The letter is a unique and versatile literary format in the published biomedical literature. Here we argue for more inclusive editorial practices to encourage authors to publish more of them. At the same time, we offer an appreciation of the complementarity of letters to commentaries, and how the strengths of one paper type could make up for the weaknesses of the other.
Rheumatoid arthritis (RA) patients exhibit a notable 50%-70% elevation in heart disease risk compared to the general population, attributable to their heightened susceptibility to cardiovascular disease (CVD). The contribution of the rheumatology branch in preventing cardiovascular (CV) risk remains challenging to comprehend fully. Traditional CV risk factors alone fail to elucidate the augmented mortality and morbidity linked to RA; rather, the cumulative inflammatory burden and cardiotoxicity associated with antirheumatic therapy emerge as pivotal determinants. A noteworthy correlation exists between the use of anti-inflammatory medications, commonly prescribed for arthritis, and an increased risk of premature mortality. Despite acknowledging and comprehending the burden of CVD in RA, caring for affected individuals continues to present challenges. Effective management of CV risk in RA necessitates meticulous consideration of established risk factors and behavioral adaptations. Collaborative engagement among rheumatologists, cardiologists, internists, and primary care providers becomes imperative for optimally attending to RA patients at cardiovascular risk. This review critically evaluates pivotal studies in this domain, shedding light on potential future directions for enhancing CV risk management in RA patients.
Recent data has brought into question the safety of minimally invasive techniques for radical hysterectomy in the treatment of early stage cervical cancer. After the publication of several new studies, we aimed to compare robotic radical hysterectomy (RRH) with open radical hysterectomy (ORH) in the management of women with early stage cervical cancer, while excluding minimally invasive cases performed without robotic assistance.
We searched six databases from inception until 11/30/2021. The original search found 233 unique papers, and ultimately 35 studies, comprising 11,888 total radical hysterectomies, met criteria for our final analysis. We included all studies including the intervention of RRH for early stage cervical cancer, with the comparator of ORH. We included randomized clinical trials (RCTs), case-control, retrospective cohort, and prospective cohort. We included studies that had robotic and laparoscopic arms, but excluded any studies that did not specifically provide specific data as to each group. We analyzed continuous data using mean difference and a 95% confidence interval, while dichotomous data were analyzed using odds ratio and a 95% confidence interval.
We found that there was no significant difference between RRH and ORH regarding five-year Overall Survival (OR=1.28[0.66,2.46], (P = 0.46)), disease free survival (OR=0.94[0.77,1.14], (P = 0.51)), or recurrence (OR=0.92[0.75,1.13], (P = 0.44)) intraoperative complications (OR=0.75[0.55,1.02], (P = 0.07)), or mortality (OR=0.81[0.53,1.22], (P = 0.31)).
We found that RRH was better than ORH in terms of estimated blood loss (MD=-397.95[-471.65,-324.24], (P < 0.001)), blood transfusion rate (OR=0.13[0.10,0.17], (P = 0.001), post-operative complications (OR=0.65[0.46,0.91], (P = 0.01)), and length of hospital stay (MD=-3.99[-4.67,-3.31], (P < 0.001)). While ORH was better than RRH regarding operation time (MD=15.34[2.21,28.47], (P = 0.02)) and number of resected lymph nodes (MD=-2.64[-4.12,-1.15], (P = 0.005)).
The previously seen increase in cancer recurrence and decrease in survival no longer seem to be present when we consider the newest high-quality data and exclude non-robotic minimally invasive techniques. RRH was associated with less estimated blood loss, a lower transfusion rate, a shorter hospital stay, and fewer postoperative complications. ORH seems to be associated with a higher number of resected lymph nodes, and a shorter operative time.
Trial registration details: Prospero Prospective Registration Number: CRD42022306991 Registration link: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=306991
Tenofovir is one of the antiretroviral (ARV) drugs used as a first-line regimen known to suppress HIV viral load successfully. However, its clinical application is limited by a lack of understanding of its inflammatory response in human liver cells. Liver toxicity has been linked to long-term use of tenofovir.
This review was conducted to outline tenofovir's potential pro and anti-inflammatory properties in liver cells at acute and chronic exposure.
The relevant studies were analysed in PubMed, Google Scholar, Medline and Web of Science. This analysis outlined tenofovir's potential pro and anti-inflammatory properties in liver cells at acute and chronic exposure, with special attention to inflammatory markers.
Tenofovir's acute and chronic usage is associated with mitochondrial toxicity, resulting in hepatocyte damage through mitochondrial DNA (mtDNA) depletion. Tenofovir has been shown to cause mitochondrial dysfunction and elevate mitochondrial reactive oxygen species (MtROS), resulting in hepatotoxicity. Enhanced generation of MtROS can activate the NF-κB signalling pathway through the IĸB kinase (IKK) complex system. NF-κB is an important pro-inflammatory transcription factor that plays a significant role in oxidative stress-induced inflammation. Following its activation, it can increase the transcription of various genes and subsequently regulate inflammation.
This review demonstrated that tenofovir exhibits its cytotoxic effect via induced mitochondrial dysfunction; however, its impact on liver inflammation is yet to be determined. Therefore, a study investigating tenofovir's inflammatory properties in HepG2 cells at acute and chronic exposure is warranted.
Australia performs more appendicectomies per capita than nearly any other country. The surgical specialty responsible for performing appendicectomies in Australia, General Surgery, has recently undergone a paradigm shift away from traditional models of care and towards Acute Surgical Unit (ASU) models. ASUs are defined by the presence of a dedicated emergency general surgeon and the separation of elective and emergency surgical caseload. The aim of this meta-analysis is to determine the effect of care model type on the rate of negative appendicectomy, as well as other clinical outcomes pertaining to the appendicectomy patient.
A comprehensive literature search of Medline, Embase and Cochrane library was performed to identify studies investigating the effect of ASU care model on the outcomes of appendicectomy for Australian and New Zealand patients. These studies were required to have a comparison to a pre-existing or geographically related traditional care cohort. The PRISMA guidelines were used to identify, screen and analyse papers. Random-effects methods were used to perform a meta-analysis of negative appendicectomy rate and other relevant outcomes. Results were reported in either odds ratio or weighted mean difference.
Thirteen studies meeting the inclusion criteria were identified describing the outcomes of 8787 patients undergoing appendicectomy in Australian and New Zealand hospitals. There was no effect on negative appendicectomy rate between the ASU and traditional cohorts (OR: 1.10, CI: 0.944-1.262, p-value 0.20). Furthermore, no significant effect on time-to-theatre (WMD: 1.107, CI: 0.332 – 2.882, p-value 0.22), length of stay (MD: 0.563, CI: 0 – 1.135, p-value 0.13) or complication rate (OR: 0.872, CI: 0.596 – 1.148, p-value 0.36) was observed between the two cohorts.
Rates of negative appendicectomy in Australia are similar in both ASU and traditional model cohorts. Significant improvements in appendicectomy outcomes seen under an ASU model in international data, or in data for other emergency conditions, have not been replicated on this meta-analysis of the Australian literature.
Conduction system pacing (CSP) is considered an effective and physiological form of pacing in patients requiring cardiac resynchronization therapy (CRT).
To compare electrocardiographic (ECG), echocardiographic (ECHO) characteristics and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) undergoing CRT with CSP or biventricular pacing (BVP).
This study protocol was registered in the PROSPERO registry (CRD42022375155) and the review was conducted per the PRISMA protocol. Four major databases were searched from inception till October 20, 2022, for relevant studies comparing CSP to BVP for CRT in patients with HFrEF.
From a total of 10,072 references identified, 35 full-text were assessed and 18 studies (6 RCTs, 12 observational studies) were included in the review. Following left bundle branch area pacing (LBBAP), on average, paced QRS duration was 28 ms narrower in comparison to BVP (MD -27.69, CI -36.59 to -18.80), and a similar result was obtained with HBP vs. BVP as well. Left ventricular ejection fraction (LVEF) improvement was greater with CSP in comparison to BVP [LBBAP (MD 6.03, CI 4.16–7.91); HBP (MD 3.79, CI 0.46–7.11); HPSP (MD 6.60, CI 4.42–8.78). There were higher odds of being responders (OR 3.82, CI 1.88–7.75)/super responders (OR 2.08, CI 1.53–2.82) (per ECHO findings) in the CSP group, and overall mortality (OR 0.61, CI 0.40–0.93) and hospitalization for HF (HHF) (OR 0.37, CI 0.25–0.55) was lower in CSP group.
Our analysis showed better ECG, ECHO, and clinical outcomes in terms of mortality and HHF with CSP compared to BVP.
Medical literature shows that South Asians have approximately a 2-fold higher risk of atherosclerotic cardiovascular disease (CVD) compared with other populations. Given this high prevalence, clinical programs to promote cardiovascular health have emerged in the United States that are dedicated to clinical care for South Asian individuals. In this review, we have summarized the key characteristics of clinical programs in the U.S. dedicated to preventing and managing CVD in South Asian American patients. These clinical centers have many unique components in common that are catered to South Asian patient populations including ethnicity concordance of clinical providers, intensive cardiovascular screening protocols with laboratory studies and potentially genetic testing, dieticians and nutritionists who are familiar with South Asian-style dietary patterns, health coaches to support behavior change, community outreach programs, and involvement in clinical research to learn further about risk factors, prevention, and treatment of cardiovascular disease in South Asian populations. There are still many evidence and programmatic gaps left to uncover in the prevention, diagnosis, and management of CVD in South Asian. This review provides guidance for important features, barriers, and facilitators for future cardiovascular centers to develop in the United States where they can serve South Asian populations.
Natural disasters and pandemics can be highly challenging to blood supply chains. This review aimed to assess the impacts of pandemics and natural disasters on blood donation globally, appraise any similarities and differences, and provide an overview of the mitigation strategies and optimizations applied as well as risks modelling undertaken.
Full text, peer-reviewed articles that studied the impact of any pandemic and natural disaster on blood donation, blood supply management, and modelling searchable in PubMed, Scopus, Web of Science, and Cochrane Library between Jan 1980 and Jan 2023, inclusive were included. We performed quality assessments and summarised potential lessons learned.
Overall, 98 studies were identified and assessed in this review, of which 58 were related to pandemics and 17 related to natural disasters. 97% of the studies on pandemics and blood donation were on COVID-19, while 88% of studies on natural disasters were on earthquakes. We confirmed that during the COVID-19 pandemic, blood donation numbers decreased compared to the pre-pandemic period, while just after an earthquake, blood donation numbers tended to increase, which in both cases put the blood supply chain under pressure (creating shortage or wastage). The increase of first-time donors was higher after a sudden destructive earthquake than after the COVID-19 pandemic. Public awareness campaigns, donors transportation, home visits, measures to minimize wastage of blood components, activation of contingency plans, and altering donor eligibility criteria were implemented to help the blood supply chain to respond to the demand and reduce wastage. However, no pandemic plans, per se were identified highlighting the lack of an emergency plan in collaboration with health authorities. Several optimization models were developed to help the blood supply chain reduce costs and identify faster transportation in times of earthquake, however, optimization models targeting a pandemic were lacking, as were risk modelling analyses for both events.
Optimization models, risk modelling, serosurveillance and haemovigilance should be combined with infectious diseases case surveillance to better prepare the whole supply chain logistics to safely attend the demand. Findings on blood donor demographics were inconclusive during or after major events, which highlight the need for further investigations.
Docetaxel (DTX) has been reported to be one of the most effective anticancer agents with wide application in various cancer therapy. Conversely, it has under utilized clinical application owing to its compromised aqueous solubility, dose-dependent and systemic toxicity. However, the recent advances in drug delivery systems (DDS) and nanotechnology have addressed the aforementioned drawbacks of such drugs. The novel DDS of DTX are worth enhancing aqueous solubility and minimizing dose-dependent-side effects. Also, they have shown great potential as targeted delivery to the tumor site with improved biodistribution and drug retention in the tumor vicinity. This review summarizes the current status of DTX DDS and nanostructured formulations comprising nanoparticles, lipid-based delivery, carbon nanotubes and quantum dots (QDs) with a focus on enhanced therapeutic outcomes. It also summarizes previous and current in-vitro, in-vivo, cell lines studies and clinical trials-based pieces of evidence corroborating the inherited promises.
Gestational diabetes mellitus (GDM) is a medical complication of glycaemic intolerance that develops in 2nd or 3rd trimester of pregnancy. The speculative cause behind insulin resistance or chronic glycemic intolerance occurs due to pancreatic β-cell alterations during gestation. Women who have GDM are more likely to acquire type 2 diabetes mellitus (T2DM) and other metabolic problems later in life. GDM is linked to several risk factors including gestational age, diabetic family history, polycystic ovary syndrome, obesity, ethnicity, hypertension during pregnancy, and spontaneous pregnancy loss. GDM causes several adverse effects in the mother and fetus like pre-eclampsia, neonatal hypoglycemia, macrosomia, hypocalcemia, and congenital malformations. T2DM and GDM share similar pathophysiology and a common genetic background. Previous studies suggested that alterations in insulin homeostatic genes associated with T2DM could also be responsible for the development of GDM. GDM development is influenced by several placental hormones like progesterone, estrogen, and insulin insensitivity. In the past few years, there has been a significant focus on molecular biomarkers in the field of GDM prognosis/diagnosis and use for screening. The present review suggests the role of genetic and epigenetic alterations in the pathophysiology of GDM.
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