AREAS COVERED: This review covers issues pertinent to infection in the HSCT patient, including bacterial and viral infection; strategies to reduce GVHD; infection patterns; resistance and treatment options; adverse drug reactions to antimicrobials, problems of antimicrobial resistance; perturbation of the microbiome; the role of prebiotics, probiotics, and antimicrobial peptides. We highlight potential strategies to minimize the use of antimicrobials.
EXPERT OPINION: Measures to control infection and its transmission remain significant HSCT management policy and planning issues. Transplant centers need to consider carefully prophylactic use of antimicrobials for neutropenic patients. The judicious use of appropriate antimicrobials remains a crucial part of the treatment protocol. However, antimicrobials' adverse effects cause microbiome diversity and dysbiosis and have been shown to increase morbidity and mortality.
AREAS COVERED: The present article reviews the cholesterol metabolism in the brain, which includes: the synthesis, transport, storage, and elimination process. Additionally, it reviews the role of cholesterol in the pathogenesis of dementia and statin as a therapeutic intervention in dementia. In addition to the above, it further reviews evidence in support of as well as against statin therapy in dementia, recent updates of statin pharmacology, and demerits of use of statin pharmacotherapy.
EXPERT OPINION: Amyloid-β peptides and intraneuronal neurofibrillary tangles are markers of Alzheimer's disease. Evidence shows cholesterol modulates the functioning of enzymes associated with Amyloid-β peptide processing and synthesis. Lowering cholesterol using statin may help prevent or delay the progression of dementia. This paper reviews the role of statin in dementia and recommends extensive future studies, including genetic research, to obtain a precise medication approach for patients with dementia.
RESEARCH DESIGN AND METHODS: All suspected ADEs associated with tocilizumab between April to August 2020 were analyzed based on COVID-19 patients' demographic and clinical variables, and severity of involvement of organ system.
RESULTS: A total of 1005 ADEs were reported among 513 recipients. The majority of the ADEs (46.26%) were reported from 18-64 years, were males and reported spontaneously. Around 80%, 20%, and 64% were serious, fatal, and administered intravenously, respectively. 'Injury, Poisoning, and Procedural Complications' remain as highest (35%) among categorized ADEs. Neutropenia, hypofibrinogenemia were common hematological ADEs. The above 64 years was found to have significantly lower odds than of below 45 years. In comparison, those in the European Region have substantially higher odds compared to the Region of Americas.
CONCLUSION: Neutropenia, superinfections, reactivation of latent infections, hepatitis, and cardiac abnormalities were common ADEs observed that necessitate proper monitoring and reporting.
METHODS: A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations.
RESULTS: A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer.
CONCLUSIONS: These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region.
METHODS: We compared 2 different consecutive video libraries (40 video per arm) collected at Humanitas Research Hospital with 2 different CADe system brands (CADe A and CADe B). For each video, the number of CADe false activations, the cause and the time spent by the endoscopist to examine the area erroneously highlighted were reported. The FP activations were classified according to the previously developed classification of false positives (the NOISE classification) according to their cause and relevance.
RESULTS: A total of 1021 FP activations were registered across the 40 videos of the Group A (25.5±12.2 FPs per colonoscopy). A comparable number of FPs were identified in the Group B (n=1028, mean:25.7±13.2 FPs per colonoscopy) (p 0.53). Among them, 22.9±9.9 (89.8%, Group A), and 22.1±10.0 (86.0%, Group B) were due to artifacts from bowel wall. Conversely, 2.6±1.9 (10.2%) and 3.5±2.1 (14%) were caused by bowel content (p 0.45). Within the Group A each false activation required 0.2±0.9 seconds, with 1.6±1.0 (6.3%) FPs requiring additional time for endoscopic assessment. Comparable results were reported within the Group B with 0.2±0.8 seconds spent per false activation and 1.8±1.2 FPs per colonoscopy requiring additional inspection.
CONCLUSION: The use of a standardized nomenclature permitted to provide comparable results with either of the 2 recently approved CADe systems.
METHODS: We searched PubMed, Embase, and Web of Science through August 2024 for randomized controlled trials evaluating ensifentrine in COPD patients over a minimum of four weeks. Data extraction and screening utilized Knowledge software, and meta-analyses were performed using R v4.4 with a random-effects model.
RESULTS: From 206 studies identified, four met our inclusion criteria. Ensifentrine improved FEV1 significantly at a dose of 3 mg (LS mean difference: 40.90 mL; 95 % CI: 19.65-62.15). It also improved dyspnea as measured by the Transition Dyspnea Index (TDI) (LS mean difference: 0.91; 95 % CI: 0.61-1.21) and quality of life according to the St. George's Respiratory Questionnaire-C (SGRQ-C) scores (LS mean difference: -1.92; 95 % CI: -3.28 to -0.55). Safety profiles were comparable between the ensifentrine and placebo groups, with no significant increase in treatment-emergent adverse events (TEAEs) (RR: 1.02; 95 % CI: 0.94-1.10).
CONCLUSION: Ensifentrine significantly enhances lung function, reduces dyspnea, and improves quality of life in COPD patients, especially at a 3 mg dose. These benefits, coupled with a stable safety profile, support its use as an adjunctive therapy in COPD management.
METHODS: A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus, covering studies up to September 8, 2024. Studies focusing on conjunctivitis, keratitis, eye lesions, visual impairment, and other ophthalmic outcomes in Mpox cases were included. Meta-analyses were performed using a random-effects model to estimate pooled prevalence rates, with heterogeneity assessed using the I² statistic. Sensitivity analyses and publication bias assessments were also conducted.
RESULTS: A total of 25 studies were included, with 22 contributing to the meta-analysis. The pooled prevalence of conjunctivitis in Mpox cases was 8.9% (95% CI: 4.4%-17.1%), keratitis 3.4% (95% CI: 1.4%-7.7%), eye lesions 3.4% (95% CI: 1.4%-7.7%), and visual impairment 4.3% (95% CI: 0.8%-20.6%). Other ocular manifestations had a pooled prevalence of 12.4% (95% CI: 0.6%-76.9%). Significant heterogeneity was observed, particularly for conjunctivitis and other ocular manifestations, suggesting variability in presentation.
CONCLUSION: Conjunctivitis is the most common ophthalmic complication of Mpox, followed by notable rates for keratitis, eye lesions, and visual impairment. These findings emphasize the need for early recognition, routine ocular exams, and effective management of Mpox-related eye complications. Further high-quality research is necessary to better understand and address these ocular complications.
METHODS: Following PRISMA 2020 guidelines, we conducted a comprehensive search of PubMed, Embase, and Web of Science up to October 2024. Articles were screened using Nested Knowledge software by two independent reviewers. Eligible studies included those involving geriatric cancer patients aged 60 years or older reporting on fall prevalence. Quality assessment was performed using a modified Newcastle-Ottawa Scale, and meta-analysis was conducted using random-effects models with R software.
RESULTS: From 1,365 identified studies, 86 met the inclusion criteria, encompassing 180,974 participants. The pooled prevalence of falls was 24% (95% CI, 20%-28%), with substantial heterogeneity (I2 = 100%). Country- and cancer-type-specific analyses revealed variability in fall prevalence, with breast cancer patients showing the highest prevalence. The comparative risk analysis did not show a statistically significant difference in fall risk between cancer patients and non-cancer controls.
CONCLUSION: Falls are a prevalent and concerning issue among geriatric cancer patients, with substantial variability influenced by cancer type and study design. Personalized fall prevention strategies tailored to cancer-specific risk factors are essential. Further research is warranted to explore the complex interplay of cancer treatments, frailty, and fall risk in this vulnerable population.
MATERIALS AND METHODS: A systematic search of PubMed, Embase, and Web of Science databases was conducted through October 2024, following PRISMA 2020 guidelines. Studies reporting fall prevalence in patients with cancer aged 65 years or older were included. Pooled prevalence estimates were calculated using a random-effects meta-analysis.
RESULTS: Seventy-six studies, including 177,212 participants, met the inclusion criteria. The pooled prevalence of falls was 24 % (95 % confidence interval [CI], 20; 28), with significant heterogeneity (I2 = 100 %). Fall prevalence increased with follow-up duration: short-term 12 % (95 % CI, 5.2; 28.4), medium-term 23 % (95 % CI, 18.9; 29.5), and long-term 54 % (95 % CI, 14.9; 89.1) studies (p = 0.13). Older adults with breast cancer had the highest prevalence of falls at 31 % (95 % CI, 17; 48), while patients with colorectal cancer had the lowest at 15 % (95 % CI, 1; 78) (P ≤0.001). Fall prevalence ranged from 19 % in Australia to 24 % in North America (p = 0.89).
DISCUSSION: Falls are frequent among older adults with cancer, with prevalence varying by cancer type, geographic region, and follow-up duration.