Middle East respiratory syndrome (MERS) is a respiratory disease caused by MERS coronavirus. Because of lack of vaccination, various studies investigated the therapeutic efficacy of antiviral drugs and supportive remedies. A systematic literature search from 10 databases was conducted and screened for relevant articles. Studies reporting information about the treatment of MERS coronavirus infection were extracted and analyzed. Despite receiving treatment with ribavirin plus IFN, the case fatality rate was as high as 71% in the IFN-treatment group and exactly the same in patients who received supportive treatment only. Having chronic renal disease, diabetes mellitus and hypertension increased the risk of mortality (P < .05), and chronic renal disease is the best parameter to predict the mortality. The mean of survival days from onset of illness to death was 46.6 (95% CI, 30.5-62.6) for the IFN group compared with 18.8 (95% CI, 10.3-27.4) for the supportive-only group (P = .001). Delay in starting treatment, older age group, and preexisting comorbidities are associated with worse outcomes. In conclusion, there is no difference between IFN treatment and supportive treatment for MERS patients in terms of mortality. However, ribavirin and IFN combination might have efficacious effects with timely administration and monitoring of adverse events. Large-scale prospective randomized studies are required to assess the role of antiviral drugs for the treatment of this high mortality infection.

Aspiration and tube drainage have no significant difference in treating patients with first episode of PSP regarding recurrence. Aspiration reduced hospitalization days when compared with tube drainage. Thoracotomy with mechanical pleurodesis and VATS with or without pleurodesis are not significantly different in preventing recurrence in patients with recurrent or persistent PSP. VATS alone reduced complications compared with others treatments except for thoracotomy with abrasion.

Background Dengue infection can cause a wide spectrum of clinical outcomes. The severe clinical manifestations occur sufficiently late in the disease course, during day 4–6 of illness, to allow a window of opportunity for risk stratification. Markers of inflammation may be useful biomarkers. We investigated the value of C-reactive protein (CRP) measured early on illness days 1–3 to predict dengue disease outcome and the difference in CRP levels between dengue and other febrile illnesses (OFI). Method We performed a nested case-control study using the clinical data and samples collected from the IDAMS-consortium multi-country study. This was a prospective multi-center observational study that enrolled almost 8000 participants presenting with a dengue-like illness to outpatient facilities in 8 countries across Asia and Latin America. Predefined severity definitions of severe and intermediate dengue were used as the primary outcomes. A total of 281 cases with severe/intermediate dengue were compared to 836 uncomplicated dengue patients as controls (ratio 1:3), and also 394 patients with OFI. Results In patients with confirmed dengue, median (interquartile range) of CRP level within the first 3 days was 30.2 mg/L (12.4–61.2 mg/L) (uncomplicated dengue, 28.6 (10.5–58.9); severe or intermediate dengue, 34.0 (17.4–71.8)). Higher CRP levels in the first 3 days of illness were associated with a higher risk of severe or intermediate outcome (OR 1.17, 95% CI 1.07–1.29), especially in children. Higher CRP levels, exceeding 30 mg/L, also associated with hospitalization (OR 1.37, 95% CI 1.14–1.64) and longer fever clearance time (HR 0.84, 95% CI 0.76–0.93), especially in adults. CRP levels in patients with dengue were higher than patients with potential viral infection but lower than patients with potential bacterial infection, resulting in a quadratic association between dengue diagnosis and CRP, with levels of approximately 30 mg/L associated with the highest risk of having dengue. CRP had a positive correlation with total white cell count and neutrophils and negative correlation with lymphocytes, but did not correlate with liver transaminases, albumin, or platelet nadir. Conclusions In summary, CRP measured in the first 3 days of illness could be a useful biomarker for early dengue risk prediction and may assist differentiating dengue from other febrile illnesses.

BackgroundMinimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately.MethodsA total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method.ResultsMIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate.ConclusionMIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery.Trial registrationThe research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.

Background: Malaria parasites have developed resistance to most of the known antimalarial drugs in clinical practice, with reports of artemisinin resistance emerging in South East Asia (SEA). We sort to find the status of artemisinin resistance and efficacy of different modalities of the current artemisinin-based combination therapies (ACTs). Methods: We carried out a systematic search in 11 electronic databases to identify in vivo studies published between 2001 and 2017 that reported artemisinin resistance. This was then followed by A network meta-analysis to compare the efficacy of different ACTs. Quality assessment was performed using the Cochrane Risk of Bias (ROB) tool for randomized controlled trials and National Institute of Health (NIH) tool for cross-sectional studies. The study protocol was registered in PROSPERO under number CRD42018087574. Results: With 8400 studies initially identified, 82 were eligible for qualitative and quantitative analysis. Artemisinin resistance was only reported in South East Asia. K13 mutation C580Y was the most abundant mutation associated with resistance having an abundance of 63.1% among all K13 mutations reported. Although the overall network meta-analysis had shown good performance of dihydroartemisinin piperaquine in the early years, a subgroup analysis of the recent years revealed a poor performance of the drug in relation to

Systematic reviews and/or meta-analyses generally provide the best evidence for medical research. Authors are recommended to use flow diagrams to present the review process, allowing for better understanding among readers. However, no studies as of yet have assessed the quality of flow diagrams in systematic review/meta-analyses. Our study aims to evaluate the quality of systematic review/meta-analyses over a period of ten years, by assessing the quality of the flow diagrams, and the correlation to the methodological quality. Two hundred articles of “systematic review” and/or “meta-analysis” from January 2004 to August 2015 were randomly retrieved in Pubmed to be assessed for the flow diagram and methodological qualities. The flow diagrams were evaluated using a 16-grade scale corresponding to the four stages of PRISMA flow diagram. It composes four parts: Identification, Screening, Eligibility and Inclusion. Of the 200 articles screened, 154 articles were included and were assessed with AMSTAR checklist. Among them, 78 articles (50.6%) had the flow diagram. Over ten years, the proportion of papers with flow diagram available had been increasing significantly with regression coefficient beta = 5.649 (p = 0.002). However, the improvement in quality of the flow diagram increased slightly but not significantly (regression coefficient beta = 0.177, p = 0.133). Our analysis showed high variation in the proportion of articles that reported flow diagram components. The lowest proportions were 1% for reporting methods of duplicates removal in screening phase, followed by 6% for manual search in identification phase, 22% for number of studies for each specific/subgroup analysis, 27% for number of articles retrieved from each database, and 31% for number of studies included in qualitative analysis. The flow diagram quality was correlated with the methodological quality with the Pearson’s coefficient r = 0.32 (p = 0.0039). Therefore, this review suggests that the reporting quality of flow diagram is less satisfactory, hence not maximizing the potential benefit of the flow diagrams. A guideline with standardized flow diagram is recommended to improve the quality of systematic reviews, and to enable better reader comprehension of the review process.

ObjectiveWe assessed the impact of political conflict (Boko Haram) on tuberculosis (TB) case notifications in Adamawa State in North-east Nigeria.DesignA retrospective analysis of TB case notifications from TB registers (2010–2016) to describe changes in TB notification, sex and age ratios by the degree of conflict by local government area.SettingAdamawa State.Participants21 076 TB cases notified.Results21 076 cases (62% male) were notified between 2010 and 2016, of which 19 604 (93%) were new TB cases. Areas affected by conflict in 2014 and 2015 had decreased case notification while neighbouring areas reported increased case notifications. The male to female ratio of TB cases changed in areas in conflict with more female cases being notified. The young and elderly (1–14 and >65 years old) had low notifications in all areas, with a small increase in case notifications during the years of conflict.ConclusionTB case notifications decreased in conflict areas and increased in areas without conflict. More males were notified during peace times and more female cases were reported from areas in conflict. Young and elderly populations had decreased case notifications but experienced a slight increase during the conflict years. These changes are likely to reflect population displacement and a dissimilar effect of conflict on the accessibility of services. TB services in conflict areas deserve further study to identify resilient approaches that could reach affected populations.

SummaryThere is a need for improved treatment of patients with chronic hepatitis B (CHB). We reviewed the literature to explore the efficacy of HB vaccines alone or in combination therapy (CT) with antiviral drugs in CHB patients and to meta‐analyze data from randomized controlled trials. We conducted a systematic search in ten databases. All studies investigating the efficacy of HBV vaccine in HBV infected patients were included with no restrictions. Among 1359 studies initially identified, 23 studies (n = 1956 patients) were included for the final analysis. CT showed a significant reduction of HBV DNA compared with analogue monotherapy (AM) at the 12‐month follow‐up period (odds ratio (OR) = 2.835, 95% confidence interval (CI) [1.275, 6.306], p = .011). Additionally, CT also remarkably induce HbsAg loss in comparison with AM (OR = 11.736, 95% CI [1.841, 74.794], p = .009). Our pooled data revealed no difference between treatment and control regarding alanine aminotransferase normalization, HBeAg seroconversion, and HBeAg disappearance. In addition, CT using vaccine and NAs resulted in a statistically significant higher incidence of adverse effects than AM. The therapeutic effects of combination therapy for patients with CHB were encouraging, but future studies need to investigate all possible treatment combinations and assess their cost‐effectiveness.