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Background: Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are superior to coronary angiography for guiding percutaneous coronary intervention (PCI). However, whether one technique is superior to the other is inconclusive. Methods: We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to November 2023 for randomized controlled trials (RCTs) comparing OCT and IVUS in patients undergoing PCI. RevMan 5.4 was used to pool outcomes with risk ratio (RR) as the effect measure. Results: Six RCTs (4,402 patients) were included in this meta-analysis. There was no significant difference between the OCT- and IVUS-guided PCI groups in the risk of major adverse cardiovascular events (RR 0.87, 95% CI: 0.65, 1.16; I2 = 0%) and cardiac mortality (RR 0.73, 95% CI: 0.24, 2.21; I2 = 0%). The results were consistent across the subgroups of the presence or absence of left main disease (P interaction >0.1). There were no significant differences between OCT and IVUS in the risk of target lesion revascularization (RR 0.78, 95% CI: 0.47, 1.30; I2 = 0%), target vessel revascularization (RR 1.06, 95% CI: 0.69, 1.62; I2 = 0%), target-vessel myocardial infarction (RR 0.79, 95% CI: 0.40, 1.53; I2 = 0%), stent thrombosis (RR 0.59, 95% CI: 0.12, 2.97; I2 = 0%), and all-cause mortality (RR 1.01, 95% CI: 0.53, 1.90; I2 = 0%). Conclusions: Our meta-analysis demonstrated similar clinical outcomes in OCT- and IVUS-guided PCI. New large-scale multicenter RCTs with long-term follow-up are required to confirm or refute our findings and provide more reliable results. Systematic Review Registration: PROSPERO, identifier, CRD42023486933.
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Key Clinical Message: Endoscopic ultrasonography (EUS) is crucial in diagnosing gastrointestinal sarcoidosis, especially when patients exhibit refractory abdominal symptoms. Our case highlights the significance of considering sarcoidosis in such cases and emphasizes the utility of EUS for accurate diagnosis and guiding appropriate treatment. Abstract: Gastrointestinal sarcoidosis is a rare and challenging manifestation of sarcoidosis that often presents with nonspecific abdominal symptoms, making diagnosis a complex process. We report the case of a 46-year-old African American female who experienced chronic epigastric abdominal pain, recurrent nausea, vomiting, and diarrhea for 15 years. Despite extensive investigations, including multiple biopsies, she was misdiagnosed with cyclic vomiting syndrome. Subsequently, an endoscopic ultrasound (EUS) revealed prominent lymph nodes and gastric granulomas, leading to a diagnosis of GS. This case underscores the importance of considering sarcoidosis in patients with refractory abdominal symptoms and highlights the utility of EUS in diagnosing this rare condition.
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BACKGROUND: Assessment of health-related quality of life (HRQOL) in patients with cirrhosis has been increasingly reported in literature. Aims: To compare quality of life scores between cirrhotic patients and healthy controls and to assess factors associated with the impairment of quality of life in cirrhotic patients. METHODS: HRQOL was measured in cirrhotic patients by the Tunisian version of MOS 36-item short-form health survey (SF-36) and the Arabic version of the Liver Disease Symptom index 2.0 (LDSI2.0). Age-and sex- matched controls were asked to complete only the SF36. The SF36 scores were compared between cirrhotic patients and controls and LDSI2.0 scores were compared across cirrhotic patients according to the characteristics of cirrhosis. Factors associated with poor perceived health status were identified by logistic regression. RESULTS: Fifty cirrhotic patients and fifty controls were enrolled in the study. The cirrhotic group had significantly lower SF36 scores than healthy controls in all 8 dimensions (p<0.001). Most impaired LDSI items were severity of fear of complications (item 8), change in use of time (item 13), decreased sexual interest (item 14) and decreased sexual activity (item 15). Multiple logistic regression analysis showed that female sex (p=0.009), diabetes (p=0.046), treatment with diuretics (p=0.022), increased levels of serum bilirubin (p=0.045) and prolonged prothrombin time (p=0.041) were associated with poorer HRQOL. CONCLUSIONS: HRQOL was significantly more impaired in cirrhotic patients than controls. Female sex, diabetes, treatment with diuretics, increased levels of serum bilirubin and prolonged prothrombin time were important factors in reducing HRQOL.
