We read with great interest the recent study by Rashid et al. assessing the effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) on the risk of adverse liver outcomes (ALO) among patients with alcohol-associated liver disease (ALD) and type 2 diabetes (T2D) [1]. In this cohort study based on the IBM MarketScan database, the authors demonstrated that GLP-1RA users were associated with lower likelihood of hepatic decompensation with a reduced adjusted incidence rate of 0.56 (95% CI 0.36–0.86) relative to non-GLP-1RA individuals [1]. Although the authors overlap propensity score weighting (OPSW) followed by Poisson regression models to analyse adjusted risk of ALO, several important confounding factors were not included in the analyses. ALD has a wide range of disease manifestations, ranging from relatively benign hepatic steatosis to more advanced forms, including alcoholic hepatitis, alcohol-associated cirrhosis and hepatocellular carcinoma [2]. Advanced ALD stages, particularly alcoholic hepatitis and liver cirrhosis, are associated with higher mortality rates compared to mild ALD. Moreover, metabolic factors such as overweight/obesity influence disease outcomes [3]. Although the authors successfully matched the prevalence of obesity in this study, utilising body mass index (BMI) measurements would help achieve a more accurate balance between the GLP-1RA and non-GLP-1RA groups. Additionally, the outcome of ALD can be affected by racial and ethnic factors [4]. Therefore, future analyses incorporating ALD severity, BMI measurements and racial and ethnic factors are warranted. In addition to the unknown severity of ALD in this study, the severity of T2D was unclear. Although the authors successfully matched the use of anti-diabetic medications other than GLP-1RA, there could be a residual imbalance in terms of T2D severity between GLP-1RA and non-GLP-1RA users. To overcome this limitation, an active comparator study design using second-line anti-diabetic medications, such as sodium-glucose cotransporter 2 or dipeptidyl peptidase-4 inhibitors, may increase similarity in measured patient characteristics between treatment groups and reduce potential unmeasured confounding. Additionally, the level of HbA1c, representing the status of T2D control, should be reported and balanced between the groups. In summary, future studies should employ active comparator designs and include comprehensive T2D severity measures to ensure more reliable comparisons between treatment groups. While the study by Rashid et al. [1] provides valuable insights into the potential benefits of GLP-1RA in patients with concurrent ALD and T2D, several limitations need to be addressed in future research. First, the lack of information regarding disease severity for both ALD and T2D may have introduced unmeasured confounding. Second, more precise measurements of metabolic factors, particularly BMI, are needed to ensure better balance between comparison groups. Third, the incorporation of racial and ethnic factors could provide more comprehensive understanding of treatment outcomes. Future studies should consider employing active comparator designs with second-line anti-diabetic medications and including detailed clinical parameters such as HbA1c levels. These methodological improvements would help establish more robust evidence for the role of GLP-1RA in managing patients with concurrent ALD and T2D. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no data sets were generated or analysed during the current study.
Objective This study evaluated the clinical efficacy and safety of interleukin-1 (IL-1) blockade for patients with COVID-19.Methods The PubMed, Web of Science, Ovid Medline, Embase and Cochrane Library databases were searched for relevant articles from their inception to 25 September 2022. Only randomized clinical trials (RCTs) that assessed the clinical efficacy and safety of IL-1 blockade in the treatment of patients with COVID-19 were included.Results This meta-analysis included seven RCTs. No significant difference in the all-cause mortality rate of patients with COVID-19 was observed between the IL-1 blockade and control groups (7.7 vs. 10.5%, odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.57–1.22; I2 = 18%). However, the study group was at significantly lower risk of requiring mechanical ventilation (MV) compared with the control group (OR = 0.53, 95% CI 0.32–0.86; I2 = 24%). Finally, the risk of adverse events was similar between the two groups.Conclusions IL-1 blockade does not provide increased survival benefits in hospitalized patients with COVID-19, but it may reduce the need for MV. Furthermore, it is a safe agent for use in the treatment of COVID-19.>
This meta-analysis of randomized controlled trials (RCTs) investigated the usefulness of mesenchymal stromal cells (MSCs) to treat patients with COVID-19. Methods: PubMed, Embase, Ovid MEDLINE, the Cochrane Library, and Clinicaltrials.gov were searched for RCTs published before November 7, 2021. Only RCTs that compared the clinical efficacy and safety of MSCs with other alternative treatments or placebos in the treatment of patients with COVID-19 were included. Six RCTs were included, in which the MSC and control groups consisted of 158 and 135 patients, respectively. The patients who received MSCs had a significantly lower 28-day mortality rate (7.6% vs 21.5%; OR, 0.18; 95% CI, 0.06–0.52; I2 = 0%) and significantly higher clinical improvement rate (OR, 6.05; 95% CI, 2.31–15.83; I2 = 0%) than the controls. The patients who received MSCs were associated with a similar risk of adverse events (AEs) and serious AEs to the control group (AEs: OR, 33; 95% CI, 0.09–1.18; I2 = 59%; serious AEs: OR, 0.30; 95% CI, 0.02–4.41; I2 = 53%). MSC treatment may help to improve the clinical outcomes of patients with COVID-19. In addition, MSC treatment appears to be a safe therapeutic option for patients with COVID-19.
Both ertapenem and other carbapenems, including imipenem, meropenem, and doripenem, are recommended in the treatment of extended-spectrum-β-lactamase (ESBL)-producing Enterobacterales infection. However, whether ertapenem is as effective as other carbapenems for ESBL-producing Enterobacterales remains unclear. Therefore, this meta-analysis was conducted to compare the clinical efficacy of ertapenem versus other carbapenems in the treatment of ESBL-producing Enterobacterales infection.PubMed, Web of Science, and Cochrane Library were searched from their inception to 29 November 2022. Only studies comparing ertapenem and other carbapenems in the treatment of patients with ESBL-producing Enterobacterales infections were included.A total of six studies meeting selection criteria were identified. Overall, ertapenem was associated with a significantly lower 30-d mortality when compared with other carbapenems (10.7% [46/431] vs. 17.7% [104/586]; risk ratio [RR], 0.61; 95% CI: 0.40-0.91). The ertapenem group exhibited a significantly shorter length of hospital stay than the other carbapenem groups (mean differences, -6.02 d; 95% CI, -9.39 to -2.64). No significant differences were noted between ertapenem and other carbapenem groups in terms of rates of clinical cure or improvement (RR, 1.11; 95% CI: 0.97-1.25) and microbiological eradication (RR, 1.01; 95% CI: 0.97-1.06).Ertapenem could be as effective as other carbapenems in the treatment of patients with ESBL-producing Enterobacterales infections.
The emergence of the monkeypox outbreak in early 2022 has posed a new global health threat. As of July 8, 2022, 9069 laboratory-confirmed cases have been reported, and most of them are from non-endemic countries. The monkeypox virus is an enveloped double-stranded DNA virus, and preliminary genetic data suggest that the 2022 monkeypox virus belongs to the West African clade. In the current outbreak, human-to-human transmission has been the primary transmission mode. Although direct skin-to-skin contact with lesions during sexual activities can spread the virus, it remains unclear whether monkeypox can spread through sexual contact, specifically through contaminated body fluids. The typical presentation of monkeypox includes prodromal symptoms, followed by a rash that usually begins within 1-3 days of symptom onset, and the skin lesions can last for 2-4 weeks and then gradually resolve. However, the monkeypox outbreak in 2022 may exhibit atypical features. A definite diagnosis of monkeypox virus infection requires nucleic acid amplification testing via the polymerase chain reaction method. Supportive care is essential, and antiviral therapy is not considered for all affected patients, but recommended for those at highrisk for severe diseases. The mitigation of monkeypox outbreaks include enhanced case detection, case isolation, contact tracing, and post-exposure vaccination. In conclusion, the current monkeypox outbreak is a new threat during the COVID-19 pandemic. Clinicians should be aware of this new situation, which presents a different scenario from those of prior outbreaks. Global health systems should develop effective strategies to mitigate the spread of monkeypox.
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