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Background Intubating a patient in an emergent setting presents significant challenges compared to planned intubation in an operating room. This study aims to compare video laryngoscopy versus direct laryngoscopy in achieving successful endotracheal intubation on the first attempt in emergency intubations, irrespective of the clinical setting. Methods We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception until 27 February 2023. We included only randomized controlled trials that included patients who had undergone emergent endotracheal intubation for any indication, regardless of the clinical setting. We used the Cochrane risk-of-bias assessment tool 2 (ROB2) to assess the included studies. We used the mean difference (MD) and risk ratio (RR), with the corresponding 95% confidence interval (CI), to pool the continuous and dichotomous variables, respectively. Results Fourteen studies were included with a total of 2470 patients. The overall analysis favored video laryngoscopy over direct laryngoscopy in first-attempt success rate ( RR  = 1.09, 95% CI [1.02, 1.18], P  = 0.02), first-attempt intubation time ( MD  =  − 6.92, 95% CI [− 12.86, − 0.99], P  = 0.02), intubation difficulty score ( MD  =  − 0.62, 95% CI [− 0.86, − 0.37], P  < 0.001), peri-intubation percentage of glottis opening ( MD  = 24.91, 95% CI [11.18, 38.64], P  < 0.001), upper airway injuries ( RR  = 0.15, 95% CI [0.04, 0.56], P  = 0.005), and esophageal intubation ( RR  = 0.37, 95% CI [0.15, 0.94], P  = 0.04). However, no difference between the two groups was found regarding the overall intubation success rate ( P  > 0.05). Conclusion In emergency intubations, video laryngoscopy is preferred to direct laryngoscopy in achieving successful intubation on the first attempt and was associated with a lower incidence of complications.

Point-of-care ultrasound (POCUS) is a bedside diagnostic tool clinicians use to provide immediate insights and guide therapeutic interventions. It has become increasingly significant in pediatric emergency departments (EDs) for diagnosing conditions, managing critical scenarios, and guiding procedures due to its portability, ease of use, and lack of radiation. This study aims to systematically review and analyze the efficacy of POCUS compared to conventional diagnostic methods in pediatric emergency settings. A literature search was conducted across PubMed, SCOPUS, Web of Science, Embase, and Cochrane Library up to February 2025. The inclusion criteria were pediatric patients aged 1 month to 18 years in EDs, with studies comparing POCUS to conventional methods. Primary outcomes included first-attempt procedural success and overall success rates. Secondary outcomes included time to procedure completion, mean number of attempts, hospitalization rates, and discharge rates. Data analysis was conducted in R employing a random-effects model, with dichotomous data analyzed as risk ratio (RR) and 95% confidence interval (CI), and continuous data as unbiased standardized mean difference (SMD). Statistical significance was defined at p  < 0.05. Eighteen randomized controlled trials involving 2264 patients met the inclusion criteria. POCUS significantly improved first-attempt success (RR = 1.25; 95% CI: 1.09–1.43). The overall procedural success showed a significant benefit with POCUS (RR = 1.12; 95% CI: 1.03–1.22). However, no significant differences were noted in the time to procedure completion, number of attempts for a successful procedure, and rates of hospitalization and discharge to home. POCUS significantly improves first-attempt and overall procedural success rates in pediatric emergency settings, although it does not significantly reduce procedure times or the number of attempts. These findings underscore the importance of integrating POCUS into pediatric emergency care to enhance diagnostic accuracy and procedural success, though further research is needed to optimize its implementation across different age groups and procedures.

Objective To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) for confirming endotracheal tube (ETT) placement in pediatric patients within emergency and critical care settings, compared with standard methods such as chest radiography and capnography. Methods A systematic search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to May 2025. Prospective studies assessing POCUS for confirmation of endotracheal placement in pediatric patients (birth to 18 years) within acute care settings (including emergency departments, intensive care units, and operating rooms) were included. Data on diagnostic accuracy (Sensitivity, Specificity, Summary receiver operating characteristic (SROC) curve, and Diagnostic odds ratio (DOR)), POCUS success rate, Confirmation of ETT placement, Time to adequate view, Reintubation rate, as well as baseline and summary characteristics of the studies were extracted. A bivariate random-effects model was used to pool diagnostic accuracy estimates, and heterogeneity and publication bias were evaluated. Sensitivity analyses were performed using the leave-one-out method to assess the robustness of the findings. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed bias risk. Results Ten studies involving 697 pediatric patients met the inclusion criteria. The pooled sensitivity of POCUS for confirming endotracheal placement was 0.95 (95% CI: 0.88–0.98; I² = 84.6%), and specificity was 0.70 (95% CI: 0.34–0.92; I² = 84.5%). The pooled DOR was 37.14 (95% CI: 6.17–223.47), and the AUC was 0.95 (95% CI: 0.91–0.99). Time to adequate ETT visualization was 45.8 s, the pooled procedural success rate was 97% (95% CI: 80–100%), and the reintubation rate was 2% (95% CI: 1–4%). Conclusion POCUS is a highly sensitive, rapid, radiation-free, and feasible adjunct method for confirming endotracheal placement in critically ill pediatric patients. This integration could reduce the risk of complications associated with ETT misplacement, thereby improving patient outcomes. This meta-analysis finds that POCUS is a highly sensitive adjunct for confirming pediatric ETT placement. However, the pooled specificity was only moderate, and significant heterogeneity across studies in populations, settings, and techniques was a major finding. This variability currently limits its utility as a standalone test. Our results underscore the need for standardized protocols and operator training to improve specificity and consistency before POCUS can be more broadly relied upon for this critical task.

Background Pediatric patients present to the emergency departments (EDs) with a wide range of clinical manifestations, ranging from mild to severe. A systematic approach is crucial to identify those at high risk of deterioration. However, the predictive value of such predictors remains unclear. Objectives Our study aims to evaluate different mortality predictors used in pediatric emergency departments (PEDs) regarding the diagnostic accuracy metrics, including sensitivity, specificity, and diagnostic odds ratio. Methods We comprehensively searched multiple databases and included all cohort studies, case-control studies, and randomized controlled trials from January 2000 to December 2024 with pediatric patients (aged 0–18 years) presenting to PEDs, where mortality predictors were used to assess for in-ED and short-term post-ED mortality. We employed a bivariate random-effects model for data synthesis and analysis to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) values. Results 329 Pediatric Early Warning Score (PEWS) thresholds were analyzed, with the model-derived optimal cutoff 2.189 (AUC) = 0.70; 95% CI: 0.63 to 0.76), high pooled sensitivity (0.95, 95% CI: 0.72 to 0.80) and specificity (0.93, 95% CI: 0.62 to 0.80). In addition, A strong negative predictive value (NPV = 0.0006) and modest positive predictive value (PPV = 0.0003) were noted. Heterogeneity was significant (I²>99%), driven by PEWS versions and clinical settings. PEWS implementation reduced mortality without increasing ICU admissions in resource-limited settings. Conclusions PEWS is a good exclusion tool for those at low mortality risk. However, a comprehensive approach with clinical judgment is needed for the risk assessment of high-risk pediatrics.

Background Pediatric pulmonary embolism is a rare yet potentially life-threatening condition, presenting significant diagnostic and therapeutic challenges owing to its nonspecific symptoms and diverse underlying risk factors. This systematic review aims to consolidate data from case series and case reports to provide a comprehensive overview of pediatric pulmonary embolism, focusing on clinical characteristics, diagnostic approaches, treatment strategies, and outcomes. Methods This systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and the Cochrane Handbook for Systematic Reviews of Interventions, version 6.3. The study protocol was registered with PROSPERO (ID: CRD42024532471). We utilized the Covidence systematic review software for deduplication and screening of search results. The literature search was developed with a subject specialist and included Medical Subject Headings terms and free-text keywords such as “pulmonary embolism,” “pediatric,” and “case reports.” Databases searched included PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2024, limited to English-language publications. Reference lists of relevant articles were also reviewed. Results Pulmonary embolism affected males and females with age ranging from 1 to 18 years. Common underlying conditions included malignancies (for example, Wilms tumor), chronic diseases (for example, nephrotic syndrome), and recent surgical interventions. Diagnostic practices primarily relied on computed tomography pulmonary angiography, supplemented by chest X-ray and ultrasound. Treatment typically involved anticoagulation therapy with unfractionated heparin and low-molecular-weight heparin, transitioning to oral anticoagulants for long-term management. Thrombolytic therapy was used in severe cases. Outcomes varied, with many patients recovering well, though complications such as recurrent embolism and pleural effusion were observed. Fatal cases underscored the critical need for early detection and prompt treatment. Conclusion This systemic review underscores the rarity and complexity of pediatric pulmonary embolism, highlighting the necessity for increased clinical vigilance given its nonspecific presentation and diverse underlying risk factors. Accurate diagnosis, primarily via computed tomography pulmonary angiography, with the prompt initiation of anticoagulation therapy are essential for optimal outcomes. Despite favorable recovery rates for most patients, the potential for severe complications and fatalities reinforces the value of timely diagnosis and personalized management approaches. Further research is essential to refine diagnostic protocols, optimize treatment approaches, establish evidence-based guidelines, and improve long-term outcomes for children with pulmonary embolism.

Background Type 2 diabetes mellitus (T2DM) accounts for over 90% of diabetes cases worldwide. Pioglitazone, a thiazolidinedione, enhances insulin sensitivity by activating PPAR‐γ. Evidence on its efficacy and safety as an add‐on to metformin and SGLT2 inhibitors in inadequately controlled T2DM is limited. This systematic review and meta‐analysis evaluates pioglitazone's role as a third‐line therapy for improving glycaemic control in addition to metformin and Dapagliflozin. Methodology We conducted comprehensive searches across PubMed, CENTRAL, WOS, Scopus and EMBASE until December 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta‐analysis is registered with PROSPERO ID: CRD42024612005. Results We included three RCTs with 885 patients. Pioglitazone add‐on therapy significantly reduced HbA1c levels (MD: −0.41; 95% CI: −0.54 to −0.27, p = < 0.00001, I2 = 0%), fasting blood glucose (MD: −11.91; 95% CI: −16.34 to −7.48, p = < 0.00001, I2 = 0%), Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR) (MD: −0.65; 95% CI: −1.05 to −0.25, p = 0.001, I2 = 4.89%), increased the rate of achieving HbA1c < 7% (RR: 2.09; 95% CI: 1.66 to 2.64, p = < 0.00001, I2 = 0%), and HbA1c < 6.5% (RR: 2.19; 95% CI: 1.36 to 3.53, p = 0.001, I2 = 0%). However, there was no difference regarding Homeostasis model assessment of β‐cell function (HOMA‐β) between the two groups (MD: 2.73; 95% CI: −5.24 to 10.70, p = 0.5, I2 = 27.53%). Conclusion Pioglitazone add‐on therapy significantly improved glycaemic control by reducing HbA1c, fasting blood glucose and HOMA‐IR while increasing the likelihood of achieving HbA1c targets. However, no significant difference was observed in HOMA‐β between groups. These findings suggest the potential benefit of pioglitazone in enhancing glycaemic outcomes in diabetes management. Pioglitazone add‐on to metformin and dapagliflozin significantly improved glycaemic control by reducing HbA1c, fasting blood glucose and HOMA‐IR while increasing the likelihood of achieving HbA1c targets in inadequately controlled type 2 diabetes, without compromising safety. This meta‐analysis highlights its potential as a third‐line therapy, despite associated weight gain and no impact on β‐cell function.

BackgroundThe humanized monoclonal antibody galcanezumab is an anti-calcitonin-gene-related-peptide (CGRP) and frequently used for migraine prevention. However, the literature revealed limited data with conflicting results. This study aims to assess the safety and efficacy of galcanezumab in treating patients with episodic or chronic migraine.MethodsWe searched for randomized controlled trials till September 2022 from six databases (Cochrane library, Embase, PubMed, Web of Science, Scopus, and Clinicaltrials.gov registry). Our primary outcomes were the change in the number of monthly migraine headache days (MHDs) and adverse events. We extracted the data and analyzed it by RevMan (5.4) software.ResultsEight studies with 4964 patients were included. Galcanezumab (≥ 120 mg) significantly reduced the MHDs for six months in migraine patients compared to placebo. The monthly risk ratio (RR) ranged from − 2.33 to − 1.62 for episodic migraine and − 2.86 to − 2.44 for chronic migraine. The response rate of ≥ 50%, ≥ 75% and 100% were higher with galcanezumab groups. The rate ranged from 1.72 to 4.19 for episodic migraine and 1.84 to 2.47 for chronic migraine. It is generally safe except for injection site safety outcomes (erythema, reaction, pruritis, and swelling), the results were significantly higher with galcanezumab groups. It appears dose independent except for injection site reaction, which showed higher with galcanezumab 120 mg only. Furthermore, any adverse events, serious adverse events (SAE) and that led to discontinuation were higher with galcanezumab 240 mg.ConclusionGalcanezumab is effective in patients with episodic or chronic migraine after one to six months use. It reduced MHDs and had an effective response rate. Moreover, it is generally safe except for injection site adverse events, and SAE, especially with galcanezumab 240mg.

To assess the effectiveness of glossopharyngeal nerve block (GNB) in the treatment of postoperative pain among patients undergoing tonsillectomy, a systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Various databases, including PubMed, Cochrane, Scopus, Web of Science, and Google Scholar, were systematically screened from inception until March 2023. The included studies were assessed using the RoB-2 tool. The outcomes of interest included reporting on at least one of the predetermined efficacy and safety endpoints, such as postoperative pain, the severity of swallowing, and the incidence of postoperative complications such as bleeding, nausea and vomiting, hoarseness, nasal obstruction, dyspnea, foreign body sensation, and dry mouth. Dichotomous data were collected as risk ratios (RR), and continuous data were collected as standardized mean differences (SMD). The overall analyses were conducted using a random-effects model. In total, 492 participants were enrolled in our investigation, with 245 and 247 participants allocated to the GNB and control arms, respectively. When comparing postoperative pain levels during rest and swallowing, the GNB arm showed a significantly reduced effect size compared to the control arm ( n  = 5 RCTs, SMD= -1.38, 95% CI [-1.82, -0.94], p  < 0.001; n  = 4 RCTs, SMD= -1.43, 95% CI [-2.15, -0.72], p  < 0.001), respectively. Overall, there was no substantial variation in effect size between the GNB and control arms with regard to the severity of difficulty in swallowing ( p  = 0.7). Additionally, there were no significant differences observed between the GNB and control groups in terms of postoperative complications endpoints ( p  > 0.05). This thorough analysis showed that GNB had both statistical and clinical advantages for patients after a tonsillectomy. It was found that GNB was an effective, safe, and straightforward method for managing early postoperative pain.

Coronavirus disease 2019 (COVID-19) has a wide-ranging spectrum of clinical symptoms, from asymptomatic/mild to severe. Recent research indicates that, among several factors, a low vitamin D level is a modifiable risk factor for COVID-19 patients. This study aims to evaluate the effect of vitamin D on hospital and laboratory outcomes of patients with COVID-19. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) and clinicaltrials.gov were searched until July 2022, using relevant keywords/Mesh terms. Only randomized clinical trials (RCTs) that addressed the topic were included. The Cochrane tool was used to assess the studies’ risk of bias, and the data were analyzed using the review manager (RevMan 5.4). We included nine RCTs with 1586 confirmed COVID-19 patients. Vitamin D group showed a significant reduction of intensive care unit (ICU) admission (risk ratio = 0.59, 95% confidence interval (CI) [0.41, 0.84], P  = 0.003), and higher change in vitamin D level (standardized mean difference = 2.27, 95% CI [2.08, 2.47], P  < 0.00001) compared to the control group. Other studied hospital and laboratory outcomes showed non-significant difference between vitamin D and the control group ( P  ≥ 0.05). In conclusion, vitamin D reduced the risk of ICU admission and showed superiority in changing vitamin D level compared to the control group. However, other outcomes showed no difference between the two groups. More RCTs are needed to confirm these results.