Video laryngoscopy versus direct laryngoscopy in achieving successful emergency endotracheal intubations: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Intubating a patient in an emergent setting presents significant challenges compared to planned intubation in an operating room. This study aims to compare video laryngoscopy versus direct laryngoscopy in achieving successful endotracheal intubation on the first attempt in emergency intubations, irrespective of the clinical setting. METHODS: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception until 27 February 2023. We included only randomized controlled trials that included patients who had undergone emergent endotracheal intubation for any indication, regardless of the clinical setting. We used the Cochrane risk-of-bias assessment tool 2 (ROB2) to assess the included studies. We used the mean difference (MD) and risk ratio (RR), with the corresponding 95% confidence interval (CI), to pool the continuous and dichotomous variables, respectively. RESULTS: Fourteen studies were included with a total of 2470 patients. The overall analysis favored video laryngoscopy over direct laryngoscopy in first-attempt success rate (RR = 1.09, 95% CI [1.02, 1.18], P = 0.02), first-attempt intubation time (MD = - 6.92, 95% CI [- 12.86, - 0.99], P = 0.02), intubation difficulty score (MD = - 0.62, 95% CI [- 0.86, - 0.37], P < 0.001), peri-intubation percentage of glottis opening (MD = 24.91, 95% CI [11.18, 38.64], P < 0.001), upper airway injuries (RR = 0.15, 95% CI [0.04, 0.56], P = 0.005), and esophageal intubation (RR = 0.37, 95% CI [0.15, 0.94], P = 0.04). However, no difference between the two groups was found regarding the overall intubation success rate (P > 0.05). CONCLUSION: In emergency intubations, video laryngoscopy is preferred to direct laryngoscopy in achieving successful intubation on the first attempt and was associated with a lower incidence of complications.

MicroRNAs (miRNAs) role in hypertension: pathogenesis and promising therapeutics.

Background: MicroRNAs (miRNAs) are small, non-coding RNA molecules that play a crucial role in regulating various cellular processes, including cell proliferation, differentiation, apoptosis, and disease development. Recent studies have highlighted the importance of miRNAs in the development and progression of essential hypertension, a common form of high blood pressure that affects millions of individuals worldwide. The molecular mechanisms by which miRNAs regulate hypertension are complex and multifaceted. MiRNAs target the 3' untranslated regions of mRNA molecules, thereby regulating the synthesis of specific proteins involved in cardiovascular function. For instance, miRNAs are known to regulate the expression of genes involved in blood vessel tone, cardiac function, and inflammation. The growing body of research on miRNAs in hypertension has highlighted their potential as therapeutic targets for managing this condition. Studies have shown that miRNA-based therapies can modulate the expression of key genes involved in hypertension, leading to improvements in blood pressure and cardiovascular function. However, more research is needed to fully understand the mechanisms of miRNA-mediated hypertension and to develop effective therapeutic strategies. Conclusions: In summary, this review highlights the current understanding of the role of miRNAs in essential hypertension, including their molecular mechanisms and potential therapeutic applications. Further research is needed to fully understand the impact of miRNAs on hypertension and to develop new treatments for this common and debilitating condition.

Association of serum leptin and ghrelin levels with smoking status on body weight: a systematic review and meta-analysis.

Background and aims: Smoking cigarettes is a major global health problem that affects appetite and weight. The aim of this systematic review was to determine how smoking affected plasma leptin and ghrelin levels. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Ovid was conducted using a well-established methodology to gather all related publications. Results: A total of 40 studies were included in the analysis of 11,336 patients. The overall effect showed a with a mean difference (MD) of -1.92[95%CI; -2.63: -1.20] and p = 0.00001. Subgroup analysis by study design revealed significant differences as well, but with high heterogeneity within the subgroups (I2 of 82.3%). Subgroup by sex showed that there was a significant difference in mean difference between the smoking and non-smoking groups for males (MD = -5.75[95% CI; -8.73: -2.77], p = 0.0002) but not for females (MD = -3.04[95% CI; -6.6:0.54], p = 0.10). Healthy, pregnant, diabetic and CVD subgroups found significant differences in the healthy (MD = -1.74[95% CI; -03.13: -0.35], p = 0.01) and diabetic (MD = -7.69[95% CI, -1.64: -0.73], p = 0.03). subgroups, but not in the pregnant or cardiovascular disease subgroups. On the other hand, the meta-analysis found no statistically significant difference in Ghrelin serum concentration between smokers and non-smokers (MD = 0.52[95% CI, -0.60:1.63], p = 0.36) and observed heterogeneity in the studies (I2 = 68%). Conclusion: This study demonstrates a correlation between smoking and serum leptin/ghrelin levels, which explains smoking's effect on body weight. Systematic review registration: https://www.crd.york.ac.uk/ prospero/display_record.php, identifier (Record ID=326680).

Efficacy of Ropivacaine Administration on Post-tonsillectomy Pain in Adults: A Systematic Review and Meta-analysis of Randomized Placebo-controlled Trials.

The objective of this investigation is to assess the efficacy of ropivacaine on intraoperative and postoperative endpoints like operative time, blood loss, pain, and bleeding among adult's patients undergoing for tonsillectomy. PubMed, CENTRAL, Scopus, and Web of Science databases were screened from inception until November 2022. The included RCTs were evaluated for risk of bias via risk of bias tool (second version). All endpoints were summarized as mean difference (MD) or standardized mean difference (SMD) for continues outcomes, and risk ration (RR) for dichotomous outcomes, under random-effect model. Four RCTs met our PICOS criteria, comprising a total of 257 patients. Regarding postoperative pain, there was a significant difference that favor ropivacaine group compared with placebo group within hours (n = 4 RCTs, SMD = -0.92, 95% CI [-1.57, -0.26], p = 0.006), and within days (n = 4 RCTs, SMD = -050, 95% CI [-0.82, -0.18], p = 0.002). However, there were no significant difference between ropivacaine and placebo groups I terms of operative time (n = 3 RCTs, SMD = -0.17, 95% CI [-0.45, 0.11], p = 0.22), intraoperative blood loss (n = 2 RCTs, SMD = -0.37, 95% CI [-1.41, 0.67], p = 0.49), and postoperative bleeding (n = 4 RCTs, RR = 2.27, 95% CI [0.90, 5.73], p = 0.08). In conclusion, administration of ropivacaine was associated with less postoperative pain among adult's patients who undergoing tonsillectomy. However, there were no benefit in term of reduction in operative time, intraoperative blood loss, and postoperative hemorrhage.

Efficacy of therapeutic plasma exchange in patients with severe COVID-19: A systematic review and meta-analysis.

We conducted this systematic review and meta-analysis to evaluate the existing evidence and to quantitatively synthesise evidence on the impact of therapeutic plasma exchange (TPE) on severe COVID-19 patients. This systematic review and meta-analysis protocol was prospectively registered on PROSPERO (CRD42022316331). We systemically searched six electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, clinicaltrial.gov, and Cochrane Central Register of Controlled Trials) from inception until 1 June 2022. We included studies comparing patients who received TPE versus those who received the standard treatment. For risk of bias assessment, we used the Cochrane risk of bias assessment tool, the ROBINS1 tool, and the Newcastle Ottawa scale for RCTs, non-RCTs, and observational studies, respectively. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as risk ratio in the random effect model with the corresponding 95% confidence intervals (CI). Thirteen studies (one randomized controlled trials (RCT) and 12 non-RCTs) were included in the meta-analysis, with a total of 829 patients. There is a moderate-quality evidence from one RCT that TPE reduces the lactic dehydrogenase (LDH) levels (SMD -1.09, 95% CI [-1.59 to -0.60]), D-dimer (SMD -0.86, 95% CI [-1.34 to -0.37]), and ferritin (SMD -0.70, 95% CI [-1.18 to -0.23]), and increases the absolute lymphocyte count (SMD 0.54, 95% CI [0.07-1.01]), There is low-quality evidence from mixed-design studies that TPE was associated with lower mortality (relative risk 0.51, 95% CI [0.35-0.74]), lower IL-6 (SMD -0.91, 95% CI [-1.19 to -0.63]), and lower ferritin (SMD -0.51, 95% CI [-0.80 to -0.22]) compared to the standard control. Among severely affected COVID-19 patients, TPE might provide benefits such as decreasing the mortality rate, LDH, D-dimer, IL-6, and ferritin, in addition to increasing the higher absolute lymphocyte count. Further well-designed RCTs are needed.

Successful use of therapeutic anticoagulation therapy in two patients with moderate stroke from the second day of onset: A case report and literature review.

Introduction and importance: Hemorrhagic transformation of ischemic stroke is one of the most traumatic consequences of ischemic stroke. Therefore, deciding the optimal time for anticoagulant application and its effect on clinical outcome, recurrence and risk for hemorrhagic transformation are still in quarry. The European Heart Rhythm Association recommends the usage of anticoagulants after 3-4 days after a mild stroke, 6 days after moderate stroke and 12 days after a severe stroke. Case presentation: In our case report, we present two patients who started full therapeutic anticoagulation of low molecular weight heparin from the first day after moderate ischemic stroke, warfarin was added later guided by INR and discharged on oral anticoagulants for associated AF. They improved clinically with improved motor function for both upper and lower limbs, sensation and gaze without any complication followed by serial CT. Clinical discussion and conclusion: As a result of this case report, clinical improvement has not been associated with hemorrhagic sequelae of anticoagulant administration on the first day. At this point, we recommend conducting a trial to study the effect of early application of anticoagulants from the first day on clinical outcome, recurrence, and hemorrhagic transfusion of stroke.

Is there a need to be worried about the new monkeypox virus outbreak? A brief review on the monkeypox outbreak.

The Monkeypox virus (MPXV) is a double-stranded DNA virus related to the orthopoxvirus genus in the family of poxviridae. MPXV is endemic in central and Western African countries. There have been several outbreaks of MPXV in non-endemic countries since it was discovered in 1958 in lab monkeys. The current spread of MPXV is different from previous outbreaks, raising concerns about its potential to cause pandemics around the world. In order to reduce the spread of the disease, several countries imposed different preventive measures. The MPXV virus is believed to be transmitted either through wild animals, such as rodents or through infected individuals. Every year, Africa experiences a few thousand cases, mostly in the west and central regions. The number of cases outside Africa has previously been limited to a handful associated with travel to Africa or with the importation of infected animals. In this narrative review, we will discuss the clinical diagnosis, transmission, distribution, treatment, and prevention of the recent monkeypox outbreak around the world.