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Dissertation
Year: 2003 Publisher: [S.l.]: [chez l'auteur],
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Dissertation
Year: 2021 Publisher: Leuven KU Leuven. Faculteit Geneeskunde
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Background: The MitraClip® (MC) is a new device for the treatment of Mitral Regurgitation (MR). It is unclear whether its use in patients suffering from functional MR (FMR) is effective at reducing mortality. Two recent published randomized controlled trials (RCTs) comparing MC to conservative treatment in patients with FMR presented conflicting results. In our systematic review we determined if MC in combination with optimal medical therapy (OMT) is superior to OMT only for heart failure patients with FMR. Method: Four databases (Cochrane central library, Medline, Embase and Web of Science) were used to find studies without restrictions on publishing date nor language. Articles comparing MC in combination with OMT to OMT alone for moderate to severe FMR (MR grade 3+ or 4+) were included. A meta-analysis was performed to assess the outcomes. The primary outcome was all-cause and cardiovascular mortality. A qualitative analysis was carried out to assess the risk of bias, study characteristics, and population characteristics of the included articles. Results: Nine articles, two RCTs and seven observational studies, were included. Our study population consisted of 3183 patients (1804 patients in the MC and 1379 in the conservatively treated group). Our results showed a significant reduction in all-cause mortality for patients treated with MC after one year [odds ratio (OR): 0.61, 95% confidence interval (CI) 0.44–0.86, p=0.001] and two years [OR: 0.57, 95% CI 0.38–0.87, p=0.001], but no significant mortality differences were observed after 1-month of follow up [OR: 0.99, 95% CI 0.54–1.82, p= 0.36]. Cardiovascular mortality and hospitalizations occurred less in the MC group but the results were not significant [Cardiovascular mortality OR: 0.46, 95% CI 0.20–1.05, p<0.00001; Hospitalizations HR 0.66, 95% CI 0.42–1.04, p = 0.007]. Between study heterogeneity, especially in the observational study subgroup, was often significant in our meta-analysis. There was considerable risk of selection and allocation bias for the observational studies. Conclusion: The MC procedure was effective at reducing FMR and serious complications seldomly occurred. A significant reduction in long term all-cause mortality was observed in patients treated with MC. There was a trend towards less cardiovascular mortality and hospitalizations in the MC group, but the difference was not significant. The risk of bias has to be considered when interpreting these results.
Dissertation
Year: 2024 Publisher: Leuven KU Leuven. Faculteit Geneeskunde
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Abstract Background: Several studies have indicated that vitamin D deficiency could play a role in the development of atopic dermatitis (AD), and that vitamin D supplementation may have a beneficial effect in its treatment. However, the relationship between vitamin D and atopic dermatitis (AD) remains controversial. The main objective of this study is to conduct a systematic review and meta-analysis to determine whether vitamin D supplementation has any impact on the severity of AD or not. Method: Up to August 31, 2023, five databases - the Cochrane Library, PubMed, Embase, CINAHL, and Web of Science - were used to search for Randomized Controlled Trials (RCTs) comparing vitamin D supplementation with a placebo. Regardless of publication date or language, and following the application of inclusion and exclusion criteria, full-text articles were assessed for eligibility. Results: Twelve randomized controlled trials (RCTs) involving 674 patients were included in our study. The severity of atopic dermatitis (AD), assessed with the SCORAD index and EASI score, was found to be significantly reduced after vitamin D supplementation compared to placebo (standardized mean difference [SMD] = -0.66, 95% CI: -1.03 to -0.30, I² = 77%, p = 0.0003). Subgroup analysis also revealed a global tendency of significant reduction in AD severity after vitamin D supplementation compared with placebo, except in three subgroups: 1) no additional treatment subgroup, 2) North America and Europe subgroup, and 3) the subgroup receiving 3 months of treatment where the reduction in AD severity was not significant (SMD = -0.19, 95% CI: -0.63 to 0.25, I² = 56%, p = 0.4; SMD = -0.20, 95% CI: -0.57 to 0.17, I² = 35%, p = 0.28; and SMD = -0.26, 95% CI: -0.60 to 0.07, I² = 35%, p = 0.12 respectively). Conclusion: In this systematic review, we present evidence that suggests vitamin D could play a significant role in the treatment of AD patients. Our meta-analysis summarizes results indicating a reduction in AD severity, as assessed using the SCORAD index or EASI score, after receiving vitamin D compared to receiving a placebo. We believe that further research is needed to investigate the molecular mechanisms that may explain the effects of vitamin D, and large-scale randomized controlled trials (RCTs) are also necessary to determine the effectiveness of vitamin D supplementation for AD.
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