Irish journal of medical science
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Review Meta Analysis
Systematic review and meta-analysis of randomized controlled trials on safety and effectiveness of oral anticoagulants for atrial fibrillation in older people.
A meta-analysis of prospective, randomized controlled trials on novel oral anticoagulants (NOACs) versus warfarin, as most commonly used vitamin K antagonists (VKAs), was done to evaluate their effect on stroke risk and bleeding complications in nonvalvular atrial fibrillation (AF) patients. The study aims to evaluate efficacy and safety of NOACs versus warfarin between patients < 75 years and ≥ 75 years old. Prospective, randomized controlled trials (RCTs) comparing NOACs with warfarin with at least 1-year follow-up in nonvalvular AF patients were included. Search was done at MEDLINE, without time and language restriction. "Cochrane risk of bias 2.0 tool" was used to assess risk of bias. In meta-analysis, random effect model was used. ⋯ In subgroup analysis, it was consistent for both younger and older patients. Older patients have higher stroke risk that leads to more benefit with anticoagulation than younger patients. NOACs have better efficacy profile than warfarin as they decrease stroke more than warfarin, without increasing bleeding risk. Need for real-world data in old population is necessary.
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Medullary thyroid cancer (MTC) accounts for only 4% of thyroid carcinomas but 15% of thyroid cancer deaths. MTC is a tumour of the calcitonin secreting parafollicular C cells in the thyroid which can occur sporadically or be hereditary in multiple endocrine neoplasias type 2 syndromes due to germline RET mutations. Sporadic forms of MTC can also be caused by mutations in the RET protooncogene. ⋯ Recently, researchers have been exploring non-surgical options including external beam radiotherapy and multikinase inhibitors such as vandetanib and cabozantinib for the treatment of MTC. Surgical management of MTC remains controversial and varies significantly dependent on the extent of disease. Chemotherapeutic options have undetermined effects on survival to date.
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Randomized Controlled Trial
Effect of home-based high-intensity interval training versus moderate-intensity continuous training in patients with myocardial infarction: a randomized controlled trial.
Supervised high-intensity interval training (HIIT) has been proposed to be more effective than moderate-intensity continuous training (MICT) for improving exercise capacity, but there are not sufficient information effects of home-based HIIT and MICT in patients with myocardial infarction (MI). ⋯ This study suggests that HIIT and MICT can be applied at home-based in patients with MI and play an important role in improving functional capacity, health outcomes, and HRQoL.
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In this study, we aimed to evaluate and compare the clinical characteristics, laboratory findings, and outcomes of hospitalized patients with and without diabetes along with poorly vs. well-controlled diabetes. ⋯ Patients with diabetes and comorbidities, apart from the glycemic control, should receive intensive monitoring and disease management.
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Little is known on the duration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies in patients following SARS-CoV-2 infection. ⋯ A substantial fraction of convalescents may exhibit a transient IgG response following SARS-CoV-2 infection. Our findings suggest that patients who have recovered from SARS-CoV-2 infection should also be vaccinated if their anti-SARS-CoV-2 IgG antibodies are undetectable.