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Surveys are an effective method for collecting a large quantity of data. However, incomplete responses to these surveys can affect the validity of the studies and introduce bias. Recent studies have suggested that monetary incentives may increase survey response rates. We intended to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of monetary incentives on survey participation. A systematic search of electronic databases was conducted to collect studies assessing the impact of monetary incentives on survey participation. The primary outcome of interest was the response rates to incentives: money, lottery, and voucher. We used the Cochrane Collaboration tool to assess the risk of bias in randomized trials. We calculated the rate ratio (RR) with its 95% confidence interval (95% CI) using Review Manager Software (version 5.3). We used random-effects analysis and considered the data statistically significant with a P-value <0.05. Forty-six RCTs were included. A total of 109,648 participants from 14 countries were involved. The mean age of participants ranged from 15 to more than 60 years, with 27.5% being males, 16.7% being females, and the other 55.8% not reported. Our analysis showed a significant increase in response rate in the incentive group compared to the control group, irrespective of the incentive methods. Money was the most efficient way to increase the response rate (RR: 1.25; 95% CI: 1.16,1.35; P = < 0.00001) compared to voucher (RR: 1.19; 95% CI: 1.08,1.31; P = < 0.0005) and lottery (RR: 1.12; 95% CI: 1.03,1.22; P = < 0.009). Monetary incentives encourage the response rate in surveys. Money was more effective than vouchers or lotteries. Therefore, researchers may include money as an incentive to improve the response rate while conducting surveys.

Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) and redo surgical mitral valve replacement (redo-SMVR) are 2 treatment strategies for patients with bioprosthetic mitral valve dysfunction. We conducted a systematic review and meta-analysis to compare the outcomes of ViV-TMVR versus redo-SMVR. We searched PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing outcomes of ViV-TMVR versus redo-SMVR in degenerated bioprosthetic mitral valves. We used a random-effects model to calculate odd ratios (ORs) with 95% confidence intervals (CIs). Outcomes included in-hospital, 30-day, 1-year, and 2-year mortality, stroke, bleeding, acute kidney injury, arrhythmias, permanent pacemaker insertion, and hospital length of stay (LOS). A total of 6 observational studies with 707 subjects were included. The median follow-up was 2.7 years. Despite their older age and greater co-morbidity burden, patients who underwent ViV-TMVR had a similar in-hospital mortality (OR 0.52, 95% CI 0.22 to 1.23, p = 0.14), 30-day mortality (OR 0.65, 95% CI 0.36 to 1.17, p = 0.15), 1-year mortality (OR 0.97, 95% CI 0.63 to 1.49, p = 0.89), and 2-year mortality (OR 1.17, 95% CI 0.65 to 2.13, p = 0.60) compared with redo-SMVR. ViV-TMVR was associated with significantly lower periprocedural complications, including stroke, bleeding, acute kidney injury, arrhythmias, and permanent pacemaker insertion, and shorter hospital LOS than redo-SMVR. In conclusion, ViV-TMVR was associated with better outcomes than redo-SMVR in patients with degenerated bioprosthetic mitral valves, including lower complication rates and shorter hospital LOS, with no significant difference in mortality rates. Large-scale randomized trials are needed to mitigate biases and confirm our findings. [Display omitted]

Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE). Secondary outcomes included all-cause and cardiovascular mortality, ischemic stroke, TIA, and device-related thrombus. Outcomes were pooled using random-effects models. We used I2 statistics to assess statistical heterogeneity; I2 >50% considered significant heterogeneity. This study included 54,279 patients from 11 studies (6 observational, 2 nonrandomized controlled trials [non-RCTs] primary results, 2 RCT post hoc analyses, and 1 analysis combining 2 RCTs data). PDL was associated with a significant increase in the composite outcome of stroke, TIA, or SE (odds ratio 1.63, 95% confidence interval 1.06 to 2.52, p = 0.03, I2 = 43%) as compared with cases with no PDL. There were no significant differences in all-cause or cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus. In conclusion, PDL after LAAC is associated with an increased risk of thromboembolism (composite stroke, TIA, or SE) without impacting mortality.

Background Several different interventions have been examined to alleviate pain and reduce frequency of trigeminal neuralgia (TN) paroxysms. However, some patients continue to have persistent or recurrent painful attacks. Using a systematic review and meta-analysis approach, we aimed to synthesize evidence from published randomized controlled trials (RCTs) regarding safety and efficacy of botulinum toxin type A (BTX-A) as a possible emerging choice of treatment for TN. Methods We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles in all languages reporting RCTs on the efficacy and safety of BTX-A in the treatment of TN were included for systematic review and meta-analysis. Results A total of four RCTs (n = 178) were identified for final meta-analysis. The overall effect favored BTX-A versus placebo in terms of proportion of responders (risk ratio RR = 2.87, 95 % confidence interval CI [1.76, 4.69], p <0.0001) with no significant detected heterogeneity (p = 0.31; I 2  = 4 %). Paroxysms frequency per day was significantly lower for BTX-A group (mean difference MD = -29.79, 95 % CI [-38.50,–21.08], p <0.00001) with no significant heterogeneity (p = 0.21; I 2  = 36 %). Conclusion Despite limited data, our results suggest that BTX-A may be an effective and safe treatment option for patients with TN. Further larger and well-designed RCTs are encouraged to translate these findings into better clinical outcome and better quality of life for TN patients.

Key Clinical Message Nirmatrelvir‐ritonavir (Paxlovid) is a brand‐new oral antiviral medication for treating mild to severe COVID‐19. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for ritonavir‐nirmatrelvir on December 22, 2021, to treat COVID‐19. We describe a case of mild COVID‐19 infection who developed severe hyponatremia following the administration of Paxlovid. Clinical and laboratory evaluations suggest SIADH, likely secondary to Paxlovid. The potential side effects of this medication still require further study. Summary of the case findings.

Background Left atrial (LA) appendage closure (LAAC) is effective in patients with atrial fibrillation who are not candidates for long‐term anticoagulation. However, the impact of LAAC on LA function is unknown. The aim of this study is to evaluate the impact of LAAC on atrial function. Methods This meta‐analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the effect of LAAC on the LA function from inception to November 20, 2021. The standardized mean difference (SMD) was calculated from the means and standard deviations. Results Of 247 studies initially identified, 8 studies comprising 260 patients were included in the final analysis. There was a significant increase in LA emptying fraction following LAAC compared with preoperative function (SMD: 0.53; 95% confidence interval [CI]: 0.04–1.01; p = .03; I2 = 75%). In contrast, there were no significant differences in LA volume (SMD: −0.07; 95% CI: −0.82–0.69; p = .86; I2 = 92%) peak atrial longitudinal strain (SMD: 0.50; 95% CI: −0.08–1.08; p = .09; I2 = 89%), peak atrial contraction strain (SMD: 0.38; 95% CI: −0.22–0.99; p = .21; I2 = 81%), strain during atrial contraction (SMD: −0.24; 95% CI: −0.61–0.13; p = .20; I2 = 0%), strain during ventricular systole (SMD: 0.47; 95% CI: −0.32–1.27; p = .24; I2 = 89%), strain during ventricular diastole (SMD: 0.09; 95% CI: −0.32–0.51; p = .66; I2 = 65%). Conclusion LAAC is associated with improvement in the left atrial emptying fraction, but did not significantly influence other parameters.

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.

A Dieulafoy lesion is an important consideration every gastroenterologist and internal medicine physician has to make in cases of recurrent, unidentifiable, and hemodynamically compromising gastrointestinal (GI) bleeding. A Dieulafoy lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can result in severe, intermittent arterial bleeding from tiny, difficult-to-visualize vessel stumps. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. As the patients presenting with Dieulafoy lesions often have concomitant cardiac and renal disease, familiarity with this condition is relevant as these patients are at risk of transfusion-related injuries. This case is unique as the Dieulafoy lesion was not visualizable in a standard location despite multiple esophagogastroduodenoscopy (EGD) and CT angiography, illustrating the difficulty of accurately managing and diagnosing this condition.