Neck Circumference in Polycystic Ovary Syndrome: A Systematic Review and Bootstrapped Meta-Analysis with GRADE Approach.

INTRODUCTION: Our aim was to perform a systematic review and meta-analysis for the association of neck circumference (NC) in polycystic ovary syndrome (PCOS) patients as compared to non-PCOS controls. METHODS: Primarily the PubMed/MEDLINE database and others such as SCOPUS, Google Scholar, Cochrane Library, were searched up to November 15, 2023 for observational studies comparing NC in PCOS versus non-PCOS women. The mean and SD values of NC and other covariates in PCOS and control groups were extracted by two independent reviewers, and the quality and risk of bias assessment was done using Newcastle-Ottawa Scale. The meta-analysis employed combined standardized mean differences (SMD) with 95% confidence intervals (CI) to compare NC between PCOS patients and controls. The heterogeneity and validity were addressed by subgroup, meta-regression, and sensitivity analyses. We conducted a Bootstrapped meta-analysis using 1,000 and 10,000 simulations to test the accuracy of the obtained results. The certainty of evidence was assessed by the GRADE approach. RESULTS: Our meta-analysis included 9 observational studies. The PCOS patients showed significantly higher NC values than the non-PCOS controls (SMD: 0.66, 95% CI: 0.41-0.91, p < 0.0001). In the bootstrap meta-analysis, the accuracy of the observed findings was proved (SMD = 0.66, 95% CI = 0.42-0.91) for the NC outcome. No publication bias was detected in the funnel plot analysis using Begg's and Egger's tests. The 95% prediction interval of 0.036-1.28 suggests that the true outcomes of the studies are generally in the same direction as the estimated average outcome. The sensitivity analysis provided the robustness of the outcome, and no single study was overly influential on the pooled estimate. CONCLUSION: This meta-analysis provides accurate evidence for significantly higher NC values in PCOS as compared to non-PCOS controls. There is no sufficient evidence on the diagnostic accuracy measures for NC in PCOS. Hence, further research on its diagnostic utility in PCOS is needed.

Pen and palm model to envision the coexistence of induced-fit and substrate-strain theories of enzyme action.

Competency-based physiology and biochemistry education can benefit from the creative integration of imaginative narratives into traditional teaching methods. This paper proposes an innovative model using a pen and palm analogy to visualize enzyme function theories. The pen (substrate) must fit snugly into the palm (enzyme's active site) for catalysis to occur, akin to induced-fit theory. Pressing the pen's top button with the thumb represents the strain needed to convert substrate (pen with nib inside) into product (pen with nub out, ready to write). By leveraging everyday objects creatively, students can enhance their understanding and engagement with enzymatic reactions.NEW & NOTEWORTHY Understanding how enzymes work can be tricky, but a new teaching method using everyday objects like pens and palms helps make it easier. Two main theories explain this: the induced-fit model and the substrate-strain model. To visualize this, imagine a pen as the substrate and your palm as the enzyme. When you hold the pen with your fingers (induced-fit), it's like the enzyme changing shape to hold the substrate. Pressing the pen's button with your thumb (substrate-strain) is like the enzyme applying pressure to make the pen ready to write. This simple analogy helps students better understand these complex processes, making learning more engaging and accessible.

Technology-based tobacco cessation training in Indian context.

In tobacco use disorders (TUDs), technology-based training of health-care professionals can reduce the treatment gap and bring attitudinal change. The study aimed to assess the practices and determine the change in knowledge and attitude among health-care professionals following an online training program (OTP). Half-day OTP on tobacco cessation using prepost quasi-experimental study design with a structured questionnaire-based assessment was conducted. Among 293 completed surveys, knowledge post-OTP was higher but insignificant (P = 1.2). Post-OTP, participants felt less angry and disappointed toward tobacco users (mean of difference (MOD) =0.21, P = 0.0007); more sympathetic and concerned (MOD = -0.22, P = 0.0005); and acknowledged tobacco users deserve the same medical care as nonusers (MOD = -0.177, P = 0.001). Post-OTP scores in attitudes did not change significantly for the responsibility domain (P < 0.05). In practice, relatively greater number of health-care professionals asked about tobacco use and advised cessation, however lesser assessed, assisted, and referred. To conclude, technology-based training program can result in attitudinal changes toward tobacco users.

Markers of coagulation dysfunction and inflammation in diabetic and non-diabetic COVID-19.

Coagulation dysfunction and inflammatory status were compared between diabetic and non-diabetic COVID-19 patients. The standardized mean difference (SMD) and its 95% confidence interval (CI) was computed for the difference of inflammatory and hypercoagulability markers. The levels of serum ferritin (standardized mean difference-SMD: 0.47, CI 0.17-0.77, p = 0.002), C-reactive protein (SMD = 0.53, CI 0.20-0.86, p = 0.002), interleukin-6 (SMD = 0.31, CI 0.09-0.52, p = 0.005), fibrinogen (SMD = 0.31, CI 0.09-0.54, p = 0.007) and D-dimers (SMD = 0.54, CI 0.16-0.91, p = 0.005) were significantly higher in diabetic COVID-19 cases as compared to non-diabetic COVID-19 patients, suggesting more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm.

Adropin levels and its associations as a fat-burning hormone in patients with polycystic ovary syndrome: a correlational meta-analysis.

AIMS: Adropin is a peptide hormone with potential implications in patients with polycystic ovary syndrome (PCOS). The aim of this meta-analysis was to compare the circulating (serum/plasma) and follicular fluid adropin levels between human PCOS patients and non-PCOS controls. METHODS: Relevant studies were retrieved by online database and manual searching. The standardized mean differences (SMDs) with 95% confidence intervals (CIs) were obtained by a random-effects meta-analysis. Meta-analysis of correlations was performed for the associations of adropin with anthropometric, lipid, insulin resistance and hormonal covariates. The funnel plot analysis with Begg's and Egger's tests was used for publication bias. RESULTS: A total of 9 studies were included in this meta-analysis. The results indicated that the adropin levels were significantly decreased in PCOS patients as compared to non-PCOS controls (SMD = -1.87, 95% CI = -2.55 to -1.18, p < .0001). This decrease was more evident in overweight PCOS patients than their normoweight counterparts (SMD = -0.55, 95% CI = -0.80 to -0.30, p < .0001). A one-study leave-out sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. There were significant associations of decreased adropin levels with the body mass index, dyslipidemia and insulin resistance in PCOS. CONCLUSION: Adropin levels are significantly reduced in PCOS patients compared to controls, and this decrease was more evident in overweight PCOS patients.

Skin Autofluorescence as a Novel and Noninvasive Technology for Advanced Glycation End Products in Diabetic Foot Ulcers: A Systematic Review and Meta-analysis.

OBJECTIVE: Skin autofluorescence (SAF) has been suggested as a novel and noninvasive technique for assessing tissue accumulation of advanced glycation end products in diabetes and related complications. The aim of this systematic review and meta-analysis was to evaluate the use of SAF in diabetic foot ulcers (DFUs). DATA SOURCES: PubMed/MEDLINE and other digital databases. STUDY SELECTION: The authors included studies comparing the SAF levels in patients with DFU with a non-DFU group to determine its association with DFU risk. DATA EXTRACTION: Collected data included the SAF method and its values in DFU and non-DFU groups, covariates used in adjustment along with the unadjusted and/or multivariate adjusted odds ratios (ORs) for the association of SAF with DFU risk, and other study characteristics. DATA SYNTHESIS: A total of six studies were included in this meta-analysis. Five studies that involved 611 participants were included to compare SAF methods. Compared with the non-DFU group, the DFU group showed a significantly increased level of SAF (standardized mean difference, 0.67; 95% confidence interval [CI], 0.32-1.01; P < .001). The results of meta-analysis of ORs revealed that the increased SAF level was independently associated with increased DFU risk in both unadjusted (OR, 3.16; 95% CI, 2.18-4.57; P < .001) and adjusted models (OR, 3.07; 95% CI, 1.95-4.81; P < .001). CONCLUSIONS: These findings suggest that SAF could be useful as a novel and noninvasive technology to help determine DFU risk. However, further studies establishing its diagnostic and prognostic utilities are needed.

Barriers to the treatment of clubfoot in low- and middle-income countries: A guide to improve compliance.

The Ponseti method of clubfoot treatment is ideal for low- and middle-income countries since it is minimally invasive and easily implementable through non-surgeon providers. However, variables related to the socioeconomic status of the community, patient-related factors, treatment provider-related factors, and health system-related factors may influence the outcome of this deformity. These barriers need a two-pronged approach, a top-down (involvement at the policy level) as well as a bottom-up method (involvement at an individual level). Improving the knowledge level of the caregiver as well as the provider and addressing the issues regarding financial constraints will help in eliminating various barriers to the treatment of clubfoot. Furthermore, regular audits help in identifying the efficacy of various solutions employed as well as identifying new barriers to treatment. Integration at the policy level with the involvement of governmental as well as non-governmental organisations helps to remove health system-level bottlenecks.

Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study.

BACKGROUND: This study aimed to identify barriers and facilitators of iron and folic acid supplementation and deworming programs among school-going adolescents. METHODS: A mixed-method observational study was conducted among adolescents in the 8th to 10th standards and their teachers across four schools in Deoghar, Jharkhand, India, using simple random sampling. The study included a questionnaire on socio-demographics, knowledge (34 items) (α=0.894), attitudes (2 items) (α=0.711) toward iron deficiency anemia, awareness of the Weekly Iron and Folic Acid Supplementation (WIFS) program and deworming (20 items) (α=0.783), and practices related to iron folic acid supplementation (IFS) and deworming, along with qualitative components. Data were analyzed using jamovi. RESULTS: Compliance rates for IFS and deworming were 27.5% and 67.9%, respectively. The multivariable logistic regression analysis showed that sex, religion, caste, father's educational status, per capita monthly family income (PCMI), diet type, adequate knowledge, and positive attitude toward anemia influenced IFS compliance. Religion, PCMI, and prior information on the importance of deworming facilitate compliance. Implementation barriers included irregular medication supply and a lack of student awareness. CONCLUSION: Periodic evaluation, regular sensitization, and a consistent drug supply are necessary to effectively implement WIFS and deworming programs in the study area.

Otoendoscopy as a better preoperative predictor than pure tone audiometry for ossicular erosion in mucosal chronic otitis media.

OBJECTIVE: To compare the diagnostic accuracy of angled otoendoscopy with pure tone audiometry in predicting ossicular discontinuity in patients of mucosal chronic otitis media. METHODS: Ninety-four patients were included in this prospective study. A 2.7-mm 30° otoendoscope was used to examine ossicular status preoperatively. Hearing thresholds were recorded by pure tone audiometry. Intraoperative ossicular status was recorded as the gold standard. Otoendoscopic findings were recorded as per the criteria has been devised by the authors of this manuscript. RESULTS: Otoendoscopy was conclusive in 56 (59.6 per cent) patients, with 100 per cent sensitivity, 95.56 per cent specificity, 84.62 per cent positive predictive value, and 100 per cent negative predictive value in the conclusive group. Overall (in 94 patients), diagnostic test values of otoendoscopy were 73.33 per cent sensitivity, 97.47 per cent specificity, 84.62 per cent positive predictive value, and 95.06 per cent negative predictive value. As per the ROC curve, air-bone gap > 38.12dB had the optimal diagnostic test values, with 73 per cent sensitivity, 72 per cent specificity, 33.3 per cent positive predictive value, and 93.4 per cent negative predictive value. CONCLUSION: Angled otoendoscopy has better diagnostic accuracy (93.6 per cent) than pure tone audiometry (72.3 per cent; p < 0.001) for preoperative ossicular discontinuity prediction in patients of mucosal chronic otitis media.

Enhanced perioperative communication elevates patients' understanding, perception, and satisfaction for anesthesia services: Insights from a survey study.

Background and Aims: Anesthesiologists' services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient's knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services. Methodology: It was a single-center, cross-sectional survey involving 550 patients aged 18-65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients' baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant. Results: Less than half comprehended anesthesia's role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists' services, which might be attributable to the survey-based interaction. Conclusion: A significant need for more understanding regarding anesthesia and anesthesiologists' roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients' knowledge, comprehension, and satisfaction.

Prevalence and association between alcohol, tobacco, and COVID-19: a study from a tribal predominant district in eastern India.

Introduction: Alcohol and tobacco use has been proposed to significantly affect COVID-19 outcomes. The study aimed to estimate the prevalence of alcohol and tobacco use among COVID-19-positive patients and compare it with the general population prevalence rates. It also aimed to assess and determine the association between the severity of COVID-19 illness and the complications with alcohol and tobacco use. Method: For this, a cross-sectional, retrospective, telephone-based study was conducted using a structured questionnaire among COVID-19 diagnosed patients in the district of Deoghar of the Indian state of Jharkhand. A multinomial logistic regression is done to determine the association. Results: Among 1,425 patients interviewed, tobacco and alcohol were used by 22.31 and 9.96%, significantly more than the prevalence of tobacco (Z = 4.9485, p < 0.00001) and alcohol use (Z = 7.118, p < 0.00001), respectively, in the district (tobacco-11.7% and alcohol-4.8%).In a regression model, patients with co-morbidity had higher odds of severe [3.34 (1.99-5.62)] and moderate [2.95 (1.97-4.41)] COVID-19. Young [0.12 (0.04-0.38)] and middle-aged individuals [0.23 (0.13-0.4)], people below the poverty line 0.28 (0.11-0.69) are at lower odds of severe COVID-19. Tobacco users [1.58 (1.16-2.14)], alcohol users [1.53 (1.03-2.28)], incomplete vaccination [3.24 (1.49-7.01)], and patients with comorbidity [3.6 (2.79-4.68)] were found to have higher odds of post-COVID-19 complications. Discussion: People with COVID-19 in our study population had significantly higher tobacco and alcohol use compared to the general population. Tobacco and alcohol use significantly increases the risk of post-COVID-19 complications. The study highlights the need for addiction treatment services to prevent complications during future pandemics.

Postoperative Delayed Facial Nerve Palsy: A Surgeon's Nightmare.

The facial nerve supplies motor, sensory, and parasympathetic innervation to the head and neck, and its paralysis can have significant physical and psychological impacts. This study discusses a compelling case involving a 21-year-old male who developed delayed facial nerve palsy (DFNP) on the eighth day after cortical mastoid surgery. Through conservative management, the patient achieved a full recovery by the 52nd day. Our experience underscores the importance of approaching DFNP with patience, emphasizing the need for thorough counseling of both the patient and their family members.

Long-COVID-19 Impact in non-hospitalized patients: Sleep and quality of life 24 months after SARS-CoV-2 infection.

Background and Aims: Sleep disruption and reduced quality of life are common long coronavirus disease (COVID) manifestations, affecting survivors irrespective of initial COVID-19 severity. Limited research investigates symptoms beyond 24 months post-infection. We aimed to address this gap by longitudinally studying sleep patterns and overall quality of life in non-hospitalized adults, 24 months after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Methods: This prospective observational study involved the enrolment of 337 adult non-hospitalized patients in a consecutive fashion. Individuals with past COVID-19 (from 15 April 2020 to 30 June 2021) were examined at two Government hospitals and completed a telephone interview between 1 May 2023 and 30 June 2023, located in Jharkhand, India. Participants were queried about their sleep patterns and quality of life, utilizing the DSM5 LEVEL 2 and EQ-ED-5L tool, respectively. Results: Among 337 non-hospitalized participants, 212 completed the survey. Within this group (59.4% men, mean age 38), 36 (17.0%) experienced sleep impairment. All five dimensions of quality of life (QoL) were adversely affected in long COVID patients. Advanced age, high income, residing in rural or semi-urban areas, and having comorbidities were associated with a higher likelihood of decreased quality of life across various domains. Conversely, participants who were married, employed in healthcare or government positions, and vaccinated exhibited a reduced likelihood of experiencing lower quality of life. Conclusion: Long COVID-19 affects sleep and quality of life, with various demographic and clinical factors influencing outcomes. This study provides insights into the extended consequences of long COVID-19 and aids healthcare systems in addressing the challenges posed by this condition.

Effectiveness of Stem Cell Therapy for Diabetic Foot Ulcers: A Systematic Review and GRADE Compliant Bootstrapped Meta-Analysis of Randomized Clinical Trials.

Diabetic foot (DF) represents a severe complication of diabetes mellitus, imposing substantial psychological and economic burdens on affected individuals. This investigation sought to assess the therapeutic efficacy of stem cell interventions in the management of DF complications. A comprehensive systematic search across PubMed, Embase, CINAHL, Scopus, and the Cochrane library databases was conducted to identify pertinent studies for meta-analysis. Outcome measures encompassed ulcer or wound healing rates, amputation rates, angiogenesis, ankle-brachial index (ABI), and pain-free walking distance. Dichotomous outcomes were expressed as risk differences (RDs) with 95% confidence intervals (CIs), while continuous data were articulated as standardized mean differences (SMDs) with corresponding 95% CIs. Statistical analyses were executed using RevMan 5.3 and Open Meta, with bootstrapped meta-analysis conducted through OpenMEE software. A total of 20 studies, comprising 24 arms and involving 1304 participants, were incorporated into the meta-analysis. The findings revealed that stem cell therapy exhibited superior efficacy compared to conventional interventions in terms of ulcer or wound healing rate [RD = 0.36 (0.28, 0.43)], pain-free walking distance [SMD = 1.27 (0.89, 1.65)], ABI [SMD = 0.61 (0.33, 0.88)], and new vessel development [RD = 0.48 (0.23, 0.78)], while concurrently reducing the amputation rate significantly [RD = -0.19 (-0.25, -0.12)]. Furthermore, no statistically significant difference in adverse events was observed [RD -0.07 (-0.16, 0.02)]. The Grading of Recommendations, Assessment, Development, and Evaluation assessment indicated varying levels of evidence certainty, ranging from very low to moderate, for different outcomes. Bootstrapping analysis substantiated the precision of the results. The meta-analysis underscores the significant superiority of stem cell therapy over conventional approaches in treating DF complications. Future investigations should prioritize large-scale, randomized, double-blind, placebo-controlled, multicenter trials, incorporating rigorous long-term follow-up protocols. These studies are essential for elucidating the optimal cell types and therapeutic parameters that contribute to the most effective treatment strategies for DF management.

A Network Meta-Analysis of Randomized Controlled Trials on the Comparative Efficacy of Stem Cells Therapy for Diabetic Foot Ulcer Healing.

Stem cell therapy in diabetic foot ulcer has emerged as a promising treatment option to promote ulcer healing. This network meta-analysis was undertaken to evaluate how they compete with each other and their ranking with respect to chances of ulcer healing. A systematic search strategy to retrieve data from five databases, were used to identify potential studies. Randomized controlled trial or clinical controlled trial, published in English, using any type of stem cells as intervention in individuals aged over 18 years diagnosed with diabetic foot ulcers were included. This network meta-analysis was performed using frequentist method using R version 4.2.1. Eighteen clinical trials were included in the study which included 13 interventions. The study found that most of the stem cells were significantly promoting ulcer healing chances with human viable wound matrix (hVWM) [RR 2.91; CI: 1.28, 6.64], peripheral blood mononuclear cells (PBMNC) [RR 2.35; CI: 1.21, 4.55], bone marrow mesenchymal stem cells (BMMSCs) [RR 2.20; CI: 1.34, 3.60], were top three stem cell options among all. P score also suggested the same. Risk of bias study suggested that there was "some concern or "high risk'' among majority of studies. It is evident from this study that bone marrow mononuclear cells were found to be most effective in wound healing in cases of diabetic foot ulcer in that order. Though there was no significant difference between these and more studies were required to ascertain whether they differ in term of efficacy for the clinical outcome of ulcer healing.

Prevention of "bygone futures" due to road traffic injuries in children.

Road traffic injuries remain one of the common and leading causes of death among children and adolescents till the age of 19 years. Road safety is important for children since their physical activity, active travel, independence and development are largely affected by it. Solutions for road safety with benefits for people as well as an economy exist which should be implemented effectively and efficiently. These solutions which combine engineering, legislation and behavioural interventions should be implemented in an integrated Safe Systems Approach. The future of the children must be safeguarded from these injuries and every effort towards it being converted into "bygone figures" must be done diligently and honestly. The various risk factors and interventions possibly explained in this review article shall help in better understanding of the causes and possible guidelines at a policy level to prevent road traffic injuries in children.

Inventory Control Mechanism of the Pharmacy Store of a Recently Established National Institute in Eastern India: A Cross-Sectional, Investigative Analysis.

Background New establishments frequently face challenges. Pharmacy is integral to healthcare delivery institutes, and inventory management is crucial. The present study investigated the problems faced by the pharmacy of a newly established health institute and proposed relevant solutions to identify drugs needing stringent management control. Methods Responses were collected from seven pharmacists for questionnaires focusing on pharmacy problems and possible solutions. Always better control (ABC), vital essential desirable (VED), and ABC-VED matrix analysis were done on the drugs dispensed during the financial 2022-23. Results The predominant challenges identified were stockouts and shortages, expiry of medications, and supplier-related issues. The causes were mainly related to rural location, communication hurdles, and vendor management. Proposed solutions were integrating patients' electronic health records and bar code technology with the pharmacy's inventory management system, conducting pharmacy knowledge and skills upgradation sessions every six months, adopting ABC and VED analysis, and first-in first-out (FIFO), just-in-time (JIT). Total annual drug expenditure (ADE) for the drugs dispensed was 1,18,81,520 Indian Rupees. ABC analysis revealed 109 (22.8%), 115 (24.06%), and 254 (53.14%) of medicines as A, B, and C categories, respectively, accounting for 69.98, 20.00, and 10.07% of ADE. On ABC-VED matrix analysis, 125 (26.15%), 267 (55.86%), and 86 (17.99%) of drugs were found to be category I, II, and III items, respectively, accounting for 71.52, 23.84, and 4.64% of ADE. Conclusion Our study identified different pharmacy problems for a developing institute and suggested relevant measures. Categorization of drugs based on ABC and VED analysis will help to strengthen inventory control.

"Taste modification" strategy for prevention and control of hypertension in India: need for robust clinical trials.

Hypertension is an important modifiable risk factor for cardiovascular disease (CVD). Among normotensives, excessive dietary salt elevates the blood pressure and thereby increases the risk of CVD events. Despite such solid evidence, there is no effective approach to address excessive salt intake in India. Instead of just encouraging patients to lower their salt intake, we must provide an alternative technique by fostering an environment that facilitates this behaviour change. In this Viewpoint, we propose 'Taste Modification' strategy, i.e., a salt-reduction technique in which individuals are informed that adding spices/herbs to meals will reduce their salt intake. We hypothesise that a gradual reduction in salt intake can aid in the treatment of hypertension over time. The goal is to progressively substitute salt with spices for effective salt reduction. However, the 'Taste Modification' strategy must be first validated using multicentric clinical trials.

Self-Reported Persistent Symptoms at 18 Months and Above Among COVID-19 Non-hospitalized Patients: A Prospective Cohort Study.

INTRODUCTION: Since the beginning of the pandemic in early 2020, there have been numerous reports of symptoms that have lingered due to COVID-19. However, there is a lack of data concerning these persistent symptoms in non-hospitalized patients. This study sought to examine the prevalence of persistent symptoms at 18 months and beyond following the diagnosis of COVID-19 non-hospitalized patients. METHODS: A prospective cohort study comprised 212 non-hospitalized adult patients consecutively assessed from data available at tertiary care institutions through telephone interviews. During the interview, participants were routinely questioned about whether they were still experiencing any post-infection symptoms at the time of the study. RESULTS: Total 212 took part in the 18-month or longer follow-up survey. The most commonly reported symptoms during the acute phase were fever (n=149, 70.3%), weakness (n=118, 55.7%), and sore throat (n=100, 47.2%). At the 18-month and above follow-up, 167 patients (78.7%) reported at least one symptom continuing. The most common symptom at this time point was fatigue (n=109, 51.4%), followed by joint pain (n=57, 26.8%), and exertional dyspnea (24.5%). The possibility of symptoms returning after an 18-month follow-up and beyond was significantly lower in patients who had taken the COVID-19 vaccine (OR=0.29; 95% CI: 0.112-0.749; p=0.011) and those did not infect a second time (OR=0.232; 95% CI: 0.057-0.93; p=0.04). CONCLUSION: The present study reveals that clinical complications persist even at 18 months and beyond during follow-up, with a prevalence similar to earlier follow-up periods, regardless of the severity of the initial COVID-19 infection.

Nucleobindin-2 derived nesfatin-1 in polycystic ovary syndrome: a PRISMA and GRADE-compliant systematic review and meta-analysis with diagnostic test accuracy.

INTRODUCTION: Nesfatin-1 is a satiety peptide secreted by central, peripheral nervous system and some peripheral tissues. This meta-analysis was conducted to explore the associations with diagnostic accuracy of circulatory nesfatin-1 in polycystic ovary syndrome (PCOS). EVIDENCE ACQUISITION: Relevant studies were retrieved by online database and manual searching. The standardized mean differences (SMDs) with 95% confidence intervals (CIs) were obtained by a random-effects meta-analysis. The subgroup analysis based on the Body Mass Index (BMI), fasting insulin (F-INS), and the homeostasis model assessment-estimated insulin resistance (HOMA-IR) was conducted. Meta-analysis of correlations and meta-regression were performed for the associations of nesfatin-1 with metabolic and hormonal covariates. The diagnostic test accuracy (DTA) meta-analysis was conducted for the utility of nesfatin-1 in PCOS. The publication bias was tested with Egger's and Begg's regression tests. EVIDENCE SYNTHESIS: The combined effect size including a total of 14 studies showed a significantly higher nesfatin-1 level in PCOS as compared to controls (SMD=0.93, Z=2.17, P=0.03). The nesfatin-1 was found to be significantly higher in a subgroup of studies with mean BMI>25 kg/m2 (SMD=1.35, Z=2.06, P=0.04), F-INS <13 mIU/mL (SMD=2.74, Z=3.59, P=0.0003), and HOMA-IR >2.7 (SMD=1.58, Z=2.65, P=0.008). The DTA meta-analysis produced a pooled diagnostic odds ratio of 19.58 and area under curve were of 0.888 for nesfatin-1 in PCOS. CONCLUSIONS: The results indicate a multifactorial involvement such as endocrine and metabolic alterations in the form of BMI, insulin and HOMA-IR status with the higher nesfatin-1 levels in PCOS. The promising results of DTA meta-analysis warrants further research into the clinical and prognostic utility of nesfatin-1 in PCOS.