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.

Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials.

PURPOSE: Propofol has become the sedative of choice for endoscopy and colonoscopy. However, it has shown associations with various adverse effects, specifically in the geriatric population. In contrast, remimazolam is a novel benzodiazepine, demonstrating a superior clinical safety profile. Hence, this systematic review and meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol in elderly patients (≥ 60 years) undergoing gastrointestinal endoscopic and colonoscopy procedures. METHODS: Electronic databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were explored from inception till January 7, 2024. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (RoB-2) was utilized to evaluate the quality of each included study reported in this meta-analysis. RESULTS: Seven randomized control trials were included, resulting in the pooling of 1,466 patients (remimazolam: 731 patients; propofol: 735 patients). Propofol demonstrated a significantly lower time to loss of consciousness (P < 0.00001, 4 studies, 784 patients) and a greater sedation success after first dose (P = 0.05, 5 studies, 1,271 patients). Remimazolam reported a significantly lower risk of bradycardia (P = 0.02, 5 studies, 1,323 patients), hypoxemia (P < 0.00001, 6 studies, 1,389 patients), and pain on injection site (P < 0.00001, 5 studies, 1,184 patients). No statistically significant differences in sedation time, number of supplemental doses, procedural parameters, and other adverse outcomes were reported. CONCLUSION: As per the results of our analyses, propofol demonstrated comparatively superior efficacy, however, remimazolam demonstrated comparatively superior safety. The debatable evidence generated from this meta-analysis may not currently be powerful enough to advocate for the use of remimazolam in elderly patients undergoing gastrointestinal procedures; hence, further comprehensive studies are necessary in order to arrive at a robust conclusion.

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.

Comparison of Clopidogrel Versus Ticagrelor for Percutaneous Coronary Intervention (PCI) Patients Managed with Therapeutic Hypothermia: A Systematic Review and Meta-Analysis.

Various antiplatelet drugs, such as clopidogrel and ticagrelor, are available on the market for use after percutaneous coronary intervention (PCI). However, the efficacy of such drugs in patients being managed with therapeutic hypothermia (TH) has always been debated. In light of this controversy, this systematic review and meta-analysis was performed to enhance existing literature. Various databases were searched for potentially relevant studies from inception to April 2023, including PubMed, Cochrane Library, and Scopus. The risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Cochrane risk of bias tool for randomized controlled trials. Outcomes of interest included risk of bleeding, stent thrombosis, and all-cause mortality. Five studies were shortlisted for inclusion into the meta-analysis, featuring a total of 245 patients receiving either clopidogrel or ticagrelor. Overall, no significant differences were noted when the use of clopidogrel and ticagrelor was compared in PCI patients being managed with TH. To the best of our knowledge, this is the most comprehensive meta-analysis comparing the outcomes of clopidogrel and ticagrelor in PCI patients being managed with TH. Despite existing studies claiming an altered efficacy of clopidogrel in such conditions, our meta-analytic findings could not prove this relationship. Due to the limited sample size, further comprehensive and randomized studies are encouraged to arrive at a robust conclusion.

Effect of Caffeine in Hypertension.

Hypertension (HTN) is characterized by an elevated arterial blood pressure with no apparent symptom while proving to be a crucial risk factor for the other underlying disorders such as cardiac failure, atrial fibrillation, stroke and various others, steering to recurrent premature deaths worldwide if left untreated. There are innumerate factors responsible for causing HTN such as age factor, obesity, inheritance, physical inactivity, stress, and unhealthy diet whereas some therapeutics and pharmaceuticals may too trigger this condition notably caffeine. As caffeine is amongst the most widely consumed drinks worldwide and hence an ordeal to cease its use, accordingly this review article in-sighted to raise cognizance specifically towards the action of caffeine affiliated with HTN. Therefore, this review is focused on the risk factors and preventive measures associated with HTN, especially the role of caffeine in inducing HTN as to create social awareness regarding how the excessive habituated caffeine consumption may aggravate this condition.

Assessment of wheat productivity responses and soil health dynamics under brackish ground water.

The continuous use of brackish groundwater for irrigation is detrimental for soil and crop attributes. A three-year research study was designed for the wheat crop to assess the effects of brackish groundwater on crop yield and soil health under a surface irrigation system. Three sites were selected in different cropping zones of Pakistan. The treatments comprised of irrigation with moderately brackish water having 0.8, 1.3 & 2.7 dSm-1 of salinity and canal water. The results indicated that EC, SAR, bicarbonates, Ca2+ and Mg2+ levels increased in the soil for consecutive years and this increase was more at site S3 followed by S2 and S1. As soil depth is concerned, the increase was more pronounced in upper layers of soil (0-15 cm) as compared to 15-30 cm depth. Growth and yield were also affected by the consecutive use of this water, the number of plants, plant height, the number of spikes per plant, and yield was reduced at all the three sites. However, the impact was less pronounced at the site S1 whereas S3 was the most affected one. Grain weight and dry matter weight were observed to be maximum at S1. Water productivity was also calculated for all the three sites. Maximum water productivity was observed at S1 followed by S2 & S3. It was concluded that the continuous use of brackish water would have an adverse effect on crop yield and subsequently, soil health is also affected by it significantly.

Methotrexate versus expectant management in ectopic pregnancy: a meta-analysis.

BACKGROUND: Ectopic pregnancy (EP) affects 1-2% of all pregnant females'(Barnhart et al., Expert Opin Pharmacother 2(3):409-417, 2001) that can require emergent surgical intervention. Noninvasive diagnostic tests like transvaginal ultrasound (TVUS), and serial ß-hCG levels have enabled early diagnosis and allowed medical therapy to be tried. Methotrexate (MTX) versus expectant management, both have been considered safe but superiority of one over the other is lacking. METHODS: We searched for RCT that have shown efficacy of MTX versus expectant management in hemodynamically stable patients. Our primary outcome was whether one modality is superior to the other. RESULTS: Four RCT were included in the meta-analysis after review. Our pooled analysis when comparing MTX and expectant management showed us that the difference between the uneventful decline in ß-hCG levels (treatment success) was statistically insignificant (RR = 1.06, 95% CI 0.93-1.21) with no significant heterogeneity between trials (I2 = 0.0%, P = 0.578). The difference between need for surgical intervention between methotrexate and expectant management was also statistically insignificant (RR = 0.77, 95% CI 0.43-1.40) with no significant heterogeneity between trials (I2 = 0.0%, P = 0.552). CONCLUSION: We conclude that expectant management is not inferior to MTX in hemodynamically stable patients with ectopic pregnancy that have declining or low ß-hCG levels.

Single dose tafenoquine for preventing relapse in people with plasmodium vivax malaria-an updated meta-analysis.

BACKGROUND: Plasmodium vivax is a frequent cause of recurring malaria in endemic areas as in its latent stage it resides in liver, and is responsible for relapse. Treatment with 8 aminoquinoline Primaquine is given for 14 days, however studies have shown dismal results with adherence to therapy. A new long acting 8 aminoquinoline, Tafenoquine was introduced that showed efficacy and safety almost similar to Primaquine in a single dose regimen, hence giving hopes for improved compliance and help in eradicating malaria. METHODS: We searched for randomized controlled trials (RCTs) that compared the efficacy of Tafenoquine with Primaquine or placebo. Our primary outcome was the recurrence of Plasmodium vivax parasitemia at 6 months and our safety outcomes included total number of adverse events as well as serious adverse events. We performed pooled data analysis by the random effects model and I2 was used to assess heterogeneity. RESULTS: 4 RCTs were included. Our pooled analysis showed that the number of episodes of recurrence at 6 months between Tafenoquine and Primaquine (RR = 1.08, 95% CI = 0.74-1.59), and between Tafenoquine and placebo (RR = 0.17, 95%CI = 0.03-1.11) was statistically insignificant. Comparison of serious adverse events did not show any significant risk associated with the use of Tafenoquine as compared to Primaquine when analyzed till day 29, which was the time period considered to show most probable drug associated events. CONCLUSION: Tafenoquine as a single dose is an effective alternative to Primaquine for prevention of recurrence of P vivax malaria, with a reasonable safety profile.