Objective: To review the efficacy and safety of reduced dose compared to standard dose Enzalutamide treatment for patients with castration-resistant prostate cancer (CRPC). Methods: PubMed, Scopus, Web of Science, and Cochrane databases were searched for randomized controlled trials and cohort studies reporting the use of Enzalutamide in reduced and standard doses in patients with castration-resistant prostate cancer. Searches were limited to articles published in the English language. Outcome assessments included progression-free survival (PFS), overall survival (OS), adverse events, and serum prostate-specific antigen (PSA) response. Results: Ten studies met the inclusion criteria, including 2481 patients treated with Enzalutamide. Seven studies were retrospective cohorts, two were prospective trials, and one was a prospective cohort. No consistent relationship was identified between OS and PFS and the Enzalutamide dosage. Reduced doses of Enzalutamide decreased the incidence of adverse events, particularly among elderly patients. Conclusions: This systematic review suggests that reduced doses of Enzalutamide in CRPC may maintain therapeutic efficacy in selected patients while improving tolerability. However, inconsistent findings and methodological limitations highlight the need for prospective randomized trials to define optimal and individualized dosing strategies.

Evaluate the effect of mavacamten on echocardiographic parameters and cardiac biomarkers in patients with hypertrophic cardiomyopathy (HCM). We searched PubMed, SCOPUS, Web of Science, and Cochrane Library until November 2023. Results were reported as mean difference (MD) and Risk Ratio (RR) with 95% confidence intervals (CI). Seven studies with 524 patients (456 with obstructive HCM and 59 with non-obstructive HCM) were included. Mavacamten significantly improved septal early diastolic mitral annular velocity (e') (MD 0.78, 95% CI [0.51 to 1.05]) and left ventricular mass index (LVMI). It reduced left ventricular outflow tract (LVOT) gradient, NT-proBNP (MD -557.14, 95% CI [-685.59 to -428.68]), and troponin levels. Improvements were also seen in left atrial volume index (MD -6.26, 95% CI [-8.88 to -3.63]) and E/e' ratios, particularly in obstructive HCM patients. Mavacamten enhances echocardiographic and cardiac biomarker outcomes in HCM patients on short-term follow-up. Limited data on non-obstructive HCM require cautious interpretation.

Background: Transfemoral access is considered the standard route for transcatheter aortic valve replacement (TAVR). However, in some cases, this access route is contraindicated. Alternative access routes, such as transaxillary, are emerging as first-line approaches to address these limitations, while the transcaval approach remains uncertain. Our Meta-analysis aims to evaluate the safety of the transcaval approach compared to other access routes for TAVR. Methods: We searched five databases, PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase, from inception until April 2024 for any study that reports transcaval access alone or compares it to any alternative access in TAVR patients. We used Risk ratio (RR) for dichotomous outcomes and Mean Difference (MD) for continuous outcomes with a 95% confidence interval. Results: Eleven studies with 1003 patients were included, transcaval showed non-statistically significant difference over alternatives in terms of intra-hospital, 30 days, and long-term all-cause mortality with a RR of 0.08 (95% CI −0.83 to 0.99, P = 0.86), 0.11 (95% CI −0.48 to 0.7, P = 0.71), and 1.08 (95% CI −0.50 to 2.66, P = 0.18), respectively. Furthermore, in our single-arm analysis, transcaval access has a low pooled 30-day all-cause mortality rate of 7% (95% CI 5–10) and long-term mortality of 21% (95% CI 2–77). The mean difference in length of stay in the hospital after the operation was 4.88 (95% CI 4.45–5.31), and the major bleeding rate was 14% (95% CI 8–23). Conclusion: Transcaval access for TAVR is a safe and feasible method that can be considered a new alternative when trans-femoral access is contraindicated.