The comparative effectiveness of biologic therapies for preventing exacerbations in severe asthma remains uncertain because no eligible direct head-to-head randomized comparisons were identified. We compared six biologic therapies using a network meta-analysis (NMA). This systematic review followed PRISMA 2020 and PRISMA-NMA guidance and a prospectively registered PROSPERO protocol (CRD420261428438). PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched from inception through 30 June 2026. Randomized controlled trials evaluating omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, or tezepelumab in severe or persistently uncontrolled asthma were included. The primary outcome was annualized asthma exacerbation rate (AAER). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. A frequentist random-effects NMA estimated rate ratios (RRs) with 95
Critically ill patients are at a higher risk of developing infections and related complications, which can lead to death. Each additional day of antipseudomonal β-lactam use increases the risk of resistance; therefore, de-escalation is highly recommended to improve antibiotic use. To our knowledge, there are limited studies that have evaluated the clinical impact of de-escalation in critically ill patients with proven Methicillin-Susceptible Staphylococcus aureus (MSSA) pneumonia alone. Therefore, our study aimed to assess the clinical impact of the de-escalation strategy compared with the non-de-escalation strategy in critically ill patients with proven MSSA pneumonia. This multicenter retrospective cohort study was conducted in three tertiary hospitals from January 2016 to July 2021. Adult critically ill patients admitted to the intensive care unit with proven MSSA respiratory culture who received antibiotics with anti-MSSA activity were screened for eligibility. Eligible patients were categorized into two groups according to their de-escalation status: De-escalated and Non-de-escalated. The De-escalation was defined as the reduction of the antimicrobial activity spectrum of antibiotics by switching to a narrower-spectrum agent that targets MSSA. The primary outcome was treatment failure rate, while other outcomes were considered secondary. Propensity score (PS) matching was applied at a 1:1 ratio, and multivariate regression analyses were utilized as appropriate. After PS matching (1:1), 58 patients were included in the study (29 patients in non-deescalated vs 29 patients in de-escalated). The treatment failure rate was significantly higher in the de-escalated group compared to the non-de-escalated (OR 16.98; 95
INTRODUCTION:In Saudi Arabia, emergency medicine (EM) is a fast growing specialty that aims to boost the public service and diversify the economy. Selecting a medical specialty, however, is a challenging process that is occasionally misunderstood. The medical lifestyle, social orientation, and hospital orientation all have an impact on the decision of medical students to specialize in EM. Delay in selection has been connected with waiting until year three to expose oneself to EM. MATERIALS AND METHODS:A cross-sectional study was conducted on 440 Saudi medical students to evaluate the factors influencing their decision to pursue EM as a future specialty. The participants included both male and female Saudi medical students who had completed their preparatory year. The present study aimed to determine and evaluate the elements that increase Saudi medical students' propensity to select EM as their future area of specialization. RESULTS:Our study included 440 medical students, of whom 256 (58%) were female and 184 (42%) were male. The gender factor had a major effect on specialty preference, with 44% of females preferring EM and 60% preferring surgery, compared to 56% of males preferring EM and 41% preferring primary care. Age was a factor, as 9.6% of students chose surgery before turning 20, while 7.9% preferred EM after the age of 40 years. Those who preferred EM and surgery had the highest median prestige score. CONCLUSION:The findings of study showed the importance of studying many factors that affect Saudi medical students' decision to choose EM as a future specialty. Educators and program directors can help students navigate their professional pathways by understanding the influence of hospital orientation, social orientation, medical lifestyle variables, and personal preferences.
Background: Acute kidney injury (AKI) is increasingly recognised in children with acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C), yet the long-term renal consequences in younger paediatric populations remain unclear. Most studies focus on acute illness or mixed-age cohorts, with limited data specific to children aged 0–12 years. Objectives: This study aimed to systematically identify, evaluate, and synthesise evidence on post-acute (≥30 days) and long-term (≥90 days) kidney outcomes following SARS-CoV-2 infection or MIS-C in children aged 0–12 years, including chronic kidney disease (CKD), eGFR decline, proteinuria, haematuria, hypertension, and need for kidney replacement therapy. Methods: We searched MEDLINE, Embase, CINAHL, and PubMed (December 2019–30 November 2025), following PRISMA 2020 guidelines and a registered PROSPERO protocol (CRD420251241949). Observational studies reporting kidney outcomes ≥30 days post-infection in children aged 0–12 years were included. Risk of bias was assessed using the Newcastle–Ottawa Scale or ROBINS-I. Owing to heterogeneity and absence of ≥3 comparable datasets, a narrative synthesis was performed. Results: Seven studies met inclusion criteria (five MIS-C cohorts, two acute COVID-19 cohorts). Only a subset provided extractable data specific to children aged 0–12 years. Follow-up ranged from 30 days to 12 months; four studies reported outcomes ≥ 180 days. Across all studies, no incident CKD, sustained eGFR decline, or kidney replacement therapy were reported among children completing long-term follow-up; however, most long-term outcome data were derived from MIS-C cohorts with median ages around 8–11 years that included some adolescents, rather than exclusively children aged 0–12 years. One MIS-C study reported long-term hypertension in 14% of children. A cross-sectional Italian cohort of mild COVID-19 demonstrated hyperfiltration, proteinuria, and microhaematuria at ~3 months, though chronicity could not be assessed due to absence of baseline values. A large US EHR-based cohort identified increased CKD risk after COVID-19 in the broader < 21-year population; however, 0–12-year-specific event counts were not reported, preventing quantitative synthesis for young children. Conclusions: Evidence on long-term kidney outcomes after SARS-CoV-2 infection in children aged 0–12 years remains limited, and only a small subset of studies provided extractable, age-specific data. On the other hand, MIS-C cohorts generally show favourable renal recovery, small sample sizes, lack of control groups, and short follow-up restrict confidence in these findings. Large paediatric EHR studies suggest potential long-term renal risk in broader paediatric populations, highlighting the need for age-stratified, prospective cohorts with serial eGFR, urine studies, and blood pressure assessments. Until definitive evidence emerges, structured renal follow-up may be warranted for children with AKI or MIS-C during COVID-19.
Abstract Background The post-acute respiratory consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in individuals with asthma remain incompletely understood. While early coronavirus disease 2019 (COVID-19) research focused on acute infection severity, less is known about asthma control and exacerbation risk following recovery, particularly beyond the acute phase. Objectives To systematically evaluate asthma control and exacerbation risk following SARS-CoV-2 infection in the post-acute COVID-19 phase among pediatric and adult populations. Methods We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and a prospectively registered PROSPERO protocol (CRD420261290371). PubMed, Embase, CINAHL, Scopus, and Web of Science were searched from 1 January 2020 to 21 January 2026. Observational studies evaluating asthma control or exacerbation outcomes assessed ≥ 4 weeks after confirmed SARS-CoV-2 infection were included. Comparators comprised uninfected asthma controls, within-individual pre–post analyses, or population-level controls. Data were synthesised narratively due to substantial clinical and methodological heterogeneity. Results Eleven observational studies involving children and adults with asthma met the eligibility criteria. Evidence regarding post-acute asthma control was heterogeneous. Several studies reported short-term worsening of asthma control following SARS-CoV-2 infection, particularly within the first one to three months, whereas larger longitudinal and registry-based studies generally demonstrated stability or recovery of asthma control over longer follow-up. In contrast, asthma exacerbation risk showed a more consistent pattern, with large population-based studies demonstrating approximately a two- to five-fold increase in post-acute exacerbation risk among individuals hospitalised with COVID-19 (adjusted hazard ratios ranging from 2.78 to 5.12), while risk was lower and more variable among non-hospitalised cases (hazard ratios approximately 1.8–2.1). Findings were more variable and often null among patients with mild infection. No consistent evidence of sustained deterioration in asthma control was observed across longer-term follow-up. Conclusion Post-acute asthma outcomes following SARS-CoV-2 infection are heterogeneous and appear to vary according to acute COVID-19 severity, follow-up duration, and study design. While transient worsening of asthma control may occur, particularly after more severe infection, the available evidence does not consistently demonstrate sustained deterioration in asthma control. These findings suggest that post-COVID asthma management may benefit from consideration of infection severity, while highlighting the need for high-quality longitudinal research to better define long-term outcomes.
