A Comparative Analysis Between Ultrasound and Electromyographic and Nerve Conduction Studies in Diagnosing Carpal Tunnel Syndrome (CTS): A Systematic Review and Meta-Analysis.

Carpal tunnel syndrome (CTS) is the most common upper extremity neuropathy. The disease initially manifests as a sensory disorder in the form of paresthesia, numbness, or tingling of the fingers. The diagnosis is usually made based on history and clinical symptoms, which are confirmed using nerve conduction studies (NCS) and electromyography. More recently, ultrasound has gained more use in CTS diagnosis due to its advantages, which include patients' comfort during diagnosis, better visualization of anatomy and nerve forms directly, and cost-effectiveness. However, a literature review shows that the diagnostic accuracy of ultrasound over NCS is still in question; therefore, the present systematic review was carried out to compare the diagnostic accuracy of ultrasound to NCS and electromyography. A systematic literature search was performed on five electronic databases: PubMed, Medline, Web of Science, Embase, and Google Scholar. The search strategy limited the retrieval of literature published between 2000 and 2022. Of the 1098 articles retrieved from the electronic databases, only 12 met the inclusion criteria. A meta-analysis of outcomes from the included studies showed that the pooled sensitivity and specificity of the ultrasound were 0.80 (95% CI: 0.73, 0.88) and 0.90 (0.83, 0.96), respectively. On the other hand, combing the outcomes of electromyography and NCS resulted in sensitivity and specificity values of 0.89 (95% CI: 0.84, 0.95) and 0.77 (95% CI; 0.64, 0.90), respectively. The results show that ultrasound has comparable sensitivity and slightly higher specificity than NCS and electromyography; therefore, ultrasound can be used as an alternative diagnostic test for CTS. However, it cannot replace NCS and electromyography since more research needs to be done on doubtful and secondary cases of CTS.

An Analytical Comparison Between Ketamine Alone and a Combination of Ketamine and Propofol (Ketofol) for Procedural Sedation and Analgesia From an Emergency Perspective: A Systematic Review and Meta-Analysis.

Procedural sedation and analgesia (PSA) is a treatment approach involving treating patients with agents with dissociative, sedative, or analgesic properties to suppress their consciousness to variable levels. Ketamine and propofol have been used historically for PSA. Because they each have their demerits, it was postulated that combining both drugs (ketofol) would result in a mixture with additive properties and lessen or eliminate the demerits attributed to each drug. The primary objective of this systematic review and meta-analysis is to compare ketamine alone and a combination of ketamine and propofol (ketofol) for procedural sedation and analgesia from an emergency perspective. A systematic search was conducted on published studies from the databases of Scopus, ScienceDirect, PubMed, Google Scholar, APA PsycInfo, and the Cochrane Central Register of Controlled Trial (CENTRAL) until July 2022. The articles that were published on the online databases were authored between January 2007 and 2018. The selected papers were scanned and examined to check whether they met the eligibility criteria for the study. The search produced six articles that were included in the systematic review and meta-analysis. All six articles that passed the eligibility criteria were viable for the analysis. All the trials focused on the effectiveness of ketofol versus ketamine for PSA from an emergency perspective. Ketofol was found to be safe and more effective in comparison to ketamine for PTA.

An Integrative Comparative Study Between Digoxin and Amiodarone as an Emergency Treatment for Patients With Atrial Fibrillation With Evidence of Heart Failure: A Systematic Review and Meta-Analysis.

The emergency treatment of atrial fibrillation (AF) involves utilizing two strategies. The first strategy normally involves permitting the atrial fibrillation to persevere as the ventricular rate is controlled. The other method involves utilizing anti-arrhythmic drugs in cardioversion and attempting to maintain sinus rhythm. Different pharmacological treatments, including digoxin and amiodarone, have been used to manage AF. A literature review on amiodarone and digoxin in the treatment of AF among patients with heart failure (HF) has shown that both drugs have potential risks. Therefore, we are conducting this systematic review and meta-analysis to compare the effectiveness of amiodarone and digoxin in the treatment of AF among patients with evidence of HF. A literature search of relevant articles was conducted on six electronic databases (PubMed, Web of Science, Medline, ScienceDirect, Cochrane Library, and Google Scholar) from 2000 to 2022. The search yielded seven studies that had met the inclusion criteria. Our meta-analysis of four studies showed that there was no significant difference in the reduction of heart rate after treatment with either amiodarone or digoxin (mean difference (MD): -5.44; 95% confidence interval (CI): -9.53 to -1.34; I2 = 25%; p = 0.26). On the other hand, the statistical analysis showed that amiodarone had a better effect on the conversion to sinus rhythm than digoxin (63% versus 35%, respectively). Based on evidence from our meta-analysis, the clinical effect of amiodarone and digoxin in the emergency treatment of AF on heart rate control was unclear. However, amiodarone has a significant impact on the restoration of sinus rhythm compared with digoxin and can be considered the first-line drug regimen in conversion to sinus rhythm for AF patients with evidence of heart failure. However, the use of amiodarone and digoxin is complicated by adverse events and all-cause mortality.

A Case of New-Onset Atrial Fibrillation With Rapid Ventricular Response Due to Iatrogenic Hypothermia.

Hypothermia is an involuntary fall in body temperature, usually below 35°C. Hypothermia is a common condition, especially in frigid zones. However, it should not be forgotten that it can also occur in temperate climates or for iatrogenic reasons. Hypothermia is associated with seriously severe arrhythmias, particularly ventricular fibrillation, and there are many reports of prolonged resuscitation in these patient groups. This case report shows that a standard thermometer, either with Emergency Medical Services or in-hospital, will be incapable of reading the temperature if it is less than 34°C and will falsely read 34°C when in reality it is lower than that; in a clinically relevant scenario, a low-reading thermometer or core body temperature readings, such as rectal or esophageal, should be used.

Molecular strategies for antibody binding and escape of SARS-CoV-2 and its mutations.

The COVID19 pandemic, caused by SARS-CoV-2, has infected more than 200 million people worldwide. Due to the rapid spreading of SARS-CoV-2 and its impact, it is paramount to find effective treatments against it. Human neutralizing antibodies are an effective method to fight viral infection. However, the recent discovery of new strains that substantially change the S-protein sequence has raised concern about vaccines and antibodies' effectiveness. Here, using molecular simulations, we investigated the binding mechanisms between the S-protein and several antibodies. Multiple mutations were included to understand the strategies for antibody escape in new variants. We found that the combination of mutations K417N, E484K, L452R, and T478K produced higher binding energy to ACE2 than the wild type, suggesting higher efficiency to enter host cells. The mutations' effect depends on the antibody class. While Class I enhances the binding avidity in the presence of N501Y mutation, class II antibodies showed a sharp decline in the binding affinity. Our simulations suggest that Class I antibodies will remain effective against the new strains. In contrast, Class II antibodies will have less affinity to the S-protein, potentially affecting these antibodies' efficiency.

Green tea extract inhibits proliferation of uterine leiomyoma cells in vitro and in nude mice.

OBJECTIVE: The purpose of this study was to investigate the effect of epigallocatechin gallate (EGCG) on rat leiomyoma (ELT3) cells in vitro and in a nude mice model. STUDY DESIGN: ELT3 cells were treated with various concentrations of EGCG. Cell proliferation, proliferation cell nuclear antigen (PCNA), and cyclin-dependent kinase 4 (Cdk4) protein levels were evaluated. ELT3 cells were inoculated subcutaneously in female athymic nude mice. Animals were fed 1.25 mg EGCG (in drinking water)/mouse/day. Tumors were collected and evaluated at 4 and 8 weeks after the treatment. RESULTS: Inhibitory effect of EGCG (200 micromol/L) on ELT3 cells was observed after 24 hours of treatment (P < .05). At > or = 50 micromol/L, EGCG significantly decreased PCNA and Cdk4 protein levels (P < .05). In vivo, EGCG treatment dramatically reduced the volume and weight of tumors at 4 and 8 weeks after the treatment (P < .05). The PCNA and Cdk4 protein levels were significantly reduced in the EGCG-treated group (P < .05). CONCLUSION: EGCG effectively inhibits proliferation and induces apoptosis in rat ELT3 uterine leiomyoma cells in vitro and in vivo.

Antiproliferative and proapoptotic effects of epigallocatechin gallate on human leiomyoma cells.

OBJECTIVE: To investigate the effects of epigallocatechin gallate (EGCG), an extract of green tea on cultured human leiomyoma cells (HuLM). DESIGN: Laboratory study. SETTING: University hospitals. PATIENT(S): Not applicable. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): The HuLM cells were treated with various EGCG concentrations. Cell proliferation was assayed using Hoechst 33258 dye, and apoptosis by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Total RNA was isolated, and gene expression profiling was performed on 84 key genes related to 18 different signal transduction pathways. The protein levels of PCNA, CDK4, BCL2, and BAX were examined by Western blot analysis. RESULT(S): The HuLM cells treated with EGCG showed a dose-dependent and time-dependent inhibition of cell proliferation. The TUNEL staining indicated a significant increase in apoptosis in HuLM cells treated with 100 µM of EGCG compared with untreated control. Gene expression profiling indicated that EGCG treatment up-regulated representative genes from the transforming growth factor ß (TGF-ß) and stress pathways, while inhibiting the survival pathway and NFκB-dependent inflammatory pathway. Western blot analysis confirmed that EGCG at ≥50 µM significantly decreased the expression of PCNA, CDK4, and BCL2 as well as increased the expression of the proapoptotic BAX in a dose-dependent manner. CONCLUSION(S): Epigallocatechin gallate inhibits the proliferation of HuLM cells and induces apoptosis. These results suggest that EGCG may be a potential anti-uterine fibroid agent acting through multiple signal transduction pathways.