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Introduction Adherence to COPD management strategies is complex, and it is unclear which intervention may enhance it. Objectives We aim to evaluate the effectiveness of adherence-enhancing interventions, alone or compared to interventions, for patients with COPD. Methods This review comprises a component network meta-analysis with a structured narrative synthesis. We searched MEDLINE, Embase, CENTRAL, CINAHL and trial registries on 9 September 2023. We included controlled studies that explored adherence in patients with COPD. Two review authors independently performed the study selection, data extraction and the risk of bias assessment. We involved patients with COPD in developing this systematic review through focus group interviews and displayed the findings in pre-designed logic models. Results We included 33 studies with 5775 participants. We included 13 studies in the component network meta-analysis that explored adherence. It was mainly assessed through questionnaires. As a continuous outcome, there was a tendency mainly for education (standardised mean difference 1.26, 95% CI 1.13–1.38, very low certainty of evidence) and motivation (mean difference 1.85, 95% CI 1.19–2.50, very low certainty of evidence) to improve adherence. As a dichotomous outcome (e.g. adherent/non-adherent), we found a possible benefit with education (odds ratio 4.77, 95% CI 2.25–10.14, low certainty of evidence) but not with the other components. We included six studies that reported quality of life in the component network meta-analysis. Again, we found a benefit of education (mean difference −9.70, 95% CI −10.82– −8.57, low certainty of evidence) but not with the other components. Conclusions Education may improve adherence and quality of life in COPD patients. Patient focus group interviews indicated that interventions that strengthen patients’ self-efficacy and help them to achieve individual goals are the most helpful.

Abstract Liver serves as a hub for key metabolic pathways such as folate cycle that provides one-carbon units for a network of metabolic reactions. Methylenetetrahydrofolate reductase (MTHFR) is a rate limiting enzyme in folate metabolism and thus it is vital for DNA methylation, synthesis and repair [1]. The objective of this study was to evaluate an eventual association between MTHFR polymorphisms C677T (rs1801133) and A1298C (rs1801131) and the susceptibility to hepatocellular carcinoma (HCC) in Egyptian population. Blood samples from patients and controls from Mansoura university hospital were used after signed consent and approval from Medical ethical committee. The two genetic loci were designed for amplification and genotyped by using PCR–RFLP. Our results clarify that, the most important predictors for HCC are T/T genotype of variant C677T and C/C genotype of variant (A1298C) with odds ratio 3.28 and 2.99 respectively. Also, MTHFR variant C677T genotype C/C or T/T combined with MTHFR variant A1298C genotype C/C were associated with an increased risk of HCC, with the OR, 2.6 and 7 respectively. CT genotype of MTHFR variant C677T showed significant difference between HCC grades and C allele of variant C677T showed significant difference in BCLC stages of HCC. Our data indicates that, the two variants (C677T and A1298C) constitute a risk factor for the development of HCC and this could be attributed to the low activities of the enzyme MTHFR that disturb one carbon metabolism and subsequently, DNA synthesis, repair and methylation, thus cellular redox state, growth, and proliferation.

Abstract Background Chronic obstructive pulmonary disease (COPD) is characterised by hyperinflation and expiratory airflow limitation due to long-term exposure to irritants. The variety and complexity of COPD treatment and the possible added comorbidities may make the patients find it difficult to cope with the required medications. That is why supporting patients’ adherence is critical because not taking medications correctly increases the risk of complications and creates an additional financial burden. A range of interventions aiming to improve patient adherence were used, and most of them are complex since they involve a mix of elements. Furthermore, despite the variety of available tools, assessing adherence is challenging because clinicians usually do not get a concrete judgement if their patients followed their treatment plan reliably. We aim to evaluate the effectiveness of adherence-enhancing interventions for COPD patients, explore which intervention (component) works for which patients and check the factors influencing the implementation and participant responses. Methods We will perform a comprehensive literature search (Medline, Embase, Cochrane Library, trial registries) without restrictions on language and publication status, and we will include all controlled studies investigating the effect of adherence-enhancing intervention on patients with COPD. We plan to involve COPD patients in the systematic review development through two patient interviews (one before and one after the systematic review). Two reviewers will perform the screening, data extraction and risk of bias (ROB) assessment. For ROB, we will use ROB 2.0 to assess randomised controlled trials, and ROBINS-I to assess non-randomised studies. We will perform pair-wise random-effects meta-analyses and component network meta-analyses to identify the most effective components and combinations of components. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. To determine the degree of complexity, we will use the iCAT_SR checklist, and then, following a logical model, we will group the interventions according to prespecified criteria. Discussion This systematic review aims to point out the most effective and implementable adherence-enhancing interventions by using methods for synthesising evidence on complex interventions and involving COPD patients all along with the review process. Systematic review registration PROSPERO CRD42022353977

Résumé Contexte Les effets possibles des vaccins contre la COVID-19 sur la santé reproductive et la fertilité masculine, en particulier, ont fait l’objet d’intenses discussions de la part de la communauté scientifique et du public depuis leur introduction pendant la pandémie. Sur les médias et les plateformes de médias sociaux, de nombreuses allégations ont été soulevées concernant les effets délétères des vaccins contre la COVID-19 sur la qualité du sperme, sans preuves scientifiques. En réponse à ce conflit émergent, nous avons conçu cette étude pour évaluer et déterminer l’effet du vaccin COVID-19 à ARNm de Pfizer-BioNTech sur la fertilité masculine représentée par les paramètres d’analyse du sperme. Résultats En comparant les paramètres du sperme des participants avant et après la vaccination, aucun effet statistiquement significatif sur le volume de sperme, le pH ou la concentration normale et la morphologie de spermatozoïdes, n’a été montré. Cependant, il y avait des différences statistiquement significatives sur la mobilité totale des spermatozoïdes (P = 0,05) et sur leur mobilité progressive (P = 0,02). Ces différences sont cliniquement insignifiantes étant donné que les deux lectures avant et après la vaccination se situaient dans des fourchettes normales, selon les directives manuelles de l’OMS pour l’examen et le traitement du sperme humain. Conclusion Nos données indiquent que le vaccin à ARNm COVID-19 de Pfizer-BioNTech n’a aucun effet délétère sur les paramètres du sperme. Mots-Clés COVID-19, Analyse du Sperme, Vaccin COVID-19 à ARNm de Pfizer-BioNTech, Infertilité masculine

Objectives/hypothesis: To evaluate the potential of a minimally invasive transoral-transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs)., Study Design: Cadaver study., Methods: Five cadaveric specimens were dissected raising an inverted U-shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross-court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared., Results: Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm 2 vs. 312.76 mm 2 , P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm 3 vs. 138.91 mm 3 , P < .005). MITA also offered greater angles of approach for all targets., Conclusions: This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA., Level of Evidence: NA Laryngoscope, 129:339-343, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Severe community-acquired pneumonia (SCAP) represents a frequent and potentially life-threatening condition. About 10% of all hospitalized patients with CAP require admission to the intensive care unit (ICU), and the mortality of these patients reaches 20-50%., Objective: To evaluate the clinical presentation, bacteriological profile and outcome of severe community-acquired pneumonia (SCAP)., Patients and Methods: 54 patients presented by symptoms and sign of severe community acquired pneumonia who were admitted to respiratory care unit of Alhussein, Al-Azhar University Hospital from August 2015 to March 2016 were subjected to full clinical examination, chest X ray, complete blood picture, sputum and blood culture, PCR for suspected cases of Influenza H1N1 and MERS-COV, treatment, follow up, data collections and statistical analysis., Results: The present study included 54 patients 26 males and 28 females with SCAP who were admitted to respiratory care unit of Alhussein, Al-Azhar University Hospital. The most common comorbidities were diabetes mellitus and hypertension. The most common presentations were fever, cough, dyspnea and hypoxemia. Two patients developed renal failure and 4 patients developed septic shock. The most common isolated organism was Streptococcus pneumoniae , Influenza H1N1, and Staphylococcus aureus . Mortality was 24% and it was common in patients with comorbidity than in patients without comorbidities., Conclusion: SCAP occurs more frequently in those with comorbidities. The most frequent isolated causative organism of SCAP is S. pneumoniae , Influenza H1N1 and S. aureus . SCAP is associated with significant mortality, early recognition and prompt treatment may improve outcome., (© 2016 The Egyptian Society of Chest Diseases and Tuberculosis. Production and hosting by Elsevier B.V.)