Gomel State Medical University

This systematic review and meta-analysis examined the impact of previous coronary artery bypass grafting (CABG) on clinical outcomes in patients presenting with acute myocardial infarction (AMI). A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from January 2010 to August 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational studies comparing outcomes between patients with AMI with and without prior CABG history were included. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). Statistical analyses employed random-effects models using RevMan 5.4 (The Nordic Cochrane Centre, Copenhagen, Denmark) and R software (R Foundation for Statistical Computing, Vienna, Austria). Nine studies comprising patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were included in the final analysis. The pooled analysis demonstrated that previous CABG history was not significantly associated with all-cause mortality in the overall AMI population (relative risk (RR): 1.06, 95% confidence interval (CI): 0.97-1.16), although considerable heterogeneity was observed (I² = 87%). Subgroup analysis revealed that patients with STEMI with prior CABG had a 16% higher mortality risk compared to CABG-naïve patients (RR: 1.16, 95% CI: 1.12-1.20), while patients with NSTEMI showed a non-significant 6% increase (RR: 1.06, 95% CI: 0.95-1.19). No significant difference was found in major adverse cardiac events (MACE) between groups (RR: 0.98, 95% CI: 0.85-1.12). Meta-regression identified age, hypertension prevalence, and CABG prevalence as significant contributors to between-study heterogeneity. These findings suggest that prior CABG may confer increased mortality risk specifically in patients with STEMI, although limited study numbers in subgroup analyses warrant cautious interpretation and highlight the need for larger targeted investigations.

The pathogenesis of ulcerative colitis (UC) is heterogeneous; the causes are considered to be external factors such as stress, infections, antibiotics, and other medications, diet, and intrinsic factors such as genetic predisposition. The aim of this narrative review is to analyze data on intestinal flora and bacteria-derived metabolites in inflammatory bowel diseases and ulcerative colitis in particular. The main focus is on proteolytic, saccharolytic, mucin-degrading, and bile acid-metabolizing bacteria. What types of metabolites are beneficial for intestinal integrity and the patient’s health? How can dietary preferences trigger disease and cause complications? What kind of changes in the microbiome promote the disease? We consider what targets/receptors metabolites act on and their physiological role. The knowledge accumulated over the past years on the gut metagenome, metabolome, and signaling mechanisms may allow, in the future, modulating the composition of the intestinal microbiome and suppressing the growth of pathogenic flora without the use of antibiotics, but due to pro- and prebiotics, products of bacterial metabolism, including quorum sensing molecules.

Burn injuries remain a major global health challenge, with surgical interventions often requiring blood transfusions due to substantial intraoperative bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing perioperative blood loss across various surgical specialties, but evidence in burn surgery remains limited and inconsistent. This systematic review and meta-analysis aimed to evaluate the hemostatic efficacy of TXA in burn patients undergoing surgical procedures. A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from the inception of databases to June 2025. Randomized controlled trials comparing TXA to placebo or no intervention in burn patients undergoing surgical procedures were included. Data extraction focused on intraoperative blood loss, hemoglobin changes, and hematocrit changes. Quality assessment was performed using the Cochrane Risk of Bias 2.0 tool, and meta-analyses were conducted using random-effects models. Four randomized controlled trials encompassing 264 participants were included, with 130 patients receiving TXA and 134 controls. The pooled analysis demonstrated that TXA significantly reduced intraoperative blood loss with a mean difference of -181.60 mL (95% CI: -267.34 to -95.86; p < 0.0001). TXA was also associated with significantly smaller declines in hemoglobin levels compared to controls (mean difference: -1.02 g/dL; 95% CI: -1.39 to -0.65; p < 0.00001). These findings suggest that TXA provides meaningful hemostatic benefits in burn surgery, although larger multicenter trials are needed to validate these results and assess long-term safety outcomes.