Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: A meta-review of systematic reviews and an updated meta-analysis.

OBJECTIVE: To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. METHODS: A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. RESULTS: Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0-1.3, I2 = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9-1.4, I2 = 0.0%), virological cure (OR 1.5, 95%CI 0.5-4.4, I2 = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3-5.9, I2 = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5-59.9, I2 = 76.6%). CONCLUSION: There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. REGISTRATION: PROSPERO: CRD42020191353.

Does sedation offer better outcomes than local anaesthesia for thyroid FNA in adult patients?

OBJECTIVE: To examine the potential benefits of sedation in adults undergoing fine needle aspiration (FNA) of thyroid nodules. METHODS: This retrospective study compared the outcomes of sedated and non-sedated FNA patients. RESULTS: A total of 860 patients underwent 1698 FNAs of thyroid nodules. The mean patient age was 52.4±14.4 years, and 80.2% of patients were women. The non-sedated group consisted of 782 patients with 1543 (93.5%) FNA procedures. The sedated group consisted of 66 patients who underwent 107 (6.5%) FNAs. There was no statistical difference between these groups with respect to age, gender, nodule size, nodule vascularity, non-diagnostic sample rate and post FNA hematoma (P > .05). CONCLUSIONS: Performing FNA of thyroid nodules in adult patients under sedation is not associated with a higher diagnostic yield or lower bleeding rate when compared to local anesthesia. Sedation should be judiciously used on only very anxious patients due to the increased overall cost.

Long term follow-up of transcatheter coil embolotherapy for major colonic haemorrhage.

AIM: Therapeutic angiography with embolization is fast becoming the preferred treatment modality for major bleeding in the lower gastrointestinal (LGI) tract. The aim of this study was to determine the long term outcome and complications of percutaneous coil embolization (PCE) and its efficacy as definitive therapy in patients with major LGI bleeding. METHODS: All patients presenting to our institution with a haemodynamically significant LGI tract bleed between 1995 and 2001 that were unresponsive to conservative measures were considered for emergency angiography and coil embolization where appropriate. The outcome of these individuals was determined by case note review and telephone interview. RESULTS: There were 20 patients (11 females) with a mean follow-up period 72 months, mean age was 67 years. All underwent PCE following positive angiogram. The most common site of bleeding was the right colon (40%); haemostasis was successfully achieved in 16 (80%) patients. Five of the 20 patients died within 30 days of the intervention, three following PCE and two following surgery. None of the mortality following PCE was considered procedure related. On long term follow-up four patients required readmission to hospital for further LGI bleeds at 1, 2, 12 and 16 months respectively. Ischaemic complications occurred in 23%. CONCLUSION: Superselective embolization as the primary technique for the treatment of haemodynamically significant LGI bleeding is an effective, feasible and safe technique. Long term follow-up in our series up to 72 months has shown that it should be considered as both a primary and potentially definitive treatment for life threatening LGI bleeds.

KTP-Laser and fibrin glue for treatment of fistulae in ano.

Fistulae-in-ano remains a significant surgical problem due to the limitations pertinent to accurate assessment and the magnitude, shortcomings and side effects of the various procedures currently employed for their management. Six consecutive fistulae-in-ano patients (males, age range 30 to 58 years) were successfully treated by KTP laser (20-watt continuous aim for 20 to 30 seconds delivering a total energy of 400 to 600 joules) with rapid solidification fibrin glue then followed up for 3 months without recurrence. This approach offers a simple, expeditious and effective treatment for fistulae-in-ano thereby overcoming many of the restrictions associated with other methods.

A report on the predominant occurrence of a dermatophyte species in cultivated soil from Kuwait.

From several soil samples screened for the occurrence of keratinolytic fungi, soils cultivated with ornamental plants were found to contain strains of the dermatophytic fungus Microsporum gypseum. One soil sample was dominated by this species.

Pathogenesis of growth failure in renal diseases.

This article reviews our current understanding of the mechanisms of growth failure in chronic renal disease. The neuro-endocrine control of growth hormone secretion and insulin-like growth factor gene expression subject to use of corticosteroids, uremia, and metabolic acidosis are presented. It has been shown in other non-growth hormone deficient conditions such as Turner's syndrome that the use of exogenous growth hormone increases linear growth but also accelerates closure of the growth plate with no significant difference in the final height of such children. An understanding of growth factors is especially important and timely because of the tendency these days to use growth hormone to overcome the growth impairment of children with chronic renal failure.

History of medicine and nephrology in Asia.

The beginning of Chinese medicine has been attributed to 3 mythical emperors who gathered herbs for medicines. During the 2nd century BC, Han dynasty physicians developed cranial trephining and sedation with wine and herbs for anesthesia. Chiang Chung-Ching (142-212 AD) used the appearance of rashes in diagnosis, treated infections with anthelmintics and asthma with ephedra, described the symptoms of diabetes mellitus and expanded medical ethics. The specialties of obstetrics, pediatrics, ophthalmology and dentistry were described in the records of the Han and Tang dynasties, and methods of setting fractures and treating trauma were comparable with those of Roman military doctors. Shen Tua (1031-1095 AD) compiled a pharmacopeia and studied acupuncture and the pulses. Forensic medicine was developed during the 10th century by Sung Tse, who also advocated hand washing with sulfur and vinegar to avoid infection during autopsies. The Daoist physicians used androgens and estrogens to treat hypogonadism with therapeutic preparations of placentas. They also had an advanced knowledge of alchemy, claiming to achieve 'immortality' by their preservation techniques. Qualifying examinations for physicians were conducted by the Chinese state as early as the 1st century AD, and later incorporated philosophy and art to conform with the Confucian ideal. Throughout these eras, Chinese medicine profited from contact with western Asia. In ancient Chinese medicine, the excretory function of the kidney was attributed to the bladder. 'Kidney weakness', which refers to somatized depression, was treated by acupuncture along the 'kidney channel'. Pulse examination was also used to give a measure of the imbalance of renal Yin and Yang.(ABSTRACT TRUNCATED AT 250 WORDS)