Objective: To investigate whether dexmedetomidine (DEX), as adjunctive therapy to benzodiazepine (BZD), is superior to BZD alone in critically ill patients with alcohol withdrawal syndrome (AWS). Data Sources: PubMed Central, Cochrane CENTRAL, ClinicalTrials.gov and Google Scholar were used as search databases. Specific keywords and MeSH terms were “dexmedetomidine,” “benzodiazepine,” and “alcohol withdrawal syndrome.” The last search was on September 16, 2022. Study Selection and Data Extraction: Randomized controlled trials (RCTs) and nonrandomized/cohort studies exploring the use of DEX in the management of AWS were included. A total of 12 studies were included in the systematic review and 7 in the meta-analysis. Data Synthesis: The intensive care unit length of stay (ICU LOS) was found to have a mean difference (MD) of 48.06 [37.48, 58.64], P = <0.001 for the cohort subgroup, significantly favoring the DEX arm, but, in contrast, pooled RCT data showed a result of –20.07 [–36.86, –3.28], P = 0.02, a shorter ICU LOS for the DEX arm. Bradycardia and hypotension incidence significantly favored the BZD arm in both subgroups. This study compares the effectiveness of adjunctive DEX in clinical practice and aims to help providers in critical decision-making by compiling and analyzing the best current available evidence of its use in AWS. Conclusions: Based on low to very low level of evidence, adjunctive DEX showed no significant difference for ICU LOS when compared with BZD alone. Pooled randomized trials potentially show a benefit but are similarly limited by their low quality of evidence.
Colorectal carcinoma (CRC) is a very common cancer found worldwide. When metastasizing, it would often seed the liver via traveling through the portal circulation; however, locoregional metastasis is also possible. Abdominal wall seeding postoperatively has been described to happen rarely in those who underwent definitive surgery for CRC. Currently, five case reports are in publication describing this phenomenon.Here, we present a case of a drain site abdominal wall tumor recurrence after definitive surgery with curative intent of a sigmoid adenocarcinoma. Those with higher tumor-node-metastasis (TNM) staging and a primary site at the sigmoid colon were found to be at a higher risk for recurrence. Despite this, abdominal wall recurrence of CRC is exceptionally rare, with less than 1% of those with locoregional recurrence presenting at the incision site or trocar site placement.Because of the rarity of this complication, few studies are available that detail the management of abdominal wall recurrence of CRC. Further studies on this subject are currently warranted.
Objective: To investigate whether Adjunctive PD-1 inhibitors have improved clinical outcomes compared to chemotherapy alone in platinum-pretreated and platinum-naive recurrent or metastatic nasopharyngeal carcinoma (R/M NPCA). Methods: The study involved a literature search from PubMed, Cochrane CENTRAL, and Google Scholar for randomized clinical trials (RCTs) on the use of PD-1 inhibitors versus chemotherapy alone in patients with R/M NPCA. Bias was assessed using Cochrane collaboration’s risk of bias tool. Overall Survival (OS) was examined as the primary endpoint. Secondary endpoints were Progression-Free Survival (PFS), Objective Response Rate, Disease Control Rate (DCR), Duration of Response, and Serious/Grade ⩾3 Adverse Events. Outcomes were measured with either Mean Difference, Risk ratio (RR), or Hazard ratios (HRs) at 95% confidence interval. Results: Four RCTs were included in the meta-analysis and systematic review. OS for the monotherapy subgroup was a HR of 0.87 [0.67, 1.13] ( p = 0.30) while the combination subgroup had 0.64 [0.45, 0.90] ( p = 0.01). The monotherapy subgroup exhibited significantly worse outcomes in PFS (HR 1.31 [1.01, 1.68]) ( p = 0.04) and DCR (RR 1.52 [1.12, 2.05]) ( p = 0.007) but no significant difference in other outcomes. For combination therapy, a statistically significant benefit can be seen in all outcomes except DCR (RR 0.62 [0.38, 1.01]) ( p = 0.06) which was a non-significant benefit favoring PD-1 inhibitors. Conclusion: Combination PD-1 inhibitor + chemotherapy followed by maintenance PD-1 inhibitor therapy is superior to chemotherapy alone in the first-line treatment of R/M NPCA, implying a potential benefit with the use of PD-1 inhibitors + chemotherapy with maintenance PD-1 inhibitors as first-line in R/M NPCA compared to standard chemotherapy alone.
The purpose of this research is to assess the antibiotic prescription analysis of inpatients at a tertiary care hospital. Methods: The Department of Pharmacology conducted this prospective investigation. We examined the source of information for relevant features such as antimicrobial dose, frequency, and duration of antimicrobial usage, as well as whether or not such use was indicated by recorded culture sensitivity reports. A possible infective aetiology was evaluated if the patient showed any of the following symptoms prior to study inclusion: fever, elevated leukocyte count, signs and symptoms of infection of a specific organ system, and sepsis. Results: Antimicrobials were prescribed to 100 (43.48 percent) of the 230 patients. The referral note was the most often utilised source for obtaining information on antibiotic prescription. The prescription habits of these individuals were studied further. 59 patients (59%) were males, whereas 41 patients (41% were women). The research participants' mean (SD) age was 48.25 12.55 years. The most patients were between the ages of 35 and 45. (40 percent). 58 patients (58%) were recommended by public sector healthcare facilities, whereas 42 (42%) were referred by private clinics. Ceftriaxone and amoxicillin-clavulanic acid were the most often given medications (21 percent and 17 percent, respectively). Piperacillin-tazobactam was then administered to 12 (12%) of the patients. More than 57 percent of patients were given four antibiotics. Antibiotics with a broad range of action accounted for 70 percent of prescriptions. Conclusion:The results of this research aided in the development of several modules of an educational intervention tailored for healthcare settings with limited or no access to antimicrobial stewardship training.
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