Background: There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines. Methods: PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as “anthracycline” and “arrhythmia.” Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis. Results: Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41–1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18–2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06–3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11–2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29–5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78–2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53–1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08–2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00–1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin. Conclusion: Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.

Background and Aims: Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients.Methods: We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded.Results: The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta‐analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68–0.97, p = 0.02).Conclusion: This meta‐analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.

In addition to the known pathophysiological sequelae of the SARS-COV-2 virus and its related respiratory symptoms, several studies have recently reported cardiovascular, gastrointestinal, and neurological symptoms of new-onset after a history of infection. Vertigo is a symptom indicating dysfunction of the vestibular system and this report of a 60-year-old female patient points out the possible association between new-onset vertigo and SARS-COV-2 infection. A 60-year-old diabetic and hypertensive female patient with a 9-days history of COVID-19 symptoms presented to the emergency department with acute vertigo attack without nausea or vomiting. A full physical examination showed no other auditory or neurological symptoms and she never experienced vertigo before. Laboratory findings confirmed a current COVID-19 infection. The patient was managed with antihypertensive, anti-vertigo medications, and COVID-19 protocol for mild cases. After discharge, the patient was advised to continue the anti-vertigo drugs and COVID-19 medications. SARS-COV-2 may lead to vestibular neuritis causing vertigo and other related symptoms, but more well-designed observational studies with a large sample size are needed to establish a definite association between COVID-19 and vertigo.

Background and Aim: Cardiopulmonary resuscitation (CPR) in full‐coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads‐up CPR versus supine CPR.Methods: We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full‐text screening of 40 eligible studies, only seven studies were eligible for our meta‐analysis. We used the RevMan software (5.4) to perform the meta‐analysis.Results: In survival outcome, the pooled analysis between heads‐up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17–5.68, p = 0.98). The pooled analyses between heads‐up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03–0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92–18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71–14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads‐up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well.Conclusion: Our study suggests that heads‐up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads‐up technique on human beings and to determine the best angle for optimization of the technique results.

Background/Aim: Recent literature suggested that the use of Minimal Invasive Extracorporeal Circulation (MIECC) may mitigate the inflammatory response in patients undergoing cardiac surgery. We aimed to perform a meta-analysis to compare post-operative inflammatory biomarkers between MIECC and conventional cardiopulmonary bypass in cardiac surgery. Methods: We searched PubMed, Web of Science, Scopus, and Cochrane Library for randomized control trials (RCTs) that quantified systemic inflammatory mediators after the use of MIECC compared to conventional extracorporeal circulation (CECC). Results: Fifteen RCTs with a total of 1189 patients were identified. The inflammatory markers that were investigated included Tumor Necrosis Factor α (TNF-α), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10), Elastase, C-Reactive protein (CRP) in addition to leucocyte count. No significant difference between both groups was detected for TNF-α and IL-6 at (30 minutes, 1 to 2 hours, 6 hours, 24 hours, and 48 hours), IL-8 at (30 minutes and 48 hours), Interleukin 10 at 6 hours, Elastase at (30 minutes to 1 hour, and 24 hours), CRP at 48 hours, and leucocytic count at (2 hours, 6 hours, 24 hours, and 48 hours). Pooled analysis showed a significant association between MIECC group and lower levels of TNF-α at 6 hours ( p -value <.0001), IL-8 at 6 hours ( p -value = .0005) and 24 hours ( p -value = .005), IL-10 at 24 hours ( p -value <.00,001), and Elastase at 6 hours ( p -value = .04). However, CRP was lower, at 24 hours, in the CECC group (MD = 1.42, 95% CI = 0.13 to 2.71, p -value = .03). Conclusion: Our findings suggest that MIECC may be associated with lower levels of systemic inflammatory mediators early after cardiac surgery. However, the impact of this reduction on clinical outcomes needs to be defined to justify the use of MIECC in the routine clinical practice.

The aim of this study is to perform a meta-analysis to evaluate the possible association between QT markers and familial Mediterranean fever (FMF). PUBMED, Web of Science, OVID, and SCOPUS databases were searched. Inclusion criteria were randomized control trials or observational studies that compared measurement of the QT markers in FMF patients and healthy controls in both males and females without any age restriction or other comorbidities. RevMan software (5.4) was used to perform the analysis. A total of 14 studies with 1,154 individuals were included in the study. The pooled effect estimate showed a statistically significant association between FMF group and prolonged corrected QT (QTc) and QT dispersion (QTd) (MD= 7.06, 95% CI = 2.68 to 11.43, p-value = 0.002) and (MD= 6.08, 95% CI = 0.84 to 11.32, p-value= 0.02), respectively. No statistically significant difference between FMF group and QT interval and corrected QT dispersion (QTcd) (MD= 2.34, 95% CI = -1.21 to 5.89, p-value = 0.20) and (MD= 4.82, 95% CI = -0.57 to 10.20, p-value = 0.08), respectively. Our findings revealed a statistically significant relationship between FMF and extended QTc and QTd. More randomized multicenter trials are required to confirm our findings.