENTRAL, and Web of Science until November 2023 for randomized trials comparing AF catheter ablation with antiarrhythmics, against antiarrhythmic drug therapy alone, reporting outcomes for > 6 months. Four investigators extracted data and appraised risk of bias (ROB) with ROB 2 tool. Meta-analyses estimated pooled efficacy and safety outcomes using R software. Results Twelve trials ( n = 3977) met the inclusion criteria. Catheter ablation was associated with lower AF recurrence (relative risk (RR) = 0.44, 95%CI (0.33, 0.59), P ˂ 0.0001) and hospitalizations (RR = 0.44, 95%CI (0.23, 0.82), P = 0.009) than antiarrhythmic medications. Catheter ablation also improved the physical quality of life component score (assessed by a 36-item Short Form survey) by 7.61 points (95%CI -0.70-15.92, P = 0.07); but, due to high heterogeneity, it was not statistically significant. Ablation was significantly associated with higher procedural-related complications RR = 15.70, 95%CI (4.53, 54.38), P < 0.0001 and cardiac tamponade RR = 9.22, 95%CI (2.16, 39.40), P = 0.0027. All-cause mortality was similar between the two groups. Conclusions For symptomatic AF, upfront catheter ablation reduces arrhythmia and hospitalizations better than continued medical therapy alone, albeit with moderately more adverse events. Careful patient selection and risk-benefit assessment are warranted regarding the timing of ablation.
Despite their continued use, the effectiveness and safety of vasopressors in post-cardiac arrest patients remain controversial. This study examined the efficacy of various vasopressors in cardiac ...arrest patients in terms of clinical, morbidity, and mortality outcomes.
A comprehensive literature search was performed using online databases (MeSH terms: MEDLINE (Ovid), CENTRAL (Cochrane Library), Embase (Ovid), CINAHL, Scopus, and Google Scholar) from 1997 to 2023 for relevant English language studies. The primary outcomes of interest for this study included short-term survival leading to death, return of spontaneous circulation (ROSC), survival to hospital discharge, neurological outcomes, survival to hospital admission, myocardial infarction, and incidence of arrhythmias.
In this meta-analysis, 26 studies, including 16 RCTs and ten non-RCTs, were evaluated. The focus was on the efficacy of epinephrine, vasopressin, methylprednisolone, dopamine, and their combinations in medical emergencies. Epinephrine treatment was associated with better odds of survival to hospital discharge (OR = 1.52, 95%CI 1.20, 1.94; p < 0.001) and achieving ROSC (OR = 3.60, 95% CI 3.45, 3.76, P < 0.00001)) over placebo but not in other outcomes of interest such as short-term survival/ death at 28-30 days, survival to hospital admission, or neurological function. In addition, our analysis indicates non-superiority of vasopressin or epinephrine vasopressin-plus-epinephrine therapy over epinephrine monotherapy except for survival to hospital admission where the combinatorial therapy was associated with better outcome (0.76, 95%CI 0.64, 0.92; p = 0.004). Similarly, we noted the non-superiority of vasopressin-plus-methylprednisolone versus placebo. Finally, while higher odds of survival to hospital discharge (OR = 3.35, 95%CI 1.81, 6.2; p < 0.001) and ROSC (OR = 2.87, 95%CI 1.97, 4.19; p < 0.001) favoring placebo over VSE therapy were observed, the risk of lethal arrhythmia was not statistically significant. There was insufficient literature to assess the effects of dopamine versus other treatment modalities meta-analytically.
This meta-analysis indicated that only epinephrine yielded superior outcomes among vasopressors than placebo, albeit limited to survival to hospital discharge and ROSC. Additionally, we demonstrate the non-superiority of vasopressin over epinephrine, although vasopressin could not be compared to placebo due to the paucity of data. The addition of vasopressin to epinephrine treatment only improved survival to hospital admission.
Acute pancreatitis poses a significant health risk due to the potential for pancreatic necrosis and multi-organ failure. Fluid resuscitation has demonstrated positive effects; however, consensus on ...the ideal intravenous fluid type and infusion rate for optimal patient outcomes remains elusive.
A comprehensive literature search was conducted using PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar for studies published between 2005 and January 2023. Reference lists of potential studies were manually searched to identify additional relevant articles. Randomized controlled trials and retrospective studies comparing high (≥ 20 ml/kg/h), moderate (≥ 10 to < 20 ml/kg/h), and low (5 to < 10 ml/kg/h) fluid therapy in acute pancreatitis were considered.
Twelve studies met our inclusion criteria. Results indicated improved clinical outcomes with low versus moderate fluid therapy (OR = 0.73; 95% CI 0.13, 4.03; p = 0.71) but higher mortality rates with low compared to moderate (OR = 0.80; 95% CI 0.37, 1.70; p = 0.55), moderate compared to high (OR = 0.58; 95% CI 0.41, 0.81, p = 0.001), and low compared to high fluids (OR = 0.42; 95% CI 0.16, 1.10; P = 0.08). Systematic complications improved with moderate versus low fluid therapy (OR = 1.22; 95% CI 0.84, 1.78; p = 0.29), but no difference was found between moderate and high fluid therapy (OR = 0.59; 95% CI 0.41, 0.86; p = 0.006).
This meta-analysis revealed differences in the clinical outcomes of patients with AP receiving low, moderate, and high fluid resuscitation. Low fluid infusion demonstrated better clinical outcomes but higher mortality, systemic complications, and SIRS persistence than moderate or high fluid therapy. Early fluid administration yielded better results than rapid fluid resuscitation.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Given the mortality risk in COVID-19 patients, it is necessary to estimate the impact of glycemic control on mortality rates among inpatients by designing and implementing evidence-based blood ...glucose (BG) control methods. There is evidence to suggest that COVID-19 patients with hyperglycemia are at risk of mortality, and glycemic control may improve outcomes. However, the optimal target range of blood glucose levels in critically ill COVID-19 patients remains unclear, and further research is needed to establish the most effective glycemic control strategies in this population.
The investigation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data sources were drawn from Google Scholar, ResearchGate, PubMed (MEDLINE), Cochrane Library, and Embase databases. Randomized controlled trials, non-randomized controlled trials, retrospective cohort studies, and observational studies with comparison groups specific to tight glycemic control in COVID-19 patients with and without diabetes.
Eleven observational studies (26,953 patients hospitalized for COVID-19) were included. The incidence of death was significantly higher among COVID-19 patients diagnosed with diabetes than those without diabetes (OR = 2.70 2.11, 3.45 at a 95% confidence interval). Incidences of death (OR of 3.76 (3.00, 4.72) at a 95% confidence interval) and complications (OR of 0.88 0.76, 1.02 at a 95% confidence interval) were also significantly higher for COVID-19 patients with poor glycemic control.
These findings suggest that poor glycemic control in critically ill patients leads to an increased mortality rate, infection rate, mechanical ventilation, and prolonged hospitalization.
INTRODUCTION:
Intrahepatic cholestasis of pregnancy (ICP) is a common clinical problem evident in approximately 1% of pregnancies in the United States. The incidence is more common in Chilean and ...Swedish ethnic groups. Due to the
pathognomonic
early symptom of severe pruritus, most patients are diagnosed and treated promptly. However, the risk of fetal demise is high, ranging from 2-11%. In very rare cases patients may present with atypical symptoms that can delay diagnosis and appropriate management.
CASE DESCRIPTION/METHODS:
A 40-year-old woman, gravida 4 para 2, presented in her 20th week of gestation with severe right upper quadrant pain radiating to the epigastric region for 3 days. Initial workup showed elevated total bilirubin of 4.3 mg/dl with a direct bilirubin of 3.7 mg/dl; Alanine aminotransferase of 39 U/L and aspartate aminotransferase of 27 U/L. Initial ultrasound of the abdomen showed an enlarged liver with the right hepatic lobe measuring up to 21 cm in length, status post cholecystectomy and normal caliber proximal common bile duct. Patient's bilirubin trended up and she became jaundiced, so MRCP without contrast was obtained. It showed no choledocholithiasis and no biliary ductal dilatation. Hepatitis A, B, C, and E virus PCR, cytomegalovirus IgM, anti-mitochondrial antibody, anti-smooth muscle antibody were all negative as well. The patient never developed pruritus, however, bile acids were checked and found to 190 µmol/L and eventually peaked at 290 µmol/L. She later developed intense pruritus 1 week after initial presentation and abdominal pain had completely resolved. She was started on ursodiol and cholestyramine. The bile acid level eventually decreased to 39 µmol/L 1 month later and her pruritus improved. She continued to follow with maternal-fetal medicine and gastroenterology, there was no harm to the fetus.
DISCUSSION:
ICP usually presents with pruritus of the hands and feet due to elevated bile acid levels in the blood during 2nd and 3rd trimester of pregnancy. Our patient's only symptom was acute right upper quadrant pain with no pruritus, which is very atypical for ICP. There are no case reports of this disorder presenting solely with abdominal pain. It is important to recognize abdominal pain as a possible presenting symptom of ICP in order to diagnose the condition early.