High Yield Medical Reviews

The Diagnostic Value of Transthoracic Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Thuraya Sayegh — 2024-12-04

Purpose

Pulmonary hypertension (PH) is an important cause of morbidity and mortality. A commonly proposed non-invasive method in the diagnosis and assessment of PH is Transthoracic Echocardiography (TTE). In this systematic review and meta-analysis, our aim was to assess the accuracy of echocardiography in the diagnosis of PH.

Methods

The search was done up to the 31st of January 2023 using MEDLINE, Scopus, CENTRAL, and Web of Sciences databases. The studies were included if they were randomized controlled trials or observational in design and evaluated the diagnostic performance of TTE in diagnosing PH in comparison to right-sided heart catheterization as a reference method. The diagnostic performance measures included sensitivity, specificity, Diagnostic Odds Ratio (DOR), Positive Likelihood Ratio (PLR), and Negative Likelihood Ratio (NLR).

Results

The total number of the included patients was 4,523 from 38 articles. The overall sensitivity and specificity of echocardiography in diagnosing pulmonary hypertension were 54.8% (95%CI: 45.7%-63.6%) and 52.1% (95%CI: 39.0%-64.9%), respectively. Moreover, the pooled DOR was 1.321 (95%CI: 0.695-2.51). The pooled PLR and NLR were 1.145 (95%CI: 0.830-1.579) and 0.867 (95%CI: 0.628-1.197), respectively. The highest diagnostic performance of TTE was among group 1 and 3 PH patients.

Conclusion

Our analysis revealed that TTE had low diagnostic sensitivity, specificity, and accuracy. Due to the overall poor diagnostic performance of TTE, the diagnosis of PH and the assessment of response to therapies require right-sided heart catheterization. Future prospective studies to improve the diagnostic performance of TTE in the diagnosis of PH are needed.

The Effect of Statin Use on the Prevention and Progression of Diabetic Kidney Disease: A Systematic Review and Meta-analysis

Thuraya Al-Sayegh — 2024-12-04

Introduction

This systematic review and meta-analysis aim to investigate the effect of statin on the prevention and progression of Diabetic Kidney Disease (DKD) hypothesizing that statin would elicit beneficial effects on patients with DKD.

Methods

PubMed, Scopus, CENTRAL, and Web of Sciences were searched. The studies were included if they investigated the impact of statin on the development or progression of DKD. DKD development was defined as the occurrence of proteinuria or albuminuria due to type 2 diabetes. DKD progression was defined as the change in proteinuria, albuminuria, and GFR over time.

Results

The total number of the included patients was 36,938 from 27 studies. Statin use was significantly associated with reduction in DKD risk (HR=0.66; 95%CI: 0.58-00.76). Moreover, patients on statin had significantly lower deterioration in albuminuria (WMD=-21.81; 95%CI: -36.91- -6.70), proteinuria (WMD= -0.12; 95%CI: -0.12- -0.03) and GFR (WMD=-1.21; 95%CI: -2.20- -0.23).

Conclusion

Our study demonstrated that statin has beneficial effect on DKD by reducing albuminuria, proteinuria and GFR. These findings were reproducible among patients with microalbuminuria, patients on low intensity statins and patients on different treatment durations. Future larger high-quality trials are needed to investigate this topic and make more fine and reliable conclusions in the view of the encouraging findings we found in our analysis.

Epidemiological Trends of Hepatitis Viral Infections: A Retrospective Study Utilizing Serological Data from a Tertiary Laboratory in Jordan

Haneen Al-Abdallat — 2024-12-04

Introduction: Hepatitis is a significant global health issue, primarily caused by viral infections that lead to severe liver complications. In Jordan, the sero-prevalence of Hepatitis A Virus (HAV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) remains uncertain. This study aims to determine the prevalence of these viral infections utilizing serological data.

Methods: A retrospective study was conducted, analyzing serological test results for HAV, HBV, and HCV from patients at MedLabs Laboratory, a network of more than 35 branches across Jordan, from 2017 to 2022. Data were analyzed using Microsoft Excel and SPSS version 26.

Results: A total of 35,018 hepatitis tests were included. The overall prevalence of HAV-IgM was 18.9%, HBsAg was 5.4%, and HCV-TAB was 5.9%. Prevalence of HAV-IgM fluctuated from 4.1% to 31.3%, with the highest rate in 2021 (31.3%) and it was significantly higher (47.0%) among individuals aged 20 years or younger. The prevalence of HBsAg remained low, ranging from 3.9% to 6.8%. Males had a higher prevalence (8.5%) compared to females (7.3%), with the highest prevalence (8.7%) in those aged 20 years or younger. The prevalence of HCV Total Antibodies varied from 0% to 13.5%, peaking in 2019, with the highest prevalence (9.7%) observed in individuals aged 41 to 60 years.

Conclusion: The sero-prevalence data provide valuable insights into Jordan’s current epidemiological landscape for hepatitis. The findings emphasize the need for sustained surveillance, vaccination efforts, and targeted public health strategies to manage and reduce the burden of viral hepatitis in the region.

A Framework for Case Simulation Surveys: Advancing Clinical Diagnosis Decision-Making

Jared Lim — 2024-12-04

Introduction:

Case simulation surveys enhance diagnostic criteria. This review presents an approach to developing such surveys, highlighting the need for standardized methods in studying rare and complex pathologies to improve patient outcomes.

Methods:

An in-depth literature review was conducted using PubMed with search terms: "Decision Analysis," "Forced-Choice," and "Classification Criteria". These terms were chosen to cover a broad range of relevant literature on decision-making frameworks and diagnostic criteria development. Studies on systemic sclerosis and systemic lupus erythematosus were selected to illustrate complex conditions with which case simulation surveys are effective. The methodology includes: 1) Reviewing literature to identify clinical characteristics; 2) Designing a representative base case; 3) Developing case variations; 4) Piloting the survey with experts; and 5) Analyzing results statistically.

Results:

This approach was effectively applied in studies of systemic sclerosis and systemic lupus erythematosus. From these examples, we identified key elements and best practices that contributed to developing a more standardized approach. This included designing a base case, systematically developing case variations, and piloting the surveys with expert audiences. This iterative process addressed challenges such as case specificity and the oversight of rare presentations, resulting in a more reliable methodology. This paper discusses these advancements, demonstrating how the standardized methodology enhances the consistency and applicability of case simulation surveys in clinical research.

Conclusion:

Systematically developed case simulation surveys are powerful tools for improving diagnostic techniques and classification criteria. They enable researchers to study clinical decision-making in controlled environments, significantly contributing to refining diagnostic criteria and treatment protocols.

The Role of CD-19 Targeting Chimeric Antigen Receptor (CAR) T-cell Therapy in Non-Hodgkin Lymphoma

Emaan Haque — 2024-12-04

Chimeric Antigen Receptor (CAR) T-cell therapy has improved outcomes in multiple hematological malignancies, such as multiple myeloma and non-Hodgkin lymphoma. CD-19 targeting CAR T-cells have improved outcomes in both aggressive and indolent types of non-Hodgkin lymphoma. Four CAR T-cell products have been approved by the United States (U.S.) Food and Drug Administration (FDA) for the management of non-Hodgkin lymphoma. This article reviews the currently available commercial CAR T-cells products' role in managing diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma. We summarize pivotal clinical trials and real-world data on their efficacy and safety.