Comparison of Effectiveness and Safety of Direct-Acting Oral Anticoagulants and Vitamin K Agonists in Patients With Atrial Fibrillation and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis.

The objective of the study is mentioned, but it could be further clarified by explicitly stating the aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) specifically in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD). We conducted a thorough electronic search of the literature, encompassing databases such as PubMed, EMBASE, Cochrane Library, and Web of Science from their inception up to March 5, 2024. Furthermore, we meticulously examined the bibliographies of included studies to identify additional relevant literature. The reporting of this meta-analysis adhered to the guidelines outlined in the Preferred Reporting of Systematic Review and Meta-analysis guidelines. The endpoints evaluated in this meta-analysis included all-cause mortality, stroke or systemic embolism, and major bleeding. Data analysis was carried out utilizing RevMan Version 5.4 (Cochrane, London, United Kingdom). Dichotomous outcomes, including all-cause mortality, stroke or systemic embolism, and major bleeding, were presented as risk ratios (RRs) with corresponding 95% confidence intervals (CI). A total of 11 studies were incorporated in this meta-analysis, comprising a pooled sample size of 44,863 participants with AF. The pooled analysis revealed no significant disparity between DOACs and VKAs concerning stroke or systemic embolism (RR: 0.93, 95% CI: 0.77 to 1.14) and all-cause mortality (RR: 0.86, 95% CI: 0.74 to 1.00). However, there was a noteworthy reduction in the risk of major bleeding events associated with DOACs compared to VKAs (RR: 0.84, 95% CI: 0.73 to 0.96). Consequently, DOACs may be considered a viable alternative to warfarin in patients with ESRD. However, we need further larger clinical trials to validate these findings.

Atrial Myxoma: An Unusual Etiology of Ischemic Stroke in an Adult Patient.

Atrial myxoma is the most frequent primary cardiac tumor; however, it is a rare, substantial cause of cardiogenic emboli causing a stroke, especially in young adults. A cardiac myxoma has no specific clinical presentation, ranging from constitutional symptoms to non-cardiac symptoms and emboli, which leads to a diagnostic challenge in the clinical process. We report a case of a left atrial myxoma in an adult female who presented with sudden onset of right-sided weakness, headache, and numbness. Imaging confirmed cardiogenic emboli from the cardiac myxoma, which was reflected in an ischemic stroke.

Weighted Blanket Therapy for Periodic Limb Movement Disorder: A Case Report Highlighting Improved Sleep Quality and Reduced Symptoms.

This case report describes a 20-year-old female patient with periodic limb movement disorder (PLMD), who experienced trouble sleeping and daytime fatigue. Polysomnography revealed frequent non-arousing periodic limb movements and a high PLMD index. The patient was advised on non-pharmacological interventions, including the use of weighted blankets, sleep hygiene education, and lifestyle modifications. At the six-week follow-up, the patient reported significant improvement in symptoms. The case report highlights the potential effectiveness of non-pharmacological interventions in managing PLMD and emphasizes the need for a multidisciplinary approach to improve patient outcomes and quality of life. Further research is required to determine the long-term efficacy and safety of these interventions. The psychological impact of PLMD on the patient's social life and academic performance is also discussed. The management of sleep disorders should involve a multidisciplinary approach to improve patient outcomes and quality of life.

Late-Onset Hypokalemic Periodic Paralysis in an Adult Female With Type 2 Renal Tubular Acidosis: A Case Report.

Proximal renal tubular acidosis (type 2 RTA) is a metabolic disorder characterized by an inability of the proximal renal tubules to reabsorb bicarbonate, resulting in excessive urinary loss of bicarbonate. In return, this causes a standard anion gap metabolic acidosis with aberrant renal acidification, culminating in excessive urinary potassium loss and hyperchloremic metabolic acidosis. Several sources can induce potassium deficiency, ranging from slight abnormalities in potassium homeostasis to catastrophic and occasionally lethal circumstances. Hypokalemic periodic paralysis (HPP) manifests with broad muscle weakness and the absence of deep tendon reflexes, with the facial, bulbar, and respiratory muscles spared, and it subsequently requires the administration of intravenous potassium chloride to address the potassium imbalance. Some patients suffering from chronic potassium shortage may have periods of weakness. The clinical symptoms of distal RTA are identical to those of attacks induced by familial hypokalemic periodic paralysis (FPP). Muscle weakness may begin slowly and worsen over 24-48 hours to flaccid quadriplegia. RTA and FPP typically spare speech, swallowing, and ocular and respiratory muscles. As a result, families with RTA children must be aware of this risk. We present a case of HPP in a female caused by type 2 RTA.

Acute Pancreatitis: A Rare Complication of Colonoscopy.

Colonoscopy is a well-tolerated therapeutic and diagnostic procedure. Although colonoscopy is relatively safe, a few complications have been reported. Abdominal pain after colonoscopy is one of the most reported symptoms, and acute pancreatitis is uncommon after colonoscopy. We present a case of acute pancreatitis in a 51-year-old female who presented with a complaint of melena. She underwent colonoscopy to rule out lower gastrointestinal pathology and developed sudden onset diffuse abdominal pain and vomiting two hours after the procedure. She was diagnosed with colonoscopy-induced acute pancreatitis based on physical examination and detailed investigations after ruling out all other potential causes. She was treated conservatively with bowel rest, intravenous fluids, analgesic, and prophylactic antibiotics. Abdominal symptoms improved quickly in a few days with complete resolution of abdominal pain, fever, and normalization of serum amylase and lipase. Early recognition and diagnosis can lead to successful treatment, and the patients should be informed about the possibility of this complication before undergoing colonoscopy.