Apixaban versus low molecular weight heparin in patients with cancer-associated venous thromboembolism: a systematic review and meta-analysis.

Background: The optimal treatment regimen for patients with cancer-associated venous thromboembolism (CA-VTE) remains unclear. Therefore, the authors sought to compare the outcomes of (VKAs) versus direct apixaban and low molecular weight heparin (LMWH) in patients with CA-VTE. Methods: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) and observational studies comparing the efficacy and safety of apixaban and LMWH in patients with CA-VTE. Major bleeding, clinically relevant non-major bleeding (CRNMB), recurrence of pulmonary embolism (PE), deep venous thrombosis (DVT) and bleeding-related mortality were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs. Results: The analysis included 12 011 patients from 3 RCTs and 2 observational studies. Compared to LMWH, apixaban significantly decreased the risk of major bleeding [RR 0.67 (95% CI 0.54, 0.83); P=0.0003, I2=0%] without significantly changing the risk of clinically relevant non-major bleeding [RR 0.96 (95% CI 0.64, 0.1.45); P=0.85, I2=57%]. Patients on apixaban had a noticeably reduced the risk of recurrence of PE than those taking LMWH, according to a meta-analysis [RR 0.56 (95% CI 0.32, 0.99); P=0.05, I2=0%]. There was no discernible difference between apixaban and LMWH in bleeding-related mortality events [RR 0.20 (95% CI 0.01, 4.18); P=0.30, I2=NA%], and recurrence of DVT [RR 0.60 (95% CI 0.22, 1.59); P=0.23, I2=32%]. Conclusion: Due to its lower risk of severe bleeding and reduced PE recurrence, apixaban may be a preferable treatment option for CA-VTE, but additional research is required to validate these conclusions and evaluate its long-term efficacy and safety.

Frequency and Type of Thyroid Carcinoma in Patients With Multinodular Goiter.

Background This study aimed to investigate the incidence and subtype of thyroid cancer in multinodular goitre (MNG) patients who underwent total thyroidectomy. Methodology A cross-sectional study was conducted at the Khyber Teaching Hospital, screening 207 MNG patients who received complete thyroidectomies between July and December 2022. The senior consultant diagnosed thyroid cancer based on a complete history, physical examination, and laboratory and radiological studies. Ultrasound-guided fine-needle aspiration cytology was performed by a senior consultant radiologist. Bethesda categories for all lesions were recorded. All patients underwent thyroidectomy, and the diagnosis of thyroid cancer was confirmed on histopathology.  Results A total of 207 patients were included in the study, with a mean age of 45.55 ± 8.75 years. Out of 207 patients, 24 (11.59%) were diagnosed with thyroid cancer. Out of 62 male patients, 15 (7.25%) had thyroid cancer. Out of 145 female patients, only nine had cancer (p < 0.001). Nine patients with thyroid cancer had a body mass index (BMI) below 18, compared to only five patients with a BMI of more than 30 kg/m2. The difference in age distribution was not significant in our study (p = 0.102).  Conclusion  In conclusion, our study sheds light on the frequency and potential risk factors associated with thyroid cancer in patients with multinodular goiter. Our findings reveal that papillary thyroid carcinoma is the most commonly observed form of thyroid cancer in this patient population, with around 12 percent of patients diagnosed with thyroid cancer. Notably, our study highlights that male patients and those with a lower BMI may have a greater risk of developing thyroid cancer in the context of multinodular goiter. The findings of this study have important implications for the care and follow-up of MNG patients who receive total thyroidectomy. Further research is needed to investigate the type and prognosis of thyroid cancer in patients with MNG.

Acute Pancreatitis: An Unusual Extrapulmonary Manifestation of Mycoplasma pneumoniae.

Mycoplasma pneumoniae is a respiratory pathogen responsible for community-acquired atypical pneumonia. Apart from respiratory manifestations, other system involvement has also been reported. We present a case of interstitial pneumonia and a concurrent episode of acute pancreatitis in a young female who presented with fever, cough, vomiting, and epigastric pain. The abdominal evaluation revealed epigastric tenderness with no signs of organomegaly. Her complete metabolic profile was nonsignificant except for elevated serum lipase and amylase. Clinical, serological, and radiological features and detailed investigations confirmed the diagnosis of acute pancreatitis and interstitial pneumonia caused by M. pneumoniae in the absence of any other etiology. Her respiratory and gastrointestinal symptoms improved rapidly after commencing clarithromycin, providing a possible link between M. pneumoniae and pancreatitis.

Interstitial Lung Disease and Transverse Myelitis: A Possible Complication of COVID-19 Vaccine.

The clinical impact of the severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic is growing, and vaccine-associated complications are becoming more evident. Although global vaccination against coronavirus disease 19 (COVID-19) is an outstanding accomplishment, safety concerns and adverse outcomes are also emerging that need to be addressed promptly. The most reported side effects of the COVID-19 vaccine include fever, myalgia, headache, and injection site reactions. Acute transverse myelitis (ATM) and interstitial lung disease (ILD) following the CoronaVac vaccine are rarely reported. We report a case of ILD followed by acute myelopathy in a female who presented with dyspnea, cough, and fever after the second dose of the COVID-19 vaccine. On the third day of admission, she developed paresthesia and bilateral upper and lower limb weakness. She was diagnosed with ILD and ATM due to the COVID-19 vaccine based on imaging and detailed investigations after ruling out all possible causes. Her neurological and respiratory manifestations improved gradually after starting intravenous methylprednisolone.

The Moderating Effects of Technostress Inhibitors on Techno-Stressors and Employee's Well-Being.

This study determined the effects of techno-stressors on employees' well-being. It also determined the moderating role of technostress inhibitors in techno-stressors and employees' well-being. We employed a time-lagged design and self-administered survey method to collect data from banking employees. We retrieved 355 usable responses. The results showed that techno-stressors significantly and negatively affected employees' well-being. Technostress inhibitors significantly and positively affected the employee's well-being. The moderating effects of techno-stressors and technostress inhibitors showed that six of nine moderating effects were significant and positive. The results implied that technostress inhibitors help to improve employees' well-being. In the end, we present some implications for theory and practice.