Safety and efficacy of chimeric antigen receptor T-cell therapy for acute myeloid leukemia: A subgroup based meta-analysis.

INTRODUCTION: Acute myeloid leukemia (AML) is a significant hematological malignancy in the United States, with a high mortality rate and limited treatment options. CAR T-cell therapy, a new and promising treatment, is being investigated for its efficacy and safety in AML. This meta-analysis aims to assess the safety and efficacy of CAR T-cell therapy in AML, considering various subgroups such as study location, study design, prior transplantation status, conditioning regimen, and CAR T-cell source. METHODS: We conducted a comprehensive literature review across multiple databases, adhering to PRISMA guidelines and focusing on studies concerning CAR T-cell therapy in AML. We included original articles in English and excluded non-original reviews, abstracts, and non-English studies. The risk of bias was assessed using the Cochrane ROBINS-I tool. Statistical analysis involved meta-analysis with Cochrane's Q-test and I² statistic, using both fixed-effect and random-effects models, and assessed for publication bias. RESULTS: Our search yielded studies encompassing 57 AML patients treated with CAR T-cell therapy. The meta-analysis revealed a 48% incidence of complete remission with CAR T-cell therapy, varying significantly across subgroups based on study design, location, prior transplantation, conditioning regimen, and CAR T-cell source. The highest complete remission rates were observed in patients from China, those who had undergone prior hematopoietic cell transplantation, and those treated with fludarabine and cyclophosphamide conditioning regimen. Adverse events included graft-versus-host disease (7%) and cytokine release syndrome (53%). CONCLUSIONS: This meta-analysis highlights the potential of CAR T-cell therapy in AML treatment, especially when integrated with certain prior treatments and conditioning regimens. The findings suggest a higher efficacy in patients with previous hematopoietic cell transplantation and specific conditioning regimens. Further large-scale, randomized trials are essential to confirm these findings and establish CAR T-cell therapy as a standard treatment for AML.

Venous sinus stenting for idiopathic intracranial hypertension: An updated Meta-analysis.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure and primarily affects obese women of reproductive age. Venous sinus stenting (VSS) is a surgical procedure used to treat IIH, but its safety and efficacy are still controversial. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Multiple databases were searched for studies evaluating the safety and efficacy of VSS in IIH patients and meta-analysis was performed to pool the data. RESULTS: A total of 36 studies involving 1066 patients who underwent VSS were included. After VSS, a significant reduction in trans-stenotic gradient pressure was observed. Patients also showed significantly lower cerebrospinal fluid (CSF) opening pressure. Clinical outcomes demonstrated improvement in tinnitus (95%), papilledema (89%), visual disturbances (88%), and headache (79%). However, 13.7% of patients experienced treatment failure or complications. The treatment failure rate was 8.35%, characterized by worsening symptoms and recurrence of IIH. The complications rate was 5.35%, including subdural hemorrhage, urinary tract infection, stent thrombus formation, and others. CONCLUSION: VSS appears to be a safe and effective treatment option for IIH patients who are unresponsive to medical therapy or have significant visual symptoms. However, long-term outcomes and safety of the procedure require further investigation.

Intracranial stenting compared to medical treatment alone for intracranial atherosclerosis patients: An updated meta-analysis.

Objective: Stroke is the second-leading cause of death globally. Intracranial atherosclerotic stenosis (ICAS) represents 10-15% of ischemic strokes in Western countries and up to 47% in Asian countries. Patients with ICAS have an especially high risk of stroke recurrence. The aim of this meta-analysis is to reassess recurrent stroke, transient ischemic attack (TIA), and other outcomes with stenting versus best medical management for symptomatic ICAS. Methods: The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to August 14th, 2022. Results: This Meta-analysis Included Four Randomized Controlled Trials (Rcts), With A Total Number Of 991 Patients. The Mean Age Of Participants Was 57 Years. The Total Number Of Intracranial Stenting Patients Was 495, And The Number Of Medical Treatment Patients Was 496. The Included Studies Were Published Between 2011 And 2022. Two Studies Were Conducted In The Usa, And The Other Two In China. All Included Studies Compared Intracranial Stenting To Medical Treatment For Icas. Conclusions: In patients with ischemic stroke due to symptomatic severe intracranial atherosclerosis, the rate of 30-day ischemic stroke, 30-day intracerebral hemorrhage, one-year stroke in territory or mortality favored the medical treatment alone without intracranial stenting. The risk of same-territory stroke at last follow-up, disabling stroke at last follow-up, and mortality did not significantly favor either group. Intracranial stenting for atherosclerosis did not result in significant benefit over medical treatment.

Rectus gyrus hematoma: An overview.

Background: Rectus gyrus hematoma (RGH) is a localized intracerebral hemorrhage involving the most medial part of the orbital surface of the frontal lobe. It can be an imaging finding in the setting of a ruptured anterior communicating artery aneurysm; however, other differentials are rarely reported in the literature. In this paper, we opt to present for the 1st time an overview of RGH regarding its history, anatomical correlation, and related neuroimaging with particular emphasis on the potential differential diagnosis for underlying pathologies. Methods: A literature review was conducted in PubMed, Medline, and Google scholar databases to review the existing literature highlighting the history, pertinent anatomy, and clinical characteristics of RGH. Results: The literature review yielded papers targeting the RGH neither as a radiological sign nor as a surgical correlate to the cerebrovascular lesion. We used the available indirectly related articles to formulate an overview to serve the aim of this paper and to highlight the potential value of studying the RGH. Conclusion: The RGH may represent an overlooked radiological finding that has potential significance through its relation to a set of vascular lesions affecting the brain. Further studies into the topic are needed to expand the utility of this sign.

Bidirectional Association between Metabolic Control in Type-2 Diabetes Mellitus and Periodontitis Inflammatory Burden: A Cross-Sectional Study in an Italian Population.

This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 ± 10.1 years) was assessed according to CDC/AAP periodontitis case definitions and Periodontal Inflamed Surface Area (PISA) Index. Data on sociodemographic factors, lifestyle behaviors, laboratory tests, and glycated hemoglobin (HbA1c) levels were collected by interview and medical records. Poor glycemic control (HbA1c ≥ 7%), family history of T2DM, and C-reactive protein levels were predictors of severe periodontitis. An increase in HbA1c of 1% was associated with a rise in PISA of 89.6 mm2. On the other hand, predictors of poor glycemic control were severe periodontitis, waist circumference, unbalanced diet, and sedentary lifestyle. A rise in PISA of 10 mm2 increased the odds of having HbA1c ≥ 7% by 2%. There is a strong bidirectional connection between periodontitis and poor glycemic control. The inflammatory burden posed by periodontitis represents the strongest predictor of poor glycemic control.

The underlying aetiologies of coma in febrile Sudanese children.

BACKGROUND: Cerebral malaria, acute bacterial meningitis and viral encephalitis are the main causes of fever and altered consciousness in the tropics. In areas where reliable laboratory testing is unavailable, over diagnosis and misdiagnosis of these conditions is likely. In malaria endemic countries non-malarial contributors to coma may be overlooked, overburdening available resources. The aim of this study is to evaluate the underlying causes of altered mental state in children presenting with fever and coma to tertiary medical facilities in Sudan. METHODS: Children over one month of age admitted to the emergency departments of three main hospitals in Khartoum with fever and coma were investigated for cerebral malaria, acute bacterial meningitis and Herpes simplex encephalitis during April to November 2011. RESULTS: One hundred and four children presenting with fever and coma were evaluated. Cerebral malaria was clinically suspected in 38 patients and 5 were confirmed. Acute bacterial meningitis was suspected in 63 patients and confirmed in 15. Herpes encephalitis was confirmed in only one case. There were five cases of mixed infection and the remainder were unknown. CONCLUSION: The clinical diagnoses of cerebral malaria, acute bacterial meningitis and viral encephalitis are unreliable. Further studies to evaluate the underlying causes of coma in febrile Sudanese children are warranted.

Cigarette smoking among medical students in The National Ribat University, Sudan.

The problem of smoking among medical students is common worldwide, but the pattern and extent of the problem varies from place to place. Data from Sudanese medical students is limited. The aims of study was to know the extent of the problem of smoking among medical students, its routes and how it can be reduced. All students in the first and fifth year in the Faculty of Medicine, The National Ribat University were asked to fill a questionnaire regarding their knowledge and practice of smoking and when they started smoking. The questionnaire inquired about the role of their peers and the staff to help them stop smoking. Two hundred and forty (96%) of the first year students and 174 (94 %) of the fifth year students responded by filling the questionnaires. Around 10 % of all students smoke. Although non-smokers knew much about the problems of smoking, many of the smokers did not. The main influence on students to start smoking was from parents, siblings and friends. Eighty per cent of the smokers are willing to give up smoking and they tried many times. The study showed that little effort was made by the University Staff to help students stop smoking. Most students started smoking in the high secondary schools. There is a need for family community and institutional campaign to contain the problem of smoking.