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Abstract Introduction Guidelines have endorsed non-vitamin K antagonist oral anticoagulants (NOACs), consisting of factor Xa inhibitors (xabans) and direct thrombin inhibitors, as the first line of treatment in venous thromboembolism (VTE) and atrial fibrillation. However, morbidly obese patients were under-represented in landmark trials of NOACs. Therefore, this study aimed to systematically review and perform a meta-analysis of studies on xabans versus vitamin K antagonist (VKA) in this high-risk population with VTE. Methods PubMed, Embase, Medline, Cochrane library, and Google Scholar databases were searched to identify studies that compared xabans and VKA in treating morbidly obese patients with VTE. Morbid obesity was defined as body weight ≥ 120 kg or BMI ≥ 40 kg/m2. Outcomes of interest included recurrent VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB). Results Eight studies comprising 30,895 patients were included. A total of 12,755 patients received xabans while 18,140 received VKAs. No significant difference in the odds of recurrent VTE (OR 0.75, 95% CI 0.55–1.01) and CRNMB (OR 0.69, 95% CI 0.44–1.09) was observed between the xabans group and the VKA group. However, the xabans group was associated with lower odds of major bleeding (OR 0.70, 95% CI 0.59–0.83). Conclusion Xabans have lower odds of major bleeding but similar odds of recurrent VTE when compared with VKAs in treating VTE in morbidly obese patients. Large registry analyses or future randomized controlled trials will be helpful in confirming these findings.

Abstract Background The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. Methods Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be “high,” “moderate,” “low,” or “critically low.” Results Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of “critically low quality” and two were of “low quality.” These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). Conclusions The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2’s rating rules.

Background: QT dispersion, defined as the difference between maximum and minimum QT interval measured at 12 lead ECG, is the most simple and widely used index of ventricular dispersion. Increased ventricular dispersion predicts predisposition to cardiac arrhythmia and therefore affects the prognosis of patients after myocardial infarction. Methods: In this study we evaluated whether QT dispersion can predict the arrhythmogenic potential in acute myocardial infarction (AMI) and whether it can behave as a risk stratification tool in such patients. Results: In all, 124 patients were included in the study. Mean QT dispersion at presentation was 112±5.4 ms. Those who were thrombolysed, or survived or did not develop significant ventricular arrhythmias had significantly lower QT dispersion than their comparative groups (P<0.001). Conclusion: In our study we found that measuring QT dispersion from presentation till hospitalisation can provide a method of risk stratification of AMI patients and can detect patients who are at increased risk of developing ventricular arrhythmias and increased cardiac mortality ?Implication for health policy/practice/research/medical education [ABSTRACT FROM AUTHOR]

Angiomyolipomas are benign neoplasms of the kidney which can clinically mimic renal malignancy. The imaging features are quite characteristic, and diagnosis can be clinched solely based on radiological investigations. Although mostly asymptomatic, they can be a cause of significant morbidity due to size and hemorrhage. We report a case of giant angiomyolipoma with a dilated vessel susceptible to hemorrhage. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a disease with a broad spectrum of clinical presentation. It varies in severity from mild edematous pancreatitis with mostly uneventful recovery to severe necrotizing forms associated with significant morbidity and mortality. Various severity scoring systems are used for assessing the prognosis of acute pancreatitis. These include the clinical scoring scales as Ranson criteria, Glasgow scales, simplified acute physiology (SAP) score and acute physiology and chronic health evaluation II (APACHE II) score. The CT severity index (CTSI) derived by Balthazar grading of pancreatitis and the extent of pancreatic necrosis is now widely used in describing CT findings of acute pancreatitis and serves as the radiological scoring system. The purpose of this review is to analyze the correlation of clinical and radiological scoring scales with patient outcome and assess their role as objective prognosticators of acute pancreatitis patients.