Publications by authors named "Milosz Jaguszewski"

190 Publications

Tirofiban in emergency conditions: Systematic review.

Am J Emerg Med 2021 Mar 24. Epub 2021 Mar 24.

1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.

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http://dx.doi.org/10.1016/j.ajem.2021.03.063DOI Listing
March 2021

Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients.

J Clin Med 2021 Mar 30;10(7). Epub 2021 Mar 30.

Polish Society of Disaster Medicine, 50-345 Warsaw, Poland.

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles ( = 2002 patients) were included, comparing TTM patients ( = 638) with controls ( = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.
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http://dx.doi.org/10.3390/jcm10071389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037776PMC
March 2021

Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis.

J Clin Med 2021 Mar 15;10(6). Epub 2021 Mar 15.

Department of Research Outcomes, Polish Society of Disaster Medicine, 05-090 Raszyn, Poland.

Out-of-hospital cardiac arrest (OHCA) is a challenge for medical staff, especially in the COVID-19 period. The COVID-19 disease caused by the SARS-CoV-2 coronavirus is highly infectious, thus requiring additional measures during cardiopulmonary resuscitation (CPR). Since CPR is a highly aerosol-generating procedure, it carries a substantial risk of viral transmission. We hypothesized that patients with diagnosed or suspected COVID-19 might have worse outcomes following OHCA outcomes compared to non-COVID-19 patients. To raise awareness of this potential problem, we performed a systematic review and meta-analysis of studies that reported OHCA in the pandemic period, comparing COVID-19 suspected or diagnosed patients vs. COVID-19 not suspected or diagnosed group. The primary outcome was survival to hospital discharge (SHD). Secondary outcomes were the return of spontaneous circulation (ROSC), survival to hospital admission or survival with favorable neurological outcomes. Data including 4210 patients included in five studies were analyzed. SHD in COVID-19 and non-COVID-19 patients were 0.5% and 2.6%, respectively (odds ratio, OR = 0.25; 95% confidence interval, CI: 0.12, 0.53; < 0.001). Bystander CPR rate was comparable in the COVID-19 vs. not COVID-19 group (OR = 0.88; 95% CI: 0.63, 1.22; = 0.43). Shockable rhythms were observed in 5.7% in COVID-19 patients compared with 37.4% in the non-COVID-19 group (OR = 0.19; 95% CI: 0.04, 0.96; = 0.04; I = 95%). ROSC in the COVID-19 and non-COVID-19 patients were 13.3% vs. 26.5%, respectively (OR = 0.67; 95% CI: 0.55, 0.81; < 0.001). SHD with favorable neurological outcome was observed in 0% in COVID-19 vs. 3.1% in non-COVID-19 patients (OR = 1.35; 95% CI: 0.07, 26.19; = 0.84). Our meta-analysis suggests that suspected or diagnosed COVID-19 reduces the SHD rate after OHCA, which seems to be due to the lower rate of shockable rhythms in COVID-19 patients, but not due to reluctance to bystander CPR. Future trials are needed to confirm these preliminary results and determine the optimal procedures to increase survival after OHCA in COVID-19 patients.
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http://dx.doi.org/10.3390/jcm10061209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001432PMC
March 2021

Efficacy and Safety of Tranexamic Acid in Emergency Trauma: A Systematic Review and Meta-Analysis.

J Clin Med 2021 Mar 3;10(5). Epub 2021 Mar 3.

1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland.

In trauma patients, bleeding can lead to coagulopathy, hemorrhagic shock, and multiorgan failure, and therefore is of fundamental significance in regard to early morbidity. We conducted a meta-analysis to evaluate the efficacy and safety of tranexamic acid (TXA) in civil and military settings and its impact on in-hospital mortality (survival to hospital discharge or 30-day survival), intensive care unit and hospital length of stay, incidence of adverse events (myocardial infarct and neurological complications), and volume of blood product transfusion. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature using PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Central Register and Controlled Trials (CENTRAL) database was conducted from inception to 10 January 2021. In-hospital mortality was reported in 14 studies and was 15.5% for the TXA group as compared with 16.4% for the non-TXA group (OR = 0.81, 95% CI 0.62-1.06, I = 83%, = 0.12). In a civilian TXA application, in-hospital mortality in the TXA and non-TXA groups amounted to 15.0% and 17.1%, respectively (OR = 0.69, 95% CI 0.51-0.93, = 0.02, I = 78%). A subgroup analysis of the randomized control trial (RCT) studies showed a statistically significant reduction in in-hospital mortality in the TXA group (14.3%) as compared with the non-TXA group (15.7%, OR = 0.89, 95% CI 0.83-0.96, = 0.003, I = 0%). To summarize, TXA used in civilian application reduces in-hospital mortality. Application of TXA is beneficial for severely injured patients who undergoing shock and require massive blood transfusions. Patients who undergo treatment with TXA should be monitored for clinical signs of thromboembolism, since TXA is a standalone risk factor of a thromboembolic event and the D-dimers in traumatic patients are almost always elevated.
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http://dx.doi.org/10.3390/jcm10051030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958951PMC
March 2021

Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis.

Acta Diabetol 2021 Mar 20. Epub 2021 Mar 20.

Department of Pediatrics and Children's Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Silesia, Poland.

Background: The novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19.

Methods: A systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms "diabetes mellitus" OR "diabetes" OR "DM" AND "survival" OR "mortality" AND "SARS-CoV-2" OR "COVID-19".

Results: Nineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001).

Conclusions: Based on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19.
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http://dx.doi.org/10.1007/s00592-021-01701-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005367PMC
March 2021

Efficacy and safety of tranexamic acid in pediatric trauma patients: Evidence from meta-analysis.

Am J Emerg Med 2021 Feb 8. Epub 2021 Feb 8.

Polish Society of Disaster Medicine, Warsaw, Poland; Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland; Maria Sklodowska-Cure Bialystok Oncology Centre, Białystok, Poland. Electronic address:

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http://dx.doi.org/10.1016/j.ajem.2021.02.009DOI Listing
February 2021

Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry.

Authors:
Ken Kato Victoria L Cammann L Christian Napp Konrad A Szawan Jozef Micek Sara Dreiding Rena A Levinson Vanya Petkova Michael Würdinger Alexandru Patrascu Rafael Sumalinog Sebastiano Gili Christian F Clarenbach Malcolm Kohler Manfred Wischnewsky Rodolfo Citro Carmine Vecchione Eduardo Bossone Michael Neuhaus Jennifer Franke Benjamin Meder Milosz Jaguszewski Michel Noutsias Maike Knorr Susanne Heiner Fabrizio D'Ascenzo Wolfgang Dichtl Christof Burgdorf Behrouz Kherad Carsten Tschöpe Annahita Sarcon Jerold Shinbane Lawrence Rajan Guido Michels Roman Pfister Alessandro Cuneo Claudius Jacobshagen Mahir Karakas Wolfgang Koenig Alexander Pott Philippe Meyer Marco Roffi Adrian Banning Mathias Wolfrum Florim Cuculi Richard Kobza Thomas A Fischer Tuija Vasankari K E Juhani Airaksinen Monika Budnik Rafal Dworakowski Philip MacCarthy Christoph Kaiser Stefan Osswald Leonarda Galiuto Christina Chan Paul Bridgman Daniel Beug Clément Delmas Olivier Lairez Ekaterina Gilyarova Alexandra Shilova Mikhail Gilyarov Ibrahim El-Battrawy Ibrahim Akin Martin Kozel Petr Tousek David E Winchester Jan Galuszka Christian Ukena Gregor Poglajen Pedro Carrilho-Ferreira Christian Hauck Carla Paolini Claudio Bilato Masanori Sano Iwao Ishibashi Masayuki Takahara Toshiharu Himi Yoshio Kobayashi Abhiram Prasad Charanjit S Rihal Kan Liu P Christian Schulze Matteo Bianco Lucas Jörg Hans Rickli Gonçalo Pestana Thanh H Nguyen Michael Böhm Lars S Maier Fausto J Pinto Petr Widimský Stephan B Felix Grzegorz Opolski Ruediger C Braun-Dullaeus Wolfgang Rottbauer Gerd Hasenfuß Burkert M Pieske Heribert Schunkert Martin Borggrefe Holger Thiele Johann Bauersachs Hugo A Katus John D Horowitz Carlo Di Mario Thomas Münzel Filippo Crea Jeroen J Bax Thomas F Lüscher Frank Ruschitzka Jelena R Ghadri Christian Templin

ESC Heart Fail 2021 Mar 13. Epub 2021 Mar 13.

Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.

Aims: Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes.

Methods And Results: Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002).

Conclusions: The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.
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http://dx.doi.org/10.1002/ehf2.13165DOI Listing
March 2021

Post-COVID-19 heart syndrome.

Cardiol J 2021 Mar 1. Epub 2021 Mar 1.

Maria Sklodowska-Curie Medical Academy in Warsaw, Poland.

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http://dx.doi.org/10.5603/CJ.a2021.0028DOI Listing
March 2021

Levosimendan or dobutamine in patients with low cardiac output syndrome: Results from meta-analysis.

Int J Cardiol 2021 Feb 24. Epub 2021 Feb 24.

Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland; Maria Sklodowska-Curie Białystok Oncology Centre, Białystok, Poland.

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http://dx.doi.org/10.1016/j.ijcard.2021.02.050DOI Listing
February 2021

Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety.

Cardiol J 2021 Feb 26. Epub 2021 Feb 26.

First Department of Cardiology, Medical University of Gdansk, Poland.

Background: Pharmaceutical pictograms have been designed to help communicate medication instructions to patients. Pictograms used within a patient counseling service can significantly improve medication compliance and adherence. The study aimed to assess the improvement of adherence to therapy with the use of pictogram intervention in comparison to standard pharmacy practice in community pharmacies.

Methods: Pictograms informing about the proper way of using metoprolol prolonged release tablets were designed to be used on the packages of the drug in community pharmacies. Pharmacies belonging to a pharmacy practice-based research network were randomly assigned to a group using pictograms when dispensing the drug or one following their normal practice. At the first visit, all patients answered a structured questionnaire about their medication behavior in the preceding 7 days. The same questions were asked 4 weeks later to follow-up treatment adherence change and compare studied groups. Descriptive statistics was used to analyze the data, and the McNemar test was used to compare categorical data at baseline and follow-up.

Results: Of a total of 253 patients screened, 117 and 104 patients completed the study in the standard practice and pictogram groups, respectively. The use of pictograms significantly improved medication adherence in the following areas: not omitting doses (p < 0.0001), not crushing tablets (p = 0.004), number of tablets/day (p = 0.49), and time of use (p = 0.001), compared to the standard practice group.

Conclusions: Our results suggest that pictograms are effective in conveying messages about the proper way of using medications, and they increase treatment adherence, in comparison to standard dispensing practice.
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http://dx.doi.org/10.5603/CJ.a2021.0022DOI Listing
February 2021

Plasma Concentrations of Extracellular Vesicles Are Decreased in Patients with Post-Infarct Cardiac Remodelling.

Biology (Basel) 2021 Jan 30;10(2). Epub 2021 Jan 30.

1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.

Background, the mechanisms underlying left ventricular remodelling (LVR) after acute myocardial infarction (AMI) remain obscure. In the course of AMI, blood cells and endothelial cells release extracellular vesicles (EVs). We hypothesized that changes in EV concentrations after AMI may underlie LVR. Methods, plasma concentrations of EVs from endothelial cells (CD146+), erythrocytes (CD235a+), leukocytes (CD45+), platelets (CD61+), activated platelets (P-selectin+), and EVs exposing phosphatidylserine after AMI were determined by flow cytometry in 55 patients with the first AMI. LVR was defined as an increase in left ventricular end-diastolic volume by 20% at 6 months after AMI, compared to baseline. Results, baseline concentrations of EVs from endothelial cells, erythrocytes and platelets were lower in patients who developed LVR ( ≤ 0.02 for all). Concentrations of EVs from endothelial cells and erythrocytes were independent LVR predictors (OR 8.2, CI 1.3-54.2 and OR 17.8, CI 2.3-138.6, respectively) in multivariate analysis. Combining the three EV subtypes allowed to predict LVR with 83% sensitivity and 87% specificity. Conclusions, decreased plasma concentrations of EVs from endothelial cells, erythrocytes and platelets predict LVR after AMI. Since EV release EVs contributes to cellular homeostasis by waste removal, decreased concentrations of EVs may indicate dysfunctional cardiac homeostasis after AMI, thus promoting LVR.
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http://dx.doi.org/10.3390/biology10020097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910841PMC
January 2021

Readiness and Willingness to Provide Immunization Services after Pilot Vaccination Training: A Survey among Community Pharmacists Trained and Not Trained in Immunization during the COVID-19 Pandemic in Poland.

Int J Environ Res Public Health 2021 01 12;18(2). Epub 2021 Jan 12.

Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada.

Background: Immunization rates among the adult population in Poland are below desired targets, urging the need to expand this service in the community. During the COVID-19 pandemic, the ultimate goals for limiting the spread of the infection are vaccines against SARS-CoV-2. Pharmaceutical companies are in a race for the fastest possible way to deliver vaccines. Community pharmacists in Poland are recognised as an accessible yet underutilised group of medical professionals. Therefore, involving pharmacists in vaccinations may have beneficial results for the healthcare system.

Objectives: The objectives of this study were to assess the readiness and willingness of community pharmacists following the Pharmacist Without Borders project who had either been trained or not in providing immunization services, and to identify the factors that may support the implementation of such services in Poland.

Methods: This study was conducted among pharmacists between February and August 2020 in Poland. A survey was developed to determine their readiness to provide vaccination services in their pharmacies, to recognise any barriers to vaccinations, as well as the factors necessary to implement vaccination services in Polish pharmacies.

Results: A total of 1777 pharmacists participated in the study, comprising 127 (7.1%) pharmacists trained in vaccinations during the Pharmacists Without Borders project and 1650 (92.9%) pharmacists not participating in the workshops. Pharmacists participating in the workshops more often indicated that providing vaccinations in community pharmacies would improve the overall vaccination rate ( = 0.0001), and that pharmacists could play an important role in advertising and promoting vaccinations ( = 0.0001). For the pharmacists not participating in the workshops, they indicated to a much greater extent possible barriers affecting the readiness to provide vaccinations in pharmacies. They most often pointed out that vaccination services would result in a significant workload increase ( = 0.0001), that pharmacies were not adapted to immunization, and that there were not enough training courses for pharmacists ( = 0.0001).

Conclusion: The pharmacists working in community pharmacies indicated many advantages of vaccinations in pharmacies. This study identified barriers to the introduction of vaccinations and factors necessary to implement these services in pharmacies. The pharmacists trained during the immunization programme of the Pharmacists Without Borders project showed a greater readiness to provide immunization services.
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http://dx.doi.org/10.3390/ijerph18020599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828205PMC
January 2021

Copeptin level differentiates takotsubo cardiomyopathy from acute myocardial infarction.

Biomarkers 2021 Mar 21;26(2):75-76. Epub 2021 Jan 21.

1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.

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http://dx.doi.org/10.1080/1354750X.2021.1875503DOI Listing
March 2021

Intraosseous versus intravenous access while wearing personal protective equipment: a meta-analysis in the era of COVID-19.

Kardiol Pol 2021 03 7;79(3):277-286. Epub 2021 Jan 7.

Background: Obtaining vascular access is one of the key procedures performed in patients in emergency settings.

Aims: The study was conducted as a meta‑analysis and a systematic review and aimed to address the following question: which intravascular access method should be used in patients with COVID‑19 when wearing full personal protective equipment (PPE)?

Methods: We performed a systematic search of PubMed, EMBASE, and CENTRAL databases for randomized controlled trials that compared intravascular access methods used by operators wearing full level C PPE. We evaluated procedure duration and the success rate of intraosseous and peripheral intravenous accesses.

Results: Eight randomized controlled trials were included in quantitative synthesis. The use of PPE during intravascular access procedures had an impact on procedure duration in the case of intraosseous access (mean difference [MD], 11.69; 95% CI, 6.47-16.92; P <0.001), as well as reduced the success rate of intraosseous access by 0.8% and intravenous access by 10.1%. Under PPE conditions, intraosseous access, compared with peripheral intravenous access, offered a shorter procedure time (MD, -41.43; 95% CI, -62.36 to -24.47; P <0.001).

Conclusion: This comprehensive meta‑analysis suggested that the use of PPE significantly extends the duration of intravascular procedures. However, under PPE conditions, operators were able to obtain intraosseous access in a shorter time and with a higher success rate than in the case of intravenous access.
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http://dx.doi.org/10.33963/KP.15741DOI Listing
March 2021

Should emergency medical service stuff use respirators with filtered valve in COVID-19 pandemic?

Adv Respir Med 2020 ;88(6):638-639

First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.

Performing medical procedures with the use of personal protective equipment may reduce the efficiency of medical procedures performed, for example, as with the current use of respiratory protection devices, including N95 or surgical masks. Healthcare workers (HCWs) using N95 respirators or medical masks may experience discomfort associated with wearing a mask when performing medical procedures, in particular those associated with increased physical activity, causing increased respiratory effort.
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http://dx.doi.org/10.5603/ARM.a2020.0167DOI Listing
January 2021

Impact of COVID-19 pandemic on out-of-hospital cardiac arrest survival rate.

Resuscitation 2021 02 28;159:40-41. Epub 2020 Dec 28.

1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.

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http://dx.doi.org/10.1016/j.resuscitation.2020.12.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833632PMC
February 2021

The plague of unexpected drug recalls and the pandemic of falsified medications in cardiovascular medicine as a threat to patient safety and global public health: A brief review.

Cardiol J 2020 Dec 21. Epub 2020 Dec 21.

First Department of Cardiology, Medical University of Gdansk, Poland, Dębinki Street 7, 80-211, Gdańsk, Poland.

Valsartan, losartan, and irbesartan, are widely used in the treatment strategies of cardiovascular medicine diseases, including hypertension and heart failure. Recently, many formulations for the aforementioned diseases contained active pharmaceutical ingredients and had been abruptly recalled from the market due to safety concerns mainly associated with unwanted impurities - nitrosamines, which are highly carcinogenic substances accidentally produced during manufacturing. Along with cardiovascular medications, formulations containing ranitidine were also recalled from the market. This poses a particular threat to public health due to the non-prescription status of these drugs. Regulatory authorities, including the Food and Drug Administration and European Medicines Agency among others, have taken action to minimize patient risk and improve the manufacturing quality as well as re-checking current guidelines and recommendations. While these steps are necessary to avoid further recalls, authorities should remember the growing concerns of patients regarding the safety and efficacy of pharmacotherapy. Apart from the genuine manufacturing mistakes mentioned above, falsified and counterfeit medications should be at the heart of global attention. The lack of a well-accepted definition of falsified/counterfeit medications has impeded political and scientific efforts to mitigate risk of this phenomenon. Falsified Medicines Directive should be considered the most pivotal legislation recently enacted to harmonize international cooperation. In summary, one should remember that only international and direct collaboration between patients, stakeholders, and authorities be considered a remedy for a pandemic of falsified medicines and plague of unexpected recalls due to safety concerns.
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http://dx.doi.org/10.5603/CJ.a2020.0168DOI Listing
December 2020

First-in-human radiofrequency ablation of ventricular tachycardia performed through an Atrial Flow Regulator device.

Cardiol J 2021 21;28(1):161-162. Epub 2020 Dec 21.

Department of Cardiology and Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland.

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http://dx.doi.org/10.5603/CJ.a2020.0172DOI Listing
December 2020

Correlation between takotsubo cardiomyopathy and SARS-CoV-2 infection.

Med Hypotheses 2021 Jan 9;146:110454. Epub 2020 Dec 9.

Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands; First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.

Takotsubo cardiomyopathy (TTS), known as stress cardiomyopathy, is a rare disorder characterized by acute and transient left ventricular systolic and diastolic dysfunction, often associated with a stressful, emotional or physical event. TTS may be closely related to SARS-CoV-2 infection and the ongoing pandemic. The enormous emotional stress caused by the pandemic and respiratory infections caused by SARS-CoV-2 could be potential triggers for TTS. The case series cited above implicates that TTS should be considered in the differential diagnosis across the entire spectrum of myocardial injury in SARS-CoV-2 infected patients. Myocardial damage associated with SARS-CoV-2 infection is usually attributed to sepsis, hypoxemia, coronary artery disease, and myocarditis. We hypothesize that TTS may also play a role among these lesions.
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http://dx.doi.org/10.1016/j.mehy.2020.110454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724514PMC
January 2021

Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials.

PLoS One 2020 15;15(12):e0242901. Epub 2020 Dec 15.

Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.

Background: Recently, several randomized controlled trials (RCTs) have evaluated the effect of N95 respirators compared with medical masks to protect against acute respiratory infections. However, these studies are limited by modest sample sizes and inconclusive results. Therefore, the goal of the present study was to review the relevant and available published RCTs with the aid of the increased power of meta-analytic methods in order to assess the effectiveness of medical masks and N95 respirators in reducing the risk of respiratory infections.

Methods: This meta-analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting results. We searched PubMed, Web of Science, Embase, and Cochrane databases from inception through April 1, 2020 to identify potentially relevant studies. Two authors (LS and JS) independently searched the titles and abstracts of the potentially eligible articles. They independently retrieved required data from the eligible trials; the data were initially tabulated for statistical analysis. Two authors (JRL and LS) independently assessed the methodological quality of the included RCTs using the Cochrane Collaboration's tool for assessing risk of bias.

Results: Six articles met the inclusion criteria. The pooled analysis showed that N95 respirators did not reduce the risk of infection with respiratory viruses compared with medical/surgical masks (5.7% vs. 7.9%; RR = 1.12; 95% CI: 0.88-1.41; p = 0.36); however, there was no statistically significant difference in laboratory-confirmed influenza between N95 and medical masks (RR = 0.91; 95% CI: 0.77-1.07; p = 0.26). Medical masks provided similar protection against other viruses, including coronavirus (RR = 0.74; 95% CI: 0.32-1.73; p = 0.49). Respiratory illness, as well as influenza-like illness were less frequently observed with N95 respirators.

Conclusions: Our meta-analysis suggests that there are insufficient data to definitively determine whether N95 respirators are superior to medical masks in protection against transmissible acute respiratory infections. Further randomized trials are necessary to compare the above methods of respiratory protection in the context of COVID-19 incidence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242901PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737973PMC
December 2020