Péter Fehérvári

Introduction: The respiratory microbiome has a vital role in maintaining respiratory health and preventing pathogen colonisation, but traditional diagnostic methods fail to capture a complete picture of it. Metagenomic sequencing has improved our understanding of microbial ecosystems in both acute and chronic pathologies. However, its results have not been systematically compared between different respiratory sampling techniques, as has been done with traditional methods. Our study aims to compare the microbial diversity in bronchoalveolar lavage (BAL) and tracheal samples using microbiome sequencing. Methods: A systematic search was conducted in Medline, Embase and CENTRAL databases to identify studies where lower respiratory tract microbiome specimens were collected simultaneously using BAL and tracheal sampling and diversity was analysed postsequencing. Risk of bias was assessed with our specifically tailored tool. A random-effects model was used for data synthesis, analysing pooled Shannon, Chao1 and Simpson indices. Results: We screened 1050 potentially relevant publications, 10 of which were included. No significant difference was found in microbial alpha diversity between BAL and tracheal samples. The subgroup analysis of tracheal sample types, including sputum and endotracheal aspirate, revealed no significant differences compared with BAL. Conclusions: Tracheal sampling methods offer a viable and less invasive alternative to BAL for characterising microbiome alpha diversity in clinical or research settings where segmental sampling is not required. However, further high-quality comparative studies are needed to confirm these findings. PROSPERO registration number: CRD42023436934.

Background: Nausea and vomiting frequently occur during postoperative recovery, chemotherapy, and pregnancy. While peppermint oil is traditionally used to relieve these symptoms, its efficacy remains uncertain. This systematic review and meta-analysis evaluates the efficacy of peppermint oil inhalation for postoperative (PONV), chemotherapy-induced (CINV), and pregnancy-related nausea and vomiting (NVP). Methods: Following PRISMA guidelines, we searched five databases (Scopus, Embase, the Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science) in November 2022, with an update in December 2024. Randomised controlled trials were included, comparing peppermint oil inhalation to a control in patients with PONV, CINV, and NVP. Separate meta-analyses were conducted for each patient group using R, focusing on the severity of the nausea and vomiting. Results: Nineteen RCTs were included. In three PONV studies, peppermint oil inhalation was associated with a reduction in nausea 2 to 6 h after the intervention (MD: −0.60 points, 95% confidence interval (CI): −0.77 to −0.44, p = 0.004). In three NVP studies, daily peppermint oil treatment was linked to lower symptom severity at 48 h (MD: −0.51, 95% CI: −0.78 to −0.24, p = 0.015) and 96 h (MD: −0.68, 95% CI: −1.09 to −0.27, p = 0.019). In three CINV studies, peppermint oil inhalation appeared to reduce symptoms at all time points, with the most notable reduction at 48 h (MD: −2.23, 95% CI: −3.13 to −1.34, p < 0.001) and 72 h (MD: −2.41, 95% CI: −3.96 to −0.86, p = 0.010). Conclusions: Peppermint oil inhalation may be a promising complementary therapy for reducing nausea and vomiting in postoperative, chemotherapy, and pregnancy settings.

Immune‐mediated inflammatory disease (IMID) patients including psoriasis, inflammatory arthritides and bowel diseases have a higher risk of developing cardiovascular (CV) diseases compared to the general population. The increased CV risk may be promoted by tumour necrosis factor (TNF)‐α‐mediated immunological processes, which are present both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional therapies in IMIDs. The systematic literature search was conducted in three databases (MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials, cohort and case–control studies were eligible for inclusion. Outcomes consisted of the incidence of CV events, with major adverse cardiovascular events (MACE) as a main endpoint. A random‐effects meta‐analysis was performed by pooling fully adjusted multivariate hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval (CI) comparing TNFis with conventional systemic non‐biologicals (CSNBs). Of a total of 8724 search results, 56 studies were included overall, of which 29 articles were eligible for the meta‐analysis, and 27 were involved in the systematic review. Including all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58–0.95, p = 0.025; IRR = 0.77, 95% CI 0.67–0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling IRRs also confirmed the significantly decreased risk of MACE in TNFi‐treated patients compared with CSNB groups (IRR = 0.79, 95% CI 0.64–0.98). The observational nature of most included studies leading to high heterogeneity represents a limitation. Based on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore, earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence may benefit CV risk in IMID patients.

In endometrial cancer (EC), deep myometrial invasion (DMI) is a prognostic factor that can be evaluated by various imaging methods; however, the best method of choice is uncertain. We aimed to compare the diagnostic performance of two-dimensional transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the preoperative detection of DMI in patients with EC. Pubmed, Embase and Cochrane Library were systematically searched in May 2023. We included original articles that compared TVS to MRI on the same cohort of patients, with final histopathological confirmation of DMI as reference standard. Several subgroup analyses were performed. Eighteen studies comprising 1548 patients were included. Pooled sensitivity and specificity were 76.6% (95% confidence interval (CI), 70.9–81.4%) and 87.4% (95% CI, 80.6–92%) for TVS. The corresponding values for MRI were 81.1% (95% CI, 74.9–85.9%) and 83.8% (95% CI, 79.2–87.5%). No significant difference was observed (sensitivity: p = 0.116, specificity: p = 0.707). A non-significant difference between TVS and MRI was observed when no-myometrium infiltration vs. myometrium infiltration was considered. However, when only low-grade EC patients were evaluated, the specificity of MRI was significantly better (p = 0.044). Both TVS and MRI demonstrated comparable sensitivity and specificity. Further studies are needed to assess the presence of myometrium infiltration in patients with fertility-sparing wishes.

This study aimed to investigate the impact of cardiac resynchronization therapy with a defibrillator (CRT-D) on mortality, comparing it with CRT with a pacemaker (CRT-P). Additionally, the study sought to identify subgroups, evaluate the time trend in treatment effects, and analyze patient characteristics, considering the changing indications over the past decades. PubMed, CENTRAL, and Embase up to October 2021 were screened for studies comparing CRT-P and CRT-D, focusing on mortality. Altogether 26 observational studies were selected comprising 128 030 CRT patients, including 55 469 with CRT-P and 72 561 with CRT-D device. Cardiac resynchronization therapy with defibrillator was able to reduce all-cause mortality by almost 20% over CRT-P [adjusted hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.76–0.94; P < 0.01] even in propensity-matched studies (HR: 0.83; 95% CI: 0.80–0.87; P < 0.001) but not in those with non-ischaemic aetiology (HR: 0.95; 95% CI: 0.79–1.15; P = 0.19) or over 75 years (HR: 1.08; 95% CI 0.96–1.21; P = 0.17). When treatment effect on mortality was investigated by the median year of inclusion, there was a difference between studies released before 2015 and those thereafter. Time-trend effects could be also observed in patients’ characteristics: CRT-P candidates were getting older and the prevalence of ischaemic aetiology was increasing over time. The results of this systematic review of observational studies, mostly retrospective with meta-analysis, suggest that patients with CRT-D had a lower risk of mortality compared with CRT-P. However, subgroups could be identified, where CRT-D was not superior such as non-ischaemic and older patients. An improved treatment effect of CRT-D on mortality could be observed between the early and late studies partly related to the changed characteristics of CRT candidates.

Currently, there is no specific pharmaceutical agent for treating acute pancreatitis (AP). Somatostatin and its analogues have been used to prevent the autolysis of the pancreas in AP, however, their effectiveness has not been confirmed. This investigation aimed to examine the efficacy of ulinastatin, a protease inhibitor, combined with somatostatin analogues in the treatment of AP. We conducted a systematic database search in 4 databases to identify randomized controlled trials in which the efficacy of ulinastatin in combination with somatostatin analogue was compared to somatostatin analogue alone in patients with AP. Since the patient populations of analysed papers were slightly different, we used random effect models to pool odds ratios (OR) and mean differences (MD) and the corresponding 95% confidence intervals (CI). A total of 9 articles comprising 1037 patients were included in the meta-analysis. The combination therapy significantly reduced the complication rates for acute respiratory distress syndrome, acute kidney injury, and multiple organ dysfunction. Symptoms were relieved threefold with the combination therapy compared to somatostatin alone, and combination therapy significantly shortened the length of hospital stay. The decrease in mortality was not statistically significant.

Ornithological studies often rely on large temporal scale ringing datasets as source of information. However, basic descriptive statistics of collected data are rarely provided. In order to fill this gap, here we present the second item of a series of exploratory analyses of migration timing and body size measurements of the most frequent Passerine species at a ringing station located in Central Hungary (1984–2015). First, we give a concise description of foreign ring recoveries of the Dunnock in relation to Hungary. We then shift focus to data of 11,617 individuals deriving from the ringing station, where birds have been trapped, handled and ringed with standardized methodology since 1984. Timing is described through annual and daily capture and recapture frequencies and their descriptive statistics. We show annual mean arrival dates within the study period and we present the cumulative distribution of first captures with stopover durations. We present the distributions of wing, third primary, tail length and body mass, and the annual means of these variables. Furthermore, we show the distribution of individual fat and muscle scores, and the distribution of body mass within each fat score category. We distinguish migration periods (spring and autumn), and age groups (i.e. juveniles and adults). Our aim is to provide a comprehensive overview of the analysed variables. However, we do not aim to interpret the obtained results, merely draw attention to interesting patterns, that may be worth exploring in detail. Data used here are available upon request for further analyses.