A Systematic Review Incorporating Meta-Analysis on the Effectiveness of Intravenous Immunoglobulin Versus Corticosteroids in the Treatment of Pediatric Myocarditis

Background:Concerns have been raised about the efficacy of intravenous immunoglobulin and corticosteroids in pediatric myocarditis;however,the relationship between the risk and efficacy of these two therapies in children with myocarditis varies.Methods:A systematic review on seventeen studies was conducted in July 2020,which included 1,960 subjects at the baseline,with 788 receiving intravenous immunoglobulin and 142 receiving corticosteroids.The mean difference(MD)or odds ratio(OR)with 95%confidence intervals(Cis)was calculated to assess the prognostic role of both treatments using dichotomous and continuous methods with random or fixed-effect models.Results:The use of intravenous immunoglobulin was significantly associated with a lower mortality rate or heart transplantation in children with myocarditis(OR,0.55;95%CI,0.40-0.77,^<0.001)compared with the control group.However,corticosteroids were not significantly associated with the same parameters(OR,0.72;95% CI,0.31-1.63,p=0.43).The use of intravenous immunoglobulin was not significantly related to improving left ventricular ejection in children with myocarditis(OR,2.30;95% CI,-9.65-14.25,p=0.71)and so were corticosteroids(MD,5.17;95% CI,-0.26-10.60,p=0.06).Conclusion:The use of intravenous immunoglobulin might have an independent risk relationship with a lower mortality rate or heart transplantation and is recommended in children with myocarditis to prevent complications.

Inflammatory Bowel Disease Patients’Risk of Developing Prostate Cancer:A Meta-Analysis

Background:Inflammatory bowel disease(IBD)has been linked to an increased risk of prostate cancer(PC)in numerous studies.However,the exact relationship between them remains conflicting.In this meta-analysis,we focus on determining the relationship between PC incidence and IBD.Methods:A comprehensive literature search was conducted up until January 2022,selecting 14 studies,comprising 127,323 subjects with IBD,at the beginning of the study,among which 61,985 were patients with ulcerative colitis(UC)and 37,802 were with Crohn’s disease(CD).The studies reported the differences between subjects with IBD and controls with regard to the incidence of PC.In order to investigate the relationship between IBD and the prevalence of PC,we estimated the odds ratio(OR)with 95%confidence intervals(CIs).Results:IBD significantly increased the incidence of PC(OR,3.46;95%CI,1.40-8.54,P=0.007)compared to controls.UC significantly increased the incidence of PC(OR,1.43;95%CI,1.03-1.98,P=0.03)compared to controls.Yet,no significant difference was observed between CD and controls in relation to PC incidence(OR,0.89;95%CI,0.75-1.06,P=0.18).Conclusion:IBD,particularly UC,may increase the risk of developing PC.This relationship prompts us to advocate for increased PC and IBD screening to reduce the risk for possible complications that could occur in these subjects.

A Meta-Analysis of the Effectiveness of Vitamin C in the Prevention and Treatment of Childhood Upper Respiratory Tract Infections

Background:The effectiveness of vitamin C in the prevention and treatment of pediatric upper respiratory tract infections was evaluated in a meta-analysis.Methods:A total 2,573 children with upper respiratory tract infections were included in the meta-analysis,1,280 of whom received vitamin C and 1,293 who received control medication.The analysis of findings related to the studies included was done through random or fixed effects model to determine whether vitamin C supplementation could stop and control upper respiratory tract infections in children using mean difference(MD)with 95%confidence intervals(CIs).Results:On average,vitamin C-treated children had fewer upper respiratory tract infection bouts,their illness lasted shorter(MD-0.84;95%CI-1.47 to-0.20,P=0.009),and they were less contagious than the control.Conclusions:The number of episodes and illness duration of upper respiratory tract-infected pediatric subjects were considerably reduced in the intervention group(vitamin C)compared to the control.Due to the small sample size in four of 11 studies and the limited number of studies included for comparison,the outcomes should be carefully examined.

Diseases of the Respiratory Tract: Asthma and Chronic Obstructive Pulmonary Disease

Short acting β2-agonists(SABAs)such as salbutamol and terbutaline are commonly used in the treatment of asthma and chronic obstructive pulmonary disease(COPD).According to the guideline produced by the British Thoracic Society(BTS)and the Scottish Intercollegiate Guidelines Network(SIGN),SABAs are considered to be the first line of treatment in asthma management.The National Institute for Health and Clinical Excellence(NICE)guidelines also recommend the use of SABA as the first line of treatment for managing patients with COPD.The recommendations in NICE guidelines state that in COPD patients,breathlessness and exercise limitation should be first medicated with short-acting bronchodilators(including β2-agonists or anticholinergics)when it is required.Both salbutamol and terbutaline have been widely used for asthma and COPD,and they have been found to be extremely beneficial in the two pathologic conditions.

Effect of Rituximab Versus Mycophenolate Mofetil or Cyclophosphamide as Control in Lupus Nephritis:A Meta-Analysis

Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation;198 of them were treated with rituximab,while 447 were treated with mycophenolate mofetil or cyclophosphamide.We determined the odds ratio(OR)and mean difference(MD)with 95%confidence index(CI)to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random-or fixed-effects model by dichotomous or continuous techniques.Results:The rituximab group showed significantly higher complete renal remission rate(OR=2.52;95%CI 1.30-4.91,P=0.006)and total renal remission rates(OR=2.22;95%CI 1.36-3.63,P=0.001)than the control group.However,there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score(MD-1.16;95%CI-2.88-0.57,P=0.19),proteinuria(MD-0.31;95%CI-0.70-0.09,P=0.013),and serum creatinine(MD 0.01;95%CI-0.04-0.07,P=0.64)between the rituximab group and the control.Conclusion:Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates,with no significant difference in terms of shorter-end SLEDAI,proteinuria,and serum creatinine,compared with the control in individuals with lupus nephritis.

Addition of Inhalation Training Devices and Smartphone Application to Verbal Counseling for Asthmatic Patients

Background:One of the main issues with pressurized metered dose inhalers(pMDI)is that some patients find it difficult to use it properly.Methods:This study was carried out to compare the effect of traditional verbal counseling and that of adding an inhalation training device,such as Flo-Tone or Clip-Tone,along with a smartphone application on the incidence of inhalation technique mistakes and the pulmonary function of asthmatic adults and children.Results:The lung function of those in the advanced counseling group significantly improved on the second visit(p<0.001),whereas for those in the verbal counseling group,their lung function only improved on the third visit(p<0.001).For both the groups,the mean number of mistakes in regard to the steps in inhalation technique decreased significantly(p<0.001),with an overall higher percentage in the advanced counseling group.Conclusion:The use of training devices and smartphone applications in addition to traditional verbal counseling for teaching asthmatic adults and children the correct inhalation technique steps using pMDI resulted in a significant improvement in pulmonary function and a significant reduction in the number of inhalation technique mistakes,compared to traditional verbal counseling alone.

Methods in Determining the Bioequivalence of Inhaled Products

Aerosol delivery to the lungs can be achieved with several devices that differ in their operating mechanisms and efficacies of aerosol delivery.There are several methods to measure aerosol delivery and deposition in a subject's lung,in order to assess the efficacy of aerosol generators and the impact of certain drugs.Instruments such as cascade impactors,imaging techniques,and laser diffraction are available for measuring the particle size of aerosols,which is the main factor in the deposition and distribution of the produced aerosol.From impactors to laser difEractors,they have different operating mechanisms,analysis times,and characteristics,in which each has its own advantages and limitations.Several models are available to investigate aerosol delivery and deposition,such as in vitro,in vivo,and ex vivo models.

The Screening of Diabetes, Obesity and Hypertension Risks Associated with Hepatitis C Within the Egyptian Population in a Community Pharmacy Setting

Background:Diabetes and hypertension have been identified as risk factors for HCV complications in previous studies.This has sparked the interest in the field of prevention by identifying at-risk individuals and increasing investments for screening among pharmacists.The aim of this study was to screen for risk factors,including age,gender,BMI,hypertension,diabetes,and obesity,in Egyptian patients with HCV Methods:A prospective cross-sectional study was carried out from September 2018 to February 2019,with a total of 1,959 medical records collected.By comparing the patients'characteristics,variables related to metabolic risk,and body composition measurements,regression models have been established to determine any confounding factors.Results:The prevalence of HCV antibody was 41.0%in men and 59.0%in women.Among the variables included in the regression analysis,age,BMI,and uncontrolled hypertension were found to have statistically significant associations with diabetes in HCV positive cases(p<0.001).HCV patients>40 years old with high BMI were found to have significant associations with both,diabetes and hypertension(p<0.001).Hypertensive HCV patients were found to have significant associations with gender,age>40,and DM(p<0.001).Conclusion:HCV infection and metabolic disorders have a closed cycle relationship.Reducing the complications of DM has a promising prospective of limiting the complications of HCV .

ICU and Aerosol-Generating Procedures in COVID Patients

Some of the COVID-19 patients required an intensive care unit admission,additionally an aerosol delivery is an important treatment method in this type of patient.The present mini-review describes the best aerosol delivery method in this type of patients.Additionally,the different delivery methods of aerosol,and the best placement of the aerosol which allows the best delivery was discussed in this paper.

An Observational Study on the Management of COVID-19 Patients in Limited-Resource Hospitals

Background:The purpose of this study was to evaluate the effectiveness of limited-resource hospitals in managing mild and moderate hospitalized cases of COVID-19 with comorbidities and in preventing their progression to severe illness.Methods:Data were obtained from 88 moderate COVID-19 patients with comorbidities who were admitted to limitedresource hospitals.The data were classified into several parts:comorbidities,chronic medication before hospital admission,symptoms of COVID-19 before and during hospitalization,clinical features,laboratory findings on hospital admission,complications during hospitalization,as well as worst laboratory values during hospitalization,hospital stay,and outcomes.The clinical features,laboratory results,type of oxygen therapy used,and the final treatment outcome were all evaluated to assess for any potential relationship.Results:All patients were alive upon discharge.Before admission,the majority of patients(60.2%)received COVID-19 treatment,and the average hospital stay was 12 days.The most common symptoms were fever(88.7%),cough(95.5%),shortness of breath(90.9%),myalgia(84.1%),confusion(63.6%),headache(62.5%),sore throat(88.7%),rhinorrhea(17%),chest pain(58%),diarrhea(19.3%),nausea and vomiting(38.6%),anosmia(62.5%),as well as dysgeusia(64.8%).Based on chest radiograph or computed tomography(CT)scan,9.1%of the patients had unilateral pneumonia,90.9% had bilateral pneumonia,and 96.6% had multiple mottling and ground-glass opacity.Age was found associated with a significant increase in headache(p=0.005),rhinorrhea(p=0.013),chest pain(p=0.007),and the need for positive airway pressure(p=0.008).Between pre-and post-hospital admissions,there was a significant increase in lactate dehydrogenase and ferritin but a decrease in platelet,D-dimer,hemoglobin,lymphocytes,neutrophils,and total leucocyte count(p<0.001).There was a significant association between hospital stay and D-dimer level(p=0.05).Conclusion:Limited-resource hospitals in Egypt were efficient in managing mild and moderate hospitalized cases of COVID-19 with comorbidities.Many of these cases did not escalate to severe illness and were all alive upon discharge.Early management of COVID-19 tends to delay the disease progression to severe illness and improves patients5 chances of survival.Treating COVID-19 or using oxygen therapy at home can also delay the need for hospitalization in mild or moderate cases.

Respiratory Tract, Ventilation, and Pulmonary Functions Tests

Breathing is considered the common factor that links studying,sleeping,and activities.It is one of the primary indicators that is frequently considered when determining whether or not an unconscious individual is still alive.The evolution and development process of the respiratory system that occurs in a foetus is primarily from head to tail(cephalocaudal).Many changes occur throughout this period until the 28th week of pregnancy at which the foetus^respiratory system will attain adequate development for the rest of his or her life.The respiratory system comprises of the lungs and the encompassing thoracic wall,which includes the thoracic cages,midriff(diaphragm),and the abdominal wall.Spirometry is a procedure used for estimating air volumes that enter and exit the pulmonary system with the aid of a spirometer.The various pulmonary parameters that reflect pulmonary ventilation are of great significance in diagnosing respiratory diseases.The respiratory system will be discussed in more detail in this article.

Overview of Spirometry and the Use of Its Parameters for Asthma Monitoring in Children

Asthma is the most common chronic pulmonary disease in the world,affecting more than three hundred million people from different races and age groups.Childhood asthma is considered one of the main causes of increased healthcare expenditures,particularly in developing countries.Spirometry is the most essential and commonly used lung function test.It is used mainly for the evaluation of lung function to obtain reliable data used for the detection of lung diseases,such as asthma,as well as for monitoring lung health.The two spirometry parameters,peak expiratory flow rate(PEFR)and forced expiratory volume in one second(FEV1),are effective in the diagnosis and management of patients with asthma.However,FEV1 is preferred as it is a more accurate parameter compared to PEFR for the evaluation and recognition of bronchoconstriction.In children with asthma,the most commonly used lung function parameter for asthma monitoring is FEV1.It was discovered that a decrease in FEV1 is associated with an increase in asthma severity.

COVID-19 Patients with Hepatic Complications During the Third Wave of Pandemic in Egypt

COVID-19 is a respiratory infection that has lately begun to affect other vital organs,including the heart,kidney,and liver.The purpose of this study was to investigate the hepatic complications in COVID-19 patients and the risk of being admitted to ICU or facing death.Methodology:Comorbidities(hypertension and diabetes),COVID-19 symptoms,laboratory findings(ALT level,AST level,and albumin),complications during hospitalization,treatment protocol used,and survival outcomes were all studied in 200 COVID-19 infected Egyptian patients who had virological symptoms and were followed up until they recovered or died.It was found that older people and those with higher blood glucose levels have a higher risk of developing liver-associated COVID-19 disorders.Also,the majority of patients who developed liver complications in the course of the infection had high mortality rates.Patients with diabetes,hypertension,or hepatic disease are at higher risk of ICU admission or death.Hence,it is important to pay attention to these problems in the diagnosis and treatment of COVID-19 to develop a suitable individualized treatment protocol.There was also a correlation between the mortality in COVID-19 patients and both,high blood glucose and liver enzyme levels.It can be attributed to the correlation between diabetes and liver disease as every disease may be a complication to the other;moreover,COVID-19 may lead to increased blood sugar levels in addition to ALT and AST levels.Another theory is that COVID-19 may afiect the liver and hence people with chronic liver disease.

Inhalation Devices and Pulmonary Drug Delivery

Inhaled drug delivery is mainly used to treat pulmonary airway disorders by transporting the drug directly to its targeted location for action.This decreases the dose required to exert a therapeutic effect and minimizes any potential adverse effects.Direct drug delivery to air passages facilitates a faster onset of action;it also minimizes irritation to the stomach,which frequently occurs with oral medications,and prevents the exposure of drugs to pre-systemic metabolism that takes place in the intestine and liver.In addition to that,the lung is regarded as a route for transporting medications throughout the entire body's blood circulation.The type of medication and the device used to deliver it are both important elements in carrying the drug to its target in the lungs.Different types of inhalation methods are used in inhaled delivery.They differ in the dose delivered,inhalation technique,and other factors.This paper will discuss these factors in more detail.