Cardiovascular events caused by dyslipidemia are one of the leading causes of death in patients with Chronic Kidney Disease (CKD). Statins are the first line of treatment for patients with hyperlipidemia and in the treatment regimen for patients with CKD. Therefore, the introduction of Proprotein Convertase Subtilisin-Kexin type 9 inhibitors (PCSK9 inhibitors) is a viable and possibly effective treatment option for patients who, despite high doses of statins, struggle to lower their low-density lipoprotein cholesterol (LDL-C) levels. Our paper's objective is to explore the safety of these biological agents, particularly in patients with varying stages of impaired kidney function, and the correlating effectiveness in lowering their LDL-C levels, thereby reducing cardiovascular risks in these patients.We methodically retrieved relevant articles from PubMed, PubMed Central, Medline, and Google scholar in April 2022. We used the Medical Subject Heading (MeSH) Strategy and used the relevant keyword, then applied our inclusion and exclusion criteria; the initial search gave 10,542 results; with the removal of duplicates, irrelevant articles, and application of quality assessments done, we finally included 15 papers for our review with 37,188 patients. PCSK9 inhibitors are reliable, safe, and efficient therapy in lowering LDL-C levels in patients with CKD. However, its safety and efficacy in severe and end-stage kidney disease are grey, as other factors such as infections lead to morbidity and mortality. Future trials on chronic kidney disease and PCSK9 inhibitors should investigate the inhibitors' ability to improve kidney functions at all stages of kidney disease while lowering lipid levels and finally analyze the safety in patients with end-stage kidney disease.

Non-alcoholic fatty liver disease (NAFLD) represents one of the leading causes of chronic liver disease globally, perhaps because of the drastic increase in prevalence around the world during the last 20 years and continues growing. The disease starts from simple steatosis (NAFL) that can progress to non-alcoholic steatohepatitis (NASH) and, in some patients, progress to cirrhosis and hepatocellular carcinoma (HCC). The pathogenesis and pathophysiology of NAFLD are complex and involve different factors (genetic, metabolic, endocrinopathies, and others). One of the concerns that appeared in recent years is hypothyroidisminduced NAFLD. The pathogenesis is compound and not well understood, and an association between hypothyroidism and NAFLD remains controversial because of insufficient studies that can confirm it. More research is needed to determine the association between hypothyroidism and NAFLD and the underlying mechanisms. In this review, we will discuss a more in-depth analysis of the physiology of thyroid hormones (TH) as well as the pathophysiology of hypothyroidism-induced NAFLD and, based on the recent metaanalyses, the association of thyroid hormones and NAFLD.

Inflammatory bowel disease (IBD) is a globally rising chronic intestinal disease that affects individuals in many parts of the world. Immunosuppressive medications such as corticosteroids are used to manage flareups and to induce remission in IBD. Corticosteroids are said to cause several systemic symptoms, but they are also associated with drug-induced neuropsychiatric disorders. This article examines the existing data on psychiatric and cognitive effects associated with corticosteroid therapy in relation to IBD. Many studies have found that corticosteroids appear to cause mood disturbances such as mania, hypomania, depression, and cognitive problems in the first few weeks of therapy, but these effects are dose-dependent and often mild. The purpose of this literature review is to shed light on the impact corticosteroids can have on individuals' mental health, which will aid physicians in the future when treating patients with IBD. Healthcare professionals should advise patients of this risk and assess the need for intervention. While there is evidence that corticosteroids can elicit neuropsychiatric symptoms, more data on people with IBD who are on corticosteroid therapy is needed to determine the prevalence of glucocorticoid-induced mood changes in this population.

Ischemic heart disease (IHD) is one of the leading causes of death globally. Rapid diagnosis of myocardial infarction (MI) will enable earlier initiation of the treatment and improve patient outcomes. Practice guidelines for non-ST-elevation acute coronary syndromes by the American College of Cardiology (ACC)/American Heart Association (AHA) had listed the diagnostic performance of absolute versus relative changes in evidence gaps. We aimed to address this evidence gap by examining the diagnostic accuracy of absolute versus relative changes in cardiac troponins at various time intervals in diagnosing MI. Grey literature, conference abstracts, animal studies, and reports published before 2009 and in languages other than English were excluded. We included reports that investigated absolute or relative changes in highly sensitive cardiac troponin T (hs-cTnT) or sensitive/highly sensitive cardiac troponin I (s/hs-cTnI) assays after specific time intervals (1, 2, or 3 h) in patients presenting with symptoms suggestive of the acute coronary syndrome. After screening, we arranged the reports in 12 separate groups based on the variables for which the data was reported. Quality assessment of the diagnostic accuracy studies-2 (QUADAS-2) was used to assess the risk of bias in the included studies. The weighted summary area under the curve (AUC) was calculated for each pool. We then performed two-sided (or two-tailed) tests to compare independent receiver operating characteristic (ROC) curves. MedCalc version 20.106 (MedCalc Software Ltd., Ostend, Belgium) was used for all statistical analysis. We included eight reports with 23,450 patients in the meta-analysis. Weighted summary estimates and their respective 95% confidence intervals (CI) under random-effects model for ROC-AUC are as follows: absolute hs-cTnI at 1 h - 0.94 (95% CI: 0.922 to 0.959, p < 0.001); absolute hs-cTnT at 1 h - 0.921 (95% CI: 0.902 to 0.941, p < 0.001); absolute s/hs-cTnI at 2 h - 0.953 (95% CI: 0.926 to 0.980, p < 0.001); absolute hs-cTnT at 2 h 0.951 (95% CI: 0.940 to 0.962, p < 0.001); relative hs-cTnT at 2 h - 0.818 (95% CI: 0.733 to 0.903, p < 0.001); relative s/hs-cTnI at 2 h - 0.762 (95% CI: 0.726 to 0.798, p < 0.001); absolute hs-cTnI at 3 h - 0.967 (95% CI: 0.95 to 0.984, p < 0.001); absolute hs-cTnT at 3 h - 0.959 (95% CI: 0.950 to 0.968, p < 0.001); and relative hs-cTnT at 3 h - 0.926 (95% CI: 0.907 to 0.945, p < 0.001). P-values of comparison of absolute and relative changes are as follows: hs-cTnT at 1 h: <0.0001; hs-cTnI at 1 h: <0.0001; hs-cTnT at 2 h: 0.0024; s/hs-cTnI at 2 h: <0.0001; hs-cTnT at 3 h: 0.0022; and hs-cTnI at 3 h: 0.0005. Our analysis found absolute changes to be superior to relative changes in both hs-cTnT and s/hs-cTnI at 1, 2, and 3 h in the diagnosis of MI. There was no statistically significant difference in comparing s/hs-cTnI vs. hs-cTnT using absolute or relative changes at any time interval. Our findings suggest that future research investigating a potential 0 h/30 min algorithm should use absol...

Osteoporosis is one of the most common metabolic bone diseases. Many studies were conducted to find the association between peptic ulcer disease (PUD), Helicobacter pylori infection, proton-pump inhibitor (PPI) use, and increased risk for fracture, but results remain ambiguous. We performed this systematic review to understand the association between PUD and osteoporosis. We comprehensively searched relevant articles on April 19, 2022, by exploring different databases including PubMed, PubMed Central (PMC), and Medline using relevant keywords. After applying inclusion and exclusion criteria and undergoing quality assessment, we retained 25 studies published in and after 2015. For our systematic review, we included a total of 5,600,636 participants. The studies included in our review demonstrated a significant association between PUD, H. pylori infection, and the risk of osteoporosis. Long-term PPI use was also found to be a risk factor for osteoporosis. Malabsorption of nutrients, increase in inflammatory cytokines, and alterations in hormone status were found to be the notable factors behind the association. Early management of H. pylori infection and cautious use of long-term PPIs may protect against osteoporosis. Further randomized controlled trials (RCTs) are necessary to establish a causal relationship.

The last two decades have changed the viewpoint on early repolarization syndrome (ERS). The prevalence of the early repolarization pattern is variable and ranges between 3-24% depending upon age, gender, and criteria used for J-point upliftment from baseline (0.05mV vs. 1 mV). While this pattern was previously linked with a benign result, multiple recent investigations have found a link between early repolarization and Sudden Cardiac Death (SCD) by causing life-threatening arrhythmias like Ventricular tachycardia/Ventricular fibrillation, a condition known as early repolarization syndrome. The syndrome falls under a broader bracket of J wave syndromes, which can be caused by early repolarization or depolarization abnormalities. The characteristics of early repolarization that are considered high risk for Sudden Cardiac Death include the amplitude of J-point upliftment from baseline ( > 0.2 mV), Inferior-lateral location of Early Repolarization pattern, and horizontal and downsloping ST-segment. Patients with symptomatic early repolarisation patterns on ECG are more likely to have repeated cardiac episodes. Implantable Cardioverter-Defibrillator (ICD) implantation and isoproterenol are the recommended treatments in symptomatic patients. On the other hand, asymptomatic patients with early repolarization patterns are prevalent and have a better outcome. Risk categorization is still obscure in asymptomatic early repolarization patterns. This traditional review outlines the known knowledge of pathophysiology behind the increased risk of sudden cardiac death, risk stratification of patients with ERS, and the treatment guidelines for patients with ERS. Further prospective studies are recommended to elucidate the exact mechanism for ventricular arrhythmogenesis in ERS patients and to risk stratifying asymptomatic patients with ERS.

As oncology practice is rapidly shifting away from toxic chemotherapy, gene therapy provides a highly specific therapeutic approach for brain tumors. In this systematic review, we investigate gene therapy's status in pediatric brain tumors and future recommendations. The search was conducted systematically using PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov databases. The field search used in the process was selected based on the keywords and Medical Subject Headings (MeSH), depending on the database used. We included cases of neurofibromatosis type 1 (NF1) brain tumors in all age groups with the additional inclusion of English language, free full text, articles published within the last 20 years, randomized controlled trials (RCTs), observational studies, systematic reviews, and meta-analyses. We excluded case reports, case studies, and editorials. The search identified a total of 1,213 articles from the databases. We included 19 studies with 16 narrative reviews, one systematic review, and two randomized clinical trials with 43 patients. After reviewing all data in the articles, we found that gene therapy can improve standard treatment efficacy when used as adjuvant therapy. It can be used to overcome barriers such as chemotherapy resistance by downregulating resistance genes. It is associated with mild toxicity when compared with other available treatment options, but given the overall poor prognosis in pediatric brain tumors, further studies are warranted.

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe since December 2019. The spectrum of clinical manifestations of COVID-19 ranges from mild to life-threatening forms. Alteration of hepatic function in COVID-19 is multifactorial. The objective of this systematic review is to assess the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced hepatic dysfunction and the clinical outcome in patients infected with COVID-19. We methodically explored several electronic databases (PubMed, PubMed Central, MEDLINE, and Google Scholar) in April 2022 using focused words and terms of medical subject headings for appropriate studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting our systematic review. Hepatic dysfunction was identified as elevation of liver function tests (LFTs) above the upper limit of normal. The clinical outcome was described as a combination of mortality, intensive care unit (ICU) transfer, and the need for mechanical ventilation (MV). The initial search yielded a total of 7187 studies. After elimination of duplicates, exclusion of studies based on irrelevant titles and abstracts, comprehensive analysis of full-text formats, and evaluation of quality, a total of 16 studies were eligible to be included in our systematic review. In the 16 selected studies, there were 23,962 patients. The SARS-CoV-2 virus can negatively affect several organ systems by interacting with specific receptors widely expressed in the human body. A multifactorial etiology of hepatic dysfunction is observed in COVID-19. SARS-CoV-2 infection is associated with abnormal LFTs. Significantly higher mortality, ICU admissions, and requirement for MV are associated with LFT alterations. For this reason, patients infected with COVID-19 must have their hepatic function closely monitored.