ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Clinical Efficacy and Safety of Fluvoxamine in COVID-19 Patients: An Umbrella Review of Systematic Reviews and Meta-Analyses
Get PDFIntroduction: Fluvoxamine is an agonist for the sigma-1 receptor, through which it controls inflammation. It helps reduce the cytokine storm associated with the COVID-19 virus by regulating the production of IL-6 and gene expression. This review of systematic reviews (SRs) aims to summarize the effects of fluvoxamine in treatment of COVID-19.
Methods: This umbrella review (CRD42025592203) of SRs and meta-analyses investigated the safety and efficacy of fluvoxamine for treatment in COVID-19 patients, irrespective of disease severity and age. Comprehensive searches were conducted from inception to December 12, 2024, covering PubMed, Cochrane CENTRAL, Google Scholar, and Cochrane COVID-19 resources. A qualitative synthesis of evidence was performed. The AMSTAR2 tool was used to assess the methodological quality of the included SRs.
Results: Eleven reviews published in 12 publications that reported the use of fluvoxamine in COVID-19 patients were finally included as part of the synthesis. The studies reported a lower mortality rate with fluvoxamine than with placebo, but only four studies reported statistical significance. Five reported a statistically significant reduction in hospitalization risk for patients treated with fluvoxamine compared to controls. Only one review evaluated COVID-19 progression, reporting a non-significant decrease in the risk of disease progression with fluvoxamine compared to placebo. Higher dosages of fluvoxamine compared to lower doses yielded better outcomes.
Conclusion: Although fluvoxamine may have potential benefits in reducing COVID-19-associated mortality and hospitalization, our findings do not support a significant role in preventing disease progression or clinical deterioration. Further research is needed to compare the efficacies of different dosages
An Unusual Case of Disseminated Hydatid Disease: A Laparoscopic Wonder
Get PDFHuman echinococcosis, caused by Echinococcus tapeworms, is a zoonotic disease in which ingested eggs of the tapeworm form cysts in the organs known as Hydatid cysts. These cysts are commonly found in the Liver and lungs, but in rare cases, they can also be found in the spleen, ovaries, round ligament, and peritoneal cavity. Treatment typically involves surgery. This is a case of a 32-year-old female who presented with chief complaints of pain in the abdomen for 2 months, which was associated with nausea, vomiting, reduced appetite, and increased size of mass per abdomen. Further investigations revealed the presence of multiple disseminated hydatid cysts in the upper abdomen and the peritoneal cavity. This was a rare & unusual entity that was meticulously managed by minimally invasive laparoscopic surgery. Echinococcosis can occur anywhere in the body, with concurrent localizations in the liver, spleen, round ligament, ovaries, and peritoneal cavity, which are rare and pose a diagnostic as well as a surgical management challenge. The inconvenience of multiple localization and the risk of contamination usually lead to open surgery in these cases. The presented case is unique due to the laparoscopic approach to the multiple localizations of hydatid disease, advocating for a minimally invasive first-line approach even in these particular localizations
A Systematic Review and Meta-Analysis of Liver Transplant Outcomes in Lean Versus Non-Lean Metabolic Dysfunction-Associated Steatotic Liver Disease Patients
Get PDFIntroduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent hepatic disease with metabolic dysfunction-associated steatohepatitis (MASH) as its severe necro-inflammatory subtype. At present, it is the second leading cause of liver transplant. A systematic literature review (SLR) was conducted to assess the effect of lean vs non-lean BMI on clinical outcomes after transplant in MASLD patients.
Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar databases was executed. Review Manager 5.4.1 was used for statistical analyses. A random-effect model was used with the results reported as Odds Ratio (OR) and 95% confidence interval (CI). A narrative approach was used where it was not feasible to conduct a meta-analysis.
Results: Eleven observational studies were included in the SLR. Pooled results from three studies showed no significant difference in mortality between lean and non-lean patients at 1 year (OR= 0.78, p= 0.76), 2 years (OR= 0.83, p= 0.24), and 5 years (OR= 1.07, p= 0.51) post-transplant. There was also no significant relation of lean and non-lean BMI in graft survival, observed over 30 days (OR= 1.34, p= 0.27), 1 year (OR= 0.75, p= 0.25), 2 years (OR= 1.20, p= 0.45), and 5 years (OR= 1.07, p= 0.60) post-transplant. Qualitative analysis suggested morbid obesity is linked with higher waitlist dropout in MASH patients.
Conclusion: The qualitative analysis of eight studies indicates a trend towards poorer outcomes in the non-lean group. There is a need for further investigations to comprehensively examine the factors influencing the relationship between BMI and post-transplant outcomes
Thyroid Hormone Resistance Syndrome: A Case Report with Literature Review
Get PDFResistance to thyroid hormone receptor beta (THRβ) is a rare condition causing abnormal thyroid function tests (TFTs) characterized by elevated thyroid hormone levels with unsuppressed Thyroid Stimulating Hormone (TSH). Thyroid hormone action involves multiple steps, and mutations affecting these steps are key to understanding and managing thyroid disorders. We present a case of THRβ resistance associated with cardiac arrhythmia. A 40-year-old male with a history of atrial fibrillation (AF) was referred for evaluation of abnormal TFTs and thyroid nodules. TFTs revealed a normal TSH and elevated free thyroxine. Imaging showed a large, peripherally enhancing necrotic mass with calcification in the left thyroid lobe and a 0.8 cm hypodense area in the right lobe. Thyroid ultrasound confirmed bilateral nodules, with the largest in the lower pole of the left lobe. The fine-needle aspiration biopsy was benign (Bethesda category II). Inherited THRβ pathogenic variants cause thyroid hormone resistance, often resulting in an enlarged thyroid gland. Despite this resistance, patients may still show clinical signs of cardiac arrhythmias. Diagnosing thyroid hormone resistance helps avoid unnecessary treatment for asymptomatic patients
Hybrid Schwannoma of the Nasal Cavity: A Rare Case Report with Literature Review
Get PDFSinonasal schwannomas are extremely rare, comprising only 4% of all head and neck schwannomas. Their atypical location and nonspecific symptoms often result in delayed diagnosis. This case highlights a rare hybrid schwannoma in the right nasal cavity of a young female, contributing to the limited literature on sinonasal nerve sheath tumors. A 27-year-old female presented with a one-year history of right-sided nasal obstruction, rhinorrhea, and recurrent epistaxis. Examination revealed a polypoidal mass in the right nasal cavity. Laboratory investigations showed mild anemia and an elevated white cell count. Imaging identified a soft tissue mass with no bone erosion or intracranial involvement. The patient underwent Functional Endoscopic Sinus Surgery (FESS), and histopathological analysis confirmed a hybrid nerve sheath tumor (70% schwannoma, 30% neurofibroma) with positive staining for S-100 and CD34. Postoperative MRI showed no residual or recurrent mass. This case underlines the importance of considering rare neural tumors in the differential diagnosis of nasal masses. Early surgical intervention with histological confirmation ensures favorable outcomes and prevents complications associated with delayed treatment
Rare Presentation of Werner Syndrome in a 28-Year-Old Female Patient: A Case Report and Literature Review
Get PDFWerner Syndrome (WS) is a rare autosomal recessive disorder characterized by accelerated aging and a broad spectrum of clinical manifestations. This case report presents a unique instance of WS from Pakistan, featuring a novel mutation in the WRN gene. Known as progeria adultorum, WS typically manifests post-pubertally due to mutations in the WRN gene, which plays a key role in DNA repair and genomic maintenance.
A 28-year-old woman presented with non-healing bilateral leg ulcers, dry skin, and photopsia. She exhibited multiple signs of premature aging, including short stature, early hair graying, and bilateral cataracts. Her medical history included hypothyroidism, cataract surgery, and recurrent gastrointestinal infections. Genetic testing confirmed a homozygous pathogenic variant in the WRN gene, thereby establishing the diagnosis of WS.
This case highlights the diagnostic challenges associated with rare genetic syndromes. The patient\u27s diverse clinical signs—such as persistent ulcers, cataracts, and failure to experience a pubertal growth spurt—were consistent with diagnostic criteria for WS. The report explores the pathophysiology of WS, particularly the role of WRN mutations in impaired DNA repair and increased genomic instability, which significantly elevates cancer risk.
There is currently no specific treatment for WS; management remains supportive, focusing mainly on symptomatic relief. This case emphasizes the importance of early recognition, targeted genetic testing, and multidisciplinary care. Greater awareness and understanding of WS are essential for timely diagnosis and intervention. Furthermore, ongoing genetic research may offer valuable insights into disease mechanisms and potential therapeutic strategies, ultimately aiming to improve patient outcomes
A Pairwise and Network Meta-Analysis Comparing the Efficacy and Safety of Ribonucleic Acid Interference Therapeutics in the Management of Hypertension
Get PDFBackground: Small interfering RNA (siRNA) and antisense agents targeting angiotensinogen are emerging antihypertensives. We synthesized their efficacy and safety.
Methods: We searched PubMed, Web of Science, Scopus, and CENTRAL through 25 Nov 2024. Eligible studies were randomized controlled trials in adults with hypertension comparing RNA-interference therapeutics with placebo. Primary outcomes were the change in ambulatory and office systolic/diastolic blood pressure. We conducted random-effects pairwise meta-analyses and a network meta-analysis with SUCRA ranking, and appraised certainty with GRADE.
Results: Four trials (n=486) met criteria. Versus placebo, RNA-interference therapy reduced ambulatory SBP (mean difference [MD] −15.46 mmHg; 95% CI −18.79 to −12.12) and DBP (MD −8.45 mmHg; −10.67 to −6.23), and lowered office SBP (MD −8.07 mmHg; −11.58 to −4.56) and DBP (MD −5.18 mmHg; −7.73 to −2.63). Injection-site reactions increased (risk ratio 5.26; 1.01–27.44); other adverse events, potassium, and eGFR were similar. In network analyses, zilebesiran 300 mg ranked highest for blood-pressure lowering; for AGT reduction, 800 mg ranked highest. GRADE certainty was high for blood-pressure outcomes and moderate for AGT, potassium, and eGFR. Few, short-term trials and sparse networks limit precision and generalizability; publication bias was not assessable.
Conclusion: siRNAs effectively reduced BP in hypertensive adults with an acceptable safety profile. Despite the indistinguishable efficacy or safety between the doses or types of siRNAs, Zilebesiran 300 mg best reduced BP compared to placebo
Trends in Mortality from Leukemia and Ischemic Heart Disease: A 22-Year Analysis in the U.S. (1999-2020)
Get PDFIntroduction: Leukemia and ischemic heart disease (IHD) are major U.S. mortality causes. This study analyzes national mortality trends from 1999 to 2020 to assess the impact of public health efforts in leukemia-associated IHD mortality rates.Methods: This retrospective study analyzed death certificate data from the CDC-WONDER database spanning 1999 to 2020, focusing on leukemia (ICD-10: C91–C95) and ischemic heart disease (ICD-10: I20–I25) as multiple causes of mortality in the U.S. population. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 population were calculated. JoinPoint analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC).Results: From 1999 to 2020, there were 53,603 deaths from combined leukemia and ischemic heart disease among U.S. adults aged 25+, with the AAMR declining from 1.39 to 1.09 per 100,000 (AAPC= -1.30%; 95% CI: -1.90 to -0.68; P= 0.000034). A significant decrease occurred from 1999 to 2018 (AAMR: 1.39 to 0.95; APC= -2.1894%; 95% CI: -2.3995 to -1.9788, P < 0.000001), followed by a period where the trend shifted upward which is statistically significant for the certain subgroups, except men and older adults. Men had higher AAMR than women (1.87 vs. 0.62). Regional AAMRs were highest in the Midwest (1.3). Non-Hispanic Whites had the highest AAMR (1.25). Adults 65+ had a CMR of 5.27 vs. 0.26 for ages 45–64.Conclusion: Significant health disparities exist, as mortality from combined leukemia and IHD is highest among men, older adults, rural populations, and non-Hispanic White individuals
Dual versus Single Ovulation Triggers in In Vitro Fertilization and Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis
Get PDFBackground: Infertility remains a significant global health concern. Optimizing hormonal triggers, such as human chorionic gonadotropin (HCG) with or without gonadotropin-releasing hormone (GnRH) agonists, is crucial to enhance reproductive outcomes. We aim to evaluate and compare the reproductive success rates of dual trigger protocols (HCG + GnRH agonist) versus HCG alone in women undergoing assisted reproductive technologies (IVF/ICSI).
Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published up to January 2025. Studies comparing reproductive outcomes in women undergoing IVF/ICSI who received either dual trigger (HCG + GnRH agonist) or HCG alone were included. Data were analyzed using RevMan version 5.4 and R Studio version 4.4.1. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, fertilization rate, and embryo quality metrics.
Results: Seventeen studies with a total of 2,239 women were included: 1,118 in the dual trigger group and1,121in the HCG onlygroup.Thedualtriggergroupshowedsignificantlybetteroutcomesinterms of total oocytes retrieved, fertilized oocytes, follicles >15mm on trigger day, viable embryos, two pronuclei (2PN) formation, clinical pregnancy, biochemical pregnancy, live birth rate, good quality embryos, and fertilization rate.
Conclusions Dual triggering with HCG and GnRH agonist appears to significantly enhance reproductive outcomes compared to HCG alone in women undergoing IVF or ICSI. These findings support the broader adoption of dual trigger protocols in assisted reproductive practice
Robotic Versus Laparoscopic Hysterectomy for Extremely Large Uteri: A Systematic Review
Get PDFIntroduction: Hysterectomy for very large uteri is technically challenging and often requires open surgery. Minimally invasive approaches, such as robotic and laparoscopic techniques, provide alternatives, but their comparative safety and effectiveness for extremely large uteri remain uncertain.
Methods: A systematic review was conducted following PRISMA 2020 guidelines. “PubMed and Scopus were searched through June 2025 using predefined keywords (e.g., ‘hysterectomy,’ ‘robotic,’ ‘robot-assisted,’ ‘laparoscopic,’ ‘uterus,’ ‘large,’ ‘enlarged,’ ‘size,’ ‘weight’); no prospective or randomized trials were identified.” for studies comparing robotic and laparoscopic hysterectomy in women with large or extremely large uteri
Results: Robotic hysterectomy (RH) showed advantages in selected outcomes for extremely large uteri. One study reported a 70-minute reduction in operative time with RH for uteri >1000 g. RH was also associated with lower conversion rates (0–4.3%) compared to laparoscopic hysterectomy (LH) (5.3–10.9%). In moderately large uteri (~500–750 g), RH reduced hemoglobin drops but had longer operative times. Complication rates were generally low, although ureteral injury was more frequent with RH in two studies. Length of hospital stay was similar across approaches.
Conclusion: Robotic hysterectomy may offer clinical and economic advantages over conventional laparoscopy for extremely large uteri but the impact of surgical experience should be carefully considered. Limitations include the retrospective design of all four cohorts, small sample sizes, the absence of randomized trials, and clinical and methodological heterogeneity precluding meta-analysis