Association between Statin Use and Chemotherapy-Induced Cardiotoxicity: A Meta-Analysis.

Background: Chemotherapy-induced cardiac dysfunction (CIC) is a significant and concerning complication observed among cancer patients. Despite the demonstrated cardioprotective benefits of statins in various cardiovascular diseases, their effectiveness in mitigating CIC remains uncertain. Objective: This meta-analysis aims to comprehensively evaluate the potential cardioprotective role of statins in patients with CIC. Methods: A systematic literature search was conducted using PubMed, Embase, and Scopus databases to identify relevant articles published from inception until 10th May 2023. The outcomes were assessed using pooled odds ratio (OR) for categorical data and mean difference (MD) for continuous data, with corresponding 95% confidence intervals (95% CIs). Results: This meta-analysis comprised nine studies involving a total of 5532 patients, with 1904 in the statin group and 3628 in the non-statin group. The pooled analysis of primary outcome shows that patients who did not receive statin suffer a greater decline in the LVEF after chemotherapy compared to those who receive statin (MD, 3.55 (95% CI: 1.04-6.05), p = 0.01). Likewise, we observed a significantly higher final mean LVEF among chemotherapy patients with statin compared to the non-statin group of patients (MD, 2.08 (95% CI: 0.86-3.30), p > 0.001). Additionally, there was a lower risk of incident heart failure in the statin group compared to the non-statin group of patients (OR, 0.41 (95% CI: 0.27-0.62), p < 0.001). Lastly, the change in the mean difference for LVEDV was not statistically significant between the statin and non-statin groups (MD, 1.55 (95% CI: -5.22-8.33), p = 0.65). Conclusion: Among patients of CIC, statin use has shown cardioprotective benefits by improving left ventricular function and reducing the risk of heart failure.

Kikuchi lymphadenitis: A differential diagnosis of tuberculous cervical lymphadenitis.

Patients from countries, endemic with tuberculosis, who present with febrile lymphadenopathy refractory to first line antibiotics are often empirically treated for extra-pulmonary tuberculosis. However, Kikuchi-Fujimoto Disease (KFD) or histiocytic necrotizing lymphadenitis, a self-limiting and benign condition, presents with similar clinical symptoms. We present an adolescent with febrile lymphadenopathy, who was initially treated for tubercular lymphadenopathy, before a diagnosis of KFD was made.

Effectiveness of artificial intelligence-assisted colonoscopy in early diagnosis of colorectal cancer: a systematic review.

INTRODUCTION: As artificial intelligence (AI)-assisted diagnosis gained immense popularity, it is imperative to consider its utility and efficiency in the early diagnosis of colorectal cancer (CRC), responsible for over 1.8 million cases and 881 000 deaths globally, as reported in 2018. Improved adenoma detection rate, as well as better characterizations of polyps, are significant advantages of AI-assisted colonoscopy (AIC). This systematic review (SR) investigates the effectiveness of AIC in the early diagnosis of CRC as compared to conventional colonoscopy. MATERIALS AND METHODS: Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science were reviewed for original studies (randomized controlled trials, observational studies), SRs, and meta-analysis between 2017 and 2022 utilizing Medical Subject Headings terminology in a broad search strategy. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and were conducted from November 2022. A data extraction form based on the Cochrane Consumers and Communication Review group's extraction template for quality assessment and evidence synthesis was used for data extraction. All included studies considered for bias and ethical criteria and provided valuable evidence to answer the research question. RESULTS: The database search identified 218 studies, including 87 from PubMed, 60 from SCOPUS, and 71 from Web of Science databases. The retrieved studies from the databases were imported to Rayyan software and a duplicate article check was performed, all duplicate articles were removed after careful evaluation of the data. The abstract and full-text screening was performed in accordance with the following eligibility criteria: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies; Preferred Reporting Items for Systematic Reviews and Meta-Analysis for review articles, ENTREQ for narrative studies; and modified JADAD for randomized controlled trials. This yielded 15 studies that met the requirements for this SR and were finally included in the review. CONCLUSION: AIC is a safe, highly effective screening tool that can increase the detection rate of adenomas, and polyps resulting in an early diagnosis of CRC in adults when compared to conventional colonoscopy. The results of this SR prompt further large-scale research to investigate the effectiveness in accordance with sex, race, and socioeconomic status, as well as its influence on prognosis and survival rate.

Association between nonalcoholic fatty liver disease and atrial fibrillation and other clinical outcomes: a meta-analysis.

The association between nonalcoholic fatty liver disease (NAFLD) with cardiovascular and cerebrovascular outcomes, as well as their clinical impact, has yet to be established in the literature. This meta-analysis aims to evaluate the association between the NAFLD patients and the risk of atrial fibrillation (AF), heart failure (HF), stroke, cardiovascular mortality (CVM), and revascularization incidence. We performed a systematic literature search using PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 2022. A total of 12 cohort studies with 18,055,072 patients (2,938,753 NAFLD vs 15,116,319 non-NAFLD) were included in our analysis. The mean age of the NAFLD patients group and the non-NAFLD group was comparable (55.68 vs 55.87). The most common comorbidities among the NAFLD patients group included hypertension (38% vs 24%) and diabetes mellitus (14% vs 8%). The mean follow-up duration was 6.26 years. The likelihood of AF (risk ratio (RR), 1.42 (95% CI 1.19, 1.68), p < 0.001), HF (RR, 1.43(95% CI 1.03, 2.00), p < 0.001), stroke (RR, 1.26(95% CI 1.16, 1.36), p < 0.001), revascularization (RR, 4.06(95% CI 1.44, 11.46), p = 0.01), and CVM (RR, 3.10(95% CI 1.43, 6.73), p < 0.001) was significantly higher in the NAFLD patients group compared to that of the non-NAFLD group. However, all-cause mortality was comparable between both the groups of patients (RR, 1.30 (95% CI 0.63, 2.67), p = 0.48). In conclusion, the patients with NAFLD are at increased risk of AF, HF, and CVM.

Future of mental health in the metaverse.

The metaverse and non-fungible tokens (NFTs) were some of the hottest tech terms in 2021, according to a Google Trends search. Our review aims to describe the metaverse and NFTs in the context of their potential application in the treatment of mental health disorders. Advancements in technology have been changing human lives at an ever-increasing pace. Metaverse, also known as the three-dimensional (3D) internet, is the convergence of virtual reality (VR) and physical reality in a digital space. It could potentially change the internet as we know it, with NFTs as the key building blocks in the new expansive virtual ecosystem. This immersive 3D virtual world boasts the features of the real world with the added ability to change the surrounding environment according to individual needs and requirements. VR, augmented reality (AR) and mixed reality (MR) have been employed as tools in the treatment of various mental health disorders for the past decade. Studies have reported positive results on their effectiveness in the diagnosis and treatment of mental health disorders. VR/AR/MR have been hailed as a solution to the acute shortage of mental health professionals and the lack of access to mental healthcare. But, on the flip side, young adults tend to spend a significant amount of time playing 3D immersive games and using social media, which can lead to insecurity, anxiety, depression, and behavioural addiction. Additionally, endless scrolling through social media platforms negatively affects individuals' attention span as well as aggravating the symptoms of adolescents with attention deficit hyperactivity disorder. We aimed to explore the ramifications of expanding applications of the metaverse on mental health. So far, no other review has explored the future of mental health in the context of the metaverse.

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts In-Hospital Mortality in Stroke Patients: A Prospective Cohort Study.

Introduction Cerebrovascular accidents or strokes are a major cause of mortality and morbidity in today's world. Post-stroke disabilities like paralysis, dementia, etc., can affect the quality of life of patients as well as their families. A combined increase in neutrophils and a decrease in lymphocytes during inflammation in stroke manifests as an elevated neutrophil-to-lymphocyte ratio (NLR), thereby indicating the severity of neural damage. Aim We aimed to determine if an elevated NLR observed on the day of hospital admission can predict a higher risk of in-hospital mortality in stroke patients. Confirmatory results could aid in developing risk stratification for management, ultimately improving clinical and functional outcomes. Materials and methods Sixty stroke patients were monitored throughout their hospital stay in this prospective cohort study. NLR was calculated at admission using routine complete blood counts. The data were analyzed using SPSS Software v23.0 (IBM Corp., Armonk, NY). An unpaired t-test was used to compare the means between the two groups. Categorical data were analyzed using the chi-square test. The receiver operating curve (ROC) was plotted and used to ascertain if a cut-off value of NLR could be obtained to predict in-hospital mortality in stroke patients. P values <0.05 were considered statistically significant. Results About 23.3% (n=14) of the patients died during their hospital stay, with no significant differences between the survivor and death cohorts in terms of comorbidities like diabetes and hypertension. The mean NLR calculated within 24 hours of hospital admission in patients who died (NLR=8.47 (standard deviation (SD)=4.67)) was significantly higher (p=0.009) than in those who survived (NLR=5.84 (SD=2.62)). Upon ROC analysis, patients with NLR >6.03 on the day of admission demonstrated a higher risk of in-hospital mortality (p=0.015 (95% CI: 0.577-0.855)). An area under the curve (AUC) of 0.72 with a sensitivity of 92.86% and a specificity of 54.35% was obtained. Conclusions Elevated NLR (cut-off >6.03) obtained within 24 hours of hospital admission is an indicator of a higher risk of in-hospital mortality in stroke patients. Hence, patients presenting with a high NLR at admission can be prioritized for personalized targeted treatment, potentially reducing mortality and post-stroke complications.

The association of COVID-19 severity and susceptibility and genetic risk factors: A systematic review of the literature.

BACKGROUND: COVID-19 is associated with several risk factors such as distinct ethnicities (genetic ancestry), races, sexes, age, pre-existing comorbidities, smoking, and genetics. The authors aim to evaluate the correlation between variability in the host genetics and the severity and susceptibility towards COVID-19 in this study. METHODS: Following the PRISMA guidelines, we retrieved all the relevant articles published until September 15, 2021, from two online databases: PubMed and Scopus. FINDINGS: High-risk HLA haplotypes, higher expression of ACE polymorphisms, and several genes of cellular proteases such as TMPRSS2, FURIN, TLL-1 increase the risk of susceptibility and severity of COVID-19. In addition, upregulation of several genes encoding for both innate and acquired immune systems proteins, mainly CCR5, IFNs, TLR, DPPs, and TNF, positively correlate with COVID-19 severity. However, reduced expression or polymorphisms in genes affecting TLR and IFNλ increase COVID-19 severity. CONCLUSION: Higher expression, polymorphisms, mutations, and deletions of several genes are linked with the susceptibility, severity, and clinical outcomes of COVID-19. Early treatment and vaccination of individuals with genetic predisposition could help minimize the severity and mortality associated with COVID-19.

A Scoping Review of Vaping, E-Cigarettes and Mental Health Impact: Depression and Suicidality.

Electronic cigarettes have grown in popularity due to natural curiosity, novel flavors, and advertising as both a means to aid smoking cessation and a "safe" smoking option. There is a substantial body of research on the harmful physical health effects of vaping, but there are relatively few studies on its mental health effects, particularly in adolescents 10-21 years of age. The purpose of this review is to examine the negative effects of vaping on mental health, in particular depression and suicidality. Using the databases PubMed, Scopus, Cochrane Library, and the search engine Google Scholar, we focused on observational studies looking into association between vaping, depression and suicidality. We found 7255 studies; after removing duplicates and other irrelevant articles, 106 articles were left. After reviewing the abstracts and titles, 99 citations were manually removed, 7 studies were included in the final review. Suicide attempts were significantly higher among e-cigarette users compared to non-users. E-cigarette use was associated with depression, suicidal ideation and suicide attempt. Suicide attempts were significantly higher among e-cigarette users compared to non-users. It is critical to raise awareness about the association between electronic cigarettes and adolescent mental health.

Systemic Lupus Erythematosus With Multi-Organ Involvement in a Young Female: Lymphadenopathy, Lupus Cerebritis, Lupus Nephritis, and Cardiac Manifestations.

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that can affect almost every organ in the body. Its complications can often be fatal. The fatal complications include lupus cerebritis, lupus nephritis, and cardiac manifestations such as pericardial effusion. In this report, we discuss the case of a 23-year-old female who presented with complaints of high-grade fever, seizures, and altered mental state (AMS) and was found to have generalized lymphadenopathy (LAP). Various blood and urine analyses and radiological findings (chest X-ray, MRI of the head) were suggestive of lupus nephritis, lupus cerebritis, massive pericardial effusion, and thrombocytopenia. Her anti-double stranded DNA (anti-dsDNA) antibody was positive, and her pericardial fluid was positive for anti-nuclear antibodies (ANAs). She was administered IV glucocorticoids and phenytoin. She reported improvements in her symptoms gradually for a few days but eventually succumbed to the disease. Although generalized LAP is a rare initial presentation of SLE, it should be included in the differential diagnosis of the disease.

Risk Factors for Postpartum Depression During COVID-19 Pandemic: A Systematic Literature Review.

INTRODUCTION: The COVID-19 pandemic has had a devastating worldwide effect on mental health. Recent studies correlate the spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with symptoms of depression, most prominent in postpartum women. Our systematic literature review scope is to identify the risk factors and predictors for postpartum depression (PPD) and describe the steps that should be taken to help postpartum women. This study will help clinicians, researchers, and policymakers to elucidate the predictors of PPD during this pandemic and prevent these adverse outcomes in future crises. METHODS: We conducted a systematic search by employing databases PubMed, Google Scholar, Scopus, and Embase to identify articles published before March 2021. About 463 publications were generated during our search process and from those, 36 were reviewed, summarized, and synthesized. Studies qualified the criteria if they (1) utilized qualitative or quantitative design, (2) explored the risk factors for PPD, and (3) were written in English. Quality evaluation of each study was achieved by using criteria set by Lincoln and Guba. RESULTS: Prevalence of depression symptoms ranged from 7% to 80.8% in postpartum women during the SARS-COV 2 pandemic. The risk factors for PPD were classified into 6 major categories: socio-demographic, psychological, pre-existing pathology, metabolic factors, previous events of miscarriage, and media misinformation. CONCLUSION: It is extremely vital to care for women's mental health during pregnancy and after childbirth during these unprecedented times. This review urges the need to design adequate interventions for this vulnerable population to prevent negative consequences of PPD.