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Intra-abdominal infections encompass a range of medical conditions categorized by their complexity. Uncomplicated infections involve inflammation or infection limited to a single abdominal organ, such as acute appendicitis or cholecystitis, without extending to the peritoneum, while complicated infections spread to the peritoneal cavity. The key associated microbiological agents include Gram-positive cocci, Gram-negative Enterobacteriaceae, and obligate anaerobes, with common pathogens being Escherichia coli, Klebsiella pneumoniae, Streptococcus species, and Bacteroides fragilis. Treatment options include well-established antibiotics and newer agents like meropenem, metronidazole, and ceftazidime/avibactam. Meropenem, a carbapenem antibiotic, is known for its broad-spectrum efficacy and low toxicity, making it suitable for severe infections. Ceftazidime, a third-generation cephalosporin, is effective against Pseudomonas aeruginosa, especially when paired with avibactam, a β-lactamase inhibitor, enhancing its effectiveness. Metronidazole disrupts bacterial DNA, targeting anaerobic bacteria and protozoa. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of the ceftazidime-avibactam plus metronidazole combination compared to meropenem for intra-abdominal infections. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a comprehensive search of databases such as PubMed, Web of Science, and the Cochrane Library was conducted. Results showed that the combination therapy had a slightly higher overall adverse event rate (5.57%) compared to meropenem (4.56%), although this difference was not statistically significant [risk ratio (RR): 1.22; 95% confidence interval (CI): 0.78-1.93; p = 0.39]. Meropenem demonstrated a significantly higher clinical response rate in ceftazidime-susceptible infections (89.93% vs. 85.88%; RR: 0.96; 95% CI: 0.93-0.99; p = 0.009). No significant differences were observed in ceftazidime-resistant infections. Overall, the findings suggest that ceftazidime-avibactam combined with metronidazole is a viable alternative to meropenem, highlighting the need for further research to optimize treatment strategies amid rising antibiotic resistance.

This systematic review and meta-analysis determine how frequently and how seriously gastrointestinal manifestations affect people with type 2 diabetes mellitus on tirzepatide. Tirzepatide is a recently developed drug that attempts to enhance type 2 diabetics' ability to regulate their blood sugar levels and promote weight reduction. Despite its potential benefits, clinical trials have revealed that the medication may lead to gastrointestinal side effects, including nausea, vomiting, decreased appetite, dyspepsia, constipation, and diarrhea. These side effects may negatively affect the drug's efficacy and patient tolerance. A comprehensive search of electronic databases such as PubMed, Web of Science, and Cochrane Library, was conducted to find pertinent studies reporting on the frequency and severity of gastrointestinal symptoms in type 2 diabetes patients receiving tirzepatide. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Study selection, data extraction, and quality assessment were performed. Six randomized controlled trials with a total of 4,586 patients were included. Most patients received tirzepatide to regulate their blood sugar levels and promote weight reduction, and the comparators were placebo, glucagon-like peptide one receptor agonists drugs, and insulin degludec. The dose of tirzepatide was 5mg, 10mg, and 15mg weekly. The incidence rate of nausea in patients who receive tirzepatide was 20.43%, while the incidence rate in the comparators was 10.47%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.90; 95% CI, 1.89 to 4.44; P ≤ 0.00001). The incidence rate of vomiting in patients who receive tirzepatide was 9.05%, while the rate in the comparators was 4.86%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.69; 95% CI, 1.67 to 4.36; P ≤ 0.0001). The incidence rate of constipation in patients who receive tirzepatide was 2.54%, while the rate in the comparators was 0.856%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 3.08; 95% CI, 1.83 to 5.20; P ≤ 0.0001). The incidence rate of decreased appetite in patients who receive tirzepatide was 9.64%, while the rate in the comparators was 2.88%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 5.04; 95% CI, 3.01 to 8.45; P ≤ 0.00001). The incidence rate of diarrhea in patients who receive tirzepatide was 16.24%, while the rate in the comparators was 8.63%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.07; 95% CI, 1.60 to 2.68; P ≤ 0.00001). The incidence rate of dyspepsia in patients who receive tirzepatide was 7.13%, while the rate in the comparators was 3.31%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.52; 95% CI, 1.58 to 4.01; P ≤ 0.0001). Tirzepatide usage is linked to a significant prevalence of gastrointestinal symptoms, including nausea, constipation, decreased appetite, dyspepsia, diarrhea, and vomiting, in people with type 2 diabetes. These findings may influence clinical decision-making and patient counseling on the use of tirzepatide and have significant implications for the medication's tolerance and efficacy. To find ways to reduce these negative effects and improve therapy for type 2 diabetes patients, more research is required.