Association between obstructive sleep apnea and floppy eyelid syndrome: A systematic review and metaanalysis

RationaleObstructive sleep apnoea (OSA) has been linked to various ocular disorders, including floppy eyelid syndrome (FES). Previous studies have hypothesised the underlying association between the 2 , but results are currently still inconclusive.ObjectiveTo investigate the association between OSA and FES.MethodsFour databases (Pubmed, Embase, Scopus, and Cochrane Library) were searched from inception until 28 February 2022 for observational studies and randomized controlled trials assessing the association between OSA and FES. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of assessment using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to metaanalyze the associations.ResultsTwelve studies were included in the systematic review, of which nine were suitable for metaanalysis, with a combined cohort of 1,109 patients. Risk of bias was low to moderate. The overall analysis showed a significant positive association between OSA and FES (OR = 1.89, 95% CI = 1.27–2.83, I 2 = 44%). Further analysis revealed that the more severe the OSA was, the higher the risk of developing FES. Patients with severe OSA had the nominally highest risk of developing FES (OR = 3.06, 95% CI = 1.62–5.78, I 2 = 0%), followed by moderate OSA (OR = 2.53, 95% CI = 1.29–4.97, I 2 = 0%), and patients with mild OSA had the lowest risk (OR = 1.76, 95% CI = 0.85–3.62, I 2 = 0%).ConclusionOur metaanalysis reports a positive association between OSA and FES, with increasing severity of OSA correlating with a significantly higher risk of FES. More longitudinal studies with sufficient duration of follow-up are needed to better characterise the relationship between OSA and FES.     

Echocardiographic Evaluation of Left and Right Ventricular Function in Patients with Coronary Slow Flow Syndrome: A Comparative Study

The Coronary Slow Flow Phenomenon is a syndrome of normal coronary anatomy and delayed progression of contrast medium through the coronary vessels. This research attempts to analyze and compare the systolic and diastolic function of the left and right ventricle in primary Slow Flow and Normal Coronary Flow.Two groups of primary Slow Coronary Flow (33 people) and Normal Coronary Flow (11 people) were included and the systolic and diastolic function of the ventricles was analyzed and compared between them.In the control group 18% of patients had mild and in the case group 24.2% mild, and 3.1% had moderate left ventricular diastolic dysfunction (P >0.05). The frequency distribution of the left and right ventricular systolic dysfunction was similar in the two groups.There was no statistically significant difference between two groups and in the association of cardiac dysfunction, it may be reasonable to investigate other causes.     

Evolving Trends in the Management of Low-Risk Prostate Cancer

IntroductionDeferred treatment is a growing management strategy for low-risk prostate cancer. However, it is unknown whether this growth is mediated by patient factors. In this study, we sought to evaluate factors associated with deferred treatment in patients with low-risk prostate cancer and shifts in these factors after recent incorporation of active surveillance into national guidelines.Materials and MethodsWe identified 137,915 men diagnosed with low-risk prostate cancer (prostate-specific antigen <10 ng/mL, Gleason score ≤6, stage cT1-cT2a) in the National Cancer Database from 2010 to 2017. Multivariate logistic regression models were used to determine factors associated with deferred treatment. Interaction variables were added to determine whether trends in use of deferred treatment over time depend on race, income, education, and insurance status.ResultsThe use of deferred treatment among men with low-risk prostate cancer increased from 14.7% in 2010-2011 to 46.3% in 2016-2017 (P < .001). On multivariate analysis, deferred treatment was associated with older age, more contemporary year of diagnosis, black race, lower income, higher educational attainment, government insurance, being uninsured, treatment at an academic/research facility, and treatment at a facility in New England (each P < .05). Incorporation of interaction variables showed that black race, belonging to the two lowest income quartiles, government insurance, and being uninsured became less associated with deferred treatment in recent years.ConclusionsThe use of deferred treatment among men with low-risk prostate cancer increased significantly from 2010 to 2017. However, patients who were black, low-income, and not privately insured experienced smaller increases in deferred treatment. Interventions to increase uptake in these groups present opportunities to improve quality of care.