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Background The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a diagnosis of CAP is made. Concerns about treatment recommendations, on the one hand, and antibiotic stewardship, on the other, motivated this review of the medical literature on the etiology of CAP. Methods We conducted a systematic review of English-language literature on the etiology of CAP using methods defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed using a combination of the keywords ‘pneumonia’, ‘CAP’, ‘etiology’, ‘microbiology’, ‘bacteriology’, and ‘pathogen’. We examined articles on antibiotics that were develop to treat pneumonia. We reviewed all ‘related articles’ as well as studies referenced by those that came up in the search. After we excluded articles that did not give sufficient microbiological data or failed to meet other predetermined criteria, 146 studies remained. Data were stratified into diagnostic categories according to the microbiologic studies that were done; results are presented as the percentage in each category of all cases in which an etiology was established. Results Streptococcus pneumoniae remains the most common cause of CAP although declining in incidence; this decline has been greater in the US than elsewhere. Haemophilus influenzae is the second most common cause of CAP, followed by Staphylococcus aureus and Gram negative bacilli. The incidence of all bacteria as causes of CAP has declined because, with routine use of PCR for viruses, the denominator, cases with an established etiology, has increased. Viruses were reported on average in about 10% of cases, but recent PCR-based studies identified a respiratory virus in about 30% of cases of CAP, with substantial rates of viral/bacterial coinfection. Conclusion The results of this study justify current guidelines for initial empiric treatment of CAP. With pneumococcus and Haemophilus continuing to predominate, efforts at antibiotic stewardship might be enhanced by greater attention to the routine use of sputum Gram stain and culture. Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR does not, by itself, allow for discontinuation of the antibiotic therapy.

ObjectivesDespite increasing trends toward the early initiation of oral feeding after gastrointestinal (GI) surgeries, current evidence has not been convincing. The present randomized clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding (LOF) following surgery for upper GI tumors.MethodsOne hundred and nine consecutive patients with esophageal or gastric tumors undergoing surgical resection in two hospitals in Tehran, Iran, were enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day and another group that remained nil by mouth until the return of bowel sounds (LOF group). The clinical and surgical outcomes were compared between the two groups.ResultsThe clinical outcomes were significantly better in the patients in the EOF group (p < 0.05). Repeated nil per os (14.8 vs. 30.9 %) and re-hospitalization (1.8 vs. 7.3 %) were more common in LOF group (p < 0.0001). Additionally, gas passage, nasogastric tube (NGT) discharge, a decrease in intravenous serum to less than 1000 ml per day, the time to start a soft diet and hospital discharge following surgery occurred significantly earlier in the EOF group than in the LOF group (p < 0.0001).ConclusionEarly oral feeding after the surgical resection of esophageal and gastric tumors is safe, and is associated with favorable early in-hospital outcomes and a sooner return to physiological GI function and hospital discharge.

IntroductionHIV infection is an established risk factor for the development of cardiovascular diseases. Although increasing evidence implicates a higher prevalence of myocardial fibrosis (MF) among patients living with HIV (PLWH) compared with the HIV-negative population, there is a paucity of knowledge regarding its determinants and factors associated with higher odds of MF development. We aim to perform a systematic review to estimate the prevalence of MF among PLWH. Additionally, we will determine the factors associated with higher odds of MF among PLWH compared with the HIV-negative population.MethodsA systematic review will be performed by consulting the Cochrane handbook for systematic reviews of interventional studies reporting a confirmed diagnosis of MF among PLWH. Articles will be eligible if they provide the prevalence of MF among PLWH and HIV-negative populations or the odds ratio (OR) and 95% confidence interval (CI) of MF development in relation to HIV. Depending on the quality of the data and the heterogeneity among the included studies, a random-effects or fixed-effects model will be used to pool and compare the ORs of MF among PLWH and HIV-negative population. Factors associated with higher odds of MF in relation to HIV will also be determined.Ethics and disseminationEthical approval and obtaining informed consent are not required for this systematic review as it does not use individual patients’ data. Results of this study will be published in a peer-reviewed medical journal.

Background The intragastric balloon (IGB) is an adjunctive treatment for obesity. This meta-analysis aimed to evaluate the efficacy and safety of IGB treatment by reviewing randomized controlled trials (RCTs). Methods A total of 20 RCTs involving 1195 patients were identified. Weight loss results before and after 3 months were analyzed separately. The weight loss results of patients with and without IGB treatment were compared. Results Our meta-analysis calculated the following significant effect sizes: 1.59 and 1.34 kg/m 2 for overall and 3-month BMI loss, respectively; 14.25 and 11.16 % for overall and >3-month percentage of excess weight loss, respectively; 4.6 and 4.77 kg for overall and 3-month weight loss, respectively; and 2.81, 1.62, and 4.09 % for overall, 3-month, and >3-month percent of weight loss, respectively. A significant effect size was calculated that favored fluid-filled IGBs over air-filled IGBs. Flatulence (8.75 vs. 3.89 %, p  = 0.0006), abdominal fullness (6.32 vs. 0.55 %, p  = 0.001), abdominal pain (13.86 vs. 7.2 %, p  = 0.0001), abdominal discomfort (4.37 vs. 0.55 %, p  = 0.006), and gastric ulcer (12.5 vs. 1.2 %, p  < 0.0001) were significantly more prevalent among IGB patients than among non-IGB control patients. No mortality was reported from IGB treatment. Conclusion IGB treatment, in addition to lifestyle modification, is an effective short-term modality for weight loss. However, there is not sufficient evidence confirming its safety or long-term efficacy.

IntroductionHeart failure (HF) is a global health issue affecting millions of people worldwide. Cognitive frailty, a syndrome characterised by physical frailty and cognitive impairment without dementia, is increasingly recognised in this population. Cognitive frailty is associated with worse outcomes, including increased hospitalisation, disability and mortality. This systematic review and meta-analysis aimed to investigate the incidence, prevalence and predictors of cognitive frailty in HF patients.MethodsA systematic search will be conducted in MEDLINE/PubMed, EMBASE/Ovid, Web of Science and Google Scholar from inception to the latest search date. Eligible studies will report original data on adult patients (age ≥18 years) with HF, focusing on the incidence, prevalence and predictors of cognitive frailty. Two investigators will independently extract data and assess study quality using the Newcastle-Ottawa Scale and mixed-methods appraisal tool. Meta-analyses and meta-regression will be performed to estimate the pooled prevalence of cognitive frailty in HF patients and to identify predictors associated with increased risk, respectively. Subgroup analyses will be conducted to explore potential sources of heterogeneity.Ethics and disseminationThis systematic review does not require ethical approval and informed consent, as it does not use identifiable patient data. The results of this study will be submitted for publication in a peer-reviewed medical journal. This comprehensive meta-analysis of the literature on cognitive frailty among HF patients will inform tailored interventions and management strategies, ultimately improving patients’ quality of life and outcomes.

Defined as the total cholesterol minus high-density lipoprotein (HDL), non-HDL cholesterol has been increasingly acknowledged as a measure of risk estimation for developing atherosclerotic cardiovascular diseases (ASCVD). Comprising of apolipoprotein B100-containing cholesterols (very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), intermediate-density lipoprotein (IDL), and lipoprotein (a) (Lp(a))), and apolipoprotein B48-containing lipoproteins (chylomicrons and its remnants), elevated serum levels of non-HDL cholesterol in early adolescence has been strongly linked with the development of ASCVD in adulthood. This article reviews the evidence from longitudinal studies, which demonstrate the cumulative risk of ASCVD in relation to the elevated levels of non-HDL cholesterol earlier in life.

Background Heart transplant (HTX) recipients are at a significantly higher risk of adverse clinical outcomes, due to chronic immunosuppression and co-existence of other chronic conditions, when contracting the SARS-CoV-2 infection. Although vaccination against SARS-CoV-2 is currently the most promising measure for the prevention of severe Coronavirus Disease 2019 (COVID-19) among solid organ transplant recipients, the extent of immune response and its protective efficacy among patients receiving HTX has not been sufficiently studied. Methods We performed a systematic review of the literature by inquiring PubMed/Medline to identify original studies among HTX recipients, who had received at least one dose of the SARS-CoV-2 vaccine. Data on the measured humoral or cellular immune response was collected from all the eligible studies. Factors associated with a poor immune response were further investigated within these studies. Results A total of 12 studies comprising 563 HTX recipients were included. The average age of the study participants was 60.8 years. Sixty four percent of the study population were male. Ninety percent of the patients had received an mRNA vaccine (Pfizer/ BNT162b2 or Moderna/mRNA-1273). A positive immune response to SARS-CoV-2 vaccine was variably reported in 0% to 100% of the patients. Older age (> 65 years), vaccine dose (first, second, or third), time since HTX to the first dose of the vaccine, the time interval between the latest dose of the vaccine and measurement of the immune response, and the type of immunosuppressive regimen were all indicated as potential determinants of a robust immune response to the SARS-CoV-2 vaccination. Conclusion HTX recipients demonstrate a weaker immune response to the vaccination against SARS-CoV-2 compared to the general population. Older age, anti-metabolite agents such as mycophenolate mofetil, and vaccination during the first year following the HTX have been indicated as potential determinants of a poor immune response.