Objectives: This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS). Methods: Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS. Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value. Meta-analysis was conducted using RStudio's "meta" package with a random-effects model. Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates. Results: Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis. The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%). Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively. Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean (P = 0.02). The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS. Conclusion: Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.

Background: Iatrogenic hyponatremia is a common complication following intravenous maintenance fluid therapy (IV-MFT) in hospitalized children. Despite the American Academy of Pediatrics' 2018 recommendations, IV-MFT prescribing practices still vary considerably. Objectives: This meta-analysis aimed to compare the safety and efficacy of isotonic versus hypotonic IV-MFT in hospitalized children. Data sources: We searched PubMed, Scopus, Web of Science, and Cochrane Central from inception to October 1, 2022. Study eligibility criteria: We included randomized controlled trials (RCTs) comparing isotonic versus hypotonic IV-MFT in hospitalized children, either with medical or surgical conditions. Our primary outcome was hyponatremia following IV-MFT. Secondary outcomes included hypernatremia, serum sodium, serum potassium, serum osmolarity, blood pH, blood sugar, serum creatinine, serum chloride, urinary sodium, length of hospital stay, and adverse outcomes. Study appraisal and synthesis methods: Random-effects models were used to pool the extracted data. We performed our analysis based on the duration of fluid administration (i.e., ≤ 24 and > 24 h). The Grades of Recommendations Assessment Development and Evaluation (GRADE) scale was used to evaluate the strength and level of evidence for recommendations. Results: A total of 33 RCTs, comprising 5049 patients were included. Isotonic IV-MFT significantly reduced the risk of mild hyponatremia at both ≤ 24 h (RR = 0.38, 95% CI [0.30, 0.48], P < 0.00001; high quality of evidence) and > 24 h (RR = 0.47, 95% CI [0.37, 0.62], P < 0.00001; high quality of evidence). This protective effect of isotonic fluid was maintained in most examined subgroups. Isotonic IV-MFT significantly increased the risk of hypernatremia in neonates (RR = 3.74, 95% CI [1.42, 9.85], P = 0.008). In addition, it significantly increased serum creatinine at ≤ 24 h (MD = 0.89, 95% CI [0.84, 0.94], P < 0.00001) and decreased blood pH (MD = –0.05, 95% CI [–0.08 to –0.02], P = 0.0006). Mean serum sodium, serum osmolarity, and serum chloride were lower in the hypotonic group at ≤ 24 h. The two fluids were comparable in terms of serum potassium, length of hospital stay, blood sugar, and the risk of adverse outcomes. Limitations: The main limitation of our study was the heterogeneity of the included studies. Conclusions and implications of key findings: Isotonic IV-MFT was superior to the hypotonic one in reducing the risk of iatrogenic hyponatremia in hospitalized children. However, it increases the risk of hypernatremia in neonates and may lead to renal dysfunction. Given that the risk of hypernatremia is not important even in the neonates, we propose to use balanced isotonic IV-MFT in hospitalized children as it is better tolerated by the kidneys than 0.9% saline. Systematic review registration number: CRD42022372359.

Objectives: We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes. Materials and methods: We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the “meta” package of RStudio software. Results: We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes. Conclusions: Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.

This study aimed to assess the perception of COVID-19 risk and the adherence to protective measures among medical students after vaccination. We conducted a cross-sectional survey on a convenience sample of students from all the 18 governmental medical schools in Egypt. A total of 2273 students participated in the online self-administered questionnaire. Around 8 in 10 (83.2%) students were fully vaccinated, of which 17.9% received the booster dose. Only 36.9% believed that COVID-19 is serious on the individual level. The majority (73.9%) strongly or slightly agreed they may become infected after vaccination if they do not follow the preventive measures. We observed a slow decline in the perceived risk of vulnerability and susceptibility to COVID-19 infection among students in parallel to a growing perception of self-efficacy and controllability. Less than one-third (28.9%) of students showed good adherence to protective measures. However, this was lower than the previously reported adherence in the same population before vaccination. Female students, those in the first academic year, those who did not contract COVID-19 infection before, and those with a higher perception of susceptibility and perceived controllability were more likely to perform better at protective measures.

Background: Episiotomy, although occasionally required during labor, can result in postpartum discomfort, perineal trauma, and delayed healing. This study offers a comprehensive comparison of the safety and effectiveness of routine, restrictive, and non-episiotomy approaches on maternal and neonatal outcomes. Methods: We systematically searched PubMed, Web of Science, Scopus, and Cochrane. We included randomized clinical trials (RCTs), comparing routine, restrictive, and non-episiotomy approaches in primiparous pregnant women. We excluded non-randomized trials, conference abstracts, and observational studies. The Cochrane ROB tool 2 was employed to appraise the selected RCTs. We conducted our analysis using the “netmeta” package of RStudio software (v.4.3.0). Dichotomous outcomes were pooled as risk ratios (RR), while continuous outcomes were pooled as the mean differences (MD). We used the random effect model for all outcomes. Results: Sixteen studies, involving 10,738 patients, were included in the network meta-analysis. The findings revealed that the non-episiotomy group had a significantly higher risk of experiencing 1st-degree perineal tear compared to the routine episiotomy group (RR = 4.69, 95% CI [2.04; 10.74], P > 0.01). Similarly, the restrictive episiotomy group showed a significantly higher risk compared to the routine group (RR = 3.88, 95% CI [1.63; 9.26], P > 0.01). However, there were no significant differences observed between the routine, restrictive, and non-episiotomy groups regarding the duration of the 2nd stage of labor, postpartum perineal pain, and the occurrence of 2nd-, 3rd-, and 4th-degree perineal tears. Conclusion: In conclusion, non-episiotomy approaches prove superior, with lower risks of complications compared to routine episiotomy. While restrictive episiotomy performs better than routine, it falls short of non-episiotomy methods. Therefore, non-episiotomy strategies are preferred, followed by restrictive episiotomy, with routine episiotomy being the least favorable. However, individual patient factors should guide treatment decisions, and further research is necessary to refine clinical practices.