Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = −1.99 [95% CI −3.01 to −0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = −1.34 [95% CI −2.29 to −0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile

Gambaran Stadium Pada Diagnosis Awal Pasien Kanker Prostat Di Smf Urologi Rsud Dr. Soetomo Surabaya

Latar Belakang: Di Indonesia, kanker prostat adalah penyebab kematian nomor 4 pada pria. Di negara maju, pasien kanker prostat terdiagnosis pada stadium dini, namun di Indonesia pada stadium lanjut. Gambaran stadium awal kanker prostat di Indonesia setiap tahunnya perlu perlu diketahui untuk evaluasi terhadap epidemiologi mengenai distribusi stadium kanker prostat di rumah sakit-rumah sakit di Indonesia, termasuk RSUD Dr. Soetomo. Dari data tersebut, strategi dalam penanganan pasien kanker prostat di Indonesia juga dapat dievaluasi. Tujuan: Untuk mengetahui gambaran stadium pada diagnosis awal pasien kanker prostat di SMF Urologi RSUD Dr. Soetomo Surabaya pada tahun 2014-2018. Metode: Penelitian ini adalah penelitian dekriptif observasional dengan rancangan retrospektif. Data dalam penelitian ini diambil dari rekam medis pasien kanker prostat di RSUD Dr. Soetomo dalam periode 1 Maret 2014 hingga 31 Mei 2018 yang masuk dalam kriteria inklusi dan eksklusi, yang berjumlah 75 pasien. Hasil: Berdasarkan temuan jumlah stadium kanker prostat, stadium III (n=35) dan stadium IV (n=39) menjadi temuan tersering di setiap tahun. Jumlah stadium III dan stadium IV tetap tinggi di setiap tahunnya. Pembesaran prostat (n=26), permukaan prostat yang abnormal (n=28) dengan temuan tersering adalah nodul positif (n=25), dan konsistensi keras (n=24); pemeriksaan kadar PSA yang tidak normal (n=71) dengan temuan tersering adalah pada rentang > 100 ng/mL (n=33); dan pada hasil biopsi, grade 5 adalah temuan terbanyak (n=40). Kesimpulan: Berdasarkan temuan jumlah stadium kanker prostat, stadium III dan stadium IV menjadi temuan tersering di setiap tahun dengan jumlah total terbanyak adalah stadium IV

Oral Delivery of Purple Sweet Potato (Ipomoea batatas L.) Extract-Loaded Carboxymethyl Chitosan and Alginate Nanocapsule in Streptozotocininduced Diabetic Mice

Background: Insulin therapy is an essential part in diabetes mellitus type 2 treatment, but it has several side effects such as allergy and hypoglycemia. Therefore, alternative treatments are needed, one of which is by using nanocapsules to increase the performance of the drug delivery system. Purple sweet potato contain high anthocyanin levels which has antidiabetic properties. The idea of this research were to determine the potential use of purple sweet potato extract-loaded CMC-Alginate nanocapsules and to address problems regarding the efficiency of encapsulation to increase the bioavailability. Methods: This experimental research used post-test only control group design. The samples were 24 mice which were separated into four groups based on the administration of the following, respectively: 0.5 mL of extract-containing CMC-Alginate nanocapsules, 0.5 mL of extract, 1 mL of glibenclamide as the positive control and 0.5 mL of 0.5% CMC sodium placebo as the negative control. Mice were conditioned to be diabetic by induction of Streptozotocin. Blood glucose levels were carried out on days 1, 3, and 7 using an “Easy Touch” glucometer. The statistical analysis was conducted by two-way ANOVA proceeded by Tukey’s post hoc test to investigate the differences between all groups. Results: Statistically, purple sweet potato extract-loaded CMCAlginate nanocapsules, which its extract concentration was 4.4 times less than that of extract without encapsulation, can reduce high glucose levels in mice when as compared to negative control (p<0.05). Conclusion: Purple sweet potato extract-loaded CMCAlginate nanocapsules has capability to reduce blood glucose levels of streptozotocininduced mice

The Efficacy and Safety of Monoclonal Antibody Treatments Against COVID-19:A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background: The use of monoclonal antibody as the proposed treatment of COVID-19 showed different results in various prior studies, and Efficacy remains open in literature. This study aimed to comprehensively determine the effect of monoclonal antibodies on clinical, laboratory, and safety outcomes in COVID-19 patients. Methods: Sixteen RCTs were analyzed in this meta-analysis using RevMan 5.4 to measure the pooled estimates of risk ratios (RRs) and standardized mean differences (SMDs) with 95% CIs. Results: The pooled effect of Monoclonal antibodies demonstrated efficacy on mortality risk reduction (RR=0,89 (95%CI 0.82-0.96), I2=13%, fixed-effect), Tocilizumab also show efficacy on mortality risk reduction for severe-critical disease (RR=0.90 (95%CI 0.83-0.97), I2=12%, fixed-effect)), need for mechanical ventilation (RR=0.76 (95%CI 0.62-0.94), I2=42%, random-effects), and hospital discharge (RR=1.07 (95%CI 1.00-1.14), I2=60%, random-effects). Bamlanivimab monotherapy did not reduce viral load (SMD=-0.07 (95%CI-0.21-0.07), I2=44%, fixed-effect). Monoclonal antibodies did not differ from placebo/ standard therapy for hospital discharge at day 28-30 (RR=1.05 (95%CI 0.99–1.12), I2=71%, random-effects) and safety (RR=1.04 (95%CI 0.76–1.43), I2=54%, random-effects). Conclusion: Tocilizumab should be used for severe to critical COVID-19 because it is not harmful and can improve mortality risk, mechanical ventilation, and hospital discharge. Bamlanivimab-Etesevimab and REGN-COV2 reduced viral load in mild-moderate outpatients

Effectiveness of COVID-19 Vaccines against SARS-CoV-2 Omicron Variant (B.1.1.529):A Systematic Review with Meta-Analysis and Meta-Regression

Vaccine effectiveness (VE) and the urgency of booster vaccination against SARS-CoV-2 Omicron variant need evaluation. A systematic search was conducted from 1-6 April, 2022. VE difference (VED) estimates were assessed using random-effects and meta-regression analyses were performed for evaluating VE over time. Compared to full dose, booster dose of overall vaccines provided better protection against any and severe Omicron infections within 3 months (p &lt; 0.001), and within 3 months or more in any, severe, and symptomatic infections (p &lt; 0.001). From meta-regression analysis of overall vaccines, the full-dose VE against any and symptomatic Omicron infections reduced per month by 2.45% and 5.5%, respectively; whereas booster dose effectiveness against any and symptomatic Omicron infections reduced per month by 1.79% and 1.14%, respectively. The VE estimates of booster dose provide excellent protection against symptomatic infection compared to full dose. The VE estimates of Ad26.COV2.S, BNT162b2, ChAdOx1 nCov-19, and mRNA-1273 against Omicron infection are generally moderate, despite the VE estimates declining over time

The Role of Plasma Interleukin-6 Levels on Atherosclerotic Cardiovascular Disease and Cardiovascular Mortality Risk Scores in Javanese Patients with Chronic Kidney Disease

Interleukin-6 (IL-6) has been identified as an important pro-inflammatory factor involved in mediating the severity of chronic kidney disease (CKD). This study sought to determine the effect of plasma IL-6 levels on atherosclerotic cardiovascular disease (ASCVD) and cardiovascular mortality risk scores in Javanese CKD patients. We also analyzed the frequency of IL-6 G174C single nucleotide polymorphism (SNP) in the population. This study was a cross-sectional study involving seventy-three patients of Javanese ethnic origin with stable chronic kidney disease. We assessed the ASCVD risk score, cardiovascular mortality score, genotyping of IL-6 G174C SNP, and plasma IL-6 levels in these patients. The genotype distribution and allele frequencies of the IL-6 G174C SNP were predominated by the G genotype/allele (GG: 97.26%, GC: 1.37%, CC: 1.37%, G-allele: 97.95%, and C-allele: 2.05%). Despite the fact that plasma IL-6 levels did not directly affect cardiovascular mortality risk, further analysis revealed its direct effect on the ASCVD risk score (path coefficient = 0.184, p = 0.043, 95% CI = 0.018&ndash;0.380), which in turn affected cardiovascular mortality risk (path coefficient = 0.851, p = &lt;0.01, 95% CI = 0.714&ndash;0.925). In conclusion, plasma IL-6 levels play important roles on ASCVD risk and cardiovascular mortality risk in Javanese patients with CKD

Impact of COVID-19 Lockdown on the Metabolic Control Parameters in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background: Abrupt implementation of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic affected the management of diabetes mellitus in patients worldwide. Limited access to health facilities and lifestyle changes potentially affected metabolic parameters in patients at risk. We conducted a meta-analysis to determine any differences in the control of metabolic parameters in patients with diabetes, before and during lockdown. Methods: We performed searches of five databases. Meta-analyses were carried out using random- or fixed-effect approaches to glycaemic control parameters as the primary outcome: glycosylated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), time-in-range (TIR), time-above-range (TAR), time-below-range (TBR). Mean difference (MD), confidence interval (CI), and P Value were calculated. Lipid Profile was a secondary outcome and is presented as a descriptive analysis. Results: Twenty-one Studies enrolling a total of 3,992 patients With type 1 or Type 2 diabetes Mellitus (T1DM Or T2DM) Were included in the study. Patients With T1DM Showed a significant improvement of TIR and TAR (MD=3.52% [95% CI, 0.29 to 6.74], I 2 =76%, P=0.03; MD=–3.36% [95% CI, –6.48 to –0.25], I 2 =75%, P=0.03), while FBG among patients with T2DM significantly worsened (MD=3.47 mg/dL [95% CI, 1.22 to 5.73], I 2 =0%, P<0.01). No significant difference was found in HbA1c, RBG, and TBR. Use of continuous glucose monitoring in T1DM facilitated good glycaemic control. Significant deterioration of lipid parameters During lockdown, particularly triglyceride, was observed. Conclusion: Implementation Of lockdowns during the COVID-19 Pandemic did not worsen glycaemic control in patients with diabetes. Other Metabolic parameters improved during lockdown, though lipid parameters, particularly triglyceride, worsened

Clinical outcomes of opioid administration in acute and chronic heart failure: A meta-analysis

BACKGROUND AND AIMS: Opioid use in heart failure (HF) management is controversial, and whether rapid symptomatic relief outweighs the risks of opioid use in HF remains unknown. This study aimed to explore the clinical outcomes of opioid administration in patients with acute or chronic HF. METHODS: A systematic search for eligible studies was conducted in databases (MEDLINE, Scopus, Web of Science, EBSCO) and registries (ClinicalTrials.gov, WHO Clinical Trial Registry) until June 8, 2022. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) or standardized MD were quantified for binary and continuous outcomes, respectively. Meta-regression was performed using the restricted maximum likelihood method. RESULTS: A total of 20 studies (154,736 participants) were included. In acute HF, opioid use presented a high risk for in-hospital mortality (OR = 2.35; 95% confidence interval (CI): 1.03-5.38; I2 = 97%), invasive (OR = 2.78; 95%CI: 1.17-6.61; I2 = 93%) and noninvasive (OR = 2.97; 95%CI: 1.06-8.28; I2 = 95%) ventilations, intensive care unit admission (OR = 3.62; 95%CI: 3.11-4.21; I2 = 6%), and inotrope use (OR = 2.54; 95%CI: 1.94-3.32; I2 = 63%). In chronic HF New York Heart Association (NYHA) Class II/III, opioid use improved ventilatory efficiency (MD = -3.16; 95%CI: (-4.78)-(-1.54); I2 = 0%), and exercise test duration (MD = 69.24; 95%CI: 10.11-128.37; I2 = 89%). CONCLUSIONS: Opioids are not recommended for acute HF management; however, they showed an advantage in exercise testing by improving ventilatory efficiency, chemosensitivity, and exercise test duration in stable patients with chronic HF NYHA Class II/III. Nonetheless, larger randomized controlled trials and individual patient-level data meta-analyses are warranted

Ozone as an adjuvant therapy for COVID-19:A systematic review and meta-analysis

OBJECTIVE: Ozone adjuvant in COVID-19 management showed conflicting results in prior studies. Here, we aimed to comprehensively evaluate benefits and side effects of ozone as adjuvant therapy in COVID-19 patients. METHODS: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and ProQuest for articles investigating ozone as adjuvant therapy in COVID-19. Clinical and laboratory outcomes, mortality, length of hospital stay, intensive care unit (ICU) admission, and adverse events were assessed. RESULTS: Thirteen studies were included in this review. Case-control studies, but not randomized controlled trials (RCTs), showed a decrease in mortality following ozone therapy (OR = 0.24 (95% CI [0.07–0.76]), p = 0.02, I(2) = 0%, fixed-effect). However, ozone therapy did not improve the length of hospital stay (SMD = -0.99 (95 %CI −2.44 to 0.45), p = 0.18, I(2) = 84%, random-effects) and ICU admission (RR = 0.57 (95 %CI [0.05–6.71]), I(2) = 73%, p = 0.65, random-effects). Consecutive case control studies suggested that ozone therapy significantly improved levels of D-dimer (p = 0.0060), lactate dehydrogenase (LDH; p = 0.0209), C-reactive protein (CRP; p = 0.0040) and interleukin (IL)-6 (p = 0.0048) as compared to standard therapy alone. CONCLUSIONS: The beneficial effect of ozone in COVID-19 management seems to be limited to the improvements of laboratory parameters among severe patients, including the reduction of IL-6, LDH, CRP, and D-dimer levels. Meanwhile, other study endpoints, such as mortality, length of stay and ICU admission, were not improved following ozone therapy, although it may partly be due to a shorter duration of viral clearance. Furthermore, no serious adverse event was reported following ozone therapy, suggesting its high safety profile. (PROSPERO ID: CRD42021278018