KIST Medical College

BackgroundChronic obstructive pulmonary disease (COPD) exacerbations and hospital readmissions are major drivers of morbidity, mortality, and healthcare costs. Artificial intelligence and machine learning (AI/ML) approaches have been applied to predict these events, but their pooled performance and methodological rigor remain unclear.MethodsFollowing PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis of peer-reviewed studies developing or validating AI/ML models for predicting acute exacerbations of COPD (AECOPD) or hospital readmissions. Databases (PubMed, IEEE Xplore, Cochrane Library, Semantic Scholar) were searched to 2025. Eligible designs included retrospective and prospective cohorts, randomized trials with embedded prediction, and case–control studies. Study quality was assessed using PROBAST, and evidence certainty with GRADE. Random-effects models pooled area under the ROC curve (AUC); subgroup analyses compared AECOPD vs. readmission outcomes and internal vs. external validation.ResultsThirteen studies were included, with sample sizes ranging from 110 to 113,786 patients. Most were retrospective cohorts using EHRs or claims data, while two used prospective or trial-based data. Models applied diverse algorithms, including random forests, gradient boosting, neural networks, and ensemble pipelines. The pooled AUC across all studies was 0.77 (95% CI: 0.74–0.80), with very high heterogeneity (I2 = 99.5%). Subgroup analyses showed similar performance for AECOPD prediction (AUC = 0.77; I2 = 98.9%) and readmission prediction (AUC = 0.73; I2 = 19.8%). Externally validated models (n = 4) achieved higher accuracy (AUC = 0.82) than internally validated models (AUC = 0.76), although differences were not statistically significant. Risk of bias was moderate to serious in 69% of studies, mainly due to incomplete reporting and overfitting.ConclusionAI/ML models demonstrate moderate-to-high discriminatory accuracy in predicting COPD exacerbations and readmissions, with pooled AUCs of 0.73–0.77. However, high heterogeneity, limited external validation, and frequent methodological concerns restrict generalizability. Standardized reporting frameworks (TRIPOD-AI, PROBAST-AI), rigorous external validations, and prospective implementation studies are needed to translate these promising tools into clinical practice.

Background: Recurrence of atrial fibrillation (AF) remains a concern even after catheter ablation. The impact of Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) on Atrial tachyarrythmia free event remains unclear. Hypothesis: This analysis aims to analyze outcomes in patients treated with SGLT2i after catheter ablation. Methods: A meta-analysis of available studies comparing SGLT2i to non- SGLT2i group following ablation was conducted using electronic databases; PubMed and Embase until May 2025. A random-effects meta-analysis using the DerSimonian–Laird model was performed. Primary outcomes: tachyarrhythmia-free survival and secondary outcomes: all-cause hospitalization and all-cause mortality, and Relative risks (RR) with 95% confidence intervals (CI) were calculated with p <0.05 considered significant. Results: A total of 10 studies were included for meta-analysis with sample size of 10,985 (SGLT2i group: 5534 and non-SGLT2i group: 5451). Primary outcome: There was no significant difference in tachyarrhythmia-free survival (RR: 0.99, 95% CI: 0.76–1.29; p = 0.96), and high heterogeneity (I2 = 84.6%) was observed for this endpoint. Secondary outcome: SGLT2i therapy significantly reduced all-cause hospitalization (RR: 0.74, 95% CI: 0.59–0.94; p = 0.01; I2 = 36.4%) and all-cause mortality (RR: 0.64, 95% CI: 0.45–0.89; p = 0.01; I2 = 0%) Conclusion: SGLT2i therapy offers additive clinical benefits over non-SGLT2i group, notably in reducing hospitalizations and cardiovascular mortality. Its effect on arrhythmia prevention remains uncertain, highlighting the need for further investigation into patient selection and mechanistic interactions.

Background: Anxiety disorders are common, but their role in cardiovascular risk is underrecognized. Traditional risk factors for coronary heart disease (CHD), such as hypertension and diabetes, are well established, but anxiety may independently influence future heart disease. Emerging evidence suggests anxiety can predict events such as myocardial infarction. We aimed to quantify the association between anxiety disorders and the risk of developing CHD in adults without prior heart disease. Hypothesis and Objectives: We hypothesized that anxiety disorders increase CHD incidence and aimed to determine whether anxiety is an independent risk factor for heart disease. We also examined anxiety subtypes such as generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD) for differential associations with CHD. Methods: We conducted a systematic review and meta-analysis. We searched MEDLINE, Scopus, Embase, and Google Scholar for English-language studies from 2010 to 2023. Eligible studies included adults with anxiety (diagnosed by standardized criteria) and measured incident CHD outcomes in individuals free of CHD at baseline. Two reviewers independently extracted data. A random-effects meta-analysis estimated pooled hazard ratios with 95% confidence intervals; heterogeneity was assessed by I2 statistic. Results: A total of ten studies (n=546,802) met inclusion criteria. The pooled hazard ratio for incident CHD (primarily myocardial infarction) in participants with anxiety versus without anxiety was 1.35 with a 95% confidence interval of 1.20–1.52 (p<0.001), indicating a significant association. Subgroup analysis identified generalized anxiety disorder and post-traumatic stress disorder as anxiety subtypes most strongly linked to higher CHD risk. Statistical heterogeneity was moderate (I2=39%, p=0.11). Most studies adjusted for traditional cardiovascular risk factors. Conclusions: These findings provide strong evidence that anxiety disorders, particularly GAD and PTSD, are independently associated with higher CHD risk. Integrating mental health assessment with cardiovascular prevention could help identify modifiable risk factors. We conclude that addressing anxiety may be important in CHD prevention strategies.

Background:Rheumatoid arthritis (RA) is associated with an elevated risk of cardiovascular disease and necessitates repeat revascularization procedures, including percutaneous coronary intervention (PCI). However, extensive data on outcomes following PCI in this cohort remain scarce. This systematic review and meta-analysis sought to evaluate the short- and long-term cardiovascular outcomes in RA patients following PCI.Methods:We conducted a search of PubMed, Embase, Google Scholar, and Cochrane Central for studies published until October 2024 that compared RA and non-RA cohorts’ post-PCI. The primary outcomes encompassed major adverse cardiovascular events, myocardial infarction, repeat revascularization, and overall mortality. The pooled odds ratio (OR) with 95% confidence intervals was computed utilizing random-effects models. A sensitivity analysis was conducted using a leave-one-out meta-analysis.Results:Our search identified 9 qualifying studies, encompassing nearly 1 million patients (174,229 with RA and 9771,911 without RA). Individuals with RA exhibited a markedly elevated risk of short-term stroke compared to non-RA patients (OR: 0.81, 95% CI: 0.6–1.02). Long-term follow-up found an elevated risk of myocardial infarction (OR: 1.08, 95% CI: 1.01–1.16), stroke (OR: 1.09, 95% CI: 1.07–1.11), major adverse cardiovascular events (OR: 1.12, 95% CI: 0.99–1.24), and repeat revascularization (OR: 1.09, 95% CI: 1.07–1.11) among patients with RA. The sensitivity analysis revealed no significant difference, even after the exclusion of each study.Conclusion:This comprehensive meta-analysis revealed that patients with RA have markedly poorer clinical outcomes post-PCI, particularly in the long term. The results underline the necessity for tailored peri-procedural approaches and ongoing monitoring in RA patients.

More Than Just a Plaque: Primary Cutaneous Localized Nodular Amyloidosis Masquerading as Common DermatosesAuthor names and Affiliations: Sandesh Shah1, Joshana Shrestha2Lecturer, Department of Dermatology, Nepal Medical College and Teaching Hospital,

Background:Chronic obstructive pulmonary disease (COPD) causes permanent lung damage and is a global health issue. Bronchoscopic Lung Volume Reduction (BLVR) with Zephyr valves has increased COPD treatment choices for individuals with persistent symptoms despite maximal drug therapy.Objectives:This systematic review and meta-analysis evaluated available Zephyr valve data in severe emphysema patients.Data and methods:We searched Cochrane, PubMed, Google Scholar, Lilacs, and Science Direct extensively and included eight randomized control trials (RCTs).Results:This meta-analysis comprises 1083 patients 669 Zephyr valve-treated and 414 control. The mean difference in 6-minute walking distance was 37.53 meters (95% CI: 22.14–52.90, P < 0.001). Statistically significant improvements were also observed in FEV1 predicted percentage (mean difference: 13.64, 95% CI: 8.51–18.77, P < 0.001) and BODE index change (mean difference: −0.79, 95% CI: −1.33 to 0.26, P < 0.05), mMRC dyspnea scale (mean difference: −0.27, 95% CI: −0.55 to 0.02, P < 0.01) and residual volume (mean difference: −0.14, 95% CI: −0.64 to 0.35, P < 0.01). The quality of life measured by SGRQ also improved significantly (mean difference: −6.69, 95% CI: −9.69, −4.23, P < 0.001). While COPD exacerbation rates (OR:1.41, 95% CI: 0.87–2.30, P > 0.05) and pneumonia rates (OR: 1.72, 95% CI: 0.7–4.23, P > 0.05) were similar between valve and control groups, pneumothorax risk was significantly higher in the treatment arm (OR: 11.06, 95% CI: 4.10–29.80, P < 0.001). However, there was no significant difference in all-cause mortality between the groups (OR: 1.69; 95% CI: 0.53–5.38, P > 0.38).Conclusion:Zephyr valves may improve lung function, exercise capacity, and quality of life in patients suffering from severe emphysema. However, the increased risk of pneumothorax requires careful patient selection and rigorous post-intervention monitoring.

IntroductionPityriasis lichenoides et varioliformis acuta (PLEVA), also known as Mucha-Habermann disease, is a rare T-cell lymphoproliferative disorder that can occur at any age but most commonly affects children and young adults, with a slight male p