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.

Age of Robotic Surgery and Telemedicine: Is Pakistan Lagging Behind?

Robotic surgery and telemedicine have revolutionized the healthcare industry, offering improved patient outcomes and access to medical knowledge. However, Pakistan lags behind in adopting these cutting-edge technologies due to several challenges, including limited infrastructure, budget constraints, and low awareness among patients and healthcare professionals. This article provides an in-depth analysis of the current state of the healthcare system in Pakistan, highlighting the need for investment and policy reforms to integrate robotic surgery and telemedicine effectively. The potential benefits, including medical tourism, enhanced facilities, and skilled workforce retention, are discussed as incentives for the government to embrace digital medicine and bridge the healthcare gap. Through increased awareness, training programs, and collaborations with other nations, Pakistan can pave the way for a digitally empowered healthcare future.

Cytomegalovirus-related Cystitis in a Patient with Membranous Glomerulonephritis Receiving Cyclophosphamide: A Case Study.

Hemorrhagic cystitis is a familiar complication of cyclophosphamide therapy in patients receiving high doses of intravenous cyclophosphamide, which is commonly used as part of a chemotherapeutic regimen and as an immunosuppressant for various malignancies and connective tissue diseases. Acrolein, an active and urotoxic metabolite of cyclophosphamide, is the leading cause of this hazardous complication. However, there are very few case reports indicating the role of pathogens such as BK virus, adenovirus, cytomegalovirus (CMV), Escherichia coli, Proteus mirabilis, Klebsiella, and Candida as the triggers for hemorrhagic cystitis, after short courses and oral use of cyclophosphamide therapy. Here, we report a case of CMV-related cystitis in a patient with membranous glomerulonephritis, who received conventional doses of oral cyclophosphamide for a short duration and presented with hematuria. Cystoscopy, along with a microscopic examination of the bladder mucosa, revealed mononuclear viral inclusions indicating CMV were observed. The patient responded to antiviral therapy.

Safety and efficacy of colchicine in COVID-19 patients: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: Colchicine has been used an effective anti-inflammatory drug to treat gout diseases. Owing to its pharmacodynamic of inhibiting interleukins, it has been repurposed to target the cytokine storm post-SARS-CoV-2 invasion. The goal of this meta-analysis was to evaluate the safety profile of colchicine in COVID-19 patients using the gold-standard randomised-control trials. METHODS: Electronic databases (Pubmed, Google Scholar, and Cochrane) were systematically searched until June 2021 and RCTs were extracted. Outcomes of interest included all-cause mortality, COVID-19 severity, mechanical ventilation, C-reactive protein and D-dimer levels. Using a random-effects model, dichotomous outcomes were pooled using odds ratios (OR) through the generic inverse variance formula while weighted mean differences were calculated using the Wan's method. P-values < 0.05 were considered statistically significant for all outcomes. RESULTS: A total population of 16,048 from five RCTs were included in the analysis. Of this, 7957 were randomized to colchicine, and 8091 received standard care, with an average age of 60.67 years. Colchicine was observed to significantly reduce COVID-19 severity (OR: 0.41, 95% CI [0.22, 0.76]; p = 0.005), and CRP levels (WMD: -19.99, 95% CI [-32.09, -7.89]; p = 0.001). However, there was no significant difference in D-dimer levels (WMD: 0.31, 95% CI [-0.61, 1.23]; p = 0.51), mechanical ventilation (OR: 0.42, 95% CI [0.17, 1.03]; p = 0.06; I2 = 74%) and all-cause mortality (OR: 0.98, 95% CI [0.83, 1.16]; p = 0.84) among patients receiving colchicine or standard care. CONCLUSION: Colchicine treatment decreased CRP levels and COVID-19 severity, with dimer levels, all-cause mortality and mechanical ventilation remaining seemingly unaffected. Thus, clinical trials need to be carried out that allow effective evaluation of colchicine in COVID-19 patients.

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.

Frequency of maintenance hemodialysis patients meeting K/DOQI criteria for serum calcium, phosphorus, calcium phosphorus product and PTH levels; a single institutional experience from Pakistan: a cross sectional study.

INTRODUCTION: There is a great scarcity of literature in Pakistan investigating the proportion of end stage renal disease (ESRD) patients undergoing hemodialysis (HD) who meet the recommended kidney diseases outcome quality initiative (K/DOQI) guidelines for serum calcium (Ca), phosphorus (P), calcium phosphorus product (Ca x P) and parathyroid hormone (PTH) levels. Our study aimed to determine frequencies of patients who met the K/DOQI targets for these minerals at a tertiary care hospital's dialysis unit. METHODS: 111 ESRD patients on maintenance HD were selected from a tertiary care hospital. Serum Ca and P were assayed on chemistry analyser. PTH was measured through electrochemiluminescence sandwich method. Data were compared with K/DOQI targets and analysed using SPSS-21. RESULTS: The mean age of patients was 55.85 years (SD ± 13.95). Gender distribution was almost equal with 49.5% males and 50.5% females. The patients had mean corrected serum Calcium 9.12 ± 0.64 mg/dL, Phosphorus 4.57 ± 1.54 mg/dL and Parathyroid hormone 333.8 ± 278.4 pg/mL. The patients had achieved K/DOQI target ranges of Ca, P, PTH, Ca x P product and all 4 criteria in 63.1%, 47.6%, 38.7%, 84.7% and 10.8% respectively. CONCLUSION: Majority of patients on maintenance HD at our institution did not achieve the recommended K/DOQI target ranges. Further studies pertaining to the Asian subcontinent will prove resourceful for comparison of mineral metabolism and dialysis outcome of ESRD patients.