Objectives: This systematic review with meta-analyses of randomised trials evaluated the preventive effects of vitamin A supplements versus placebo or no intervention on clinically important outcomes, in people of any age. Methods: We searched different electronic databases and other resources for randomised clinical trials that had compared vitamin A supplements versus placebo or no intervention (last search 16 April 2024). We used Cochrane methodology. We used the random-effects model to calculate risk ratios (RRs), with 95% CIs. We analysed individually and cluster randomised trials separately. Our primary outcomes were mortality, adverse events and quality of life. We assessed risks of bias in the trials and used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to assess the certainty of the evidence. Results: We included 120 randomised trials (1 671 672 participants); 105 trials allocated individuals and 15 allocated clusters. 92 trials included children (78 individually; 14 cluster randomised) and 28 adults (27 individually; 1 cluster randomised). 14/105 individually randomised trials (13%) and none of the cluster randomised trials were at overall low risk of bias. Vitamin A did not reduce mortality in individually randomised trials (RR 0.99, 95% CI 0.93 to 1.05; I ^² =32%; p=0.19; 105 trials; moderate certainty), and this effect was not affected by the risk of bias. In individually randomised trials, vitamin A had no effect on mortality in children (RR 0.96, 95% CI 0.88 to 1.04; I ^² =24%; p=0.28; 78 trials, 178 094 participants) nor in adults (RR 1.04, 95% CI 0.97 to 1.13; I ^² =24%; p=0.27; 27 trials, 61 880 participants). Vitamin A reduced mortality in the cluster randomised trials (0.84, 95% CI 0.76 to 0.93; I ^² =66%; p=0.0008; 15 trials, 14 in children and 1 in adults; 364 343 participants; very low certainty). No trial reported serious adverse events or quality of life. Vitamin A slightly increased bulging fontanelle of neonates and infants. We are uncertain whether vitamin A influences blindness under the conditions examined. Conclusions: Based on moderate certainty of evidence, vitamin A had no effect on mortality in the individually randomised trials. Very low certainty evidence obtained from cluster randomised trials suggested a beneficial effect of vitamin A on mortality. If preventive vitamin A programmes are to be continued, supporting evidence should come from randomised trials allocating individuals and assessing patient-meaningful outcomes. PROSPERO registration number: CRD42018104347.

Background: Chronic hepatitis C virus infection presents a substantial global health burden, frequently resulting in severe liver conditions. Hepatitis C virus (HCV) therapy requires complex decision-making. Direct-acting antivirals (DAAs) offer a potential solution by targeting viral proteins to inhibit replication. Understanding DAAs real-world effectiveness and how they impact long-term outcomes beyond clinical trials is essential. We aim to comprehensively evaluate the benefits and harms of DAAs in individuals with chronic HCV infection, reported in observational studies. Methods: We will consider for inclusion prospective and retrospective observational studies with quasirandomised, cohort, case-control, controlled before-and-after, and cross-sectional designs. Our experimental interventions will be any class of DAAs available on the market or in development. DAAs could have been administered alone, in combination, or with other medical co-interventions. Our control interventions will be untreated chronic HCV conditions, with or without placebo. Participants will be adults, regardless of demographics, treatment history, or healthcare setting. Our primary outcomes will be participants experiencing hepatitis C-related morbidity or all-cause mortality, serious adverse events, and health-related quality of life. Secondary outcomes will include all-cause mortality, cirrhosis, variceal bleeding, hepato-renal syndrome, hepatocellular carcinoma, hepatic encephalopathy, non-serious adverse events, liver transplantation, lack of sustained virological response, histological improvement, and decreases in alanine aminotransferase and aspartate aminotransferase levels. We will apply search strategies to search MEDLINE, Embase, Web of Science, grey literature, and trial registers. We will use Covidence ^® to screen the result, including citations. Individual double-data extraction will include study details and outcomes, with independent review authors resolving discrepancies. We will assess bias using the ROBINS-I tool. Meta-analyses will employ random-effects models for both dichotomous and continuous outcomes, assessing heterogeneity. Subgroup and sensitivity analyses will explore effect modifications and address missing data. Trial Sequential Analysis will control type I and type II errors. We will evaluate publication bias using funnel plots and Egger’s regression test and assess certainty of evidence using GRADE. Discussion: The findings will inform clinical decisions and benefit those affected by HCV, healthcare professionals, and policymakers. Systematic review registration: PROSPERO: CRD42023494844

The aim of this study was to determine the developmental characteristics of podocytes in the human fetal metanephros using scanning electron microscopy, light microscopy, and transmission electron microscopy. Kidney samples of 15 human fetuses of both sexes (gestational age 10–22 weeks) were analyzed. At the S-shaped body stage, primitive podocytes were arranged in a layer of cuboidal cells beneath the vascular cleft. When observed from Bowman’s space, the demarcation between adjacent podocytes was not clear, but mild depressions indicated cell boundaries. At the more advanced S-shaped body stage, podocytes were polygonal, with a flat apical surface. They were in close contact, but boundaries between adjacent cells were distinct. After initial separation of their apical parts, podocytes continued to separate from each other along their lateral sides. Their shape changed from polygonal to spherical, resembling clusters of grapes. Cytoplasmic buds could be seen at the base of some podocytes initially, when all podocytes were spherical. Parallel with the development of the first capillary loops, wider intercellular spaces were noted between elliptical-shaped podocytes. Podocytes then developed cytoplasmic processes and became flattened and star shaped. Their cell bodies separated from the glomerular basement membrane through the insertion of thick processes under the cell body. Thick primary processes ramified to form the foot processes, which interdigitated on the surface of capillary loops. During the capillary loop stage, the degree of differentiation of the podocytes varied among various glomerular regions, as well as within the same capillary loop.

Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.