Background Inhaled hypertonic saline (HS) reduces pulmonary exacerbations in patients with cystic fibrosis (CF) aged 6 or more years. However, the effectiveness of HS in improving clinical outcomes in younger children aged 6 or less years is not established. This study examines the efficacy of HS in younger CF patients. Methods Searches were conducted across three databases (Medline, Cochrane Central and EMBASE) from inception through July 2022. Randomized controlled trials assessing the impact of HS in younger CF patients were included. Trials involving only patients greater than 6 years or control group other than isotonic saline (IS) were excluded. Outcomes measured included lung clearance index (LCI), cystic fibrosis questionnaire (CFQ-R) score, spirometry measures, oxygen saturation, respiratory rate, height and weight. Outcomes were reported as mean differences (MDs) with 95% confidence intervals. Results Seven studies ( n = 390 patients) were included in this review. HS significantly reduced the LCI (MD: -0.67; 95%CI, -1.05 to 0.29, P = 0.0006) compared to IS. In addition, HS was associated with significant improvements in height (MD: 2.23; 95%CI, -0.00 to 4.46, P = 0.05) and CFQ-R (MD: 4.30; 95%CI, 0.65–7.95, P = 0.02), but not in oxygen saturation (MD: -0.15; 95%CI, -0.54 to 0.25, P = 0.47), respiratory rate (MD: -0.21; 95%CI, -2.19 to 1.77, P = 0.83) or weight (MD: 0.70; 95%CI, -0.47 to 1.87, P = 0.24). Furthermore, HS did not significantly improve spirometry measures, including FEV 1 (MD: -0.11; 95%CI, -0.21 to 0.43, P = 0.51) and forced vital capacity (MD: 0.27; 95%CI, -0.49 to 1.04, P = 0.48), but significantly improved FEF 25-75 (MD: 0.12; 95% CI, 0.05–0.20; P = 0.002). Discussion Treatment with HS in younger children with CF improves lung clearance, symptoms and quality of life. FEF 25-75 may prove a more sensitive measure for assessing intervention related improvements in pediatric CF trials. Conclusion The findings support HS as a therapeutic method in CF-affected children.
Introduction: Clinical Health Electives are an important part of academic curriculum in medical universities throughout the world. Electives are useful in developing personal and professional growth among students. Hence understanding the importance of electives among medical undergraduates on their academic life is important. Materials and Methods: A cross-sectional based study was conducted among medical undergraduates in Karachi, Pakistan. A total number of 300 students from 3rd, 4th and 5th year of MBBS were taken as a sample. Consent was taken from the participants and questionnaire was filled from everyone. Study population was selected who did at least one clinical elective in their whole academic period. Results: According to our analysed results, undergraduate students from both private and public sector medical institutes perceived clinical electives as an advantage to themselves. Majority of the students saw their clinical and academic performances to be on a higher level. This shows that opting for electives regardless of its type (local or international) have proven to be fruitful for the undergraduates’ personal growth and academic career, allowing more scope for understudies to practice and enhance their skills they have only done a limited number of times, which inevitably leads to a steep learning curve. Conclusion: There was a positive influence of clinical electives observed among the students. Overall the academic and clinical performance of the undergraduates enhanced by opting clinical electives and has positive impact on them.
Stress urine incontinence (SUI) is most common in middle-aged women and the second most common in those over 75. SUI causes significant discomfort and suffering for patients and has a considerable financial impact on the healthcare system. Conservative approaches are recommended as the first step in treatment. However, surgery is often necessary to improve a patient's quality of life due to the high failure rate of conservative treatments. A thorough literature review of studies published before March 2023 was conducted on the safety and effectiveness of single-incision mini slings (SIMS) and standard mid-urethral slings (MUS). PubMed, Embase, Cochrane Library, and Elsevier's ScienceDirect were used to retrieve the studies. Two reviewers independently searched and evaluated the data based on inclusion and exclusion criteria. Review Manager 5.4 software was used for meta-analysis. Included were seventeen studies involving 3,503 female SUI patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence. According to the results of our meta-analysis, the clinical efficacy of SIMS is comparable to that of MUS in terms of objective cure rate (RR: 0.99; 95% CI: 0.95 to 1.03, p: 0.66, I2: 29%). In contrast, it increases the post-procedure International Consultation on Incontinence Questionnaire (ICIQ) score (WMD: 0.08; 95%
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