Efficacy and safety of tenecteplase in comparison to alteplase in acute ischemic stroke: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Alteplase is the standard medical therapy for acute ischemic stroke (AIS) patients who present within 4.5 h of symptom onset. Tenecteplase is a modified alteplase variant with pharmacological and practical advantages over alteplase. Many trials have investigated the efficacy and safety of tenecteplase against alteplase. This systematic review and meta-analysis aimed to compare the efficacy and safety of tenecteplase to alteplase across randomized controlled trials. METHOD: Medline, Embase, and Cochrane CENTRAL were used to search the related articles until February 20, 2023. Randomized controlled trials (RCTs) that compared the effectiveness and safety of tenecteplase against alteplase for AIS patients were included. Screening, risk of bias assessment, and data extraction were performed following PRISMA guidelines. Data were pooled using a random-effect model. RESULTS: Ten RCTs were included, with a total of 5123 patients. There was no significant difference between the two interventions in modified rankin scale 0-1 (mRS 0-1) (RR= 1.04, 95% CI [0.99-1.10], P = 0.11, I2 =0%) and early neurological improvement (RR= 1.06, 95% CI [0.97-1.15], P = 0.21, I2 =35). There was no difference in the rates of symptomatic intracranial hemorrhage (RR= 1.18, 95% CI [0.84-1.65], P = 0.35, I2 = 0%). Tenecteplase was associated with significantly higher complete recanalization rate compared to alteplase (RR= 1.17, 95% CI [1.00-1.36], P = 0.05, I2 =0%). For large vessel occlusion (LVO) patients assigned to tenecteplase, there was a significant improvement in mRS 0-1 (RR= 1.28, 95% CI [1.07-1.52], P = 0.006, I2 =0%). CONCLUSION: Based on our meta-analysis, tenecteplase has similar efficacy and safety to alteplase, with a more promising effect in patients with LVO.

The Recurrence of Symptoms After Anterior Cervical Discectomy and Fusion.

Objectives This study aimed to evaluate the recurrence symptoms rate after anterior cervical discectomy and fusion (ACDF) for one year and seek the common cervical vertebral disk affected in a tertiary center in Saudi Arabia over the past five years. Methods This is a single-center, cross-sectional study conducted on patients followed in our center from January 2016 to December 2022. All patients who were older than 18 and underwent ACDF were included. Results Out of 77 patients, 43 (55.8%) have experienced a recurrence of symptoms after the ACDF operation. The highest rate of recurrent symptoms was neck pain 22 (28.6%), left upper limb numbness 20 (26%), and right upper limb numbness 16 (20.8%). It was found that shoulder pain recurred after one level of ACDF in six patients out of 10 (60%), and only one (10%) patient experienced shoulder pain after two-level ACDF. Conclusion ACDF has a high rate of recurrence of symptoms, and the most common type of ACDF was two levels. Most symptoms were neck pain and upper limb radicular pain. However, there is a lack of studies. We recommend conducting more studies on the secondary management of recurrent symptoms post-ACDF.

The effect of different types of anemia on HbA1c levels in non-diabetics.

BACKGROUND: Diabetes mellitus is one of the most common diseases worldwide with significant morbidity and mortality. HbA1c remains one of the most important methods for diagnosis and monitoring of the disease. Since HbA1c is a reflection of the glucose attached to red blood cells, factors affecting hemoglobin and red blood cells' half-life can influence HbA1c measurements. OBJECTIVE: This study aims to evaluate the effect of different types of anemia including iron deficiency anemia, sickle cell anemia, ß -thalassemia trait, and megaloblastic anemia on HbA1c levels in a tertiary hospital over the past 6 years (2016-2022). METHOD: This is a retrospective chart review study of 324 patients including those with one of the four types of anemia mentioned above and a control group. The control group were healthy adults with normal HbA1c and hemoglobin, who were not known to have diabetes or anemia. Patients with diabetes or prediabetes based on self-reporting or elevated fasting, random blood sugar, or 2 hours post-prandial blood glucose were excluded. RESULTS: The mean HbA1c levels were significantly higher in sickle cell anemia at 5.83% (95% CI = 5.39-6.28) and in iron deficiency anemia at 5.75% (95% CI = 5.68-5.82) when compared to the control group at 5.32% (95% CI = 5.22-5.41). However, the mean HbA1c levels in megaloblastic anemia were 5.38% (95% CI = 5.26-5.5) and 5.45% (95% CI = 5.21-5.69) in beta thalassemia trait, which were not significantly different when compared to the control group. HbA1c significantly decreased from 5.75 to 5.44% after treatment in the iron-deficient group with a p-value of < 0.001. Moreover, lower hemoglobin and higher red cell distribution width correlated with higher HbA1c levels in patients with sickle cell anemia. CONCLUSION: This study found a significant increase in HbA1c levels in iron deficiency anemia and sickle cell disease in patients not known to have diabetes. However, there was no significant effect in those patients with ß-thalassemia trait and megaloblastic anemia. Treatment of iron deficiency anemia significantly decreased the HbA1c level, bringing it back to normal.