TY - JOUR AU - Bálint, Alexandra AU - Hanák, Lilla AU - Hegyi, Péter AU - Szakács, Zsolt AU - Eitmann, Szimonetta AU - Garami, András AU - Varjú-Solymár, Margit AU - Márta, Katalin AU - Rumbus, Zoltán AU - Komócsi, András TI - Increased risk of adverse events in patients with low-on clopidogrel platelet reactivity after percutaneous coronary intervention : A systematic review and meta-analysis JF - CARDIOLOGY JOURNAL J2 - CARDIOL J VL - 30 PY - 2023 IS - 3 SP - 391 EP - 400 PG - 10 SN - 1897-5593 DO - 10.5603/CJ.a2021.0084 UR - https://m2.mtmt.hu/api/publication/32127261 ID - 32127261 N1 - Heart Institute, Medical School, University of Pécs, Hungary Institute for Translational Medicine, Medical School, University of Pécs, Hungary Szentágothai Research Center, University of Pécs, Hungary Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Hungary Export Date: 12 October 2023 Correspondence Address: Bálint, A.; Heart Institute, Ifjúság útja 13, Hungary; email: balint.alexandra@pte.hu Chemicals/CAS: acetylsalicylic acid, 493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1; clopidogrel, 113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8, 120202-65-5, 120202-67-7, 894353-16-3, 744256-69-7; ticagrelor, 274693-27-5; Clopidogrel; Platelet Aggregation Inhibitors Manufacturers: R Foundation AB - Clinical evidence has been controversial regarding the influence of low platelet reactivity (LPR), ischemic and bleeding outcomes among patients receiving coronary stent implantation. Hence, the present study performed a meta-analysis to systematically evaluate the significance of LPR on adverse cardiovascular events.MEDLINE, EMBASE and CENTRAL databases were searched up to November 2020 for relevant studies including patients with acute coronary syndrome undergoing percutaneous coronary intervention. LPR was the exposed arm while the non-LPR group represented the control. The primary outcome of interest was bleeding risk including major and minor bleeding events. Secondary outcomes included all-cause mortality, repeated revascularization, nonfatal myocardial infarction, and stent thrombosis. Study-level outcomes were evaluated in random-effect models.A total of 20 studies with 19,064 patients were included. Pooled analysis showed that LPR was associated with an increased bleeding risk (relative risk [RR] 2.80, 95% confidence interval [CI] 1.95-4.02, p < 0.01). Patients with LPR had a lower risk of non-fatal myocardial infarction (RR 0.59, 95% CI 0.38-0.91, p < 0.05) and of serious vascular events (RR 0.50, 95% CI 0.30-0.84, p < 0.01).LPR is associated with an increased bleeding risk of patients who underwent coronary stent implantation. The results suggest possible benefits of this marker in risk stratification, with potential improvement in risk prediction. There are potential advantages using combinations with other factors in prediction models, however, they require further study. PROSPERO registration number: CRD42019136393). LA - English DB - MTMT ER - TY - JOUR AU - Borbás, János AU - Vámos, Máté AU - Hategan, Lídia AU - Hanák, Lilla AU - Borbásné Farkas, Kornélia AU - Szakács, Zsolt AU - Csupor, Dezső AU - Tél, Bálint AU - Kupó, Péter AU - Csányi, Beáta AU - Nagy, Viktória AU - Komócsi, András AU - Habon, Tamás AU - Hegyi, Péter AU - Sepp, Róbert TI - Geno- and phenotypic characteristics and clinical outcomes of CACNA1C gene mutation associated Timothy syndrome, “cardiac only” Timothy syndrome and isolated long QT syndrome 8: A systematic review JF - FRONTIERS IN CARDIOVASCULAR MEDICINE J2 - FRONT CARDIOVASC MED VL - 9 PY - 2022 PG - 17 SN - 2297-055X DO - 10.3389/fcvm.2022.1021009 UR - https://m2.mtmt.hu/api/publication/33288487 ID - 33288487 LA - English DB - MTMT ER - TY - JOUR AU - Jávor, Péter János AU - Hanák, Lilla AU - Hegyi, Péter AU - Csonka, Endre AU - Butt, Edina AU - Horváth, Tamara AU - Góg, István AU - Lukács, Anita AU - Soós, Alexandra AU - Rumbus, Zoltán AU - Pákai, Eszter AU - Toldi, János AU - Hartmann, Petra TI - Predictive value of tachycardia for mortality in trauma-related haemorrhagic shock: a systematic review and meta-regression JF - BMJ OPEN J2 - BMJ OPEN VL - 12 PY - 2022 IS - 10 PG - 8 SN - 2044-6055 DO - 10.1136/bmjopen-2021-059271 UR - https://m2.mtmt.hu/api/publication/33192543 ID - 33192543 AB - Objectives Heart rate (HR) is one of the physiological variables in the early assessment of trauma-related haemorrhagic shock, according to Advanced Trauma Life Support (ATLS). However, its efficiency as predictor of mortality is contradicted by several studies. Furthermore, the linear association between HR and the severity of shock and blood loss presented by ATLS is doubtful. This systematic review aims to update current knowledge on the role of HR in the initial haemodynamic assessment of patients who had a trauma. Design This study is a systematic review and meta-regression that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Data sources EMBASE, MEDLINE, CENTRAL and Web of Science databases were systematically searched through on 1 September 2020. Eligibility criteria Papers providing early HR and mortality data on bleeding patients who had a trauma were included. Patient cohorts were considered haemorrhagic if the inclusion criteria of the studies contained transfusion and/or positive focused assessment with sonography for trauma and/or postinjury haemodynamical instability and/or abdominal gunshot injury. Studies on burns, traumatic spinal or brain injuries were excluded. Papers published before January 2010 were not considered. Data extraction and synthesis Data extraction and risk of bias were assessed by two independent investigators. The association between HR and mortality of patients who had a trauma was assessed using meta-regression analysis. As subgroup analysis, meta-regression was performed on patients who received blood products. Results From a total of 2017 papers, 19 studies met our eligibility criteria. Our primary meta-regression did not find a significant relation (p=0.847) between HR and mortality in patients who had a trauma with haemorrhage. Our subgroup analysis included 10 studies, and it could not reveal a linear association between HR and mortality rate. Conclusions In accordance with the literature demonstrating the multiphasic response of HR to bleeding, our study presents the lack of linear association between postinjury HR and mortality. Modifying the pattern of HR derangements in the ATLS shock classification may result in a more precise teaching tool for young clinicians. LA - English DB - MTMT ER - TY - JOUR AU - Kovács, Dóra Krisztina AU - Gede, Noémi AU - Szabó, László AU - Hegyi, Péter AU - Szakács, Zsolt AU - Faludi, Béla AU - Sebők, Ágnes AU - Garami, András AU - Varjú-Solymár, Margit AU - Kósa, Dániel AU - Hanák, Lilla AU - Rumbus, Zoltán AU - Balaskó, Márta TI - Weight reduction added to CPAP decreases blood pressure and triglyceride level in OSA : systematic review and meta-analysis JF - CTS-CLINICAL AND TRANSLATIONAL SCIENCE J2 - CTS-CLIN TRANSL SCI VL - 15 PY - 2022 IS - 5 SP - 1238 EP - 1248 PG - 11 SN - 1752-8054 DO - 10.1111/cts.13241 UR - https://m2.mtmt.hu/api/publication/32654314 ID - 32654314 AB - Obstructive sleep apnea (OSA) is associated with treatment-resistant hypertension and high cardiovascular risk. Continuous positive airway pressure (CPAP) fails to reduce cardiovascular risks consistently. Obesity and OSA show reciprocal association and they synergistically increase hypertension via different pathways. Our meta-analysis aimed to assess the cardiovascular benefits of combining weight reduction (WL) with CPAP (versus WL or CPAP alone) in OSA. Outcomes included systolic and diastolic blood pressure (BP) and blood lipid parameters. We explored Medline, Embase, Cochrane and Scopus. Eight randomized controlled studies (2627 patients) were included. The combined therapy decreased systolic BP more than CPAP alone. Weighted mean difference (WMD) for CPAP+WL vs. CPAP was -8.89 mmHg, 95%confidence interval (95%CI)[-13.67; -4.10], p<0.001 for systolic BP. For diastolic BP this decrease was not significant. In case of blood lipids, the combined treatment decreased triglyceride levels more than CPAP alone (WMD= -0.31, 95%CI [-0.58; -0.04] p =0.027). On the other hand, addition of CPAP to WL failed to suppress BP further. The certainty of evidence according to GRADE was very low to moderate. In conclusion, our results showed that the addition of WL to CPAP significantly improved BP and blood lipid values in OSA. On the other hand, the addition of CPAP to WL could not significantly improve BP or blood lipid values. Review protocol: PROSPERO CRD42019138998. LA - English DB - MTMT ER - TY - JOUR AU - Kiss, Szabolcs AU - Gede, Noémi AU - Soós, Alexandra AU - Hegyi, Péter AU - Nagy, Bettina AU - Imrei, Marcell AU - Czibere, Bernadett AU - Borbásné Farkas, Kornélia AU - Hanák, Lilla AU - Szakács, Zsolt AU - Erőss, Bálint Mihály AU - Alizadeh, Hussain TI - Efficacy of first-line treatment options in transplant-ineligible multiple myeloma : A network meta-analysis JF - CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY J2 - CRIT REV ONCOL HEMAT VL - 168 PY - 2021 PG - 11 SN - 1040-8428 DO - 10.1016/j.critrevonc.2021.103504 UR - https://m2.mtmt.hu/api/publication/32468150 ID - 32468150 AB - Despite major therapeutic advances, the rational choice of the most appropriate first-line regimen in newly diagnosed transplant-ineligible multiple myeloma (TIE-MM) is currently undefined.We aimed to identify the most effective first-line treatment for TIE-MM patients.A total of 37 articles, including 34 treatments and 16,681 patients, were included in this Bayesian network meta-analysis. The outcomes of interest were risk ratios (RR) for progression-free survival (PFS) and overall survival (OS).Based on surface under cumulative ranking curve values, daratumumab-bortezomib-melphalan-prednisone (Dara-VMP) and daratumumab-lenalidomide-dexamethasone (Dara-Rd28) showed superiority compared to other combinations regarding 12-, 24-, 36-, and 48-month PFS. Dara-VMP also ranked first for 12-, 24-, 36-, and 48-month OS.Our finding supports the incorporation of daratumumab into first-line regimens. Additionally, these results highlight the relative benefit of incorporating novel agents like monoclonal antibodies, immunomodulatory derivatives, and proteasome inhibitors in combination with the currently existing treatment options. LA - English DB - MTMT ER - TY - JOUR AU - Csiki, Endre AU - Szabó, Hanna AU - Hanák, Lilla AU - Szakács, Zsolt AU - Kiss, Szabolcs AU - Vörhendi, Nóra AU - Pécsi, Dániel AU - Hegyi, Eszter AU - Hegyi, Péter AU - Erőss, Bálint Mihály TI - Oral Proton Pump Inhibitors May Be as Effective as Intravenous in Peptic Ulcer Bleeding : A Systematic Review and Meta-analysis JF - CLINICAL AND TRANSLATIONAL GASTROENTEROLOGY J2 - CLIN TRANSLAT GASTROENT VL - 12 PY - 2021 IS - 4 PG - 10 SN - 2155-384X DO - 10.14309/ctg.0000000000000341 UR - https://m2.mtmt.hu/api/publication/32021654 ID - 32021654 AB - Current guidelines recommend intravenous (IV) proton pump inhibitor (PPI) therapy in peptic ulcer bleeding (PUB). We aimed to compare the efficacy of oral and IV administration of PPIs in PUB.We performed a systematic search in 4 databases for randomized controlled trials, which compared the outcomes of oral PPI therapy with IV PPI therapy for PUB. The primary outcomes were 30-day recurrent bleeding and 30-day mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, while weighted mean differences (WMDs) with CI were calculated for continuous outcomes in meta-analysis. The protocol was registered a priori onto PROSPERO (CRD42020155852).A total of 14 randomized controlled trials reported 1,951 peptic ulcer patients, 977 and 974 of which were in the control and intervention groups, respectively. There were no statistically significant differences between oral and IV administration regarding 30-day rebleeding rate (OR = 0.96, CI: 0.65-1.44); 30-day mortality (OR = 0.70, CI: 0.35-1.40); length of hospital stay (WMD = -0.25, CI: -0.93 to -0.42); transfusion requirements (WMD = -0.09, CI: -0.07 to 0.24); need for surgery (OR = 0.91, CI: 0.40-2.07); further endoscopic therapy (OR = 1.04, CI: 0.56-1.93); and need for re-endoscopy (OR = 0.81, CI: 0.52-1.28). Heterogeneity was negligible in all analysis, except for the analysis on the length of hospitalization (I2 = 82.3%, P = 0.001).Recent evidence suggests that the oral administration of PPI is not inferior to the IV PPI treatment in PUB after endoscopic management, but further studies are warranted. LA - English DB - MTMT ER - TY - JOUR AU - Pécsi, Dániel AU - Gódi, Szilárd AU - Hegyi, Péter AU - Hanák, Lilla AU - Szentesi, Andrea Ildikó AU - Altorjay, István AU - Bakucz, Tamás AU - Czakó, László AU - Kovács, György AU - Orbán-Szilágyi, Ákos AU - Pakodi, Ferenc AU - Patai, Árpád AU - Szepes, Zoltán AU - Gyökeres, Tibor Zoltán AU - Fejes, Roland AU - Dubravcsik, Zsolt AU - Vincze, Áron TI - ERCP is more challenging in cases of acute biliary pancreatitis than in acute cholangitis - Analysis of the Hungarian ERCP registry data JF - PANCREATOLOGY J2 - PANCREATOLOGY VL - 21 PY - 2021 IS - 1 SP - 59 EP - 63 PG - 5 SN - 1424-3903 DO - 10.1016/j.pan.2020.11.025 UR - https://m2.mtmt.hu/api/publication/31782996 ID - 31782996 N1 - Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary Second Department of Medicine, University of Debrecen, Debrecen, Hungary Department of Gastroenterology, Medical Centre Hungarian Defence Forces, Budapest, Hungary First Department of Medicine, University of Szeged, Szeged, Hungary First Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, Szombathely, Hungary First Department of Medicine, Szent György University Teaching Hospital of County Fejér, Székesfehérvár, Hungary Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary Cited By :3 Export Date: 13 October 2023 CODEN: PANCC Correspondence Address: Vincze, Á.Ifjúság u. 13., Hungary; email: vincze.aron@pte.hu Chemicals/CAS: clopidogrel, 113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8 Tradenames: SPSS, IBM, United States Manufacturers: IBM, United States AB - Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic modality in acute biliary pancreatitis (ABP) cases with cholangitis or ongoing common bile duct obstruction. Theoretically, inflammation of the surrounding tissues would result in a more difficult procedure. No previous studies examined this hypothesis.ABP and acute cholangitis (AC) without ABP cases were compared to assess difficulty of ERCP.The rate of successful biliary access, advanced cannulation method, adverse events, cannulation and fluoroscopy time were compared in 240 ABP cases and 250 AC cases without ABP. Previous papillotomy, altered gastroduodenal anatomy, and cases with biliary stricture were excluded.Significantly more pancreatic guidewire manipulation (adjusted odds ratio (aOR) 1.921 [1.241-2.974]) and prophylactic pancreatic stent use (aOR 4.687 [2.415-9.098]) were seen in the ABP than in AC group. Average cannulation time in the ABP patients (248 vs. 185 s; p = 0.043) were longer than in AC cases. No difference was found between biliary cannulation and adverse events rates.ERCP in ABP cases seem to be more challenging than in AC. Difficult biliary access is more frequent in the ABP cases which warrants the involvement of an experienced endoscopist. LA - English DB - MTMT ER - TY - JOUR AU - Dohos, Dóra AU - Hanák, Lilla AU - Szakács, Zsolt AU - Kiss, Szabolcs AU - Párniczky, Andrea AU - Erőss, Bálint Mihály AU - Pázmány, Piroska AU - Hegyi, Péter AU - Sarlós, Patrícia TI - Systematic review with meta-analysis : the effects of immunomodulator or biological withdrawal from mono- or combination therapy in inflammatory bowel disease JF - ALIMENTARY PHARMACOLOGY & THERAPEUTICS J2 - ALIMENT PHARM THER VL - 53 PY - 2021 IS - 2 SP - 220 EP - 233 PG - 14 SN - 0269-2813 DO - 10.1111/apt.16182 UR - https://m2.mtmt.hu/api/publication/31677385 ID - 31677385 AB - Withdrawal of treatment is a common therapeutic problem in patients with long-standing remission of inflammatory bowel disease.To evaluate the relapse rate in patients with quiescent inflammatory bowel disease after cessation of biologic or immunomodulator therapy.We searched five databases for studies evaluating disease relapse after withdrawal of monotherapy or a drug from combination therapy in Crohn's disease or ulcerative colitis. In meta-analysis, risk ratios (RR) were calculated with 95% confidence intervals (CI).Ten randomised controlled trials (587 patients) were included in the meta-analysis, and another nine studies in systematic review. Withdrawal of immunomodulator monotherapy resulted in a significantly higher risk of relapse within 24 months of follow-up compared to ongoing therapy in Crohn's disease, but not in ulcerative colitis (RR = 2.06, CI: 1.53-2.77 and RR = 1.39, CI: 0.85-2.26, respectively). Trial sequential analysis indicated that further studies with similar design are unlikely to change the significant association on relapse rates after withdrawing immunomodulator monotherapy in patients with Crohn's disease. Discontinuation of an immunomodulator from combination with biologics did not show a higher risk of relapse than continuation of both drugs (RR = 1.30, CI: 0.81-2.08). The relapse rate increased after withdrawal of biologic monotherapy, whereas contradictory results were observed after biologic withdrawal from combination regimens.Continuing immunomodulator monotherapy should remain the preferred approach among patients with Crohn's disease, although long-term toxicity is a concern. Further randomised controlled trials are warranted in ulcerative colitis and on combination regimens including biologics. LA - English DB - MTMT ER - TY - JOUR AU - Trimmel, Bálint AU - Gede, Noémi AU - Hegyi, Péter AU - Szakács, Zsolt AU - Mezey, Gyöngyi Anna AU - Varga, Eszter AU - Kivovics, Márton AU - Hanák, Lilla AU - Rumbus, Zoltán AU - Szabó, György TI - Relative performance of various biomaterials used for maxillary sinus augmentation. A Bayesian network meta-analysis. JF - CLINICAL ORAL IMPLANTS RESEARCH J2 - CLIN ORAL IMPLANTS RES VL - 32 PY - 2021 IS - 2 SP - 135 EP - 153 PG - 19 SN - 0905-7161 DO - 10.1111/clr.13690 UR - https://m2.mtmt.hu/api/publication/31673117 ID - 31673117 AB - To assess the histomorphometric outcomes obtained in randomized clinical trials (RCTs) with different biomaterials used for maxillary sinus augmentation (MSA).A search of the existing medical literature until October 1, 2019 was performed. Inclusion criteria were (1) RCTs assessing a two-stage MSA from the lateral approach using autologous bone or biomaterials for grafting, (2) reported histomorphometric outcomes based on crestal bone core biopsy samples. The Bayesian method was used to perform pairwise meta-analyses and network meta-analysis (NMA). The primary outcome, the new bone percentage (NB%), was calculated as mean differences with 95% credible intervals. The interventions were ranked by their posterior probability by calculating the Surface Under the Cumulative Ranking curve values.Thirty-four RCTs (842 MSAs) were included in the analysis with a normal healing period (5-8 months). All comparisons were presented in a league table. On the basis of the ranking probability, the most effective bone grafting material for NB% was bovine xenograft + bone marrow concentrate (BMC) (81%), followed by bovine xenograft + platelet-rich plasma (PRP) (77%), bioactive glass ceramic + autologous bone 1:1 (70 %), nanocrystalline hydroxyapatite in silica gel (70%), and bioactive glass ceramic (70%). Autologous bone graft alone took the twelfth position with 57%.Within the limitations of the present NMA, the analysis did not confirm autologous bone alone as the gold standard for MSA and showed superiority of composite grafts such as bovine xenograft + BMC after 5-8 months of healing. LA - English DB - MTMT ER - TY - JOUR AU - Hegyi, Péter Jenő AU - Soós, Alexandra AU - Hegyi, Péter AU - Szakács, Zsolt AU - Hanák, Lilla AU - Váncsa, Szilárd AU - Ocskay, Klementina AU - Pétervári, Erika AU - Balaskó, Márta AU - Erőss, Bálint Mihály AU - Pár, Gabriella TI - Pre-transplant Sarcopenic Obesity Worsens the Survival After Liver Transplantation : A Meta-Analysis and a Systematic Review JF - FRONTIERS IN MEDICINE J2 - FRONT MED VL - 7 PY - 2020 PG - 9 SN - 2296-858X DO - 10.3389/fmed.2020.599434 UR - https://m2.mtmt.hu/api/publication/31796923 ID - 31796923 AB - Background: The rising prevalence of cirrhotic cases related to non-alcoholic steatohepatitis has led to an increased number of cirrhotic patients with coexistence of obesity and muscle mass loss, known as sarcopenic obesity (SO). In patients undergoing liver transplantation (LT), the presence of SO may worsen prognosis, and increase morbidity and mortality. Objective: We aimed to evaluate the effect of the presence of pre-transplant SO on the outcomes of LT. Methods: A comprehensive search was performed in seven medical databases for studies comparing morbidity and mortality of patients with and without SO after LT. The primary outcome was overall mortality in the short- (1 year), intermediate- (3 years), and long- (5 years) term. We calculated pooled relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was quantified with I2-statistics. Results: Based on the analysis of 1,515 patients from three articles, SO increased overall mortality compared to non-SO at short-, intermediate-, and long-term follow-up (RR = 2.06, 95% CI: 1.28-3.33; RR = 1.67, 95% CI: 1.10-2.51; and RR = 2.08, 95% CI: 1.10-3.93, respectively) without significant between-study heterogeneity for the short- and intermediate- term (I2 = 0.0% for both) and considerable heterogeneity for long-term follow-up (I2 = 81.1%). Conclusion: Pre-transplant SO proved to be a risk factor after LT and was associated with two times higher mortality at short- and long- term follow-up. Since SO worsens the prognosis of patients after LT, the inclusion of body composition assessment before LT may help to plan a more individualized nutritional treatment, physiotherapy, and postoperative care and may improve morbidity and mortality. LA - English DB - MTMT ER -