Comparison of manual chest compression versus mechanical chest compression for out-of-hospital cardiac arrest: A systematic review and meta-analysis.

BACKGROUND: Out-of-hospital cardiac arrest is a life-threatening condition that requires immediate intervention to increase the prospect of survival. There are various ways to achieve cardiopulmonary resuscitation in such patients, either through manual chest compression or mechanical chest compression. Thus, we performed a systematic review and meta-analysis to investigate the differences between these interventions. METHODS: PubMed, Cochrane Library, and Scopus were explored from inception to May 2023. Additionally, the bibliographies of relevant studies were searched. The Cochrane Risk of Bias Tool for Randomized Controlled Trials, Newcastle-Ottawa Scale, and the Risk of Bias in Non-Randomized Studies-I tools were utilized to perform quality and risk of bias assessments. RESULTS: There were 24 studies included within this quantitative synthesis, featuring a total of 111,681 cardiac arrest patients. Overall, no statistically significant differences were observed between the return of spontaneous circulation, survival to hospital discharge, short-term survival, and long-term survival. However, manual chest compression was associated with a significantly superior favorability of neurological outcomes (OR: 1.41; 95% CI: 1.07, 1.84; P = .01). CONCLUSION: Although there were no major differences between the strategies, the poorer post-resuscitation neurological outcomes observed in mechanical chest compression indicate the need for further innovation and advancements within the current array of mechanical devices. However, future high-quality studies are necessary in order to arrive at a valid conclusion.

Recurrent peri-myocarditis: A rarer but unfortunate redundant presentation of thyroid storm.

Thyroid storm represents a critical and life-threatening complication from hyperthyroidism, with a notable mortality risk. Limited literature reports have explored the correlation between thyroid storm and peri-myocarditis, although the precise pathophysiological underpinnings remain unclear. The pathophysiology of how thyroid storm and peri-myocarditis are associated is not clearly understood; however, unfavorable prognostic factors include atrial fibrillation and recurrent thyrotoxicosis. Here, we present a case concerning recurrent peri-myocarditis concomitant with a thyroid storm.

Comparative effectiveness of intra-articular therapies in knee osteoarthritis: a meta-analysis comparing platelet-rich plasma (PRP) with other treatment modalities.

Introduction: Knee osteoarthritis (KOA) is a progressive joint disease commonly treated with intra-articular injections, including platelet-rich plasma (PRP), hyaluronic acid (HA), or corticosteroids (CS). This updated meta-analysis aims to enhance the statistical power of the results and provide comprehensive clinical evidence that reflects the most current research. By doing so, the authors aim to suggest a reliable estimate for the development of guidelines, addressing the pressing need for effective and minimally invasive treatment options. Methods: PubMed, Scopus, clinicaltrials.gov, Cochrane Central were searched until March 2023, for randomized controlled trials (RCTs) comparing the effectiveness of intra-articular injectable therapies, including PRP, HA, CS, and placebo, in KOA. Data extraction involved baseline characteristics and outcome measures [Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain scores, KOOS, and IKDC scores] at 1, 3, 6 and 12 months. Statistical analysis, including subgroup analysis, assessment of heterogeneity, and publication bias, was conducted using Review Manager. Results: Our meta-analysis of 42 studies involving 3696 patients demonstrated that PRP treatment resulted in significant pain relief compared to HA injections, as evidenced by improved WOMAC pain (MD: -0.74; 95% CI: -1.02 to -0.46; P≤0.00001; I 2=94%) and VAS pain (MD: -0.65; 95% CI: -1.24 to -0.06; P=0.03; I2=97%) outcomes. Similarly, PRP showed greater efficacy in reducing WOMAC pain (MD: -8.06; 95% CI: -13.62 to -2.51: P=0.004; I 2=96%) and VAS pain (MD: -1.11; 95% CI: -1.64 to -0.59; P≤0.0001; I 2=68%) compared to CS injections, with the most significant improvement observed at 6 months. Conclusions: PRP is an effective treatment for KOA. It provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months. PRP offers superior pain relief and functional enhancement compared to CS and HA injections.

Efficacy and safety of fezolinetant, a neurokinin-3 antagonist, in treating vasomotor symptoms in postmenopausal women: A systematic review and meta-analysis.

BACKGROUND: Menopause causes a variety of symptoms such as hot flashes and night sweats. While menopausal hormonal therapy has been used for managing postmenopausal vasomotor symptoms (VMS) for quite a while, it has a considerably poor safety profile. OBJECTIVE: To review and analyze existing data to evaluate the efficacy of the neurokinin-3 antagonist, fezolinetant, in treating postmenopausal VMS and to assess its safety profile. METHODS: A thorough literature search was performed on PubMed, Cochrane Library, and Google Scholar in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020, to find publications on the efficacy of fezolinetant for postmenopausal VMS. Changes in the frequency and severity scores of moderate/severe VMS and changes in the Hot Flash-Related Daily Interference Scale (HFRDIS), Greene Climacteric Scale (GCS), and Menopause-Specific Quality of Life (MENQoL) were the efficacy outcomes. Adverse events, drug-related treatment-emergent adverse effects (TEAEs), drug-related dropouts, hepatotoxicity, endometrial hyperplasia or tumor, and uterine bleeding were all safety outcomes. We used Review Manager 5.4 for pooling risk ratios (RRs) and mean differences (MDs) for dichotomous and continuous outcomes, respectively. A P value of < .05 was considered significant. RESULTS: There was a significant reduction in mean daily VMS frequency at weeks 4 and 12 (MD, -2.36; 95% confidence interval [CI], -2.85 to -1.87; P < .00001, for week 12) and also a significant decrease in VMS severity scores in the treatment group. Furthermore, improvements in MENQoL, HFRDIS, and GCS scores were observed. There was no significant difference in adverse events while drug-related TEAEs (RR, 1.21; 95% CI, 0.90-1.63; P = .21) showed a slight increase with fezolinetant. Drug-related dropouts were again similar across the 2 groups. Uterine bleeding had a lower incidence while endometrial events and hepatotoxicity showed a statistically insignificant, increasing trend in the fezolinetant group. DISCUSSION AND IMPLICATIONS: Fezolinetant can be a treatment option for postmenopausal VMS but warns of a risk increase in endometrial hyperplasia or tumors. The heterogeneity in the data being analyzed, short follow-up period, and small sample size in most of the included randomized controlled trials were the greatest limitations, which must be considered in further research and safety profile exploration.

Type IV-A choledochal cyst with choledocholithiasis in an adult female: A case report.

A choledochal cyst is a rare congenital anomaly of the biliary system, characterized by bile duct cystic dilatation, typically affecting the common bile duct. Choledochal cysts are generally categorized using the Todani classification system. The typical symptoms are jaundice, abdominal masses, and recurrent abdominal pain. As most cases are diagnosed in children, adult presentations are uncommon and often associated with complications. A 22-year-old female patient complained of severe abdominal pain and vomiting for 5 days, with signs of jaundice. Her abdominal ultrasound revealed fusiform dilation of the extrahepatic common bile duct with multiple calculi in its distal-most part. On CT cholangiogram of the abdomen, Type IV-A Choledochal cyst with non-obstructive choledocholithiasis was found. Although rare, choledochal cysts are a well-known clinical entity. It is essential to diagnose and treat patients because they may develop complications. Cholecystectomy combined with Roux-en-Y hepaticojejunostomy is the preferred treatment for Type IV-A choledochal cysts. Since choledochal cysts in adults are uncommon, early detection and treatment are essential to avoid serious complications. Ultrasonography (USG), Magnetic resonance cholangiopancreatography (MRCP), and Computed tomography (CT) can provide a diagnosis.

Gastric organoaxial volvulus: A lethal twist and a rare cause of acute abdomen.

Organoaxial gastric volvulus is a rare clinical condition. We present a 55 years old man with an acute episode of melena and hematemesis with moderate epigastric pain which was unresponsive to analgesics. Initially, the patient was misdiagnosed and treated symptomatically for other gastrointestinal conditions but later contrast-enhanced abdominal CT scan revealed gastric organo-axial volvulus, which was associated with a right hiatal hernia. The patient underwent surgical treatment, including crural dissection, posterior esophageal window creation, lower esophageal sling, crural defect repair with porcine meshes, and anterior gastropexy, followed by intensive physiotherapy and antibiotics. Diagnosis of gastric volvulus can be challenging, due to its symptom similarity to other gastrointestinal disorders, necessitating a high level of suspicion.

A rare case of recurrent hydatid cyst of the spleen: A case report.

Cystic echinococcosis (CE), or hydatid disease, is a parasitic infection caused by Echinococcus granulosus endemic to areas with considerable pastoral farming and animal husbandry. Typical presentations include hydatid cyst formation in the liver, lungs, brain, kidneys, or bones. An isolated splenic hydatid cyst is an extremely rare occurrence, accounting for only 0.5%-4% worldwide incidence rates, and recurrent cases are even more infrequent. Globalization, cross-border travel, and altered immigration patterns over time have shifted some of the burden of CE from the developing to the developed world, making the diagnosis challenging for these nonendemic areas. Judicious use of imaging modalities for prompt diagnosis and effective intervention is necessary to treat the initial disease and prevent a recurrence. Herein, we present the case of a 13-year-old male with recurrent isolated splenic hydatid cyst. The patient presented with chronic and nonradiating pain in his left hypochondrium. Physical examination revealed splenomegaly. Ultrasonography showed multiple cysts. Computerized tomography (CT) scan showed cystic lesions in splenic parenchyma with numerous internal enhancing septae. Surgical evacuation was performed for the management of disease.