BACKGROUND Immune checkpoint inhibitors(ICIs)are novel therapeutic agents used for various types of cancer.ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients.However,immune-...BACKGROUND Immune checkpoint inhibitors(ICIs)are novel therapeutic agents used for various types of cancer.ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients.However,immune-related adverse effects of ICI therapy are common.Cardiovascular immune-related adverse events(irAEs)are rare but potentially life-threatening complications.AIM To estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies.METHODS We conducted this systematic review and meta-analysis by searching PubMed,Cochrane CENTRAL,Web of Science,and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs.We performed a single-arm meta-analysis using OpenMeta[Analyst]software of the following outcomes:Myocarditis,pericardial effusion,heart failure,cardiomyopathy,atrial fibrillation,myocardial infarction,and cardiac arrest.We assessed the heterogeneity using the I2 test and managed to solve it with Cochrane’s leave-one-out method.The risk of bias was performed with the Cochrane’s risk of bias tool.RESULTS A total of 26 studies were included.The incidence of irAEs follows:Myocarditis:0.5%[95%confidence interval(CI):0.1%-0.9%];Pericardial effusion:0.5%(95%CI:0.1%-1.0%);Heart failure:0.3%(95%CI:0.0%-0.5%);Cardiomyopathy:0.3%(95%CI:-0.1%-0.6%);atrial fibrillation:4.6%(95%CI:1.0%-14.1%);Myocardial infarction:0.4%(95%CI:0.0%-0.7%);and Cardiac arrest:0.4%(95%CI:0.1%-0.8%).CONCLUSION The most common cardiovascular irAEs were atrial fibrillation,myocarditis,and pericardial effusion.Although rare,data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICIassociated cardiovascular complications.展开更多
The dying liver causes the suffocation of the kidneys,which is a simplified way of describing the pathophysiology of hepatorenal syndrome(HRS).HRS is characterized by reversible functional renal impairment due to redu...The dying liver causes the suffocation of the kidneys,which is a simplified way of describing the pathophysiology of hepatorenal syndrome(HRS).HRS is characterized by reversible functional renal impairment due to reduced blood supply and glomerular filtration rate,secondary to increased vasodilators.Over the years,HRS has gained much attention and focus among hepatologists and nephrologists.HRS is a diagnosis of exclusion,and in some cases,it carries a poor prognosis.Different classifications have emerged to better understand,diagnose,and promptly treat this condition.This targeted review aims to provide substantial insight into the epidemiology,pathophysiology,diagnosis,and management of HRS,shed light on the various milestones of this condition,and add to our current understanding.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with ...BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.展开更多
ABO blood group incompatibility(ABO-I)was historically considered an absolute contraindication to kidney transplantation due to the significant risk of acute antibody-mediated rejection and early graft loss.Neverthele...ABO blood group incompatibility(ABO-I)was historically considered an absolute contraindication to kidney transplantation due to the significant risk of acute antibody-mediated rejection and early graft loss.Nevertheless,the urge to minimize the gap between the candidates’number on the waitlist for kidney transplants and the available kidney donors encourage investigation into finding ways to use organs from ABO-I kidney donors,especially in the era of using more potent immunosuppression therapies.This review aims to discuss a general overview of ABO-I kidney transplantation and the different protocols adopted by some transplant centers to meaningfully overcome this barrier.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at t...BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.展开更多
The coronavirus disease 2019(COVID-19)caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally.Liver transplantation(LT)has faced an une...The coronavirus disease 2019(COVID-19)caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally.Liver transplantation(LT)has faced an unequivocal challenge during this unprecedented time.This targeted review aims to cover most of the clinical issues,challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.展开更多
Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Pr...Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Prevention,kidney transplant recipients are stratified as being high risk of developing fatal illness from COVID-19 infection.Kidney transplant is the gold-standard treatment for end-stage kidney disease subjects.During the pandemic,significant concerns have emerged regarding continuation of kidney transplant surgeries and management of kidney transplant recipients post-transplant.The added risk of immunosuppression in this cohort was and remains a theoretical concern,posing a potential risk of transplantation rather than benefit.This comprehensive review aims to cover most of the faced challenges in kidney transplantation in different stages of the pandemic.In addition,it will elucidate the epidemiology,nature,course of the disease,surgical consideration in donors and recipients as well as role of immunosuppression and management of COVID-19 infected kidney transplant recipients during these extraordinary circumstances.展开更多
It has been reported that up to 90%of organ transplant recipients have suboptimal blood pressure control.Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality.In addit...It has been reported that up to 90%of organ transplant recipients have suboptimal blood pressure control.Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality.In addition,rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival.Nevertheless,hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients.Hence,specific management awareness of those factors is mandated.An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification.This article provides a comprehensive review of the prevalence,risk factors,etiology,complications,prevention,and management of hypertension after organ transplantation.展开更多
文摘BACKGROUND Immune checkpoint inhibitors(ICIs)are novel therapeutic agents used for various types of cancer.ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients.However,immune-related adverse effects of ICI therapy are common.Cardiovascular immune-related adverse events(irAEs)are rare but potentially life-threatening complications.AIM To estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies.METHODS We conducted this systematic review and meta-analysis by searching PubMed,Cochrane CENTRAL,Web of Science,and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs.We performed a single-arm meta-analysis using OpenMeta[Analyst]software of the following outcomes:Myocarditis,pericardial effusion,heart failure,cardiomyopathy,atrial fibrillation,myocardial infarction,and cardiac arrest.We assessed the heterogeneity using the I2 test and managed to solve it with Cochrane’s leave-one-out method.The risk of bias was performed with the Cochrane’s risk of bias tool.RESULTS A total of 26 studies were included.The incidence of irAEs follows:Myocarditis:0.5%[95%confidence interval(CI):0.1%-0.9%];Pericardial effusion:0.5%(95%CI:0.1%-1.0%);Heart failure:0.3%(95%CI:0.0%-0.5%);Cardiomyopathy:0.3%(95%CI:-0.1%-0.6%);atrial fibrillation:4.6%(95%CI:1.0%-14.1%);Myocardial infarction:0.4%(95%CI:0.0%-0.7%);and Cardiac arrest:0.4%(95%CI:0.1%-0.8%).CONCLUSION The most common cardiovascular irAEs were atrial fibrillation,myocarditis,and pericardial effusion.Although rare,data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICIassociated cardiovascular complications.
文摘The dying liver causes the suffocation of the kidneys,which is a simplified way of describing the pathophysiology of hepatorenal syndrome(HRS).HRS is characterized by reversible functional renal impairment due to reduced blood supply and glomerular filtration rate,secondary to increased vasodilators.Over the years,HRS has gained much attention and focus among hepatologists and nephrologists.HRS is a diagnosis of exclusion,and in some cases,it carries a poor prognosis.Different classifications have emerged to better understand,diagnose,and promptly treat this condition.This targeted review aims to provide substantial insight into the epidemiology,pathophysiology,diagnosis,and management of HRS,shed light on the various milestones of this condition,and add to our current understanding.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.
文摘ABO blood group incompatibility(ABO-I)was historically considered an absolute contraindication to kidney transplantation due to the significant risk of acute antibody-mediated rejection and early graft loss.Nevertheless,the urge to minimize the gap between the candidates’number on the waitlist for kidney transplants and the available kidney donors encourage investigation into finding ways to use organs from ABO-I kidney donors,especially in the era of using more potent immunosuppression therapies.This review aims to discuss a general overview of ABO-I kidney transplantation and the different protocols adopted by some transplant centers to meaningfully overcome this barrier.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.
文摘The coronavirus disease 2019(COVID-19)caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally.Liver transplantation(LT)has faced an unequivocal challenge during this unprecedented time.This targeted review aims to cover most of the clinical issues,challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.
文摘Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Prevention,kidney transplant recipients are stratified as being high risk of developing fatal illness from COVID-19 infection.Kidney transplant is the gold-standard treatment for end-stage kidney disease subjects.During the pandemic,significant concerns have emerged regarding continuation of kidney transplant surgeries and management of kidney transplant recipients post-transplant.The added risk of immunosuppression in this cohort was and remains a theoretical concern,posing a potential risk of transplantation rather than benefit.This comprehensive review aims to cover most of the faced challenges in kidney transplantation in different stages of the pandemic.In addition,it will elucidate the epidemiology,nature,course of the disease,surgical consideration in donors and recipients as well as role of immunosuppression and management of COVID-19 infected kidney transplant recipients during these extraordinary circumstances.
文摘It has been reported that up to 90%of organ transplant recipients have suboptimal blood pressure control.Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality.In addition,rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival.Nevertheless,hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients.Hence,specific management awareness of those factors is mandated.An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification.This article provides a comprehensive review of the prevalence,risk factors,etiology,complications,prevention,and management of hypertension after organ transplantation.
