Amir, Omniat

Background: Hybrid coronary revascularization (HCR), a combination of percutaneous coronary intervention and coronary artery bypass grafting (CABG), is an emerging treatment for patients with multivessel coronary artery disease (MVCAD). While traditional CABG is considered the standard, HCR may mitigate issues like saphenous vein graft failure. Methods: We systematically searched PubMed, Scopus, Web of Science, and Embase until September 2024, targeting randomized controlled trials (RCTs) that evaluated HCR against CABG in MVCAD patients. The quality of included studies was assessed using the ROB2 tool, and data were analyzed using RevMan 5.4. Four RCTs ( n = 382) involving 382 participants were analyzed using a random-effects model. Risk of bias was assessed using the ROB2 tool. Results: Four RCTs ( n = 382) met inclusion criteria. At 30 days, there were no statistically significant differences between HCR and CABG in all-cause death (risk ratios [RR] = 1.35, P = 0.74), stroke (RR = 0.99, P = 0.99), myocardial infarction (RR = 1.17, P = 0.74), or blood transfusion (RR = 0.70, P = 0.14), with zero heterogeneity ( I 2 = 0%). At 1-year follow-up, pooled analyses showed no significant differences in all-cause death (RR = 1.37, P = 0.62) or myocardial infarction (RR = 1.29, P = 0.56), also with consistent homogeneity ( I 2 = 0%). Conclusion: HCR demonstrates comparable safety and effectiveness to CABG for MVCAD, with similar rates of key outcomes at both 30 days and 1 year. Further research with larger samples and longer follow-up is recommended to confirm these findings.

Background: Functional dyspepsia (FD), a disease of the gastroduodenal tract, is one of the functional gastrointestinal disorders (FGID) characterized by postprandial fullness and epigastric pain not attributed to any underlying organic diseases. Sleep quality refers to individuals’ satisfaction with their overall sleep, including sleep initiation, maintenance, duration, and feeling refreshed upon waking. Despite frequent associations between sleep disorders and FGID, comprehensive data on poor sleep quality (PSQ) in FD patients is lacking. Therefore, this study was conducted to investigate the occurrence of PSQ in patients with PSQ. Methods: PubMed, Scopus, and Web of Science were systematically searched to identify relevant literature. All studies reporting PSQ prevalence in FD patients or sufficient data to calculate it were included. Pooled prevalence was calculated for all studies, and an odds ratio was determined for studies with a healthy control group. Meta-regression and subgroup analyses assessed the moderating effects of different variables. Publication bias was examined using funnel plots and Egger’s test p-value. The work has been reported in line with AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Results: To the best of our knowledge, this is the first study that pooled the estimate of prevalence of patients with FD with PSQ. Based on 2138 FD patients, the pooled prevalence of poor sleep quality is 57.2% (95% CI: 37%–75.2%), I 2 = 98.4%. The asymmetric funnel plot and Egger’s test P-value indicated a significant publication bias for the pooled prevalence estimate. FD patients are at higher risk for poor sleep, with an odds ratio of 2.39 (95% CI: 1.86–3.06), I 2 = 1.73%. Conclusion: Poor sleep is highly prevalent among FD patients, who are more susceptible to poor sleep than healthy individuals. The findings of the study should be interpreted with caution owing to the high heterogeneity and the publication bias observed for the pooled prevalence. Future research should standardize diagnostic parameters and investigate other confounding factors like anxiety and depression to achieve more accurate estimates.

AbstractBackgroundScleroderma, also referred to as systemic sclerosis, is a multifaceted autoimmune condition characterized by abnormal fibrosis and impaired vascular function. Pathologically, it encompasses the persistent presence of inflammation, abnormal collagen buildup, and restructuring of blood vessels in various organs, resulting in a wide range of clinical symptoms. This review incorporates the most recent scientific literature on scleroderma, with a particular emphasis on its pathophysiology, clinical manifestations, diagnostic approaches, and treatment options.MethodologyA comprehensive investigation was carried out on numerous databases, such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar, to collect pertinent studies covering diverse facets of scleroderma research.ResultsScleroderma presents with a range of systemic manifestations, such as interstitial lung disease, gastrointestinal dysmotility, Raynaud's phenomenon, pulmonary arterial hypertension, renal complications, neurological symptoms, and cardiac abnormalities. Serological markers, such as antinuclear antibodies, anti‐centromere antibodies, and anti‐topoisomerase antibodies, are important for classifying diseases and predicting their outcomes.DiscussionThe precise identification of scleroderma is crucial for promptly and correctly implementing effective treatment plans. Treatment approaches aim to improve symptoms, reduce complications, and slow down the progression of the disease. An integrated approach that combines pharmacological agents, including immunosuppressants, endothelin receptor antagonists, and prostanoids, with nonpharmacological interventions such as physical and occupational therapy is essential for maximizing patient care.ConclusionThrough the clarification of existing gaps in knowledge and identification of emerging trends, our goal is to improve the accuracy of diagnosis, enhance the effectiveness of therapeutic interventions, and ultimately enhance the overall quality of life for individuals suffering from scleroderma. Ongoing cooperation and creative research are necessary to advance the field and achieve improved patient outcomes and new therapeutic discoveries.

Juvenile multiple sclerosis (JMS) is a rare but significant subtype of multiple sclerosis (MS) that affects a small percentage of patients under the age of 10 and 3–5% of all MS patients. Despite its rarity, JMS poses unique challenges in terms of diagnosis, treatment, and management, as it can significantly impact a child or adolescent’s physical, cognitive, and emotional development. JMS presents with a varying spectrum of signs and symptoms such as coordination difficulties and permanent cognitive dysfunctions and may include atypical clinical features such as seizures, acute disseminated encephalomyelitis, and optic neuritis, making diagnostic evaluations challenging. Whilst the biology of JMS shares similarities with adult-onset MS, there exist notable distinctions in disease progression, clinical manifestations, and ultimate prognoses. The International Pediatric MS Study Group (IPMSSG) was founded in 2005 to improve understanding of JMS, but there remains a lack of knowledge and guidelines on the management of this condition. This review summarizes the current knowledge on JMS, including its epidemiology, clinical presentations, diagnostic challenges, current treatment options, and outcomes. Current treatment options for JMS include disease-modifying therapies, but JMS can also result in impaired quality of life and psychiatric comorbidity, highlighting the need for comprehensive care for affected children. Through gathering and analyzing scattered studies and recent updates on JMS, the authors aim to address the gaps in current knowledge on JMS and provide an improved understanding of appropriate care for affected children. By doing so, this review hopes to contribute to improving the quality of life and outcomes for JMS patients.

Multiple sclerosis (MS) and myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) share the symptom of fatigue, and might even coexist together. Specifically focusing on genetics, pathophysiology, and neuroimaging data, the authors discuss an overview of the parallels, correlation, and differences in fatigue between MS and ME/CFS along with ME/CFS presence in MS. Studies have revealed that the prefrontal cortex and basal ganglia regions, which are involved in fatigue regulation, have similar neuroimaging findings in the brains of people with both MS and ME/CFS. Additionally, in both conditions, genetic factors have been implicated, with particular genes known to enhance susceptibility to MS and CFS. Management approaches for fatigue in MS and ME/CFS differ based on the underlying factors contributing to fatigue. The authors also focus on the recent updates and the relationship between MS and sleep disorders, including restless legs syndrome, focusing on pathophysiology and therapeutic approaches. Latest therapeutic approaches like supervised physical activity and moderate-intensity exercises have shown better outcomes.

AbstractBackgroundPrimary‐progressive multiple sclerosis (PPMS) and relapsing‐remitting multiple sclerosis (RRMS) are two frequent multiple sclerosis (MS) subtypes that involve 10%–15% of patients. PPMS progresses slowly and is diagnosed later in life. Both subtypes are influenced by genetic and environmental factors such as smoking, obesity, and vitamin D insufficiency. Although there is no cure, ocrelizumab can reduce symptoms and delay disease development. RRMS is an autoimmune disease that causes inflammation, demyelination, and disability. Early detection, therapy, and lifestyle changes are critical. This study delves into genetics, immunology, biomarkers, neuroimaging, and the usefulness of ocrelizumab in the treatment of refractory patients of PPMS.MethodIn search of published literature providing up‐to‐date information on PPMS and RRMS, this review conducted numerous searches in databases such as PubMed, Google Scholar, MEDLINE, and Scopus. We looked into genetics, immunology, biomarkers, current breakthroughs in neuroimaging, and the role of ocrelizumab in refractory cases.ResultsOur comprehensive analysis found considerable advances in genetics, immunology, biomarkers, neuroimaging, and the efficacy of ocrelizumab in the treatment of refractory patients.ConclusionEarly detection, timely intervention, and the adoption of lifestyle modifications play pivotal roles in enhancing treatment outcomes. Notably, ocrelizumab has demonstrated potential in symptom control and mitigating the rate of disease advancement, further underscoring its clinical significance in the management of MS.