Issue 2 (October)

Background

Most patients infected with COVID-19 experienced cold-like symptoms. Some other patients developed more serious symptoms such as pneumonia. N-Acetylcysteine ​​(NAC) is known to be effective against acute respiratory distress syndrome (ARDS) due to its anti-inflammatory and antioxidant properties. The effect of NAC on hospitalized COVID-19 patients was unknown. Therefore, this meta-analysis aimed to establish a relationship between the effects of NAC and non-NAC protocols in inpatients with COVID-19.

Method

By March 2022, a systemic review was conducted to assess the effects of NAC and non-NAC in inpatients with COVID-19. The clinical trials were identified in 20553 subjects admitted with COVID-19 at baseline. 2909 was treated with NAC and 17644 was treated without NAC. This study attempts to compare the effects of NAC and non-NAC in COVID-19 patients hospitalized with pneumonia. Statistical analysis uses the dichotomous method as a tool for odds ratio (OR) at  95% confidence interval (CI) to assess the effectiveness of NAC and non-NAC in COVID-19 patients hospitalized with pneumonia in random or fixed-effect model.

Results

Patients managed with NAC had fewer days in the ICU (OR, 2.79; 95% CI, -1.11-6.69, p = 0.16), lower mortality (OR, 0.69; 95% CI, 0.40-1.20, p = 0.19), and fewer number needed mechanical ventilation (OR, 0.74; 95% CI, 0.25-2.21, p = 0.59) compared with non-NAC in COVID-19 subjects hospitalized with pneumonia.

Conclusion

NAC has decreased the days stayed in the ICU, number of deaths, and number of patients needed mechanical ventilation in COVID-19 hospitalized with pneumonia, although, this difference was insignificant. Further studies are required that could affect the level of significance.

Coronavirus disease 2019 (COVID-19); caused by the novel coronavirus (SARS-CoV-2) is the talk of everyone all over the world in 2020 since it has been considered as a public health emergency of international concern by WHO in 30^th January, 2020. COVID-19 is a highly transmittable disease with different symptoms which can vary from mild to severe and life threatening. Scientists all over the world are working on finding a treatment or vaccine for this disease. All of these studies are currently not finished yet during writing this review. However, in this review a summary about the current status of these studies is given. This summary includes medicinal plants and natural products, antivirals like remdesivir, favipiravir, oseltamivir and nelfinavir as well as other miscellaneous drugs like chloroquine, hydroxychloroquine and ivermectin which showed promising results in treating COVID-19. In conclusion, the review recommends conducting further investigations worldwide and reporting them in peer-reviewed publications to aid in improving the drugs’ dosing regimens and clinical studies.

Diloxanide furoate (DXF) and Metronidazole (MTZ) are commonly combined as a binary mixture for the treatment of a variety of diseases brought on by bacteria and parasites including amoebiasis and giardiasis. Different analytical methods were established for determination of both DXF and MTZ, However, only one chemometric spectrophotometric method was established for their stability indicating determination which involves problematical steps and specific software program. Herein, double divisor ratio spectra derivative (DDRSD) method is exploited for quantification of DXF and MTZ in presence of DXF-degradation products (FUR and DEG). The recommended DDRSD method is linear over the range of 2–25 and 1–25 µg/mL for DXF and MTZ, correspondingly. Additionally, the suggested method was effectively employed to their pharmaceutical formulations with good findings. Besides, the recommended DDRSD method was validated conforming to ICH guidelines. The introduced DDRSD method is simple, selective, and economic and could be implemented for quality control samples of the studied drugs.

Background

We performed a meta-analysis to evaluate the effects of neuraxial anesthesia compared to general anesthesia on postoperative results in hip fracture surgery subjects.

Methods

A systematic literature search up to January 2021 was done and 20 studies included 298785 subjects with hip fracture surgery at the start of the study; 80783 of them were under neuraxial anesthesia, and 218002 of them were under general anesthesia. They were reporting relationships between the effects of neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery using the dichotomous or continuous method with a random or fixed-effect model.

Results

Neuraxial anesthesia in subjects with hip fracture surgery was significantly related to lower acute myocardial infarction (OR, 0.73; 95% CI, 0.54-0.99, p=0.04), hypotension (OR, 0.37; 95% CI, 0.20-0.70, p=0.002), and postoperative cognitive dysfunction postoperative 1day (OR, 0.27; 95% CI, 0.17-0.42, p<0.001) compared to general anesthesia.

However, no significant difference was found between neuraxial anesthesia and general anesthesia in subjects with hip fracture surgery in a postoperative cognitive dysfunction postoperative 7days (OR, 0.64; 95% CI, 0.37-1.09, p=0.10), pneumonia (OR, 0.69; 95% CI, 0.29-1.62, p=0.39), length of hospital stay (MD, 0.75; 95% CI, -1.39-2.90, p=0.49),  deep venous thrombosis (OR, 1.21; 95% CI, 0.50-2.95, p=0.68), 30-day mortality (OR, 1.12; 95% CI, 0.53-2.34, p=0.77), blood loss (MD, -57.47; 95% CI, -123.36-8.41, p=0.09), and delirium (OR, 0.98; 95% CI, 0.32-2.49, p=0.96).

Conclusions

Neuraxial anesthesia in subjects with hip fracture surgery may decrease the risk of acute myocardial infarction, hypotension, and postoperative cognitive dysfunction postoperative 1 day compared to general anesthesia. Furthers studies are required to validate these findings.

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.