Ahella Ismail A. Mousa

BACKGROUND: The ideal timing for complete revascularization (CR) in patients with ST-segment–elevation myocardial infarction and multivessel disease is uncertain. This meta-analysis examined outcomes of immediate CR (ICR) versus staged CR (SCR). METHODS: Four databases were searched for randomized controlled trials that compared ICR and SCR in ST-segment–elevation myocardial infarction and multivessel disease. The primary end points of interest were short-term and long-term all-cause mortality. Outcomes are presented as risk ratios for short-term outcomes and incidence rate ratios for long-term outcomes with 95% CIs. RESULTS: The analysis included 9 randomized controlled trials in which 4213 patients were enrolled. Short-term all-cause mortality occurred in 2.0% of patients after ICR compared with 1.2% of patients after SCR (risk ratio, 1.66 [95% CI, 0.99–2.78], P =0.053; I ² =0%). Short-term cardiac death was increased after ICR (risk ratio, 2.19 [95% CI, 1.08–4.44], P =0.03; I ² =0%). At a median 1-year follow-up, all-cause mortality occurred in 4.7% of patients after ICR compared with 3.5% of patients after SCR (incidence rate ratio, 1.40 [95% CI, 0.97–2.03], P =0.07; I ² =0%). No significant differences were identified between the ICR and SCR strategies at either short-term or long-term follow-up for other outcomes, including myocardial infarction, repeat revascularization, stent thrombosis, stroke, major bleeding, and the composite of major adverse cardiac or cerebrovascular events. CONCLUSIONS: In hemodynamically stable patients with ST-segment–elevation myocardial infarction and multivessel disease, an ICR strategy may increase short-term cardiac death compared with SCR, and the possibility of increased early and late all-cause mortality cannot be excluded. Despite some uncertainty, these results currently favor a staged CR strategy for most patients with ST-segment–elevation myocardial infarction and multivessel disease. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD420251163719.

Introduction: Upadacitinib, a selective JAK1 inhibitor, has demonstrated promising results in the treatment of axial Spondyloarthritis (AxSpA). AxSpA management remains challenging since there is a gap in knowledge regarding the potential effect of upadacitinib in axSpA patients. Exploring novel therapeutic options is crucial. Therefore, we performed this systematic review and meta-analysis to summarize and synthesize results collected from available randomized-- controlled trials (RCTs) about the efficacy and safety of upadacitinib for patients with axSpA. Methods: A systematic literature search of Medline via PubMed, Web of Science, Scopus, EBSCO, and Cochrane Central was conducted in October 2023. Relevant RCTs were selected, and their data were extracted and analyzed using the RevMan 5.4 software. The main outcomes were assessment in Spondylarthritis International Society (ASAS) 20, ASAS40, SPARCC MRI sacroiliac joint, and Bath Ankylosing Spondylitis disease activity index (BASDAI) 50. Results: Three RCTs with a total of 920 participants were included in this study. Upadacitinib showed significant improvement in the ASAS40 response, ASAS20 response, BASDAI50 response, and SPARCC MRI Sacroiliac Joint change from baseline compared to placebo at 14-week duration (RR 2.19, 95% CI (1.79 to 2.68), P < 0.00001), (RR 1.62, 95% CI [1.42 to 1.84), P < 0.00001), (RR 2.16, 95% CI (1.75 to 2.67), P < 0.00001), and (MD -3.32 points, 95% CI (-3.96 to -2.68), P < 0.00001) respectively. However, this efficacy decreased after the 52-week duration in terms of ASAS40 RR 2.19 vs. 1.02, ASAS20 RR 1.62 vs. 0.98, BASDAI 50 RR 2.16 vs. 1.05, and ASAS Partial Remission RR 3.82 vs. 1.07. Conclusion: Upadacitinib 15 mg showed satisfactory and promising efficacy in the treatment of AxSpA, with no difference in safety profile compared to the placebo.

Alzheimer's disease (AD) is the most common neurodegenerative disorder. A key factor in its pathogenesis is the dysfunction of the N-methyl-D-aspartate (NMDA) receptor due to D-serine degradation by D-amino acid oxidase. Benzoate has been suggested to enhance NMDA receptor function, potentially benefiting early-phase AD. This study aimed to synthesize evidence from randomized clinical trials (RCTs) on the safety and efficacy of sodium benzoate in AD patients. We followed PRISMA statement guidelines during the accommodation of this systematic review and meta-analysis. A computer literature search (PubMed, Scopus, Web of Science, and Cochrane Central) was conducted. We included RCTs that compared sodium benzoate with placebo regarding cognitive functions. The primary outcome measure was the Alzheimer's disease assessment scale-cognitive subscale, pooled as the mean difference between the two groups from baseline to the endpoint. The secondary outcomes measures are the clinician's interview-based impression of change plus caregiver input, catalase, and superoxide dismutase antioxidants. Three RCTs (described in four articles) with 306 patients were included in this study. Sodium benzoate significantly improved the ADAS-cog score compared with placebo (MD -2.13 points, 95% CI [-3.35 to -0.90]; P= 0.0007). Sodium benzoate is a safe drug that may improve cognitive function in patients with early-stage Alzheimer's disease. However, the significant effect arises primarily from one small study, highlighting the need for caution in interpretation. Further research with larger sample sizes and longer durations is necessary to validate these findings and assess safety and efficacy.