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The effectiveness of oral antiviral therapy including nirmatrelvir plus ritonavir and molnupiravir in managing COVID-19 among individuals with pre-existing lung cancer was unclear. Therefore, this study was conducted to evaluate the usefulness of antiviral agents in the management of COVID-19 among patients with lung cancer. Utilizing data from the TriNetX – a global health research network, a retrospective cohort study was conducted involving 2484 patients diagnosed with both lung cancer and COVID-19. Propensity score matching (PSM) was employed to create well-balanced cohorts. The study assessed the primary outcome of all-cause hospitalization or mortality within a 30-day follow-up. After PSM, the oral antiviral group exhibited a significantly lower risk of the primary composite outcome compared to the control group (6.1 % vs. 9.9 %; HR: 0.60; 95 % CI: 0.45–0.80). This association was consistent across various subgroups according to age, sex, vaccine status, type of oral antiviral agent, and lung cancer characteristics. Additionally, the oral antiviral group showed a lower risk of all-cause hospitalization (HR: 0.73; 95 % CI: 0.54–0.99) and a significantly lower risk of mortality (HR: 0.16; 95 % CI: 0.06–0.41). The study suggests a favorable impact of oral antiviral therapy on the outcomes of COVID-19 in individuals with lung cancer and support the potential utility of oral antiviral agents in improving outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

• This study investigated the association between nirmatrelvir plus ritonavir (NMV-r) and the outcomes of non-hospitalized obese patients with coronavirus disease 2019 (COVID-19). • The NMV-r group had a lower risk of all-cause emergency department (ED) visits, hospitalization or death [4.80% (n =1489) vs 5.50% (n =1705); hazard ratio (HR) 0.900, 95% confidence interval (CI) 0.839–0.965)] compared with the control group. • Compared with the control group, the NMV-r group had a lower risk of all-cause ED visits (HR 0.812, 95% CI 0.740–0.891) and all-cause mortality (HR 0.089, 95% CI 0.027–0.288). • NMV-r is associated with reduced risk of all-cause ED visits, hospitalization or death for non-hospitalized obese patients with COVID-19. To investigate the association between nirmatrelvir plus ritonavir (NMV-r) and the outcomes of non-hospitalized obese patients with coronavirus disease 2019 (COVID-19). This retrospective cohort study used the TriNetX research network to identify non-hospitalized obese adult patients with COVID-19 between 1 January 2022 and 30 June 2023. Propensity score matching was used to match patients receiving NMV-r (NMV-r group) with those not receiving NMV-r (control group). The primary outcome was the compositive outcome of all-cause emergency department (ED) visits, hospitalization or death during the 30-day follow-up period. Using propensity score matching methods, two cohorts of 30,969 patients each with balanced baseline characteristics were identified. During the follow-up period, the NMV-r group had a lower risk of all-cause ED visits, hospitalization or death [4.80% (n =1489) vs 5.50% (n =1705); hazard ratio (HR) 0.900, 95% confidence interval (CI) 0.839–0.965]. Compared with the control group, the NMV-r group had a lower risk of all-cause ED visits (HR 0.812, 95% CI 0.740–0.891) and all-cause mortality (HR 0.089, 95% CI 0.027–0.288). The lower risk in the NMV-r group compared with the control group was observed consistently in most subgroup analyses according to body mass index (30.0–34.9 kg/m2: HR 0.68, 95% CI 0.55–0.82; 35.0–39.9 kg/m2: HR 0.67, 95% CI 0.52–0.87), age (4–64 years: HR 0.83, 95% CI 0.75–0.92; ≥65 years: HR 0.88, 95% CI 0.79–0.98), sex (men: HR 0.69, 95% CI 0.60–0.79; women: HR 0.69, 95% CI 0.63–0.76) and vaccination status (unvaccinated: HR 0.75, 95% CI 0.70–0.81). NMV-r is associated with reduced risk of all-cause ED visits, hospitalization and death for non-hospitalized obese patients with COVID-19. Accordingly, these findings support the use of NMV-r in obese patients. [ABSTRACT FROM AUTHOR]

This meta-analysis aimed to compare the risk of brain swelling during craniotomy between propofol-based and volatile-based anesthesia. Meta-analysis of randomized controlled trials (RCTs). Operating room. Propofol-based anesthesia. Adult patients undergoing craniotomy. Databases, including EMBASE, MEDLINE, Google Scholar, and Cochrane Library, were searched from inception to April 2023. The primary outcome was the risk of brain swelling, while the secondary outcomes included the impact of anesthetic regimens on surgical and recovery outcomes, as well as the risk of hemodynamic instability. Our meta-analysis of 17 RCTs showed a significantly lower risk of brain swelling (risk ratio [RR]: 0.85, p = 0.03, I2 = 21%, n = 1976) in patients receiving propofol than in those using volatile agents, without significant differences in surgical time or blood loss between the two groups. Moreover, propofol was associated with a lower intracranial pressure (ICP) (mean difference: −4.06 mmHg, p < 0.00001, I2 = 44%, n = 409) as well as a lower risk of tachycardia (RR = 0.54, p = 0.005, I2 = 0%, n = 822) and postoperative nausea/vomiting (PONV) (RR = 0.59, p = 0.002, I2 = 19%, n = 1382). There were no significant differences in other recovery outcomes (e.g., extubation time), risk of bradycardia, hypertension, or hypotension between the two groups. Subgroup analysis indicated that propofol was not associated with a reduced risk of brain swelling when compared to individual volatile agents. Stratified by craniotomy indications, propofol reduced brain swelling in elective craniotomy, but not in emergency craniotomy (e.g., traumatic brain injury), when compared to volatile anesthetics. By reviewing the available evidence, our results demonstrate the beneficial effects of propofol on the risk of brain swelling, ICP, PONV, and intraoperative tachycardia. In emergency craniotomy for traumatic brain injury and subarachnoid hemorrhage, brain swelling showed no significant difference between propofol and volatile agents. Further large-scale studies are warranted for verification. • Analysis showed a lower brain swelling (BS) risk with propofol than volatile agents. • Propofol correlated with a lower intracranial pressure and risk of nausea/vomiting. • Propofol was also linked to a lower risk of intraoperative tachycardia. • Propofol lowered BS in elective craniotomy versus volatile anesthetics. • Propofol didn't reduce BS in emergency craniotomy vs. volatile anesthetics. [ABSTRACT FROM AUTHOR]