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We aimed to perform a meta-analysis to find out whether PCT and MDW could be used as accurate diagnostic markers for sepsis. We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any observational or clinical trials that compared monocyte Distribution Width [MDW] with Procalcitonin [PCT] as diagnostic markers in a patient with sepsis. Case reports, editorials, conference abstracts, and animal studies were excluded. RevMan software [5.4] was used to perform the meta-analysis. After the complete screening, 5 observational studies were included in the meta-analysis. The total number of patients included in the meta-analysis in the sepsis group is 565 and 781 in the control group. The pooled analysis between the sepsis group and controls showed a statistically significant association between sepsis and increased levels of MDW and PCT [MD = 3.94, 95% CI = 2.53 to 5.36, p-value < 0.00001] and [MD = 9.29, 95% CI = 0.67 to 17.91, p-value = 0.03] respectively. Moreover, the subgroup analysis showed that the p-value of MDW levels [< 0.00001] is more significant than the p-value of PCT levels = 0.03, the p-value between the two subgroups [< 0.00001]. Additionally, the overall ROC Area for MDW [0.790] > the overall ROC Area for PCT [0.760]. Our study revealed a statistically significant association between sepsis and increased MDW and PCT levels compared with controls and the overall ROC Area for MDW is higher than the overall ROC Area for PCT, indicating that the diagnostic accuracy of MDW is higher than PCT.MDW can be used as a diagnostic marker for sepsis patients in the emergency department. More multicenter studies are needed to support our findings.

Our aim was to perform a meta-analysis to evaluate the possible link between diabetes and high levels of immunoglobulin M (IgM) antibodies against Gonadotropin-Releasing Hormone (GnRH). The search included PubMed, Web of Science, and Scopus databases. Inclusion criteria were any controlled clinical trials or observational studies that measured the level of IgM antibodies against GnRH hormone in diabetic patients, we excluded case reports, editorials, and animal studies. RevMan software, version 5.4 (The Cochrane Collaboration 2020) was used to perform the meta-analysis. Following the screening, three studies were included in the meta-analysis. The meta-analysis included 99 patients in the diabetes group and 318 healthy persons in the control group. The pooled effect showed no statistically significant association between diabetes and the prevalence of GnRH IgM antibodies compared with the control group (risk ratio {RR} = 1.64, 95% CI = 0.96 to 2.79, p-value = 0.03). The pooled effect showed a statistically significant association between diabetes and increased levels of GnRH IgM antibodies compared with the control group (mean difference {MD} = 2.13, 95% CI = 0.25 to 4.02, p-value = 0.03). Our study found a significant association between diabetes and increased levels of GnRH IgM antibodies. Therefore, GnRH IgM antibodies may play a role in the pathogenesis of diabetes or may be considered a unique immunological reaction in diabetic patients. More multicenter randomized studies are needed to support our results confirming the positive relationship between diabetes and high levels of IgM antibodies against GnRH hormone.

Eight elderly confirmed SARS-CoV-2 patients who had severe course of COVID-19 and admitted to ICU expressed high lactate dehydrogenase (LDH) above normal level. The mean value of LDH was 440.40 U/L with 84.52 standard deviation (normal range = 100 – 190 U/L). The mean age of patients was 73.63 years (standard deviation = 3.34). The patients were 4 males (50%) and 4 females (50%). The median of stay duration at ICU was 2 days (range = 1-32 days). Four patients died (50%) and four patients survived (50%). All the patients were at the same ICU and received the same treatment course for COVID-19. It has been shown that LDH is a potential marker of vascular permeability in immune-mediated lung injury. Areas within the body where LDH are most active include the liver, striated muscles, heart, kidneys, lungs, brain, and red blood cells. LDH is a known marker for different inflammatory states, sepsis, myocardial infarctions, infections, and malignancies. One study showed that LDH elevation was associated with a 6-fold increase in the odds of developing a severe COVID-19 disease. Furthermore elevated LDH was associated with a 16 fold increase in patient mortality. Elevated LDH levels seem to reflect that the multiple organ injury and failure may play a more prominent role in influencing the clinical outcomes in patients with COVID-19. This study is a report of 8 elderly critically ill COVID-19 patients who expressed high lactate dehydrogenase above normal level. This indicates that lactate dehydrogenase can predict the outcome of elderly COVID-19 patients. All the eight patients developed severe course of COVID-19, four of them died. High levels of lactate dehydrogenase can predict the severity and mortality of COVID-19 in elderly patients. LDH levels could be considered for inclusion in future risk stratification models for COVID-19 severity and mortality. More observational studies

Aim This meta‐analysis aims to look at the impact of early intravenous Metoprolol in ST‐segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI) on infarct size, as measured by cardio magnetic resonance (CMR) and left ventricular ejection fraction. Methods We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included only randomized control trials that reported the use of early intravenous Metoprolol in STEMI before PCI on infarct size, as measured by CMR and left ventricular ejection fraction. RevMan software 5.4 was used for performing the analysis. Results Following a literature search, 340 publications were found. Finally, 18 studies were included for the systematic review, and 8 clinical trials were included in the meta‐analysis after the full‐text screening. At 6 months, the pooled effect revealed a statistically significant association between Metoprolol and increased left ventricular ejection fraction (LVEF) (%) compared to controls (mean difference [MD] = 3.57, [95% confidence interval [CI] = 2.22–4.92], p < .00001), as well as decreased infarcted myocardium(g) compared to controls (MD = −3.84, [95% [CI] = −5.75 to −1.93], p < .0001). At 1 week, the pooled effect revealed a statistically significant association between Metoprolol and increased LVEF (%) compared to controls (MD = 2.98, [95% CI = 1.26−4.69], p = .0007), as well as decreased infarcted myocardium(%) compared to controls (MD = −3.21, [95% CI = −5.24 to −1.18], p = .002). Conclusion A significant decrease in myocardial infarction and increase in LVEF (%) was linked to receiving Metoprolol at 1 week and 6‐month follow‐up.

Some clinical trials reported conflicting results about the efficacy of anterior lateral electrode compared with anterior posterior electrode in electrical cardioversion of atrial fibrillation, and some studies reported no difference in the efficacy between the two procedures. Our aim is to perform a meta-analysis to compare the efficacy of anterior lateral electrode versus anterior posterior electrode in external cardioversion of atrial fibrillation. We searched the following databases: PUBMED, WOS, OVID and SCOPUS. Inclusion criteria were clinical trials that compared anterior lateral electrode with anterior posterior electrode in external cardioversion of atrial fibrillation. We excluded cohort studies, case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis. Cardioversion rate outcome was presented as Odds ratios (OR) with 95% confidence interval (CI). After full text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode (OR = 1.40, 95% CI = 1.02 to 1.92, p-value = 0.04). We observed no heterogeneity among studies (P= 0.14, I² = 32%). No publication bias was observed. Subgroup analysis revealed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode in subgroups of less than 5 shocks, patients with 60years-old or more and patients with left atrial diameter > 45 mm (OR= 1.72, 95% CI = 1.17 to 2.54, p value = 0.006), (OR= 1.73, 95% CI = 1.18 to 2.54, p value= 0.005), and (OR= 1.86, 95% CI = 1.04 to 3.34, p value = 0.04), respectively. Our meta-analysis revealed that anterior lateral electrode is more effective than anterior posterior electrode in external cardioversion of atrial fibrillation. Subgroup analysis showed that patients who received less than 5 shocks, patients with 60 years-old or more and patients with left atrial diameter > 45 mm benefit from anterior lateral electrode more than anterior posterior electrode in external cardioversion of atrial fibrillation.

The efficacy of anteriolateral versus anterior–posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is to perform a meta‐analysis to compare the success rate of both electrode positions. PUBMED, WOS, OVID, and SCOPUS were searched. Inclusion criteria were clinical trials that compared anterior–lateral with anterior–posterior electrodes in external cardioversion of AF. After the full‐text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior–lateral electrode and increased cardioversion rate of AF (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.02–1.92, p = .04). Subgroup analysis revealed a statistically significant association between the anterior–lateral electrode and increased cardioversion rate of AF in subgroups of less than five shocks, patients with 60 years old or more and patients with left atrial (LA) diameter >45 mm (OR = 1.72, 95% CI = 1.17–2.54, p = .006), (OR = 1.73, 95% CI = 1.18–2.54, p = .005), and (OR = 1.86, 95% CI = 1.04–3.34, p = .04), respectively. Anteriolateral electrode is more effective than anterior–posterior electrode in external cardioversion of AF, particularly in patients who have received less than 5 shocks, are 60 years old or older and have a LA diameter greater than 45 mm. Anterior–lateral versus anterior–posterior electrodes in external cardioversion of atrial fibrillation. A meta‐analysis

Background and Aim Cardiopulmonary resuscitation (CPR) in full‐coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads‐up CPR versus supine CPR. Methods We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full‐text screening of 40 eligible studies, only seven studies were eligible for our meta‐analysis. We used the RevMan software (5.4) to perform the meta‐analysis. Results In survival outcome, the pooled analysis between heads‐up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17–5.68, p = 0.98). The pooled analyses between heads‐up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03–0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92–18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71–14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads‐up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well. Conclusion Our study suggests that heads‐up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads‐up technique on human beings and to determine the best angle for optimization of the technique results.

Background Diabetes mellitus is a chronic disease that affects millions of people worldwide. Several studies have suggested using stem cells for diabetes treatment. However, there is a lack of research assessing the population's awareness of stem cells. This study aimed to evaluate the level of awareness regarding the use of stem cell therapy for type 2 diabetes mellitus (T2DM). Methodology This study was conducted from December 2021 to April 2022 through an online survey that was distributed electronically via social media platforms. T2DM patients or their care providers who lived in Makkah were included. Patients aged less than 18 years and those with mental disabilities were excluded. Results Of the 316 participants included in the study, 56% were males, 33% had an age range of 46-55 years, and 76% were married. T2DM patients and their caregivers had a moderate level of awareness about stem cell therapy, with caregivers having higher awareness than diabetic patients. A non-significant relationship was found between educational level, income, diabetes control, time of diagnosis, and patients' awareness. However, regarding the decision of treatment, participants aged less than 35 years were highly likely to decide to undergo stem cell treatment compared to other age groups. Conclusions There is a moderate level of awareness about stem cell therapy as a treatment option for T2DM among T2DM patients and caregivers in Makkah. Hence, there is a need to raise awareness by using online and in-person well-organized education programs in Makkah.