Background and Aims: Finerenone, a nonsteroidal MR antagonist (MRA), enhances renal and cardiovascular outcomes in patients with type 2 diabetes (T2DM). Finerenone’s safety and effectiveness in renal function are debatable. This meta-analysis evaluates the efficacy and safety of treatments for patients with diabetic kidney disease.Methods: To find relevant RCTs, the databases PubMed, Embase, and Google Scholar were searched. Finerenone’s effects were quantified using estimated pooled mean differences (MDs) and relative risks with 95% confidence intervals (CIs).Results: This meta-analysis combines seven double-blind trials involving patients with CKD and type 2 diabetes who were randomly assigned to finerenone or placebo. The primary efficacy time-to-event outcomes were cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization, kidney failure, a sustained 57% decrease in estimated glomerular filtration rate from baseline over 4 weeks, or renal death. In this meta-analysis of 39,995 patients, treatment with Finerenone was associated with a lower risk of death due to cardiovascular and renal outcomes than placebo (RR = 0.86 [0.80, 0.93] p=0.0002; I2= 0%) and (RR = 0.56 [0.17, 1.82] p=0.34; I2= 0%), respectively. Finerenone treatment was also associated with a marginally lower risk of serious adverse events (RR = 0.95 [0.92, 0.97] p 0.0001; I2= 0%), but no overall difference in the risk of adverse events was found between the two groups (RR = 1.00 [0.99, 1.01] p=0.56; I2= 0%).Conclusion: The administration of finerenone decreases the likelihood of end-stage kidney disease, renal failure, cardiovascular death, and hospitalization. Therefore, we propose that patients with T2DM and CKD undergo finerenone therapy.Keywords: Diabetes, Chronic kidney disease, CKD, Cardiovascular disease, Finerenone, Non-steroidal Mineralocorticoid receptor antagonist, Meta-analysis.

Background: High power short duration (HPSD) radiofrequency ablation was expected to be more effective and safer than low power long duration (LPLD) in treating atrial fibrillation (AF). Given the limited data, the findings were controversial. This meta-analysis evaluated whether HPSD’s clinical effects outweigh LPLD’s. Methods: A systematic search of PubMed, EMBASE, and Google Scholar databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. Results: This analysis included 21 studies with a total of 4169 patients. Pooled analyses revealed that HPSD was associated with a lower recurrence of atrial tachyarrhythmias (ATAs) at one year (RR: 0.62; 95% CI: 0.50 to 0.78, p: 0.00001, I 2: 0%). Furthermore, the HPSD approach reduced the risk of AF recurrence (RR: 0.64; 95% CI: 0.40 to 1.01, p: 0.06, I 2: 86%), The HPSD approach was associated with a lower risk of esophageal thermal injury (ETI) (RR: 0.78; 95% CI: 0.58 to 1.04, p: 0.09, I 2: 73%;). The HPSD strategy increased first-pass pulmonary vein isolation (FPI) and decreased acute pulmonary vein re-connection (PVR) both of which were predominantly manifested in bilateral and left pulmonary veins (PVs). HPSD demonstrated a reduction in procedural time, ablation number for pulmonary vein isolation (PVI), and fluoroscopy time. Conclusion: The HPSD method reduces ETI, PV reconnection, and recurrent AF. The HPSD approach also reduced procedural time, PVI ablation number, fluoroscopy time, and post-ablation AF relapse in one year, improving patient outcomes and safety.

Title page:Title : Letter to the editor: Mitral valve repair with the edge‐to‐edge technique: A 20 years single‐center experienceArticle type : Letter to the editorCorrespondence : 1. Syed HussainContact : +923323230575 Email : [email protected] : Shaheed Mohtarma Benazir Bhutto Medical College Liyari KarachiAddress : R-75 Railway Housing Society, 13-D1, Gulshan-e-Iqbal, Karachi, 75300Co-authors : 2.Muhammad MaazContact : +923032194036 Email : [email protected] : Shaheed Mohtarma Benazir Bhutto Medical College Liyari KarachiAddress : Flat No. B-16, Hasham Apartment, Rafa-e-aam, Malir Halt, Karachi, 752103. Dr. Sumeet KumarContact : +92-3337351513Email :[email protected] : Dow University of Health Sciences, KarachiAddress : Mission Rd, New Labour Colony Nanakwara, Karachi, Karachi City, Sindh 74200Word count : 482Conflict of interest : NoneDeclaration : NoneAcknowledgment : None