Efficacy and safety of inhaled heparin in asthmatic and chronic obstructive pulmonary disease patients: a systematic review and a meta-analysis

Abstract Asthma and chronic obstructive pulmonary disease (COPD) are prevalent chronic respiratory disorders that cause significant morbidity and mortality. Some studies evaluated the use of inhaled unfractionated heparin (UFH) in the treatment of asthma and COPD. We aimed to synthesize the available evidence for the efficacy and safety of inhaled heparin in improving lung functions among asthmatic and COPD patients. A comprehensive search was performed using Pubmed, Embase, EBSCO, Scopus, Web of Science, Cochrane CENTRAL, WHO Clinical trials, clinicaltrials.gov, Iranian Clinical trials, Google Scholar, Research Gate, ProQuest Thesis, OVID, and medRxiv databases. Two independent reviewers included all pertinent articles according to PRISMA guidelines, and extract data independently. The two reviewers checked the quality of studies using the ROB2 tool. To determine the pooled effect estimate of the efficacy and safety of inhaled heparin, a meta-analysis was carried out using the R programming language. Publication bias was evaluated using Egger’s regression test. The heterogeneity was explained using a meta-regression, and the quality of evidence was assessed by the GRADE approach. Twenty-six studies with a total of 581 patients were included in the qualitative analysis and 16 in the meta-analysis. The primary outcome was treatment success (improvement of lung function) that was measured by standardized mean differences (SMD) of the forced expiratory volume per second (FEV1) either per ml or percentage. Heparin has a large effect on both FEV1% and FEV1 ml when compared to the control group (SMD 2.7, 95% CI 1.00; 4.39; GRADE high, SMD 2.12, 95% CI − 1.49; 5.72: GRADE moderate, respectively). Secondary outcomes are other lung functions improving parameters such as PC20 (SMD 0.91, 95% CI − 0.15; 1.96). Meta-regression and subgroup analysis show that heparin type, dose, year of publication, study design, and quality of studies had a substantial effect. Regarding safety, inhaled heparin showed a good coagulation profile and mild tolerable side effects. Inhaled heparin showed improvement in lung functions either alone or when added to standard care. More large parallel RCTs are needed including COPD patients, children, and other types, and stages of asthmatic patients

Impact of bedaquiline regimen on the treatment success rates of multidrug-resistant tuberculosis patients in Egypt

Abstract Bedaquiline (BDQ), an innovative anti-tuberculous (TB) agent, has attracted attention for its potential effectiveness against drug-resistant TB. This study investigated the impact of BDQ-containing regimens on treatment success rates among multi-drug resistant tuberculosis (MDR-TB) patients in Egypt. We conducted a prospective cohort study that included all adult non-pregnant patients treated in MDR-TB centers in Egypt from April 1, 2020, to June 30, 2021, with follow-up extended until December 31, 2022. The study compared patients prescribed BDQ according to national protocols with those receiving conventional treatments for MDR-TB. Treatment success rates, mortality rates, and adverse events were analyzed using descriptive statistics, chi-square tests, logistic regression, and Kaplan–Meier survival curves. Adjustment for potential confounders was conducted using propensity score matching and Cox-hazard regressions. A total of 84 patients were included in this study. The median age of the study participants was 39 years; 22.6% were women, 57.1% were unemployed or housewives, and 1.2% had human immunodeficiency virus (HIV). Regarding the treatment regimen, 67.8% were exposed to BDQ-based treatment. Among the 55 patients (65.5%) with treatment success, a significantly higher success rate was observed in the BDQ group (73.7%) compared to the conventional group (48.1%), P = 0.042. Additionally, the incidence of skin discoloration was significantly higher in the BDQ group compared to the conventional group (38.6% versus 0.0%, P < 0.001). Despite the lower mortality incidence in the BDQ-group (14.0% versus 22.2% in the conventional group), the Kaplan–Meier survival analysis revealed no excess mortality associated with the BDQ-group, with a hazard ratio (HR) of 0.62 (95% CI 0.21–1.78, P = 0.372). Propensity score matching, while considering factors such as lesion site, diabetes mellitus, hepatitis C virus, and smoking, revealed a significant increase in the success rate associated with BDQ inclusion, with an HR of 6.79 (95% CI 1.8–25.8). In conclusion, BDQ is an effective and tolerable medication for treating MDR-TB, associated with lower mortality rates compared to conventional treatment

Survey of current maintenance intravenous fluids prescribing practices among Egyptian pediatricians

Abstract Background Recent research has firmly linked the administration of hypotonic fluids with the incidence of hospital-acquired hyponatremia in pediatric patients. Objective This study examined the prevailing practices in prescribing maintenance intravenous fluids (mIVFs) among Egyptian pediatricians, assessed the compliance of current prescribing practices with the American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG), and emphasized the urgency for revised educational initiatives. Materials and methods To recruit pediatricians for this study, a convenience and snowballing sampling methods were used. The questionnaire was created in Google Forms and then distributed in English to Egyptian Facebook groups devoted to pediatric education. The data collection phase started on January 1, and ended on February 28, 2022. Different case scenarios with increased antidiuretic hormone were introduced, and respondents were asked to choose the optimum mIVFs in each case scenario. Finally, respondents were directly asked how often they use isotonic fluids as their primary mIVFs and what caused them to not use isotonic fluids. Results For this study, a total of 513 participatants were included. The survey revealed that Egyptian pediatricians did not not fully comply with AAP-CPG regarding the mIVFs in pediatrics. Hypotonic fluids are still preferred, but there is a shift towards 0.45% sodium chloride (NaCl) from the previously favored 0.2% NaCl. Isotonic fluids are more common in older age groups and conditions that involve potential excessive antidiuretic hormone secretion, while 0.2% NaCl remains popular in neonatal care. Balanced solutions are underused, indicating practice variation. Conclusions The utilization of isotonic fluids in the treatment of neurologic conditions has experienced a notable increase, propelled by heightened awareness and a growing demand for continuous medical education. To comprehensively address concerns related to fluid management beyond the scope of AAP-CPG, it is imperative to conduct multicenter studies across governmental, private, and educational pediatric healthcare settings to assess and improve pediatracians' clinical practice

Interplay between Comorbidities and Long COVID: Challenges and Multidisciplinary Approaches

Long COVID, a name often given to the persistent symptoms following acute SARS-CoV-2 infection, poses a multifaceted challenge for health. This review explores the intrinsic relationship between comorbidities and autoimmune responses in shaping the trajectory of long COVID. Autoantibodies have emerged as significant players in COVID-19 pathophysiology, with implications for disease severity and progression. Studies show immune dysregulation persisting months after infection, marked by activated innate immune cells and high cytokine levels. The presence of autoantibodies against various autoantigens suggests their potential as comorbid factors in long COVID. Additionally, the formation of immune complexes may lead to severe disease progression, highlighting the urgency for early detection and intervention. Furthermore, long COVID is highly linked to cardiovascular complications and neurological symptoms, posing challenges in diagnosis and management. Multidisciplinary approaches, including vaccination, tailored rehabilitation, and pharmacological interventions, are used for mitigating long COVID’s burden. However, numerous challenges persist, from evolving diagnostic criteria to addressing the psychosocial impact and predicting disease outcomes. Leveraging AI-based applications holds promise in enhancing patient management and improving our understanding of long COVID. As research continues to unfold, unravelling the complexities of long COVID remains paramount for effective intervention and patient care

Survey to measure the quality of life of patients with tuberculosis in Alexandria, Egypt: a cross-sectional study

Abstract Background Assessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers’ understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt. Methods This cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire. Results A total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18–40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients’ group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0–4.0) vs. 3.0(2.0–4.0)) for general health, and (4.0(3.0–4.0) vs. 2.0(2.0–3.0)) for the general QoL, P < 0.0001. Patients with TB aged 18–30 years had the highest environmental score compared with the other age groups (P = 0.021). Conclusions TB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

Abstract Background Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services. Methods We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. Results Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 − 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 − 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 − 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers. Conclusions The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness

Clinical Outcomes and Survival Analysis of Remdesivir as a Treatment Option for Moderate to Severe COVID-19 Patients

Background: Remdesivir is a broad-spectrum antiviral that has been approved as promising medicine worldwide for the fatal pandemic COVID-19 disease. There is a debate over its efficacy, with different studies taking into account a variety of factors. Therefore, we conducted this study to evaluate the primary composite outcome of mortality rate, need for mechanical ventilation (MV), and escalation of care among Remdesivir (RDV) and non-Remdesivir (NoRDV) groups. Methods: Patients with moderate and severe PCR-confirmed COVID-19 infection were observed retrospectively, before and after including RDV in the treatment protocol during the period from August 2020 to February 2021. Result: From the 509 hospitalized patients, 35% received Remdesivir, with 64% being severe patients. The median age in both groups was 59 years old, and there was no significant difference between the two groups regarding gender, baseline characteristics, and comorbidities. In contrast, the median hospital length of stay in the RDV group was lower (8 days) than the NoRDV (9 days), p = 0.004. The composite outcome was 17.7% in the RDV group and 22.2% in the NoRDV group, but the difference was statistically insignificant (p-value 0.289). Adjusted logistic regression demonstrated a non-significant lower association of the composite outcome with RDV use (OR 0.623, 95CI% 0.37&ndash;1.02), and a significant reduction occurred in patients &lt;60 years old (OR 0.39, 95%CI 0.17&ndash;0.83). However, survival analysis for mortality, MV, and transfer to a higher level revealed insignificant differences in the median time between groups. Subgroup analyses showed that RDV utilization had a non-significant effect on the risk of all three outcomes across different groups. Conclusion: Despite controlling all patient characteristics, treatment with RDV did not improve patient outcomes over other antivirals and standard care. There is an urgent need for further studies to investigate and evaluate new therapeutic approaches or combinations

Encephalitozoon cuniculi infection among immunocompromised and immunocompetent humans in Egypt

Background: Encephalitozoon cuniculi infects a wide range of homoeothermic animals, including man. Complications due to this microsporidian have been reported only in immunocompromised patients. Reports on E. cuniculi in immunocompetent humans are lacking, most probably, because it is not linked to any clinical manifestations in such hosts. The present work was carried out with the aim of studying, for the first time in Egypt, the prevalence of E. cuniculi infection of urinary tract among non-HIV immunocompromised patients and immunocompetent individuals. It tested also the influence of some factors on the risk of infection. Methods: Blood and urine samples were collected from 88 persons (44 non-HIV immunocompromised patients and 44 subjects as immunocompetent control group). IFAT serological assay and Weber’s green modified trichrome stain (MTS) urine smears were carried out. Molecular study by PCR was also performed to detect DNA of E. cuniculi in urine samples. A full history sheet was fulfilled for each subject to test the suspected risk factors. Results: The IFAT examination confirmed the presence of antibodies against E. cunic­uli in 44.3% of the human subjects. The seroprevalence of E. cuniculi was significantly higher in the immunocompromised patients compared with the immunocompetent individuals (77.3% versus 11.4%). Compared with IFAT (the gold standard), the sensitivity and specificity of Weber’s green MTS smears were 69.23% and 89.80%. By using PCR, no positive cases were detected among human subjects. Conclusion: A high prevalence of E. cuniculi infection in the studied individuals was noted. Although infection was found in some immunocompetent individuals, the im­mune status of the host remains the corner stone for occurrence of the infection

Efficacy and Effectiveness of SARS-CoV-2 Vaccines: A Systematic Review and Meta-Analysis

The coronavirus disease 2019 (COVID-19) pandemic has threatened global health and prompted the need for mass vaccination. We aimed to assess the efficacy and effectiveness of COVID-19 vaccines to prevent mortality and reduce the risk of developing severe disease after the 1st and 2nd doses. From conception to 28 June 2021, we searched PubMed, Cochrane, EBSCO, Scopus, ProQuest, Web of Science, WHO-ICTRP, and Google Scholar. We included both observational and randomized controlled trials. The pooled vaccine efficacy and effectiveness following vaccination, as well as their 95 percent confidence intervals (CI), were estimated using the random-effects model. In total, 22 of the 21,567 screened articles were eligible for quantitative analysis. Mortality 7 and 14 days after full vaccination decreased significantly among the vaccinated group compared to the unvaccinated group (OR = 0.10, ([95% CI, 0.04&ndash;0.27], I2 = 54%) and (OR = 0.46, [95% CI, 0.35&ndash;0.61], I2 = 0%), respectively. The probability of having severe disease one or two weeks after 2nd dose decreased significantly (OR = 0.29 [95% CI, 0.19&ndash;0.46], I2 = 25%) and (OR = 0.08 [95% CI, 0.03&ndash;0.25], I2 = 74%), respectively. The incidence of infection any time after the 1st and 2nd doses diminished significantly (OR = 0.14 [95% CI, 0.07&ndash;0.4], I2 = 100%) and (OR = 0.179 [95% CI, 0.15&ndash;0.19], I2 = 98%), respectively. Also, incidence of infection one week after 2nd dose decreased significantly, (OR = 0.04, [95% CI (0.01&ndash;0.2], I2 = 100%). After meta-regression, the type of vaccine and country were the main predictors of outcome [non-mRNA type, &szlig; = 2.99, p = 0.0001; country UK, &szlig; = &minus;0.75, p = 0.038; country USA, &szlig; = 0.8, p = 0.02]. This study showed that most vaccines have comparable effectiveness, and it is purported that mass vaccination may help to end this pandemic

Revealing the significance of early detection of chronic obstructive pulmonary disease: insights from healthy lung initiative data at COP27 conference

Abstract Background Climate change poses a significant threat to respiratory health, exacerbating conditions like asthma, Chronic Obstructive Pulmonary Disease (COPD), and respiratory infections increasing morbidity and mortality indirectly through exposure to greenhouse gases. During the 27th Climate Change Conference (COP27), the Healthy Lung Initiative (HLI) for the early detection of COPD among smokers was launched in Egypt. Objective We aimed to detect the prevalence and predictors of confirmed COPD among smokers and assess physicians’ adherence to prescribing pulmonary function tests (PFTs) among the COP27 conference attendees. Methods This study utilized smokers’ data from the HLI, employing a cross-sectional design with an interview-based questionnaire, supplemented by spirometry for lung function evaluation. Participants, comprising Egyptian and non-Egyptian residents in Sharm El-Sheikh city, were provided with educational materials and encouraged to seek further evaluation from a pulmonologist. Results The HLI study, conducted from November 6th to 20th, 2022, involved 1133 participants, 90% (1047) of whom were smokers. Most smokers were males (96.3%) and Egyptians (98.6%), with half aged 30–39 and the majority starting smoking within the last 20 years. Despite common respiratory symptoms, 47% suffered from dyspnea on exertion, and only 4.3% have undergone lung function tests, suggesting a potential underdiagnosis of COPD. Most participants (82.6%) had an FEV1/FVC ratio > 70%, indicating no spirometry-confirmed COPD diagnosis, while 147 participants (17% of them) exhibited all three cardinal COPD symptoms simultaneously. Male gender and daily cigarette consumption were significant predictors for confirmed COPD, while age showed no significance in regression analyses. Conclusion The ongoing HLI focuses on early detection and education to combat smoking-related risks, particularly among middle-aged males, while also highlighting the need for comprehensive strategies to address the intersection of smoking and climate change