Background:The intestinal microbiome has been recently linked to several metabolic and chronic disorders, one of which is coronary artery disease (CAD). Our study aimed to analyze the intestinal microbiome of CAD patients and assess the eligibility of dysbiosis as a diagnostic marker of CAD. Methods:PubMed, Scopus, Embase, and Web of Science were searched using terms, such as 'CAD' and 'microbiome'. Only observational controlled studies were included. R version 4.2.2 was used for the analysis. Results:A significant association was found between the CAD group and increased Simpson and Shannon Indices compared with the control group (MD=0.04, 95% CI=0.03-0.05, and MD=0.11, 95% CI=0.01-0.22, respectively). Our analysis yielded a statistically significant association between the CAD group and increased Prevotella genus (MD=13.27, 95% CI=4.12-22.42, P-value=0.004), Catenibacterium genus (MD=0.09, 95% CI=0.09-0.10), Pseudomonas genus (MD=0.54, 95% CI=0.29-0.78, P-value), and Subdoligranulum (MD=-0.06, 95% CI=-0.06 to -0.06) compared with the control group. Another significant association was detected between the CAD group and decreased Bacteroides vulgatus and Bacteroides dorei (MD=-10.31, 95% CI=-14.78 to -5.84, P-value <0.00001). Conclusion:Dysbiosis is an acceptable diagnostic marker of CAD. Decreased B. dorei and B. vulgatus among CAD patients suggests a protective role of these bacteria. Future clinical trials are necessary to investigate the potential benefit of supplementation of these bacteria in treating or preventing CAD.

Studies have shown an increased incidence of metabolic syndrome (MS) among irritable bowel syndrome (IBS) patients; we aimed to assess the eligibility of IBS as a risk factor for MS. PubMed, Scopus, Embase, and Web of Science were searched on the 1st of January 2023. Only observational controlled studies were included. Analysis was conducted by RevMan software version 5.4. IBS was associated with an increased incidence of MS (RR = 2.05, 95% CI = 1.50 to 2.79, p-value >0.00001). A significant association was seen between IBS, abdominal obesity (RR = 1.28, p-value = 0.0003), and increased waist circumference (MD = 5.01, 95% CI = 1.29 to 8.72, p-value = 0.008). IBS patients didn't have an increased risk of diabetes (RR= 1.29, 95% CI = 0.85 to 1.98, p-value = 0.23), however, they had increased HOMA- IR (MD = 0.21, 95% CI = 0.15 to 0.26, p-value < 0.00001). Analysis of blood pressure revealed an association between systolic not diastolic hypertension and IBS (MD = -0.50, 95% CI = -0.60 to -0.40, p-value >0.00001). Higher levels of LDL cholesterol (MD = 5.98, 95% CI = 0.91 to 11.05, p-value = 0.02), total cholesterol (MD = 12.21, 95% CI = 6.23 to 18.18, p-value >0.0001), and triglyceride (MD = 11.93, 95% CI = 11.55 to 12.31, p-value >0.00001) were detected among IBS patients. IBS patients are at increased risk for MS and its components. Accordingly, patients should be screened for MS, and preventive programs should be implemented.

Aim: The authors aimed to perform a meta-analysis to evaluate the association between herpes simplex virus (HSV) infection and the risk of developing dementia. Methods: The authors searched the following databases: PubMed, Scopus, Cochrane Library, and Web of Science. The authors included any randomized control trials and controlled observational studies that investigated the prevalence of dementia in HSV-infected patients and HSV-free control group. Also, if the studies measured the levels of HSV antibodies and incidence of these antibodies in patients with dementia compared with a healthy control group. Results: After a comprehensive literature search, 19 studies were included in the meta-analysis with 342 535 patients included in the analysis. The pooled analysis showed a statistically significant association between Alzheimer’s disease (AD), mild cognitive impairment (MCI), and increased levels of IgG titer group [mean difference (MD) = 0.99, 95% confidence interval (CI) = 0.36–1.63, P-value = 0.002], (MD = 0.80, 95% CI = 0.26–1.35, P-value = 0.004), respectively. Additionally, the generic inverse variance showed a statistically significant association between the HSV group and increased incidence of dementia compared with the no HSV control group [risk ratio (RR) = 2.23, 95% CI = 1.18–2.29, P-value <0.00001]. Moreover, this analysis showed no statistically significant difference between the AD group and the control group in anti-HSV IgM titer n (%) outcome (RR = 1.35, 95% CI = 0.91–2.01, P-value = 0.14), respectively. Conclusion: This study revealed that AD and MCI patients have increased levels of IgG antibodies titer against HSV infection. The study showed a significant association between HSV infection and increased incidence of dementia. Thus, regular follow-up of HSV patients’ IgG titer levels could be useful in the prevention of dementia in these patients.

Background and aim Recent studies evaluated the role of vamorolone in treating Duchenne muscular dystrophy (DMD), so we aimed in our Meta-analysis to assess the efficacy of vamorolone in comparison with placebo and corticosteroids for treating DMD patients. Methods We searched PubMed, Web of Science, Scopus, and Cochrane library databases. We included any randomized control trials and controlled observational studies that investigated the role of vamorolone in treating DMD patients. We used RevMan software, version 5.4. to perform our meta-analysis. Results After a search of the literature, 4 studies were included in the meta-analysis; the total number of patients included in the study is 277 patients, 125 patients in the vamorolone group, 106 in the glucocorticoids group, and 46 in placebo (steroid naïve) group. The pooled analysis showed a statistically significant association between the vamorolone group and increased TTSTAND velocity, TTRW velocity and TTCLIMB velocity compared with the placebo group (MD = 0.04, 95% CI = 0.02–0.07, p = 0.002), (MD = 0.24, 95% CI = 0.11–0.37, p = 0.0003), and (MD = 0.06, 95% CI = 0.05–0.06, p < 0.00001), respectively. Also, the analysis showed a statistically significant association between vamorolone and increased TTRW velocity and increased Height percentile for age compared with the glucocorticoid group (MD = −0.14, 95% CI = −0.26 to −0.01, p = 0.03) and (MD = 17.82, 95% CI = 3.89–31.75, p = 0.01), respectively. Conclusion Our study revealed a significant association between vamorolone and increased TTSTAND velocity, TTRW velocity, and TTCLIMB velocity compared with the placebo (steroid naïve), also showed a statistically significant association between increased TTRW velocity and increased Height percentile for age compared with the glucocorticoid that enhances the privilege of vamorolone over glucocorticoid in treating DMD patients. More multicenter randomized studies are needed to support our results.

The efficacy of anteriolateral versus anterior-posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is to perform a meta-analysis to compare the success rate of both electrode positions. PUBMED, WOS, OVID, and SCOPUS were searched. Inclusion criteria were clinical trials that compared anterior-lateral with anterior-posterior electrodes in external cardioversion of AF. After the full-text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior-lateral electrode and increased cardioversion rate of AF (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.02-1.92, p = .04). Subgroup analysis revealed a statistically significant association between the anterior-lateral electrode and increased cardioversion rate of AF in subgroups of less than five shocks, patients with 60 years old or more and patients with left atrial (LA) diameter >45 mm (OR = 1.72, 95% CI = 1.17-2.54, p = .006), (OR = 1.73, 95% CI = 1.18-2.54, p = .005), and (OR = 1.86, 95% CI = 1.04-3.34, p = .04), respectively. Anteriolateral electrode is more effective than anterior-posterior electrode in external cardioversion of AF, particularly in patients who have received less than 5 shocks, are 60 years old or older and have a LA diameter greater than 45 mm.

Aim We aimed to perform a meta-analysis to find out whether PCT and MDW could be used as accurate diagnostic markers for sepsis. Methods We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any observational or clinical trials that compared monocyte Distribution Width [MDW] with Procalcitonin [PCT] as diagnostic markers in a patient with sepsis. Case reports, editorials, conference abstracts, and animal studies were excluded. RevMan software [5.4] was used to perform the meta-analysis. Results After the complete screening, 5 observational studies were included in the meta-analysis. The total number of patients included in the meta-analysis in the sepsis group is 565 and 781 in the control group. The pooled analysis between the sepsis group and controls showed a statistically significant association between sepsis and increased levels of MDW and PCT [MD = 3.94, 95% CI = 2.53 to 5.36, p-value < 0.00001] and [MD = 9.29, 95% CI = 0.67 to 17.91, p-value = 0.03] respectively. Moreover, the subgroup analysis showed that the p-value of MDW levels [< 0.00001] is more significant than the p-value of PCT levels = 0.03, the p-value between the two subgroups [< 0.00001]. Additionally, the overall ROC Area for MDW [0.790] > the overall ROC Area for PCT [0.760]. Conclusion Our study revealed a statistically significant association between sepsis and increased MDW and PCT levels compared with controls and the overall ROC Area for MDW is higher than the overall ROC Area for PCT, indicating that the diagnostic accuracy of MDW is higher than PCT.MDW can be used as a diagnostic marker for sepsis patients in the emergency department. More multicenter studies are needed to support our findings.

Background: Some studies reported a positive link between high levels of lipoprotein (a) and aortic valve calcification. The aim of this study is to perform a meta-analysis to find whether aortic valve calcification has a significant association with high levels of lipoprotein (a). Methods: We searched PUBMED, WOS and OVID databases. We included cohort studies or clinical trials that measured lipoprotein (a) levels in patients with aortic valve calcium and controls without aortic valve calcium. Case reports, editorials and animal studies were excluded. RevMan software (5.4) was used to perform the meta-analysis. Levels of lipoprotein (a) and number of patients with increased levels of lipoprotein (a) outcomes were presented as standardized mean difference (SMD) and Odds ratio (OR) with 95% confidence interval (CI). Results: After complete screening, 7 studies were included with a total number of 446179 patients included in the analysis. The pooled analysis showed a statistically significant association between incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls (SMD = 1.71, 95% CI = 1.04 to 2.38, p-value < 0.00001). The pooled analysis showed a statistically significant association between incidence of aortic valve calcium and increased number of patients with high levels of lipoprotein (a) compared with controls (OR = 2.21, 95% CI = 1.26 to 3.87, p-value = 0.006). We observed a significant heterogeneity in both outcomes ( P < 0.00001) that was not solved by subgroup analysis or leave-one out test. Conclusion: This meta-analysis showed a statistically significant association between incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls. Patients with high levels of lipoprotein (a) are at increased risk of developing aortic valve calcification. Medications targeting lipoprotein (a) in future clinical trials may be useful in primary prevention of aortic valve calcification in high risk patients.

BACKGROUND:Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI. METHODS:PubMed, Scopus, and Web of Science were searched using terms; such as "Insomnia" and "MI." Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis. RESULTS:Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41-2.02, p < .00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7-8 h of sleep (RR = 1.56, 95% CI = 1.41-1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04-1.23, p = .003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91-1.23, p = .46). Analysis of age, follow-up duration, sex, and comorbidities showed a significant association in insomniacs. CONCLUSION:Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.

Background and Aim: Some studies reported a positive relation between aortic dissection (AD) and increased lipoprotein (a) (LP(a)), while other studies reported no association, so the authors aimed to do a meta-analysis to establish the relation between AD and high levels of LP(a). Methods: PubMed, Scopus, Web of Science, SAGE, EMBASE, Science Direct, and Cochrane Library were searched. The inclusion criteria were any randomized control trials or observational studies that measured the levels of LP(a) in AD patients and healthy controls. The authors excluded case reports, case series, noncontrolled studies, reviews, editorials, and animal studies. Results: After a search of the literature, four studies were included in the meta-analysis with 678 patients included in the analysis. The pooled analysis showed a statistically significant association between the AD group and increased levels of LP(a), decreased levels of TG, low-density lipoprotein cholesterol, and TC compared with the control group (MD=11.71, 95% CI=4.11–19.32, P-value=0.003), (MD=−0,32, 95% CI=−0.48 to −0.16, P-value<0.0001 ), (MD=−0,21, 95% CI=−0.42 to −0.1, P-value=0.04), (MD=−0,58, 95% CI=−0.62 to −0.54, P-value<0.00001), respectively. Conclusion: Our study showed that AD is significantly associated with increased levels of LP(a). The significant increase in LP(a) in AD was associated with decreased levels of TG, low-density lipoprotein cholesterol, and TC. Future clinical trials testing Lp (a) targeting medications could be useful in the primary, or secondary prevention of AD in high risk patients.

There is a scarcity of studies focusing on irritable bowel syndrome (IBS) and anxiety in Egypt. Accordingly, our study aimed to assess the association between anxiety and IBS symptomatology among Egyptian females. Three hundred eighty-three females (145 IBS and 238 controls) were included in the study, and data were obtained using structured predesigned questionnaires. IBS and anxiety symptoms were assessed according to the Rome IV criteria and the Arabic version of the beck anxiety inventory, respectively. Both IBS and non-IBS groups showed increased anxiety during the pandemic, without a significant difference between both groups ( P value = .657). Higher levels of education were significantly associated with severe anxiety ( P value = .031). Multivariate analysis of IBS patients showed that intermediate education was significantly associated with 75% lower odds for increased IBS symptoms compared with illiterate or read-and-write IBS patients [odds ratio (OR): 0.25, 95% confidence interval (CI) 0.06–0.95, P value = .042]. Urban residence was significantly associated with 13.5 times greater odds of increased IBS symptoms, compared with rural residence (OR: 13.48, 95% CI 3.55–51.25, P value < .001). Moreover, patients who lost their job during the pandemic were 12.9 times more likely to have increased symptoms (OR: 12.89, 95% CI 1.84–90.15, P value = 0.01). A unit increase in patients age and beck anxiety inventory score was associated with 68% and 75% greater odds for increased IBS symptoms, respectively (OR: 1.68, 95% CI 1.12–2.53, P value = .012; OR: 1.75, 95% CI 1.08–2.84, P value = .024). Increasing anxiety is associated with increased IBS symptoms. Therefore, IBS patients should be screened for anxiety, and the role of psychiatric management of anxiety in the amelioration of IBS symptoms must be explored.

Background: Herpes Zoster, commonly known as shingles, is a viral infection that affects a significant portion of the adult population; however, its potential role in the onset or progression of neurodegenerative disorders like dementia remains unclear. Methods: We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included any randomized control trials and controlled observational studies as Cross-sectional, prospective, or retrospective cohort and case-control studies that investigated the prevalence of dementia in Herpes Zoster Virus (HZV)-infected patients and HZV-free control group or if the study investigated the prevalence of HZV in demented patients. Also, if the studies measured the levels of dementia biomarkers in patients with HZV compared with a healthy control group. Results: After the complete screening, 9 studies were included in the meta-analysis. In the outcome of the incidence of HZV, the pooled analysis showed no statistically significant difference between the dementia group and the No dementia group (RR = 1.04% CI = 0.86–1.25, P = .70). In the outcome of incidences of dementia and Alzheimer’s disease, the pooled analysis showed no statistically significant difference between the HZV group and the incidence of dementia (RR = 0.99, 95% CI = 0.92–1.08, P = .89), (RR = 3.74, 95% CI = 0.22–62.70, P = .36) respectively. In the outcome of incidences of Herpes Zoster ophthalmicus (HZO), the generic inverse variance showed a statistically significant association between patients who have HZO and increased incidence of dementia (RR = 6.26, 95% CI = 1.30–30.19, P = .02). Conclusion: Our study showed no significant association between HZV and the incidence of dementia or Alzheimer’s disease, but it shows a significant association between HZO and the incidence of dementia. More multicenter studies are needed to establish the actual association between the HZV and dementia.

We aimed to perform a meta-analysis to investigate the value of Cyclophilin C as a diagnostic and prognostic biomarker in Coronary Artery Disease. PubMed, Web of Science, Scopus and Cochrane library databases were searched. The inclusion criteria were any randomized control trials or controlled observational studies that measured the levels of Cyclophilin C in Coronary Artery disease patients and healthy controls. We excluded case reports, case series, reviews, editorials and animal studies. After search of the literature, 4 studies were included in the meta-analysis with a total number of 454 individuals included in the study. The pooled analysis showed a significant association between CAD group and increased levels of Cyclophilin C (MD = 28.94, 95% confidence interval (CI) = 19.28-38.60, P-value < 0.00001). Subgroup analysis showed a significant association between acute and chronic CAD group with increased levels of cyclophilin c compared with the control group (MD = 35.98, 95% CI = 19.84-52.11, P-value < 0.0001) and (MD = 26.36, 95% CI = 21.87 to 30.85, P-value < 0.00001), respectively. The pooled effect estimate showed that the ROC area for the cyclophillin c as a diagnostic biomarker of CAD was (ROC= 0.880, 95% CI =0.844-0.917, P-value < 0.001). Our study revealed a significant association between acute and chronic coronary artery disease with increased levels of Cyclophilin C. Cyclophilin C could be used as a novel diagnostic and prognostic biomarker in acute and chronic CAD. More research is warranted to support our results.

Background and aim: Techniques in endovascular therapy have evolved offering a promising alternative to medical therapy alone in Type B aortic dissections (TBADs). The aim of this meta-analysis is to compare mortality and overall complications in thoracic endovascular aortic repair (TEVAR) with best medical therapy (BMT) in patients with TBADs. Methods: We included any randomized control trials, case controls, prospective or retrospective cohort and cross sectional studies that compared TEVAR versus BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched to identify relevant articles including PubMed, Scopus, and Web of Science. Review Manager (RevMan) software, version 5.4 was used to perform the analysis. Results: A total of 1966 studies were screened with 32 studies included. Thirty-two cohort studies including 150836 patients (19512 TEVAR and 131324 BMT) were included. TEVAR was associated with a significantly lower 30-day mortality rate compared to BMT (RR= 0.79, CI= 0.63, 0.99, P = 0.04) notably in patients ≥ 65 years of age (RR=0.78, CI=0.64, 0.95, P=0.01). TEVAR group had a statistically significant prolonged length of hospital (MD= 3.42, CI= 1.69, 5.13, P = 0.0001), and ICU stay (MD= 3.18, CI= 1.48, 4.89, P = 0.0003) compared to BMT. BMT was associated with increased overall complications (RR= 1.50, CI= 1.20, 1.86, P = 0.0003) and stroke (RR= 1.52, CI= 1.29, 1.79, P < 0.00001). No statistically significant difference in late mortality (1, 3, and 5 year), intervention-related (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis), was noted between both groups. Conclusion: In patients with TBAD, TEVAR was associated with a decreased risk of 30-day mortality rate and overall complications compared to BMT. More randomized control trials are needed to support our findings.

Background and Aim: Recent studies have linked trimethylamine N-oxide (TMAO) to cardiovascular diseases; our study aimed to analyze the association between coronary artery disease (CAD), acute coronary syndrome (ACS), and TMAO. Methods: PubMed, Scopus, Embase, and Web of Science were searched using terms such as ʻCADʼ and ʻTMAOʼ. Only observational controlled studies were included. RevMan software version 5.4 was used for the analysis. Results: A significant association was found between the CAD group and increased serum TMAO levels compared with the control group (MD=1.16, 95% CI=0.54–1.78, P=0.0003). This association remained significant among acute coronary syndrome patients (MD=0.98, 95% CI=0.73–1.23, P<0.00001) and was also detected among young and old CAD patients (MD=0.35, 95% CI=0.06–0.64, P=0.02 and MD=1.36, 95% CI=0.71–2.01, P<0.0001, respectively). On further analysis of intestinal metabolites, the authors detected an insignificant association between choline, betaine, carnitine, and CAD. According to our sensitivity analysis, TMAO is an acceptable diagnostic marker for CAD (0.721, SE was 0.0816, 95% CI: 0.561–0.881). Conclusion: TMAO is an acceptable diagnostic marker for CAD, with significantly higher levels among these patients regardless of their age. Other metabolites did not show such an association. The role of serum level TMAO in the early diagnosis of CAD should be further explored.

Our aim was to perform a meta-analysis to evaluate the possible link between diabetes and high levels of immunoglobulin M (IgM) antibodies against Gonadotropin-Releasing Hormone (GnRH). The search included PubMed, Web of Science, and Scopus databases. Inclusion criteria were any controlled clinical trials or observational studies that measured the level of IgM antibodies against GnRH hormone in diabetic patients, we excluded case reports, editorials, and animal studies. RevMan software, version 5.4 (The Cochrane Collaboration 2020) was used to perform the meta-analysis. Following the screening, three studies were included in the meta-analysis. The meta-analysis included 99 patients in the diabetes group and 318 healthy persons in the control group. The pooled effect showed no statistically significant association between diabetes and the prevalence of GnRH IgM antibodies compared with the control group (risk ratio {RR} = 1.64, 95% CI = 0.96 to 2.79, p-value = 0.03). The pooled effect showed a statistically significant association between diabetes and increased levels of GnRH IgM antibodies compared with the control group (mean difference {MD} = 2.13, 95% CI = 0.25 to 4.02, p-value = 0.03). Our study found a significant association between diabetes and increased levels of GnRH IgM antibodies. Therefore, GnRH IgM antibodies may play a role in the pathogenesis of diabetes or may be considered a unique immunological reaction in diabetic patients. More multicenter randomized studies are needed to support our results confirming the positive relationship between diabetes and high levels of IgM antibodies against GnRH hormone.

Some clinical trials reported conflicting results about the efficacy of anterior lateral electrode compared with anterior posterior electrode in electrical cardioversion of atrial fibrillation, and some studies reported no difference in the efficacy between the two procedures. Our aim is to perform a meta-analysis to compare the efficacy of anterior lateral electrode versus anterior posterior electrode in external cardioversion of atrial fibrillation. We searched the following databases: PUBMED, WOS, OVID and SCOPUS. Inclusion criteria were clinical trials that compared anterior lateral electrode with anterior posterior electrode in external cardioversion of atrial fibrillation. We excluded cohort studies, case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis. Cardioversion rate outcome was presented as Odds ratios (OR) with 95% confidence interval (CI). After full text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode (OR = 1.40, 95% CI = 1.02 to 1.92, p-value = 0.04). We observed no heterogeneity among studies (P= 0.14, I² = 32%). No publication bias was observed. Subgroup analysis revealed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode in subgroups of less than 5 shocks, patients with 60years-old or more and patients with left atrial diameter > 45 mm (OR= 1.72, 95% CI = 1.17 to 2.54, p value = 0.006), (OR= 1.73, 95% CI = 1.18 to 2.54, p value= 0.005), and (OR= 1.86, 95% CI = 1.04 to 3.34, p value = 0.04), respectively. Our meta-analysis revealed that anterior lateral electrode is more effective than anterior posterior electrode in external cardioversion of atrial fibrillation. Subgroup analysis showed that patients who received less than 5 shocks, patients with 60 years-old or more and patients with left atrial diameter > 45 mm benefit from anterior lateral electrode more than anterior posterior electrode in external cardioversion of atrial fibrillation.

Cardiopulmonary resuscitation (CPR) in full‐coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads‐up CPR versus supine CPR.

Background: This paper aims to compare the effectiveness and safety of pembrolizumab and paclitaxel as a second line for patients with locally advanced gastroesophageal cancer. Methods: By searching PubMed, Scopus, Web of Science, and Ovid, any randomized clinical study comparing the effectiveness of paclitaxel and pembrolizumab as second-line therapy for advanced gastroesophageal cancer met the inclusion criteria. Only 3 of the 23 eligible studies that were fully reviewed were eligible for meta-analysis. Results: The total number of patients included in the meta-analysis was 635 in the pembrolizumab group and 596 in the paclitaxel group. In terms of objective response rate, there was no statistically significant difference between pembrolizumab and paclitaxel (relative risk = 1.10, 95% CI = 0.80–1.50, P = .57). Furthermore, Pembrolizumab and paclitaxel did not differ in terms of the rate of partial response statistically significantly from one another, according to the overall analysis (relative risk = 0.93, 95% CI = 0.57–1.52, P -value = .78). Conclusion: There is no difference between pembrolizumab and paclitaxel in objective response rate. The objective response rate shows that doctors may consider either treatment for patients with advanced gastroesophageal cancer, given the time to response is comparable across therapies.

Eight elderly confirmed SARS-CoV-2 patients who had severe course of COVID-19 and admitted to ICU expressed high lactate dehydrogenase (LDH) above normal level. The mean value of LDH was 440.40 U/L with 84.52 standard deviation (normal range = 100 – 190 U/L). The mean age of patients was 73.63 years (standard deviation = 3.34). The patients were 4 males (50%) and 4 females (50%). The median of stay duration at ICU was 2 days (range = 1-32 days). Four patients died (50%) and four patients survived (50%). All the patients were at the same ICU and received the same treatment course for COVID-19. It has been shown that LDH is a potential marker of vascular permeability in immune-mediated lung injury. Areas within the body where LDH are most active include the liver, striated muscles, heart, kidneys, lungs, brain, and red blood cells. LDH is a known marker for different inflammatory states, sepsis, myocardial infarctions, infections, and malignancies. One study showed that LDH elevation was associated with a 6-fold increase in the odds of developing a severe COVID-19 disease. Furthermore elevated LDH was associated with a 16 fold increase in patient mortality. Elevated LDH levels seem to reflect that the multiple organ injury and failure may play a more prominent role in influencing the clinical outcomes in patients with COVID-19. This study is a report of 8 elderly critically ill COVID-19 patients who expressed high lactate dehydrogenase above normal level. This indicates that lactate dehydrogenase can predict the outcome of elderly COVID-19 patients. All the eight patients developed severe course of COVID-19, four of them died. High levels of lactate dehydrogenase can predict the severity and mortality of COVID-19 in elderly patients. LDH levels could be considered for inclusion in future risk stratification models for COVID-19 severity and mortality. More observational studies