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Introduction: Mechanical thrombectomy (MT) is the gold standard for large vessel occlusion (LVO) strokes. The current guidelines state that LVO patients who are eligible for intravenous thrombolysis (IVT) and MT should receive both treatments. However, a few trials investigated the benefits and safety of combining MT with IVT. We conducted this meta-analysis to provide collective evidence on the efficacy and safety of IVT+MT, and to estimate the risk of complications of this approach as compared to MT alone. Methods: We performed a comprehensive literature search of 4 databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL). For outcomes with continuous data, the mean difference (MD) between both groups from the baseline to the endpoint, with its standard deviation (SD), were pooled in the DerSimonian-Laird (DL) random-effect model. For studies reporting data in multiple time points, we considered the last endpoint for the primary analysis. For outcomes with dichotomous data, the frequency of events and the total number of patients in each group were pooled as relative risk (RR) between both groups in the DL random-effect model. All statistical analyses were done by RevMan. Results: 7 clinical trials were included in the meta-analysis with a total of 2,317 patients. There were no significant differences between both groups in terms of functional independence (90-day mRS score 0-2: RR 1.03, 95% CI [0.90 to 1.19], P=0.65), successful recanalization (TICI score ≥2b: RR 1.04, 95% CI [0.92 to 1.17], P=0.53), complete recanalization (TICI score 3: RR 1.06, 95% CI [0.86 to 1.30], P=0.60), or mortality (RR 0.94, 95% CI [0.76 to 1.18], P=0.61). Regarding complications, there were no significant differences between both groups in terms of symptomatic intracranial hemorrhage (RR 0.94, 95% CI [0.74 to 1.20], P=0.64), or any intracranial hemorrhage (RR 1.12, 95% CI [0.94 to 1.34], P=0.57). Conclusion: Our results did not favor either IVT+MT or MT alone in terms of clinical outcomes and complications. However, more trials are needed to further compare both approaches and to evaluate the impact of certain factors on this comparison such as MT technique (Stent Retriever versus Aspiration), LVO location, and the used thrombolytic agent (Alteplase versus Tenecteplase).

BackgroundDiabetic Muslims who choose to fast during Ramadan encounter major risks such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, and dehydration. Recently, newer antidiabetic agents have been found to be less likely to cause hypoglycemic emergencies. This meta-analysis aimed to present collective and conclusive results from major randomized controlled trials (RCTs) to determine the risk of hypoglycemia among patients taking oral antidiabetics during Ramadan.MethodsWe searched PubMed, Web of Science, and Google Scholar for RCTs. We performed a frequentist network meta-analysis using the “netmeta” package of R software version 4.1.1 to investigate the risk of developing hypoglycemia after taking oral antidiabetic drugs during Ramadan.ResultsNine RCTs with a total of 3464 patients were included in the final analysis. In the comparison of all antidiabetic drug classes with sulfonylureas, SGLT-2 inhibitors were associated with the lowest hypoglycemic risk (RR, 0.18; 95% CI, 0.04-0.78; P-score, 0.909), followed by GLP-1 agonists (RR, 0.31; 95% CI, 0.17-0.56; P-score, 0.799), and DDP-4 inhibitors (RR, 0.57; 95% CI, 0.43-0.75; P-score, 0.483). When comparing individual drugs, dapagliflozin was associated with the lowest hypoglycemic risk (RR, 0.18; 95% CI, 0.04-0.78; P-score, 0.874), followed by lixisenatide (RR, 0.25; 95% CI, 0.09-0.71; P-score, 0.813), liraglutide (RR, 0.34; 95% CI, 0.17-0.69; P-score, 0.715), and sitagliptin (RR. 0.51; 95% CI, 0.37-0.71; P-score, 0.515).ConclusionSGLT-2 inhibitors are associated with the least documented hypoglycemic events and adverse outcomes compared with other oral hypoglycemic drugs. These findings could have considerable public health and clinical implications when extrapolated to the global Muslim population with a similar clinical background.Abstract Figure

A Rare Coincidence of Turner syndrome and Bronchiectasis: Case Report

We report a rare case of a 50-year-old female with covid19 presented to the emergency department where supplementary oxygen is delivered via non-invasive face mask ventilation. x-ray imaging performed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the paient.