Practice of Infection Prevention and Control Strategies in Risk Departments during the COVID-19 Epidemic

Objective: To explore the practice and application of infection prevention and control strategies in risk departments during the COVID-19 epidemic, and to formulate the infection prevention and control measures to provide advice and guidance in risk departments. Methods: According to the latest plan of diagnosis and treatment, prevention and control issued by the National Health Commission, expert advice and consensus, combined with the actual situation in our hospital, a series of infection prevention and control measures of COVID-19 in risk department was formulated. Results: During the epidemic period, the prevention and control measures of nine risk departments including emergency operation, anesthesiology, endoscopy center, blood purification center, otolaryngology, stomatology, medical imaging department, medical cosmetology department and pulmonary function room were established from six aspects, including pre-examination and screening, medical technology control, personnel management, personal protection, environmental disinfection, medical waste disposal, etc. Conclusion: During the epidemic period, the infection prevention and control strategy of risk departments is one of the key links to control the spread of the epidemic, and risk departments must pay attention to and strictly implement various infection prevention and control measures.

Comparative Study of Transvesical and Retropubic Prostatic Adenomectomies in the Urology-Andrology Department of Ignace Deen University Hospital Center

Objective: To compare the results of transvesical and retropubic prostatic adenomectomies at the Urology-Andrology Department of Conakry University Hospital. Methodology: This was a prospective multi-operator analytical study lasting 6 months. It included 70 patients operated on for benign prostatic hypertrophy (BPH), divided into 2 groups of 35 according to the retropubic or transvesical technique. The data was collected using a questionnaire and entered into the Epi info application. The analysis was initially descriptive and then univariate. To identify confounding factors, a multivariate analysis was performed. The application conditions of each test were checked before their application. A p-value Results: Upper adenomectomies represented 53.6% of surgeries performed for BPH. The average age was 73.2 years. The mean prostate volume was 117 ± 51.6 cc and the mean total PSA was 9.2 ± 11.4 ng/ml. The majority of patients had an ASA1 (60%) and ASA2 (37.1%) score. Spinal anesthesia, a double-current silicone probe with hinged hinge 22, and drainage of the prevesical space were carried out in all patients, i.e. 100%. The average overall blood loss was 229 ± 98.2 ml. It was lower in the group of patients operated via the retropubic route (187 ± 60.4 ml). The same was true for the duration of intervention (49.1 ± 7.17 vs 55.4 ± 7.9 min), the catheter wearing time (5.14 ± 0.97 vs 9.29 ± 2 .9 days) and the length of hospitalization (=6.26 ± 1.15 vs 12.1 ± 5.74 days). Conclusion: The retropubic technique has advantages over the transvesical one. These advantages are translated by a gain in the duration of the intervention, blood loss, catheter wearing time and length of hospitalization.

Management of Malignants Gliomas: About 20 Cases Treated in the Medical Oncology Department of Fattouma Bourguiba University Hospital-Monastir

Introduction: Malignant gliomas refer to grade III or IV brain tumors defined according to the World Health Organization (WHO) classification. They are a heterogeneous group of pathologies and represent a serious health problem by their frequency, severity and treatment difficulties. The prognosis of malignant gliomas remains poor despite all the medical advances. Materials and Methods: It is a retrospective study included 20 cases of malignant glial tumors treated at the medical oncology department, Fattouma Bourguiba hospital in Monastir between 2012 and 2016, according to the STUPP protocol. Results: These were 12 men and 8 women with a median age of 43. Clinical signs were not very specific, dominated by intracranial hypertension and deficit signs. Imagery referred to the diagnosis of malignant gliomas in 1st intention. Surgery consisted of a macroscopically complete exeresis in (15%) cases, a partial exeresis in (50%), the rest of the patients had a stereotactic biopsy. Histology found GBM in 16 patients (80%), 2 cases of Grade III anaplastic astrocytoma (10%), 1 case of anaplastic oligodendroglioma (5%), and 1 case of Grade III anaplastic eppendymoma (5%). Most of our patients received concurrent radio-chemotherapy and adjuvant TMZ chemotherapy was administered in 15 patients, 7 of whom received the full 6 scheduled cures. A relapse treatment was decided in only one of the 12 patients who relapsed. 6 patients are still alive. The median survival is 11.27 months. In our series, overall survival was related to histological type (p = 0.006) and neurological status assessed at the end of RT-CT (p = 0.001). While age, general condition score, type of surgery, and post-therapeutic development did not show a statistically significant relationship, although survival rates were consistent with the criteria assessed. Conclusion: Malignant gliomas are rare tumors, bad prognosis, aggravated in Tunisia by a diagnostic delay. The creation of a multidisciplinary neuro-oncology group can help to improve management.

Study on Compliance with Radiation Protection Rules in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali)

Objective: Evaluate the level of compliance with radiation protection rules in the medical imaging department of the University Hospital Center (CHU) of Kati. Methodology: This was a cross-sectional and descriptive study carried out in the medical imaging department of Pr Bocar Sidy Sall (BSS) Hospital of Kati. A questionnaire was developed and sent to the staff of the medical imaging department. The assessment focused on the radiation protection of personnel, radiation protection measures for patients, the delimitation and signage of zoning as well as the application of radiation protection principles. Results: Twenty-one people participated in the study, 90% of whom were men. The 30 - 39 age group was predominant with 61.90%. 33.33% of the staff knew the principles of radiation protection;86% of our sample knew the basic rules of radiation protection. The majority of the staff in the imaging department (61.90%) had a perfect knowledge of protective equipment. For 76% of our workforce, the limits of the radiation doses received are regulated in Mali. 76% of those surveyed have not taken any additional training in radiation protection. The doors are closed during the X-ray examination for 76.19% of the respondents and 95% of the staff put themselves behind the sealed screen during the examination. For 81% of the respondents, the design of the premises met radiation protection standards. 62% of practitioners have a dosimeter and 80% of them wear it during their shift. For 62% of our sample, the change of the dosimeter is quarterly. The systematic request for DDR (date of last menstrual period) in women and the adaptation of the delivered dose to the patient’s morphology was only carried out by 65% of practitioners. The majority of staff (81%) did not benefit from medical surveillance, while for 55% of respondents the level of radiation protection in the establishment was average. Conclusion: This study enabled us to highlight the shortcomings in terms of radiation protection within the imaging department of the CHU Kati.

Retroperitoneal Teratoma in Infants: About a Case in the Medical Imaging Department of the Mother and Child Hospital Center “Luxembourg”

Introduction: Retroperitoneal teratoma is a rare congenital tumour, representing only 1% to 10% of primary retroperitoneal tumors in children, far behind ovarian and testicular locations. There is a clear female predominance with a sex ratio of 3.4/1. The purpose of this study is to review the clinical manifestations, the mode of revelation of retroperitoneal teratoma, the diagnostic means and the anatomopathologic aspect of retroperitoneal teratoma, then to show the contribution and the limits of the various imaging examinations: ultrasound, CT and MRI in the diagnosis of retroperitoneal teratoma. Observation: We report the case of a mature retroperitoneal teratoma discovered in a 10-month-old male infant. The diagnosis evoked by ultrasound and abdominal CT was confirmed by histological study of the excised specimen. The postoperative evolution after 3 months was favorable in particular with no signs of recurrence. Conclusion: Retroperitoneal teratoma is a rare congenital tumour. The complete imaging assessment including ultrasound and computed tomography is necessary preoperatively in order to make the diagnosis and to clearly determine the relationship with the various organs. The anatomopathological study confirms the diagnosis of retroperitoneal teratoma. Tumor excision must be radical to avoid recurrence, which readily occurs in a malignant form. Even if the tumor appears benign, postoperative monitoring based on clinical, biological and radiological examination is essential.

Feasibility of Scanopelvimetry in the Medical Imaging Department of the University Hospital of Point “G”.

Purpose: The purpose of our study was to describe the technique of scanopelvimetry used in the radiology department of the Point G University Hospital, to specify the indications of scanopelvimetry in the department and to evaluate the cost of radiopelvimetry. Patients and Method: This was a prospective, cross-sectional study that took place over a 12-month period from January 1 to December 31, 2018. It focused on pregnant women in whom scanopelvimetry was performed in the medical imaging department of Point G University Hospital during the study period. Results: Out of 8615 CT examinations performed in the radiology department, we collected 65 cases of scanopelvimetry, i.e., 0.7% of the CT examinations. Primigravida and paucigravida dominated the study (40% each). In 60% of the pregnant women the height was less than 150 cm. The most frequent indication for CT scanning was clinical pelvic narrowing (50%). In 80% of the cases, the scanopelvimetry was performed after 37 weeks of amenorrhea. A predominance of narrowing of the superior strait was noted (40%). 4.6% of the pregnant women had a Magnin index of less than 20. CT scanopelvimetry is a feasible examination in our context but the level of demand is low because of the high cost of the examination (49500 fca). Conclusion: In light of the results obtained, we can say that CT pelvimetry allows us to predict the probable route of delivery and thus we can reduce the risk of fetomaternal morbidity and mortality to improve maternal and child health.

Mortality in Cardiology in Sub-Saharan Africa: Case of the Cardiology Department of the Teaching Hospital Sylvanus Olympio of Lome

Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.

Varicocele and Spermogram Abnormality: About 264 Cases at the Fertilia Medical Clinic in Bamako

Aims: To determine the impact of varicocele on the result of the spermogram in a group of hypo-fertile or infertile men. Patients and Method: This was a cross-sectional, descriptive study concerning 264 men collected between February 2020 and March 2022 at the Fertilia medical clinic in Bamako. The study population consisted of consenting male subjects presenting for infertility. All of our patients had already done a spermogram, they then benefited from a scrotal Doppler ultrasound. The scrotal echo-doppler was completed by an abdominal and pelvic echography in search of a possible etiology, in particular a renal cancer, a thrombosis of the renal or spermatic vein, a retroperitoneal mass or a nutcraker syndrome. Testicular volume was measured on ultrasound according to Lambert’s formula (length × width × height × 0.71). A volume = 16 ml was considered normal. Results: 264 patients were recruited in ours. The average age was 33 years with extremes ranging from 25 to 65 years. 149 patients or 56.44% were between 30 and 45 years old. 213 patients or 80.68% had primary infertility. All the patients, i.e. 100%, had a sperm anomaly and dilation of the pampiniform plexus veins. The most common sperm abnormalities were oligoasthenoteratozoospermia, which concerned 214 patients, or 81%, followed by azoospermia (40 patients, or 15%) and oligospermia (10 patients, or 4%). 213 patients or 80.68% had a Hirshen grade II varicocele, 45 patients or 17% had grade I and 06 patients or 2.27% had grade III. Among the 6 patients, 04 had left testicular atrophy and 2 bilateral atrophy. The venous reflux was more accentuated on the left than on the right. Conclusion: Varicocele is significantly found in men with infertility. Sperm alterations concern both the concentration of spermatozoa, their mobility and their vitality. Even if the mechanism of alteration of the sperm parameters is not well elucidated, our study made it possible to make the link between the dilation of the veins of the pampiniform plexus and the sperm abnormalities mentioned above. It should be recognized that varicocelectomy has allowed a significant improvement in the quality of sperm with the obtaining of a certain number of natural pregnancies and those resulting from medically assisted procreation.

Endometrial Status and Embryonic Implantation about 150 Cases at the Medically Assisted Procreation Laboratory “Le Diafounou”

Background: The endometrium is the tissue that lines the inside of the uterus. It undergoes multiple changes during the menstrual cycle and prepares to welcome the fertilized egg. Endovaginal ultrasound is a first-line examination in the assessment of female infertility. Objective: We aimed to determine the impact of endometrial status by endovaginal ultrasound on the outcome of embryo transfers. Subjects and Methods: This was a prospective cross-sectional study of 150 women collected between January and October 2020 at the “Le Diafounou” medically assisted procreation laboratory. Were included in the study, women presenting for desire of pregnancy and having continued the treatment until the transfer of fresh or frozen embryos. An uterine score was used. This score took into account the thickness of endometrium, it is coffee bean aspect, the presence of the notch, the echogenicity of the endometrium, the pulsatility index, the presence of the flow at the end of diastole and sub-endometrial flow. Ultrasounds were performed using a General Electric logic 500, logic 9 and Voluson E8 device. The data was entered into Excel and then analyzed using SPSS version 21. Results: 150 women were selected for the study. 83 women or 55.3% were between 17 and 35 years old and 44.7% were over 35 years old with an upper limit of 50 years old. The number of women who became pregnant was 69% or 46%. The average thickness of the endometrium was 11.40 mm with extremes of 4.65 mm and 18.6 mm. There was a correlation between the thickness of the endometrium and obtaining a pregnancy (p i.e. 88.7%. The pulsatility index was relatively low for those who started a pregnancy, i.e. 90%. The high pulsatility index is one of the reasons for the failure of embryo implantation. The correlation was significant (p = 0.009). 141 women had no notch in the uterine arteries, i.e. 94%. 94 women or 62.7% had a triple line endometrium or typical coffee bean appearance. End-diastolic flow was observed in 127 women, i.e. 84.7%. The sub-endometrial flow was found in 128 women or 85.3%. Conclusion: The Knowledge of the status of the endometrium is essential and has an impact on the outcome of embryo transfers. The thinner (7 and <15). Doppler factors also play an important role.

Mixed neuroendocrine non-neuroendocrine neoplasms in gastroenteropancreatic tract

Mixed neuroendocrine non-neuroendocrine neoplasms(MiNENs)are a hetero-geneous group of malignant neoplasms that can settle in the gastroenteropan-creatic tract.They are composed of a neuroendocrine(NE)and a non-NE compo-nent in at least 30%of each tumour.The non-NE component can include different histological combinations of glandular,squamous,mucinous and sarcomatoid phenotypes,and one or both of the components can be low-or high grade malignant.Recent changes in the nomenclature of these neoplasms might lead to great deal of confusion,and the lack of specific clinical trials is the main reason why their management is difficult.The review aims to clarify the definition of MiNEN and analyze available evidence about their diagnosis and treatment options according to their location and extension through careful analysis of the available data.It would be important to reach a general consensus on their diagnosis in order to construct a classification that remains stable over time and facilitates the design of clinical trials that,due to their low incidence,will require long recruitment periods.

Management of autoimmune hepatitis induced by hepatitis delta virus

Approximately 12-72 million people worldwide are co-infected with hepatitis B virus(HBV)and hepatitis delta virus(HDV).This concurrent infection can lead to several severe outcomes with hepatic disease,such as cirrhosis,fulminant hepatitis,and hepatocellular carcinoma,being the most common.Over the past few decades,a correlation between viral hepatitis and autoimmune diseases has been reported.Furthermore,autoantibodies have been detected in the serum of patients co-infected with HBV/HDV,and autoimmune features have been reported.However,to date,very few cases of clinically significant autoimmune hepatitis(AIH)have been reported in patients with HDV infection,mainly in those who have received treatment with pegylated interferon.Interestingly,there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants.Consequently,several questions remain unanswered with the challenge to distinguish whether it is autoimmune or“autoimmune-like”hepatitis being the most crucial.Second,it remains uncertain whether autoimmunity is induced by HBV or delta virus.Finally,we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon.These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV,such as Bulevirtide or immu-nosuppressive drugs,are more appropriate for the management of patients with HDV and AIH.

Prognostic Nutritional Index Associates with the Severity of Silicosis:A Study from a Tertiary Class A Prevention and Treatment Institute for Occupational Diseases in China

Pneumoconiosis is a group of heterogeneous fibrotic lung diseases caused by inorganic mineral dust and includes coal workers’pneumoconiosis and silicosis.Silicosis involves diffuse or nodular interstitial pulmonary fibrosis caused by exposure to asbestos or silica dust.China is thought to have the highest number of silicosis cases,with 6,000 new cases reported annually^([1]).Currently,the clinical diagnosis and monitoring of silicosis relies mainly on a history of occupational exposure and radiological abnormalities^([2]).Therefore,determining further indicators is crucial to reflect the severity of silicosis.

Molecular features of gastroenteropancreatic neuroendocrine carcinoma: A comparative analysis with lung neuroendocrine carcinoma and digestive adenocarcinomas

Objective: There is an ongoing debate about whether the management of gastroenteropancreatic(GEP)neuroendocrine carcinoma(NEC) should follow the guidelines of small-cell lung cancer(SCLC). We aim to identify the genetic differences of GEPNEC and its counterpart.Methods: We recruited GEPNEC patients as the main cohort, with lung NEC and digestive adenocarcinomas as comparative cohorts. All patients undergone next-generation sequencing(NGS). Different gene alterations were compared and analyzed between GEPNEC and lung NEC(LNEC), GEPNEC and adenocarcinoma to yield the remarkable genes.Results: We recruited 257 patients, including 99 GEPNEC, 57 LNEC, and 101 digestive adenocarcinomas.Among the mutations, KRAS, RB1, TERT, IL7R, and CTNNB1 were found to have different gene alterations between GEPNEC and LNEC samples. Specific genes for each site were revealed: gastric NEC(TERT amplification),colorectal NEC(KRAS mutation), and bile tract NEC(ARID1A mutation). The gene disparities between small-cell NEC(SCNEC) and large-cell NEC(LCNEC) were KEAP1 and CDH1. Digestive adenocarcinoma was also compared with GEPNEC and suggested RB1, APC, and KRAS as significant genes. The TP53/RB1 mutation pattern was associated with first-line effectiveness. Putative targetable genes and biomarkers in GEPNEC were identified in22.2% of the patients, and they had longer progression-free survival(PFS) upon targetable treatment [12.5 months vs. 3.0 months, HR=0.40(0.21-0.75), P=0.006].Conclusions: This work demonstrated striking gene distinctions in GEPNEC compared with LNEC and adenocarcinoma and their clinical utility.

Is it a normal phenomenon for pediatric patients to have brain leptomeningeal contrast enhancement on 3-tesla magnetic resonance imaging?

Determining whether sevoflurane sedation in children leads to“pseudo”prominent leptomeningeal contrast enhancement(pLMCE)on 3 Tesla magnetic resonance imaging will help reduce overdiagnosis by radiologists and clarify the pathophysiological changes of pLMCE.

Research Progress on Individualized Treatment of Splenic Aneurysm

Splenic artery aneurysm has a hidden onset and atypical symptoms.There are various diagnostic methods for splenic aneurysms,among which ultrasound is the first choice for aneurysm screening.The diagnostic rate of CTA and DSA reaches 100%.In clinical practice,it is necessary to integrate medical history,symptoms and signs,and multiple imaging results to improve the diagnostic rate.In terms of treatment plans,both intervention and surgical procedures have their strengths,and the application of intervention will be more extensive.We need to adhere to the principle of individualization and choose a reasonable treatment plan for patients.At present,there are many reports on pregnant women with large splenic aneurysms both domestically and internationally.Some scholars believe that large splenic aneurysms may be related to hormonal imbalances during pregnancy,and the specific pathogenic mechanism will become a hot topic in future research.

Research Progress on Myocardial Protection Strategies

Myocaridial protection aims to salvage myocardium from ischemia and reperfusion injury and to reduce infarct size and its consequences.After more than 30 years of development,the concept of ischemic preconditioning has evolved into"ischemic conditioning",a term that encompasses a number of related endogenous cardioprotective strategies,which can be applied either directly to the heart(ischemic preconditioning or postconditioning)or from afar,for example to a limb(remote ischemic preconditioning,preconditioning,or postconditioning).A variety of cardioprotective therapies have shown promising results in reducing infarct size and improving clinical outcomes in patients with ischemic heart disease.

Real-World Evidence in Localized Pancreatic: Coping with Uncertainty in Unselected Populations

Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based on clinical trials in selected populations. Hence, exploring with real world evidence (RWE) clinicians’ preferences for treatment options and their results seems pertinent. Methods: In a set of consecutive patients with localized pancreatic cancer assisted in a third level hospital from January 2013 to December 2022, medical records, symptoms, diagnostic process, distribution between subtypes, and treatment plans, with safety and efficacy results, were assessed. Results: A total of 152 patients with localized disease were included (43.4% R, 21.0% BR, 33.6% LAU). The population characteristics exemplified differences between daily practice and clinical trials. Tumor location and symptoms were as expected. Treatment plan was conditioned by PS or comorbidities in 23.0% of patients. In patients with R disease, surgery followed by different adjuvant chemotherapy (CT) regimes was the antineoplastic treatment of choice (64.8%) with efficacy results (OS 37.5 months;95% CI 18.4 - 56.7), in the range of contemporary standards. The common use of neoadjuvant CT for BR disease (94.4%), with surgery in 50% of them, and its results (OS 30.8 months;95% CI 10.5 - 51.2) reflected current controversies of treatment recommendations and evolution in this scenario. Paliative CT with or without radiotherapy was the standard specific treatment in LAU disease (95.1%) with survival results (PFS: 10.8 months;95% CI 8.8 - 12.7. OS: 20.3 months;95% CI 13.5 - 27.2) that justify the distinct character and the specific study of this entity. Conclusion: RWE for localized pancreatic cancer aroused from the analysis of this population confirms the distinct nature of patients assisted in daily practice, as well as mirrors the complexity of decision making in clinical assumptions in which achieving stronger evidence should be paramount.

Current Research Status of Traditional Chinese Medicine External Treatment for Diarrhea Type Irritable Bowel Syndrome

Irritable bowel syndrome(IBS-D)with diarrhea is a common gastrointestinal functional disease in clinical practice,which seriously affects the quality of life of patients.Cur‐rently,Western medicine has poor therapeutic effects,while traditional Chinese medi‐cine has unique advantages in relieving IBS-D symptoms and preventing recurrence.In recent years,especially with external treatment of traditional Chinese medicine,it has become a new treatment direction in clinical practice and has achieved good therapeutic effects.This article will provide a review of recent research on the treatment of IBS-D using traditional Chinese medicine external treatment methods.

Prevention and Control Strategies of Nosocomial Infection and Effectiveness Evaluation in a Tertiary Teaching Hospital during the Epidemic of COVID-19

Objective: To evaluate the role of prevention and control strategies for nosocomial infection in a tertiary teaching hospital during the sudden outbreak of Corona Virus Disease 2019 (COVID-19). Methods: The hospital initiated an emergency plan involving multi-departmental defense and control. It adopted a series of nosocomial infection prevention and control measures, including strengthening pre-examination and triage, optimizing the consultation process, improving the hospital’s architectural composition, implementing graded risk management, enhancing personal protection, and implementing staff training and supervision. Descriptive research was used to evaluate the short-term effects of these in-hospital prevention and control strategies. The analysis compared changes in related evaluation indicators between January 24, 2020 and February 12, 2020 (Chinese Lunar New Year’s Eve 2020 to lunar January 19) and the corresponding lunar period of the previous year. Results: Compared to the same period last year, the outpatient fever rate increased by 1.85-fold (P P Conclusion: The nosocomial infection prevention and control strategies implemented during this specific period improved the detection and control abilities for the COVID-19 source of infection and enhanced the compliance with measures. This likely contributed significantly to avoiding the occurrence of nosocomial infection.

Carbocysteine as Adjuvant Therapy in Acute Respiratory Tract Infections in Patients without Underlying Chronic Conditions: Systematic Review and Meta-Analysis

Objective: This study aims to systematically examine the existing evidence regarding the clinical benefits of carbocysteine as an adjunctive treatment in acute bronchopulmonary and otorhinological processes. Design: Systematic review and meta-analysis. Data sources: An electronic search was conducted across PubMed, Cochrane Library, clinicaltrials.gov, and the European Clinical Trial Register, with the search dated to May 2023. Bibliographic references from other literature reviews and meta-analyses were also reviewed. The search was limited to randomized clinical trials published in any language and year. It was completed by cross-checking the references of the located articles. Methods: Inclusion criteria covered studies assessing systemic or inhaled carbocysteine, regardless of dosing regimen. Concomitant medication use was acceptable if balanced between intervention and control groups. Authors independently extracted data, resolving disagreements through consensus. Methodological quality assessment relied on critical reading of each study. Dichotomous variables were analyzed using odds ratio (OR), and a final effect size was calculated. Statistical significance was established when confidence intervals did not cross the neutral value. Heterogeneity was assessed via the X2 test and I2 index. Results: Out of 318 initially identified studies, 4 met inclusion criteria. The meta-analysis for poor general condition yielded an OR of 0.45 in favor of intervention, p = 0.013, with non-significant heterogeneity. Cough events showed a percentage of 15.8% for carbocysteine vs. 27.2% for placebo. On the seventh day, expectoration rates were 18.37% for carbocysteinevs 33.3% for placebo. Conclusions: The observed clinical benefits align with carbocysteine’s mucoactive and muco-regulatory properties, complemented by anti-inflammatory and antioxidant actions. Carbocysteine stands out among mucolytic agents. In the context of persistent infectious diseases, the study emphasizes the need for further exploration of carbocysteine’s therapeutic potential as an adjunctive treatment for acute respiratory infections. These findings underscore its significance in the evolving landscape of respiratory healthcare.