Background:

We conducted a meta-analysis to assess the impact of gastrectomy versus endoscopic submucosal dissection for early stomach cancer.

There are-now-a-variety-of-viewpoints-on-gastrectomy-versus-endoscopic-submucosal-dissection-for-early-stomach-cancer,-and-there-are-not-many-thorough-assessments-that-are-pertinent.

Methods:

A-systematic-literature-search-up-to-July-2022-was-performed-and-2456-related-studies-were-evaluated.-The-chosen-studies-comprised-15461-early-stomach-cancer-subjects-who-participated-in-the-selected-studies'-baseline-trials;-6503-of-them-used-the-endoscopic-submucosal-dissection, while 8958 used gastrectomy. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of the gastrectomy versus endoscopic submucosal dissection for early stomach cancer by the dichotomous, and contentious methods with a random or fixed effect model.

Results:

The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survivals (OR, 0.59; 95% CI, 0.45-0.77, p<0.001), lower the 5-year overall survival in propensity score-matched patients (OR, 0.49; 95% CI, 0.41-0.59, p<0.001), higher recurrences (OR, 6.99; 95% CI, 5,03-9.70, p<0.001), and higher synchronous lesion (OR, 7.24; 95% CI, 2.78-18.83, p<0.001), and higher metachronous lesion (OR,10.05; 95% CI, 6.44-15.67, p<0.001) compared to the gastrectomy for early stomach cancer.

However, no significant difference was found between submucosal dissection and gastrectomy for early stomach cancer in recurrence-free survival (OR, 0.74; 95% CI, 0.54-1.00, p=0.05), disease-free survival (OR, 0.43; 95% CI, 0.16-1.16, p=0.10), and disease-specific survival (OR, 1.05; 95% CI, 0.38-2.89, p=0.92).

Conclusions:

The use of endoscopic submucosal dissection resulted in significantly lower 5-year overall survival, lower 5-year overall survival in propensity score-matched patients, higher recurrences, higher-synchronous lesion, and higher metachronous lesion, however, no significant difference was found in recurrence-free survival, disease-free survival, and disease-specific survival compared to the gastrectomy for early stomach cancer. The small number of studies in several comparisons calls for care when analyzing the results.

Background:

The objective of this research endeavor was to assess the effects of rosiglitazone (RSG) and ursolic acid (UA) on hepatic insulin signaling indicators and inflammatory marker concentrations in C57/BL/6J mice that were provided with a high-fat diet (HFD).

Methods:

C57BL/6J mice were fed a HFD for 16 weeks and orally administered UA (5 mg/kg BW), RSG (4 mg/kg BW), and UA (5 mg/kg BW) + RSG (4 mg/kg BW) for the last 6 weeks.

Results:

The HFD groups showed a significant increase in leptin, TNF-α, and IL-6, whereas adiponection level significantly decreased. The expression of insulin signaling markers in the liver also significantly increased in HFD mice.

Conclusions:

Combination treatment improves above said parameters than individual parameters. These data suggest that combination treatment (UA with RSG) has potential benefits for the treatment of HFD-induced insulin resistance, and its effects may be associated with improvements in the inhibition of the expression of inflammatory markers in plasma and liver.

The pyrrolizine nucleus is a bicyclic ring system that consists of a pyrrole ring fused to another pyrrolidin ring. It constitutes the basic skeleton in many natural and synthetic compounds with diverse biological activities such as the anti-inflammatory, nootropic, antiemetic, antibacterial, antiviral, anticonvulsant, antiarrhythmic, and anticancer activities. At least two of these derivatives, ketorolac and mitomycin C, have been approved for the treatment of inflammation and cancer, respectively. Licofelone, a dual inhibitor of COX and 5-LOX, was also evaluated in clinical trials for the treatment of osteoarthritis. On the other hand, a large number of the pyrrolizine-based derivatives have displayed anticancer activity against different types of cancer cells. In this review, the pyrrolizine-based derivatives with anticancer activity were classified based on their chemical structure into substituted, fused, and spiro-pyrrolizine. The mechanisms of action of these compounds included alkylation of the DNA, inhibition of COX, or alteration of the permeability of the cytoplasmic membrane in cancer cells. In addition, other pyrrolizines were found to act by inhibiting DNA replication, rRNA, Rac1 kinase, thioredoxin reductase, or oncogenic kinases. The last section of this review also focuses on the reported X-ray crystal structures of these compounds with different proteins. The binding modes and interactions of ketorolac and licofelone were illustrated in this review. To sum up, we anticipate that the data compiled in this review will be useful to researchers in the design of pyrrolizines with potent biological activities.

Background: The objective of this study was to compare the cost of outpatient ferric carboxymaltose (FCM; Ferinject®) versus Iron sucrose complex (ISC; Ferosac®), two prevalent intravenous iron therapy used in the treatment of iron-deficiency anemia (IDA) in the Kingdom of Saudi Arabia (KSA) from a tertiary care hospital perspective.

Methods: A retrospective study was performed for all patients who were administered FCM in the outpatient clinical setting at Prince Sultan Military Medical City from January 1, 2019, until December 31, 2019. The descriptive data was analyzed using Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA, USA). The total cost of treatment reflected the cost of drugs, the cost of disposables for each infusion, drug monitoring costs during infusion, the cost of productivity loss, and patient traveling cost.

Result: Overall, 993 patients with IDA, treated with FCM in 1,688 outpatient visits were recruited in the study. In the outpatient setting, the per annum cost of treatment was SAR 1,434,092.50 with FCM treatment and SAR 1,715,299.70 with ISC treatment, with a corresponding saving of 16.4% (SAR 281,207.20) with FCM. The cost savings with FCM treatment can be attributed to the reduced frequency of patient visits and corresponding reduction in drug monitoring costs (SAR 266,995.20;77.3%), loss of productivity per year (SAR 163,550.20; 77.3%), and cost of transportation per year (SAR 573,920.00; 77.3%).

Conclusion: The use of FCM, as opposed to ISC resulted in a reduced number of iron infusions (4.4 visits for ISC as compared to one visit for FCM), accompanied by a reduction in the total cost. FCM may represent a cost-saving option compared with the existing alternative therapy used for the management of IDA in KSA.

Backgrounds:

This study aims to determine the relation between ABO and RhD and the prevalence and severity of COVID-19 disease.

Methods:

Data of 495 SARS-CoV-2 infected patients admitted to hospitals were collected. The ABO and RhD were determined for each patient to detect any possible relation between the prevalence of SARS-CoV-2 infection and each blood group. The patients were followed up to determine oxygen saturation and surveillance outcome (died or improved) to detect any possible relation between the severity of COVID-19 disease and each blood group.

Results:

A+ blood group was found to have a percentage of 32.3%, O+ to have a percentage of 30.3%, B+ to have a percentage of 21.2%, and AB+ to have a percentage of 10.1%. 19% of all the patients died. 20% of the dead patients were with O+ blood group, 60.5% were with A+ blood group, 10% with B+ blood group and 5% were with O- blood group.

The mean ± SD oxygen saturation on hospital admission was 94.2 ± 6.2% for the patients with O+ blood group, 91.06 ± 7.5% for the patients with A+ blood group, 92.8 ± 6.9% for the patients with B+ blood group, 93.4 ± 3.5% for the patients with AB+ blood group, and 94.5 ± 5.9% for the patients with O- blood group.

Conclusion:

Blood group A+ was the most common in the COVID-19 patients followed by O+ then B+ then AB+. Patients with blood group A+ had the worst oxygen saturation at hospital admission and had a higher mortality rate.

Background:

We performed a meta-analysis to evaluate the effects of dual antithrombotic treatment (DATT) including direct oral anticoagulants (OAs) versus triple antithrombotic (TAT) with vitamin K antagonist on bleeding and ischemic results in atrial fibrillation (AF) after percutaneous coronary intervention.

Methods:

A systematic literature search up to April 2021 was done and 5 studies included 8019 subjects with AF using antithrombotic treatment after percutaneous coronary intervention at the start of the study; 4325 of them were using DATT and 3694 were using TATs. They were reporting relationships between the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention using the dichotomous method with a random or fixed-effect model.

Results:

Dual antithrombotics had significantly lower major bleeding (OR, 0.58; 95% CI, 0.51-0.66, p<0.001), and thrombolysis in myocardial infarction major and minor bleeding (OR, 0.49; 95% CI, 0.36-0.67, p<0.001) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention.

However, antithrombotics had no significantly difference in all-cause mortality (OR, 1.08; 95% CI, 0.88-1.33, p=0.46), cardiovascular mortality (OR, 1.07; 95% CI, 0.83-1.38, p=0.63), myocardial infarction (OR, 1.16; 95% CI, 0.92-1.46, p=0.01), stent thrombosis (OR, 1.42; 95% CI, 0.94-2.12., p=0.09), and stroke (OR, 0.86; 95% CI, 0.59-1.25, p=0.42) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention.

Conclusions:

Dual antithrombotics may have a lower risk of major bleeding, and thrombolysis in myocardial infarction major and minor bleeding compared to TATs in subjects with AF using antithrombotic treatment after percutaneous coronary intervention. However, antithrombotics had no significant difference in all-cause mortality, cardiovascular mortality, myocardial infarction, stent thrombosis, and stroke compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention. Furthers studies are required to validate these findings.

Background

Cardiac implantable electronic devices (CIED) represent established life-sustaining interventions for various cardiac conditions, but post-placement infections are associated with high morbidity and mortality. Although pre-procedural antibiotic prophylaxis effectively reduces CIED infection rates, limited data exist on post-procedural antibiotic use, especially beyond 24 hours. This study assesses the efficacy of post-procedural antibiotic usage in preventing CIED placement-related infections.

Methods

We conducted a systematic review and meta-analysis, including studies that examined the comparative outcomes among patients. The study cohorts were divided into two groups: (1) those who underwent preoperative antibiotic prophylaxis followed by a continuation of 24 hours or more postoperatively (intervention group); and (2) those who received either preoperative-only antibiotic prophylaxis or preoperative prophylaxis with a duration of less than 24 hours postoperatively (control group). Risk of bias was assessed with ROBINS-I and ROB-2 tools. Risk ratio (RR) was pooled using random-effect or fixed-effect meta-analyses with inverse variance method.

Results

Our analysis of ten studies, including four randomized controlled trials and six cohort studies with 27,375 participants, revealed no statistically significant differences in outcomes between two groups. These outcomes included (CIED) infection rates (RR 0.83, 95% CI 0.47, 1.44), mortality (RR 1.22, 95% CI 0.66, 2.25), pocket hematoma (RR 1.01, 95% CI 0.54, 1.92) and re-intervention (RR 0.71, 95% CI 0.20, 2.50). The larger randomized controlled trial had an obvious impact on the overall findings.

Conclusions

The present systematic review and meta-analysis found no advantage in extending postoperative antibiotic prophylaxis for more than 24 hours following (CIED) implantation. These findings align with prevailing guidelines which support antibiotic stewardship practices. This approach has the ability to reduce adverse drug events, curb the potential for antibiotic resistance and alleviate the financial burdens associated with prolonged postoperative antibiotic prophylaxis.

Background: Measurement of educated people knowledge about COVID-19 is important to enhance health measures to reduce the rate of infection. Also, knowing the most usable source of data for the public is important point for enhancing the public awareness about the disease. Hence, this study aimed to evaluate the awareness and the practices related to COVID-19 among educated people.

Methods: 360 participant received a questionnaire that was divided into several parts aimed at collecting data about participant awareness regarding COVID-19. Data collected using a designed questionnaire; to evaluate the knowledge related to COVID-19. The questionnaire was classified into 6 parts covering all aspects of COVID-19 awareness data. The first part was to evaluate the respondent’s general knowledge [6 items]; the second was to evaluate symptoms knowledge [1 item]; the third was to evaluate transmission knowledge [2 items]; the fourth was to evaluate preventive knowledge [4 items]; the fifth was to evaluate treatment knowledge [2 items] and the sixth was indicted the main source of gathering information about the disease [1 item].

Results: A total of 360 participants participated, 91% of them know the main clinical symptoms of COVID-19. 86% believed that following preventive measures (the etiquette of sneezing, coughing, personal hygiene or wearing a mask) reduce infection transmission. More than 90 % of participants used the social media for gathering information about the disease, while highly educated (Master and PhD holders) used the published articles as a source for their knowledge, however they represent a few percent of the participant.

Conclusion: Overall, the study participants had good knowledge about COVID-19, however, more efforts are needed to maximize the awareness of the public. Further clinical study is required to evaluate the effect of such good knowledge on decreasing the infection rate.