Efficacy and safety of eptinezumab as preventive treatment for episodic/chronic migraine: A systematic review and meta-analysis.

Migraine, the third most common neurological disorders worldwide, can cause significant burden to the patients. Currently, it has been found that calcitonin gene-related peptide (CGRP) has a significant role in pathophysiology of migraine. This study sought to analyse the efficacy and safety of eptinezumab, one of the CGRP-monoclonal antibody as preventive treatment for episodic/chronic migraine. Specific keywords were used to comprehensively go through the potential articles on ClinicalTrials.gov, Europe PMC, Scopus and PubMed databases until April 2022. All published randomized clinical trials (RCTs) on eptinezumab and migraine were gathered. Statistical analysis was conducted by using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software. There were four RCTs with 2739 migraine patients in the meta-analysis. In terms of efficacy, our analysis revealed that eptinezumab corresponded with higher reduction in monthly migraine days from baseline to week 12 (standardized mean difference, -0.34 [95% confidence interval (CI), -0.41, -0.28], P < 0.00001; I2  = 0%), higher 75% and 50% migraine responder rate, reduction in rate of migraine on day-1 after dosing, lower headache impact test-6 score on week 4 and week 12. In terms of safety, eptinezumab has comparable adverse events when compared with placebo (risk ratio, 1.01 [95% CI 0.96-1.07], P = 0.63, I2  = 0%). Further regression analysis also revealed that the association between eptinezumab and each outcomes of interest were not influenced by age, gender, body mass index and duration of migraine. This study proposes that eptinezumab is generally effective and safe for the preventive treatment of episodic or chronic migraine.

Epilepsy and the risk of severe coronavirus disease 2019 outcomes: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: Patients with epilepsy experience seizures, which have been reported to increase and worsen during the coronavirus disease (COVID-19) pandemic. However, the association between epilepsy and COVID-19 outcomes remains unclear. The aim of this study was to analyze whether patients with epilepsy have an increased risk of having poor COVID-19 outcomes. METHODS: We comprehensively evaluated potential articles extracted from the medRxiv, Europe PMC, and PubMed databases until June 30, 2021, using selected keywords. All published studies on epilepsy and COVID-19 were selected. We used the Review Manager 5.4 and Comprehensive Meta-Analysis 3 software for statistical analysis. RESULTS: Thirteen studies with 67,131 patients with COVID-19 were included in the analysis. Evaluation of the collated data revealed an association between epilepsy and increased severity of COVID-19 (OR, 1.69; 95%CI: 1.11-2.59; p = 0.010; I2 = 29%; random-effect modeling) and mortality from COVID-19 (OR, 1.71; 95%CI: 1.14-2.56; p = 0.010; I2 = 53%; random-effect modeling). The results also showed that the association between epilepsy and increased risk of developing severe COVID-19 is influenced by sex and neurodegenerative disease. CONCLUSIONS: The findings of this study suggest that patients with epilepsy are at risk of having poor COVID-19 outcomes. Patients with epilepsy need special attention and should be prioritized for administration of the COVID-19 vaccine. Registration details: PROSPERO (CRD42021264979).

High C-Reactive Protein/ Albumin Ratio Predicts Mortality and Hemorrhage in Stroke Patients Undergoing Mechanical Thrombectomy: A Systematic Review and Meta-Analysis.

BACKGROUND: Stroke outcomes are multifactorial, and the C-Reactive Protein to Albumin Ratio (CAR) has emerged as a potential prognostic marker. This study aims to evaluate CAR prognostic significance in stroke. METHODS: Systematic searches across ScienceDirect, Medline, and Cochrane databases identified longitudinal studies. Unfavorable outcomes, including poor prognosis (modified rankin scale> 2), mortality, and severe complications like hemorrhage or restenosis, were considered. Analyses for unfavorable outcomes were conducted based on prior intervention, stroke type, and outcome type. RESULTS: The meta-analysis included 12 cohort studies comprising 5042 participants. Elevated CAR (OR: 1.72; 95% confidence interval [CI]: 1.17-2.52; P = 0.01) and CRP (OR: 1.91; 95% CI: 1.31-2.77; P < 0.001) levels on admission were associated with unfavorable outcomes; no such association was observed for albumin (OR: 0.66; 95%CI: 0.24-1.80; P = 0.42). Elevated CAR levels were associated with unfavorable outcomes in patients undergoing mechanical thrombectomy (odds ratio [OR]: 2.70; 95% CI: 1.14-6.38; P < 0.02) and those with ischemic stroke (OR: 1.99; 95% CI: 1.24-3.18; P < 0.001), but no significant association was found in patients with hemorrhagic stroke. Furthermore, concerning specific outcomes, high CAR levels were associated with mortality (OR: 1.71; 95% CI: 1.00-2.95; P = 0.05) and hemorrhage (OR: 6.02; 95% CI: 1.61-23.87; P = 0.05). The area under the curve for CAR was 0.72 (0.68-0.76), with a sensitivity of 0.61 (0.49-0.71) and specificity of 0.73 (0.64-0.81). CONCLUSIONS: Elevated CAR emerges as an effective marker in assessing unfavorable outcomes in stroke patients with moderately high sensitivity and specificity. High CAR levels exhibited statistically significant mortality and hemorrhage in stroke patients undergoing mechanical thrombectomy.

COVID-19-Associated Encephalopathy: Systematic Review of Case Reports.

BACKGROUND AND PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, but there are also several reports of the involvement of the central nervous system, with one of the manifestations being encephalopathy. The relatively new emergence of COVID-19 means that few studies have investigated the clinical profile of encephalopathy associated with this disease. This study aimed to determine the clinical profile, laboratory, and imaging results of encephalopathy associated with COVID-19. METHODS: Three databases, namely PubMed/MEDLINE, Embase, and Scopus, were systematically searched for case reports and case series related to COVID-19-associated encephalopathy published from January 1, 2019 to July 20, 2020. RESULTS: This review included 24 studies involving 33 cases. The most-reported neurological symptoms were disorientation/confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). Laboratory examinations revealed increases in the C-reactive protein level (48.48%), the lactate dehydrogenase level (30.30%), and lymphopenia (27.27%). Brain imaging did not produce any pathological findings in 51.51% of the cases. Electroencephalography showed generalized slowing in 45.45% of the cases. Elevated protein (42.42%) and lymphocytosis (24.24%) were found in the cerebrospinal fluid. Fifteen patients were reportedly discharged from the hospital in a stable condition, while four cases of mortality were recorded. CONCLUSIONS: The clinical, laboratory, and imaging findings in this review support the hypothesis that cerebral damage in COVID-19-associated encephalopathy is caused by cytokine-immune-mediated inflammation rather than by direct invasion.

Coronavirus disease 2019 (Covid-19) outcomes in patients with sarcopenia: A meta-analysis and meta-regression.

BACKGROUND: Sarcopenia has been associated with patients' poor quality of life, disability, and hospitalization. As of today, evidence that highlights the association between sarcopenia and Covid-19 outcomes remains unclear. This study sought to analyze whether patients with sarcopenia are at higher risk for developing poor Covid-19 outcomes. METHODS: Using specific keywords, we comprehensively go through the potential articles on medRxiv, Europe PMC, and PubMed sources until July 31st, 2021. All published studies on sarcopenia and coronavirus disease 2019 were collected. We were using Review Manager 5.4 and Comprehensive Meta-Analysis 3 software to conduct statistical analysis. RESULTS: There were 9 studies with 492,245 Covid-19 patients included in the analysis. Evaluation of the data gathered yielded an association between sarcopenia and increased severity of Covid-19 (OR 1.99; 95%CI: 1.37-2.90, p = 0.0003, I2 = 79%, random-effect modelling); and mortality from Covid-19 (OR 1.96; 95%CI: 1.11-3.46, p = 0.020, I2 = 49%, random-effect modelling). The increased risk of developing severe Covid-19 in a sarcopenic patient is also further influenced by cancer. CONCLUSIONS: This study proposes that patients with sarcopenia are at risk of developing poor Covid-19 outcomes. Patients with sarcopenia need special attention and should be prioritized to receive the SARS-CoV-2 vaccine. REGISTRATION DETAILS: PROSPERO (CRD42021270725).

Ultrasound-Guided Measurement of Piriformis Muscle Thickness to Diagnose Piriformis Syndrome.

Background: Piriformis syndrome (PS) is a neuromuscular condition caused by the entrapment of the sciatic nerve at the level of the piriformis muscle (PM). Diagnosing PS remains challenging despite recent invasive and non-invasive diagnostic methods. Response to invasive nerve block is still one of the most reliable diagnostic modalities because there is no gold standard test for PS. As early diagnosis may prevent delayed diagnosis that results in chronic somatic dysfunction and muscle weakness, a screening test with high sensitivity could guide clinicians in performing the next appropriate step in diagnosing PS. Aim: The purpose of this study is to determine the sensitivity, specificity, and best cut-off point of ultrasound-guided PM thickness in PS. Method: This case-control study was conducted in a general hospital in Tangerang during a 3-month period. We recruited 58 patients clinically diagnosed with PS and 58 healthy patients (without a history of hip and buttock pain) during their visits to the outpatient clinic. All patients underwent ultrasound assessment to measure bilateral PM thickness. Sex, age, body mass index, history of micro-/macro-trauma, and prolonged sitting duration were recorded. Statistical analyses were performed using the Statistical Package for the Social Sciences version 25. Result: The PS and control groups predominantly comprised female subjects, with mean ages of 51.79 ± 14.10 and 50.09 ± 13.26 years on PS and healthy subjects, respectively. The mean ultrasound-guided PM thickness was higher in PS subjects compared to healthy subjects with mean thicknesses of 1.16 ± 0.13 and 0.85 ± 0.11 cm, respectively (p < 0.05). The area under the receiver operating characteristic curve of the PM was 0.970 (95% confidence interval 0.943-0.998, p < 0.05). The best cut-off point defined by Youden's J index was 0.9950 cm for all PS subjects. Conclusion: We propose 0.9950 cm as the cut-off point for diagnosing PS by ultrasound, which has the sensitivity and specificity of 94.8 and 87.9%, respectively.