Racial, Ethnic, and Geographic Disparities in Digestive Diseases Mortality in the United States, 2000-2019.

BACKGROUND AND AIMS: The global burden of digestive diseases mortality has been increasing over the last 3 decades. However, little is known about disparities in digestive diseases-specific mortality in the United States. This study aimed to examine racial, ethnic, and state- and county-level disparities in digestive diseases mortality rate in the United States between 2000 and 2019. METHODS: We used the Institute of Health Metrics and Evaluation Global Health Data Exchange to gather digestive diseases age-standardized mortality rates for 5 racial and ethnic groups (White, Black, Latino, American Indian/Alaska Native [AI/AN], and Asian/Pacific Islander [API]) by sex, state, and county between 2000 and 2019. We used joinpoint regression analysis to evaluate the overall temporal trends by demography. RESULTS: The overall cause-specific mortality rate decreased from 36.0 to 34.5 deaths per 100,000 population across all groups (2000-2019). In 2019, AI/AN individuals had the highest mortality rate (86.2), followed by White (35.5), Latino and Black (both at 33.6), and API (15.6) individuals. Significant increases occurred across some of the racial and ethnic groups, with an increased average annual percentage change for 2000-2019 among AI/AN (0.87%; 95% confidence interval, 0.77%-0.97%) and White individuals (0.12%; 95% confidence interval, 0.02%-0.22%) particularly among females, while Latino, Black, and API individuals showed reduced average annual percentage change for 2000-2019. AI/AN constitutes the main race affected in the top 10 counties. Substantial state-level variation emerged, with the highest mortality rates in 2019 seen in West Virginia. CONCLUSIONS: Despite an overall decrease in digestive diseases mortality, significant disparities persist across racial and ethnic groups. AI/AN and White individuals experienced increased mortality rates, particularly among females. Targeted interventions and further research are needed to address these disparities and improve digestive health equity.

Helicobacter pylori: A concise review of the latest treatments against an old foe.

Helicobacter pylori is a significant public health concern given its high prevalence, growing rates of antibiotic resistance, and carcinogenic effect, all of which create management challenges for internists, gastroenterologists, and other specialty physicians. With almost half of the world's human population harboring H pylori, carcinogenic sequelae are a concern to many practitioners. Recent guidelines recommend testing high-risk populations for H pylori using noninvasive or invasive methods. H pylori eradication regimens are tailored based on the presence of effective empiric therapy (local cure rates ≥ 90% for a given regimen) or antimicrobial susceptibility testing. When empiric therapy cure rates are not optimal, guidelines recommend antimicrobial susceptibility testing to improve eradication rates and reduce the progression of antibiotic resistance.

Trends and Age-Period-Cohort Effect on the Incidence of Early-Onset Colorectal Cancer (20-44 Years) from 1990 to 2021 in the United States.

The incidence of early-onset colorectal cancer (EO-CRC) in individuals under 50 years old is rapidly increasing in the United States. This study aims to evaluate EO-CRC incidence rates using data from the Global Burden of Disease Study (GBD) 2021, providing insights into trends from 1990 to 2021. We employed an age-period-cohort (APC) model analysis to estimate the effects of age, time period, and birth cohort on EO-CRC incidence. Our findings indicate that the number of EO-CRC cases rose from 6256 (95% UI: 6059-6456) in 1990 to 9311 (95% UI: 8859-9744) in 2021, a 49% increase from 1990 to 2021. The age-standardized incidence rate per 100,000 population increased by 34% during this period. The net drift in females (0.22%, 95% CI: 0.20-0.24) was slightly higher than in males (0.21%, 95% CI: 0.19-0.23) (p = 0.45). The APC analysis revealed that being over 25 years old, the period from 2005-2021, and being born after 1983 negatively impacted EO-CRC incidence rates, with a sharp rise after 2000 and a reduction among females from 2017 to 2021. Our study highlights the need for targeted prevention strategies and further research to understand these trends.

The effect of virtual reality on perioperative pain management in patients undergoing gastrointestinal procedures and surgeries: a systematic review of clinical trials.

BACKGROUND: Virtual reality (VR) is an advanced technology that transports users into a virtual world. It has been proven to be effective in pain management via distraction and alteration of pain perception. However, the impact of VR on treating perioperative pain is inconclusive. This systematic review aimed to evaluate the effect of VR on perioperative pain after a gastrointestinal (GI) procedure or surgery. METHODS: A systematic review of randomized controlled trials was conducted from inception to January 31, 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The updated Cochrane risk of bias (RoB 2) assessment tool was used to evaluate the risk of bias. RESULTS: Of 724 articles screened, 8 studies with 678 participants were included in the systematic review. Four studies evaluated the effect of VR on perioperative pain during GI procedure (eg, colonoscopy) focused on its use after GI surgeries (eg, abdominal surgeries). Some studies reported a reduction in pain scores after the procedure; however, the findings of pain difference in before or during vs after the procedure in the VR vs control groups were mixed. CONCLUSION: VR is a promising tool to control perioperative pain after a GI procedure or surgery. Differences in study protocols, pain assessment scales, and pain therapy used were limitations in performing a comprehensive meta-analysis. Further studies are needed to better evaluate the effects of VR on perioperative pain compared with standard of care.

Glucagon-like Peptide-1 Receptor Agonists Associated Gastrointestinal Adverse Events: A Cross-Sectional Analysis of the National Institutes of Health All of Us Cohort.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used diabetes and obesity medications but have been associated with gastrointestinal (GI) adverse events. However, real-world evidence on comparative GI adverse reaction profiles is limited. OBJECTIVES: This study aimed to evaluate GI adverse events among GLP-1 RA users and compare semaglutide, dulaglutide, liraglutide, and exenatide safety regarding the GI adverse reaction profile. METHODS: This retrospective cross-sectional analysis utilized real-world data on 10,328 adults with diabetes/obesity in the National Institutes of Health All of Us cohort. New GLP-1 RA users were identified, and GI adverse events were examined. Logistic regression determined factors associated with GI adverse events. RESULTS: The mean age of the study population was 61.4 ± 12.6 years, 65.7% were female, 51.3% were White, and they had a high comorbidity burden. Abdominal pain (57.6%) was the most common GI adverse event, followed by constipation (30.4%), diarrhea (32.7%), nausea and vomiting (23.4%), GI bleeding (15.9%), gastroparesis (5.1%), and pancreatitis (3.4%). Dulaglutide and liraglutide had higher rates of abdominal pain, constipation, diarrhea, and nausea and vomiting than semaglutide and exenatide. Liraglutide and exenatide had the highest pancreatitis (4.0% and 3.8%, respectively). Compared to semaglutide, dulaglutide and liraglutide had higher odds of abdominal pain, and nausea and vomiting. They also had higher odds of gastroparesis than semaglutide. No significant differences existed in GI bleeding or pancreatitis risks between the GLP-1 RAs. CONCLUSIONS: In this real-world cohort, GI adverse events were common with GLP-1 RAs. Differences in GI safety profiles existed between agents, with exenatide appearing safer than other GLP-1 RAs, except for gastroparesis. These findings can inform GLP-1 RA selection considering GI risk factors. Further studies are needed to evaluate the causal relationship and GLP-1 RA safety with concomitant medication use.

Alcohol and Substance Use Among the Working Age Population: A Nationwide Study of Fall-Related Emergency Department Visits.

OBJECTIVE: Prior studies have linked fall-related emergency department (ED) visits among older adults to alcohol use. Characteristics related to falls in the working age population (WAP; 15-64 years) may vary with alcohol and substance use. This study aimed to identify factors associated with fall-related ED visits related to alcohol and substance use in the WAP. METHOD: Using nationally representative 2019-2020 National Hospital Ambulatory Medical Care Survey data, fall-related ED visits within 72 hours were stratified by indication of alcohol use, substance use, and concurrent alcohol and substance use. Descriptive statistics accounting for the survey's complex design were used along with multivariable logistic regression to identify associated factors. RESULTS: Between 2019 and 2020, an estimated 10,800,000 fall-related ED visits occurred among the WAP, with 51.7% related to alcohol use, substance use, or both. Multivariable logistic regression analysis revealed that the WAP with fall-injury ED visits were associated with alcohol use (adjusted odds ratio [AOR] = 2.3, 95% CI [1.0, 5.9]) or concurrent alcohol and substance use (AOR = 8.5, 95% CI [1.6, 43.0]), and individuals with alcohol and substance use with a depression diagnosis are twice as likely to visit EDs with fall injuries. CONCLUSIONS: Individuals with alcohol and substance use with depression were twice as likely to visit EDs for fall injuries. Higher fall-related ED visits in the WAP were attributed to alcohol and substance use. Identified factors could improve injury prevention and timely intervention among the WAP in the United States.

Bridging the Telehealth Divide: Racial and Ethnic Disparities in Medicare Telehealth Usage Highlights the Need for Equity-Focused Approaches.

Background: The COVID-19 pandemic led to a dramatic increase in Medicare reimbursed telehealth utilization in the United States, but significant racial disparities persist. Methods: This research analyzed trends and disparities in Medicare reimbursed telehealth usage and claims from 2020 through 2022 using data from the Centers for Medicare & Medicaid Services. Results: Medicare telehealth user claims were 10.1 million in 2020, 52.7 million in 2021, and 85.3 million in 2023. The adjusted odds of telehealth use were significantly lower in 2021 (adjusted odds ratios [aORs]: 0.746; 95% confidence intervals [CI]: 0.683-0.815) and 2022 (aOR: 0.529; 95% CI: 0.484-0.578) compared with 2020. Large racial differences were observed in 2020-2022, with lower telehealth usage among African Americans (aOR: 0.068; 95% CI: 0.054-0.087), Hispanics (aOR: 0.036; 95% CI: 0.027-0.047), American Indians/Alaska Natives (aOR: 0.012; 95% CI: 0.009-0.017), and Asian Pacific Americans (aOR: 0.001; 95% CI: 0.001-0.002) versus Non-Hispanic Whites. Rural residents, older adults, and beneficiaries with disabilities also had reduced telehealth utilization. However, women were more likely to use telehealth versus men (aOR: 1.689; 95% CI: 1.363-2.094). Conclusion: Despite telehealth expansion during the pandemic, significant disparities remain, highlighting the need for targeted efforts to increase access and reduce barriers among underserved populations. Addressing disparities is critical to ensuring equitable access to health care through telehealth.

Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review and Meta-Analysis.

BACKGROUND: Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS. OBJECTIVE: The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS. METHODS: A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and ß-blockers. RESULTS: We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] -0.01, 95% CI -0.03 to 0.03 at 6 months and RD -0.02, 95% CI -0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD -0.01, 95% CI -0.04 to 0.02 and RD -0.01, 95% CI -0.03 to 0.02), aspirin (RD 0.00, 95% CI -0.06 to 0.07 and RD -0.00, 95% CI -0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD -0.01, 95% CI -0.04 to 0.02 and RD 0.01, 95% CI -0.04 to 0.05), and ß-blockers (RD 0.00, 95% CI -0.03 to 0.03 and RD -0.01, 95% CI -0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective). CONCLUSIONS: This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context.

The association between menopausal hormone therapy and gastroesophageal reflux disease: a systematic review and meta-analysis.

IMPORTANCE AND OBJECTIVE: Gastroesophageal reflux disease (GERD) is a chronic condition associated with several risk factors, but little is known about the association between hormone therapy (HT) and GERD in postmenopausal women. EVIDENCE REVIEW: We investigated the association between ever or current menopausal HT use and GERD using a systematic review and meta-analysis. Studies published between 2008 and August 31, 2022, were pooled using a DerSimonian and Laird random-effects model, and outcomes were reported as adjusted odds ratios (aOR) with a corresponding 95% CI. FINDINGS: The pooled analysis of five studies found a significant direct association between estrogen use and GERD (aOR, 1.41; 95% CI, 1.16-1.66; I2 = 97.6%), and progestogen use and GERD (two studies: aOR, 1.39; 95% CI, 1.15-1.64; I2 = 0.0%). The use of combined HT was also associated with GERD (1.16; 95% CI, 1.00-1.33; I2 = 87.9%). Overall, HT use was associated with 29% higher odds for GERD (aOR, 1.29; 95% CI, 1.17-1.42; I2 = 94.8%). The large number of pooled participants, differences in study design, geography, patient characteristics, and outcome assessment resulted in significant high heterogeneity. CONCLUSIONS AND RELEVANCE: There is a significant association between ever or current HT use and GERD. However, the results should be interpreted with caution, given the small number of included studies and high heterogeneity. This warrants careful evaluation of GERD risk factors when prescribing HT to reduce the risk of potential GERD complications.

Wilson's Disease Presenting in Late Adult Life.

Wilson's disease (WD) is an autosomal recessive disease affecting the copper metabolism resulting in various clinical presentations. Diagnosis includes the presence of low serum copper and ceruloplasmin concentrations, increased urinary copper excretion, and/or increased hepatic copper concentrations. Yet, genetic testing remains diagnostic. Management includes copper chelating agents and liver transplant in advance cases. We report a case of WD presenting with liver function impairment in late adult life and started on treatment. Therefore, early diagnosis and treatment of WD can prevent related complications.

P034 State of Health Maintenance Among IBD Patients at a Tertiary Care Center in Abu Dhabi, United Arab Emirates.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) affecting 6.8 million persons globally. Treatment of IBD focuses largely on immune suppression or modulation using corticosteroids, aminosalicylates, thiopurines, or biologic agents. These agents are effective but most of them pose a risk of infections, cancers, and osteoporosis. Many of these complications can be prevented by implementing vaccination, cancer screening, and bone health programs. Despite the progress in IBD care, recent data suggest that many IBD patients do not get preventative services. Previous studies have examined rates of vaccinations and other health maintenance metrics in North America and Europe where IBD patients are mainly of European and African descent. In comparison, Middle Eastern and Asian descent persons comprise the majority of the IBD population in Abu Dhabi, the capital city of United Arab Emirates (UAE), a major country in the Gulf region of the Middle East. Little is known to date about the state of IBD preventative care in this region. We sought to assess the proportion of patients with IBD that underwent recommended vaccinations, cancer screening (surveillance colonoscopy, PAP smear, annual skin examination), and bone health evaluation at Sheikh Shakhbout Medical City (SSMC), the largest tertiary care hospital in Abu Dhabi. METHODS: This study was a retrospective case series of adult IBD patients (>18 years) seen in the outpatient setting at SSMC from 2019 to 2020. Patients were identified based on ICD-10 codes for IBD [K50.90, K50.00, K51.90, and K50.80] as well as administrative/pharmacy records of the IBD agents (e.g. infliximab). Proportions were assessed using simple summary statistics and one sample proportion 95% confidence intervals were calculated. RESULTS: A total of 55 IBD patients were identified in our study with the majority being males (76.3%). The mean age was 31.6 years. Sixty-nine percent had Crohn's. Most of the patients were on infliximab (58.1%), followed by vedolizumab, ustekinumab, and adalimumab. The proportion of patients who received vaccinations was as follows; HAV (67%, 95% CI 28-100%), HBV (50%, 95% CI 28-72%), pneumococcal 23 (20%, 95% CI 9.4-31%), pneumococcal 13 (18.2%, 95% CI 8-28%) and influenza vaccine (16.4%, 95% CI 7-26%). Moreover, the study showed that the proportion of IBD patients who underwent recommended colonoscopy surveillance was 91% (95% CI 79-100%) and the proportion of women IBD patients who had recommended PAP smear was 30%, (95% CI 2-58%). Regarding bone health, the proportion who underwent DXA bone scans was 36%, (95% CI 24-49%) However, the compliance rate of the Tdap, HPV and Zoster vaccinations, and annual skin examination were poor warranting further quality improvement studies. CONCLUSION: This study revealed that the state of health maintenance among IBD patients seen at our facility before 2021 was largely dismal. Efforts are being taken to improve the proportion of patients who receive recommended vaccinations including annual influenza, pneumococcal 13 and 23, HPV, Zoster, and COVID-19 vaccines. Furthermore, there is a focus on bone health and skin cancer examinations with plans to calculate, report, and publish health maintenance data annually.

Dyke-Davidoff-Masson syndrome presenting as recurrent chronic headache in the late adult life.

Dyke-Davidoff-Masson syndrome (DDMS) (also referred to as cerebral hemiatrophy) is a rare condition characterized by seizures, facial asymmetry, contralateral spastic hemiplegia, or hemiparesis, with or without learning difficulties. It usually presents in the early childhood or late adolescence. The diagnosis is mainly associated with the presence of radiologic findings which include contralateral cerebral hemiatrophy with ipsilateral dilatation of the lateral ventricle and hypertrophy of the sinuses. Here, we report a case of a 49-year-old female patient who presented with chronic headache episodes for 10 years, and radiological findings revealed the DDMS.

Hypertriglyceridemia-Induced Acute Pancreatitis in a Patient With Type 2 Diabetes Mellitus.

Acute pancreatitis (AP) is an uncommon potential complication of severe hypertriglyceridemia (HTG). We reported a case of a 45-year-old man admitted with HTG-induced AP (HTG-AP). The patient was a known diabetic (glycated hemoglobin levels: 9.5%), his triglycerides level was 3587.2 mg/dl, and the lipase level was 242 IU/L. A CT scan revealed AP. The patient was treated with a low-dose insulin infusion (0.05 unit/kg/hr) with dextrose for six days. His triglycerides came down to 673.1 mg/dl, and he was discharged. Further investigations are needed to understand the efficacy of low-dose insulin in the management of HTG-AP.

Efficacy of Statin/Ezetimibe for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Asian Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Several clinical trials have investigated the effect of statin/ezetimibe combination therapy on secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the Asian population. OBJECTIVE: This study aimed to summarize study results regarding the effect of statin/ezetimibe combination therapy on lipid parameters and highly sensitive C-reactive protein (HsCRP) biomarkers in ASCVD patients from Asian countries. METHODS: We searched the PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar databases for relevant papers published from 2008 to June 2020. We included randomized controlled trials (RCTs) that (1) were conducted in ASCVD patients in Asian countries; (2) examined the effects of statin/ezetimibe combination therapies compared with a control group; and (3) reported sufficient data on lipid parameters and HsCRP biomarkers. The results were reported as weighted mean differences (WMDs) with 95% confidence intervals (CI) using random-effects models. Funnel plots and Egger's regression test were used to assess publication bias. RESULTS: Twenty-four RCTs were reviewed and 20 were included in the meta-analysis. A total of 4344 participants were included (n = 2197 in the intervention group and n = 2147 in the control group), and the intervention durations ranged from 6 weeks to 3.6 years. Ezetimibe coadministered with statin therapy, compared with control treatment, significantly reduced low-density lipoprotein cholesterol (LDL-C; n = 20 studies) [WMD - 0.39 mmol/L, 95% CI - 0.73 to - 0.05; p < 0.001], triglycerides (TG; n = 18 studies) [WMD - 0.23 mmol/L, 95% CI - 0.33 to - 0.13; p < 0.001], and total cholesterol (TC; n = 17 studies) [WMD - 0.31 mmol/L, 95% CI - 0.45 to - 0.17; p < 0.001). Although the effect of statin/ezetimibe combinations on high-density lipoprotein cholesterol (HDL-C; n = 17 studies) [WMD 0.02 mmol/L, 95% CI - 0.05 to 0.09; p < 0.001) was very minimal and no effect was observed on HsCRP levels (n = 11 studies). CONCLUSIONS: Our study found that statin/ezetimibe combinations reduced LDL-C, TC, and TG levels but had minimal effects on HDL-C and no effect HsCRP biomarkers in ASCVD patients. The statin/ezetimibe therapy enabled a more effective reduction in LDL-C levels; however, the duration of the treatment was suboptimal.

Preoperative antiviral therapy and microvascular invasion in hepatitis B virus-related hepatocellular carcinoma: A meta-analysis.

Microvascular invasion (MVI) is an important predictor of metastatic tumour recurrence and is associated with adverse outcomes and poor prognosis in Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients. The association between varying regimens of anti-viral drugs with the incidence of MVI in HBV-related HCC has been demonstrated, however, no meta-analysis of the available data has been conducted. Therefore, the current study sought to evaluate the association of preoperative antiviral therapy with incidence of microvascular invasion in HCC hepatitis virus patients. A systematic search of the literature was performed in MEDLINE/PubMed, Web of Science (WoS), and Scopus, up to January 2020. A random-effects model was used to estimate pooled odds ratios (ORs). Overall, six studies, with 4988 patients, met our inclusion criteria. The pooled OR of MVI in the patients who had preoperative antiviral therapy versus the patients who did not have antiviral therapy was; OR: 0.60, 95% Confidence Interval (CI): 0.49-0.73; I2 = 25%. In this study, a significant reduction in the OR of MVI was evident in patients who had anti-viral therapy.

COVID-19 Induced Hepatitis B Virus Reactivation: A Novel Case From the United Arab Emirates.

The novel coronavirus disease 2019 (COVID-19) clinically manifests as respiratory and gastrointestinal presentations, most commonly vomiting, diarrhea, and abdominal pain. Although the impaired liver function is prevalent in COVID-19, it is poorly understood. We report the first case of hepatitis B virus (HBV) reactivation caused by COVID-19 in a young adult with altered mental status and severe transaminitis. The patient was asymptomatic, hypothermic, his skin was jaundiced with the icteric sclera, with very high levels of aspartate aminotransferase (AST; 4,933 U/L), alanine aminotransferase (ALT; 4,758 U/L), and total bilirubin (183.9 mmol/L) levels. It is warranted that patients with abnormal liver functions tend to have an increased risk of COVID-19. Thus, increased attention should be paid to the care of patients with abnormal liver functions, and testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is warranted in the COVID era.

Vaccines and Drug Therapeutics to Lock Down Novel Coronavirus Disease 2019 (COVID-19): A Systematic Review of Clinical Trials.

The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has been responsible for millions of infections and hundreds of thousands of deaths. To date, there is no approved targeted treatment, and many investigational therapeutic agents and vaccine candidates are being considered for the treatment of COVID-19. To extract and summarize information on potential vaccines and therapeutic agents against COVID-19 at different stages of clinical trials from January to March 2020, we reviewed major clinical trial databases such as ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and other primary registries between January and March 15, 2020. Interventional studies at different phases under the COVID-19 pipeline were included. A total of 249 clinical trials were identified between January to March 15, 2020. After filtering observational studies (194 studies), a total of 56 interventional trials were considered. The majority of clinical trials have been conducted on chloroquine (n=10) and traditional Chinese medications (TCMs; n=10), followed by antivirals (n=8), anti-inflammatory/immunosuppressants (n=9), cellular therapies (n=4), combinations of different antivirals therapies (n=3), antibacterial (n=1), and other therapies (n=5). Five vaccines are under phase I, and there are a couple of phase III trials on the Bacillus Calmette-Guérin (BCG) vaccine under investigation among healthcare workers. Many novel compounds and vaccines against COVID-19 are currently under investigation. Some candidates have been tested for other viral infections and are listed for clinical trials against the COVID-19 pipeline. Currently, there are no effective specific antivirals or drug combinations available for the treatment of COVID-19.

HIV/AIDS-knowledge and attitudes in the Arabian Peninsula: A systematic review and meta-analysis.

BACKGROUND: HIV/AIDS prevention has been widely adopted worldwide, but little is known about HIV/AIDS knowledge and attitudes in the Arabian Peninsula. AIM: To summarize the level of knowledge and attitude about HIV/AIDS in seven Arabian Peninsula countries (Saudi Arabia, Oman, Kuwait, Qatar, Bahrain, Yemen, and the United Arab Emirates (UAE)). METHODS: A systematic literature search was performed using combined keywords in four scientific databases of peer-reviewed publications from January 2010 to June 2019. Twenty-five articles were included in the systematic review, and twenty studies in the meta-analysis. The data was analyzed using a random-effect model due to the heterogeneity between the studies. RESULTS: Seventeen studies reported on the level of knowledge and overall knowledge about HIV/AIDS in this region: 74.4% (95% confidence interval (CI): 66.8%-82.0%, p<0.001) and the attitude was 52.8% (95% CI: 36.9%-68.6%, p<0.001). A study from Oman reported higher knowledge levels (95.5%, 95% CI: 94.2%-96.8%) while less than a quarter of the Bahrain population had positive attitudes 22.5% (95% CI: 20.5%-24.5%). Medical doctors showed higher knowledge (94.1%, 95% CI: 92.9%-95.3%), but a positive attitude was only observed in 32.5% (95% CI: 28.8%-36.2%) of the dentists toward HIV/AIDS. CONCLUSION: The overall knowledge about HIV/AIDS was found to be satisfactory (74.4%), but about half (52.8%) of those displayed negative attitudes toward HIV/AIDS. Regular training courses as well as reviewing and reinforcing HIV/AIDS prevention guidelines can be useful to update knowledge and improve attitudes in this region.