The delaying of elective surgeries after COVID-19 infection decreases postoperative complications.

BACKGROUND: Huge controversy surrounds delaying elective surgeries after COVID-19 infection. Although two studies evaluated the issue, several gaps still exist. METHODS: A propensity score matched retrospective single center cohort design was used to evaluate the optimum time of delaying elective surgeries after COVID-19 infection and the validity of the current ASA guidelines in this regard. The exposure of interest was a previous COVID-19 infection. The primary composite included the incidence of death, unplanned Intensive Care Unit admission or postoperative mechanical ventilation. The secondary composite included the occurrence of pneumonia, acute respiratory distress, or venous thromboembolic. RESULTS: The total number of patients was 774, half of them had a history of COVID-19 infection. The analysis revealed that delaying surgeries for 4 weeks was associated with significant reduction in primary composite (AOR = 0.02; 95%CI: 0.00-0.33) and the length of hospital stay (B = 3.05; 95%CI: 0.41-5.70). Furthermore, before implementing the ASA guidelines in our hospital, a significant higher risk for the primary composite (AOR = 15.15; 95%CI: 1.84-124.44; P-value = 0.011) was observed compared to after applying it. CONCLUSION: Our study showed that the optimum period of delaying elective surgery after COVID-19 infection is four weeks, with no further benefits from waiting for longer times. This finding provide further support to the current ASA guidelines about delaying elective surgeries. Further large-scale prospective studies are needed to give more evidence-based support to the appropriateness of the 4-week waiting time for elective surgeries after COVID-19 infection and to investigate the effect of type of surgery on the required delay.

Significance of Statin-Associated Muscle Symptoms and Its Impact on Patients Adherence and Outcomes.

ABSTRACT: Statin-associated muscle symptoms (SAMS) are one of the most common side effects of statins. This study aimed to explore the significance of SAMS among statin users by comparing statin users with a control group. To achieve our aims, a propensity score matching the retrospective cohort study was conducted in a single center tertiary hospital. The statin muscle symptoms were assessed using the Proposed Statin Myalgia Index Score, whereas the patient's adherence to medications was evaluated using the Morisky Medication Adherence Scale-8. We included 743 patients in our study; of them, 64.9% were on statin, whereas the rest were controls (35.1%). After propensity score matching, patients on statin had significantly higher rates of SAMS (5.0%) compared with control (1.6%) (AOR = 3.209; 95% CI: 1.020-10.091). However, there was no significant difference between statin users and controls in medications nonadherence ( P -value = 0.820). Our analysis among statins users revealed that moderate-intensity (2.671; 95% CI: 1.691-3.310) and high-intensity (3.552; 95% CI: 2.190-4.129) statin therapy was significantly associated with SAMS. In addition, autoimmune diseases were significantly associated with SAMS occurrence (AOR = 32.301; 95% CI: 1.785-584.374). Also, patients on PPIs had significantly less occurrence of SAMS (AOR = 0.145; 95% CI: 0.044-0.483), whereas patients on antiepileptic drugs had significantly higher SAMS occurrence (AOR = 72.337; 95% CI: 2.649-1975.201). Regarding MACE among statin users, there was no significant difference in the 1-year or 5-year MACE rate between statin users and controls. Our study suggests that SAMS are significant among statin users and must be addressed by health care providers to ensure that patients are still adherent to their medications and hence protected against cardiac events.

Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common diseases that require surgical intervention amongst the paediatric population. Although the treatment and the diagnosis of pyloric stenosis are well established, the perinatal risk factors associated with it still need further investigation. METHODS: We searched the following databases: Cochrane, Google Scholar, PubMed, and Scopus. Studies were included if they were case-control or cohort in design and studied the perinatal risk factors associated with IHPS. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). RESULTS: Twenty-one articles were included in this meta-analysis, including 18,104,753 participants. Our analysis showed a significant association between IHPS and male sex (RR=2.71, 95% CI:1.93-3.78), maternal smoking (RR=1.75, 95% CI: 1.54 - 2.00), bottle-feeding (RR=1.68, 95% CI: 1.42 - 1.98), being first born (RR=1.23, 95% CI:1.07-1.40), African ethnicity (RR=0.51, 95% CI: 0.35-0.75), and cesarean section (RR=1.57, 95% CI: 1.49-1.66). On the contrary, there was no significant association between IHPS and multiple gestations, preterm labour, being born in summer, and small for gestational age (SGA). CONCLUSION: In conclusion, our analysis showed that male sex, bottle feeding, maternal smoking and African ethnicity were significantly associated with the risk of IHPS. However, most of the included articles were retrospective in design which necessitates conducting future prospective well-designed studies to further investigate the risk factors of IHPS.

Efficacy and safety of COVID-19 vaccines: A network meta-analysis.

OBJECTIVE: Several vaccines showed a good safety profile and significant efficacy against COVID-19. Moreover, in the absence of direct head to head comparison between COVID-19 vaccines, a network meta-analysis that indirectly compares between them is needed. METHODS: Databases PubMed, CENTRAL, medRxiv, and clinicaltrials.gov were searched. Studies were included if they were placebo-controlled clinical trials and reported the safety profile and/or effectiveness of COVID-19 vaccines. The quality of the included studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials and the Revised Cochrane risk-of-bias tool for nonrandomized trials. RESULTS: Forty-nine clinical trials that included 421,173 participants and assessed 28 vaccines were included in this network meta-analysis. The network meta-analysis showed that Pfizer is the most effective in preventing COVID-19 infection whereas the Sputnik Vaccine was the most effective in preventing severe COVID-19 infection. In terms of the local and systemic side, the Sinopharm and V-01 vaccines were the safest. CONCLUSION: We found that almost all of the vaccines included in this study crossed the threshold of 50% efficacy. However, some of them did not reach the previously mentioned threshold against the B.1.351 variant while the remainder have not yet investigated vaccine efficacy against this variant. Since each vaccine has its own strong and weak points, we strongly advocate continued vaccination efforts in individualized manner that recommend the best vaccine for each group in the community which is abundantly required to save lives and to avert the emergence of future variants.

Safety and Efficacy of SSRIs in Improving Poststroke Recovery: A Systematic Review and Meta-Analysis.

Background Several studies investigated the role of selective serotonin reuptake inhibitors (SSRIs) in improving poststroke recovery; thus, we have decided to conduct this systematic review and meta-analysis to investigate the efficacy and safety of SSRIs in poststroke recovery. Methods and Results In this meta-analysis we searched the following databases: PubMed, Cochrane, Scopus, and Google Scholar. The studies were included if they were placebo-controlled trials in design and reported SSRIs' effects on poststroke depression, anxiety, disability, dependence, motor abilities, and cognitive functions. The quality of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. The search yielded 44 articles that included 16 164 patients, and about half of the participants were treated with SSRIs. Our results showed that SSRIs had a significant effect on preventing depression (weighted mean difference [WMD], -7.05 [95% CI, -11.78 to -2.31]), treating depression according to the Hamilton Rating Scale for Depression score (WMD, -1.45 [95% CI, -2.77 to -0.14]), anxiety (relative risk, 0.23 [95% CI, 0.09-0.61]), dependence (WMD, 8.86 [95% CI, 1.23-16.48]), motor abilities according to National Institutes of Health Stroke Scale score (WMD, -0.79 [95% CI, -1.42 to -0.15]), and cognitive functions (WMD, 1.00 [95% CI, 0.12-1.89]). On the other hand, no significant effect of SSRIs on disability was observed. Additionally, we found that treating with SSRIs increased the risk of seizures (relative risk, 1.44 [95% CI, 1.13-1.83]), whereas there was no difference in the incidence of gastrointestinal symptoms or bleeding between SSRIs and a placebo. Conclusions Our study showed that SSRIs are effective in preventing and treating depression, and improving anxiety, motor function, cognitive function, and dependence in patients after stroke. These benefits were only reproducible with the citalopram subanalysis but not fluoxetine. Further well-conducted placebo-controlled trials are needed to investigate the safety and efficacy of citalopram among patients after stroke. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021285766.

Quality of Distance Learning After One and a Half Year From Its Integration Due to the COVID-19 Pandemic: A Cross-Sectional Study at the University of Jordan.

Background The coronavirus disease 2019 (COVID-19) pandemic mandated the change from face-to-face learning to distance learning. As a result, the quality of distance learning worldwide is questionable. Objectives and aims The aim of this study is to investigate the quality of distance learning among university students at the University of Jordan, as well as its determinants and obstacles. Methods A questionnaire-based cross-sectional study was conducted among undergraduate students at the University of Jordan from May 29 to July 11, 2021. Using a quantitative approach, students' attitudes toward and perceptions of online and distance education were analyzed. The Distance Education Learning Environments Survey (DELES) tool was used to evaluate the quality of distance learning during COVID-19 pandemic. IBM SPSS Version 25 was used for data analysis. Results The total number of participants was 486, and the mean total DELES score was 61.6 ± 24.6. The lowest mean of DELES score components was for the active learning component (6.9 ± 2.9). Moreover, 65.9% of the students were very dissatisfied or dissatisfied with the quality of distance learning. The quality of distance learning derived by the total DELES score was determined by several general demographics, and students' perceptions and attitudes. Conclusions The present study showed a low quality of distance learning and high levels of dissatisfaction among students at the University of Jordan. Thus, improvement of distance learning quality by filling its infrastructural defects and the implementation of its adjunct tools are required. In addition, we recommend collaboration with regional and international educational institutions to improve the quality of distance learning.