Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials

Background The role of corticosteroids in the treatment of community-acquired pneumonia (CAP) remains uncertain. We conducted an updated meta-analysis to investigate the effectiveness and potential effect modifiers of adjunctive corticosteroids in patients with CAP. Methods The protocol of this meta-analysis was registered with PROSPERO (CRD42022354920). We searched MEDLINE, Embase, the Cochrane Library and trial registers from inception till March 2023 to identify randomized controlled trials (RCTs) investigating corticosteroids in adult patients with CAP. Our primary outcome was the risk of all-cause mortality within 30 days after randomization (if not reported at day 30, we extracted the outcome closest to 30 days). Risk ratios (RR) and mean differences (MDs) were pooled under a random-effects model. Results Fifteen RCTs (n = 3252 patients) were included in this review. Corticosteroids reduced the risk of all-cause mortality in CAP patients (RR: 0.69, 95% CI: 0.53–0.89; high certainty). This significant result was restricted to hydrocortisone therapy and patients with severe CAP. Additionally, younger patients demonstrated a greater reduction in mortality. Corticosteroids reduced the incidence of shock and the need for mechanical ventilation (MV), and decreased the length of hospital and ICU stay (moderate certainty). Conclusions Corticosteroids reduce the risk of all-cause mortality, especially in younger patients receiving hydrocortisone, and probably decrease the need for MV, the incidence of shock, and the length of hospital and ICU stay in patients with CAP. Our findings indicate that patients with CAP, especially severe CAP, will benefit from adjunctive corticosteroid therapy

Risk factors associated with gallstone disease in women

Background & aims: Gallstone disease in middle-aged women has been increasing due to changing dietary and environmental factors varying from country to country. The aim of the study was to determine the risk factors associated with gallstone disease in women aged ≥35 years of the district of Peshawar, Pakistan. Study design: A hospital-based case-control study. Methods: One hundred and ten women (55 cases and 55 controls) attending the Surgical Departments of two Government hospitals were enrolled for the study. All subjects were screened for ultra-sonography; biochemical and anthropometric measurements. They were interviewed for their past medical history; physical activity; 24-hr dietary recall and for demographic and socio-economic characteristics. Data were analyzed using Student's t-test, chi-square and multivariate conditional logistic regression to determine mean differences between the continuous variables; establish association between the categorical variables and to determine risk factors associated with gallstone disease, respectively. Results: Of 55 cases, 15 (27%) had a family history of gallstone disease. Thirty five percent of the cases had a single calculus while 65% had multiple calculi with mean size of 14.85 ± 14.46 mm. Conditional logistic regression analysis demonstrated that the body mass index was the most significant risk factor for women's gallstone disease. The adjusted odds ratio for women's BMI ≥ 25 kg/m 2 was 2.93 (95% CI: 1.43-6.01), indicating almost a three times higher risk of gallstone disease than women with BMI < 25 kg/m 2. The risk of gallstone disease was higher for women with low vitamin C intake (OR = 0.27; 95% CI: 0.08-0.91) and low physical activity (OR = 0.48; 95% CI: 0.24-0.96) than women with more physically active (score > 1.3) and having dietary vitamin C intake ≥ 75 mg per day. Conclusion: High body mass index, physical inactivity and low vitamin C intake are associated with gallstone disease in Pakistani women. Longitudinal studies are needed to confirm these findings. © 2012 European Society for Clinical Nutrition and Metabolism

Novel Coronavirus (2019-NCOV) Outbreak: A Mini Review

The SARS pandemic produces new avenues to discover and anticipate the variations made in SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) and how human angiotensin converting enzyme 2 receptor ideally becomes congenial with &ldquo;S&rdquo; region of this virus and in consequence ofits spread in human species all over the globe. At the end of 2019, the earliest wave of SARS-CoV-2 transmission was notified from Wuhan-Hubei China and thereafter spread globally. COVID-19 infection got widespread and upto now, 2,776,224 active cases, 334,058 deceased and 2,078,505-recovered cases have been reported. Morbidity and mortality rate vary in every region which pondered the researcher to look into the linkage between a different variant of the SARS-CoV-2 with disease severity along with other determining factors like climatic changes, diagnostic techniques, hospitals and laboratory quality control measures.</p

DOACs or VKAs or LMWH - what is the optimal regimen for cancer-associated venous thromboembolism? A systematic review and meta-analysis

Background: Clinical guidelines have supported the use of direct anticoagulants (DOACs) for the treatment of cancer-associated venous thromboembolism (Ca-VTE). However, recent trials have reported increased bleeding risks associated with DOACs usage, raising concerns regarding its efficacy. Objectives: The authors conducted a meta-analysis to study the efficacy and safety of DOACs for the treatment of VTE in cancer patients, compared with Low-weight molecular heparin (LMWH) and Vitamin-K antagonists (VKAs). Methods: PubMed, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL) were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from inception to June 17th, 2021.The primary outcomes studied were VTE recurrence and major bleeding. Results: A total of 8 randomized controlled trials (RCTs) enrolling almost 7000 patients were included. Direct oral anticoagulants significantly reduced VTE Recurrence in cancer patients when compared to patients treated with LMWH or VKAs (Hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.46-0.83; P = 0.002; I2 = 26%). There were no statistically significant differences for major bleeding (HR 0.86, 95% confidence interval [CI] 0.56-1.33; P = 0.50; I2 = 34%), clinically relevant non-major bleeding (HR 1.23, 95% confidence interval [CI] 0.79-1.91; P = 0.35; I2 = 66%), pulmonary embolism (HR 0.71, 95% confidence interval [CI] 0.47-1.06; P = 0.10; I2 = 7%), and all-cause mortality (HR 0.98, 95% confidence interval [CI] 0.86-1.12; P = 0.78; I2 = 1%), between DOACs and LMWH. Conclusion: This analysis shows that DOACs are the optimal regimen to treat Ca-VTE. They have a similar to slightly increased bleeding risk compared with LMWH and are a safer alternative to VKAs.</p