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Background Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI. Methods PubMed, Scopus, and Web of Science were searched using terms; such as “Insomnia” and “MI.” Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis. Results Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41–2.02, p < .00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7−8 h of sleep (RR = 1.56, 95% CI = 1.41–1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04–1.23, p = .003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91–1.23, p = .46). Analysis of age, follow‐up duration, sex, and comorbidities showed a significant association in insomniacs. Conclusion Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.

Background Early oral feeding has been previously postulated to contribute to developing postoperative complications following head and neck reconstructive surgeries using free flaps. This study assessed the association between the timing of oral feeding (early vs. late) and postoperative complications and length of hospital stay among these patients. Method PubMed, Scopus, Cochrane, and Web of Science were searched using terms such as “oral feeding” and “head or neck cancer.” We utilized RevMan software version 5.4 for the analysis. The study defined early oral feeding as feeding within 5-day post-operation, while late oral feeding was defined as feeding after the fifth postoperative day. Five papers that met the inclusion criteria were included in the analysis, with 1097 patients. Results The results showed that early feeding was not significantly associated with postoperative fistulas ( RR 0.49, 95% CI 0.23 to 1.05, p -value = 0.07), hematoma/seroma ( RR 0.71, 95% CI 0.33 to 1.51, p -value = 0.38), or flap failure ( RR 0.84, 95% CI = 0.38 to 1.87, p -value = 0.67). However, early oral feeding was significantly associated with shorter hospital stays than late oral feeding ( MD −3.18, 95% CI −4.90 to −1.46, p -value = 0.0003). Conclusion No significant difference exists between early and late oral feeding regarding the risk of postoperative complications in head and neck cancer (HNC) patients who underwent free flap reconstruction surgery. However, early oral feeding is significantly associated with a shorter hospital stay than late oral feeding. Thus, surgeons should consider implementing early oral feeding after free flap reconstruction in HNC patients.

Woven coronary artery anomaly is a rare description of an epicardial vessel segment that divides into multiple intertwining segments with eventual convergence of the distal vessel. We present our case, a 57-year-old male with an incidental woven coronary artery anomaly found during work-up investigations for a possible lung transplant, and we conduct a literature review on woven anomaly cases reported from 1988 to 2021 and provide a thorough analysis of its diversified clinical presentation. Imaging identification and various treatment modalities are also discussed.

Some clinical trials reported conflicting results about the efficacy of anterior lateral electrode compared with anterior posterior electrode in electrical cardioversion of atrial fibrillation, and some studies reported no difference in the efficacy between the two procedures. Our aim is to perform a meta-analysis to compare the efficacy of anterior lateral electrode versus anterior posterior electrode in external cardioversion of atrial fibrillation. We searched the following databases: PUBMED, WOS, OVID and SCOPUS. Inclusion criteria were clinical trials that compared anterior lateral electrode with anterior posterior electrode in external cardioversion of atrial fibrillation. We excluded cohort studies, case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis. Cardioversion rate outcome was presented as Odds ratios (OR) with 95% confidence interval (CI). After full text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode (OR = 1.40, 95% CI = 1.02 to 1.92, p-value = 0.04). We observed no heterogeneity among studies (P= 0.14, I² = 32%). No publication bias was observed. Subgroup analysis revealed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode in subgroups of less than 5 shocks, patients with 60years-old or more and patients with left atrial diameter > 45 mm (OR= 1.72, 95% CI = 1.17 to 2.54, p value = 0.006), (OR= 1.73, 95% CI = 1.18 to 2.54, p value= 0.005), and (OR= 1.86, 95% CI = 1.04 to 3.34, p value = 0.04), respectively. Our meta-analysis revealed that anterior lateral electrode is more effective than anterior posterior electrode in external cardioversion of atrial fibrillation. Subgroup analysis showed that patients who received less than 5 shocks, patients with 60 years-old or more and patients with left atrial diameter > 45 mm benefit from anterior lateral electrode more than anterior posterior electrode in external cardioversion of atrial fibrillation.