The TAK-003 dengue vaccine was licensed in Europe in December 2022, and the official recommendations from most EU countries are still under formulation. To support policymakers, we performed a meta-analysis to quantify TAK-003’s immunogenicity, efficacy and safety among seronegative and seropositive populations after the administration of one or two vaccine doses. We included trials retrieved from MEDLINE, Scopus and ClinicalTrials.gov. The outcomes were the rates of seroconversion, virologically confirmed dengue fever and serious adverse events after each vaccine dose. Data were combined using random-effect proportion or head-to-head meta-analyses. We retrieved a total of 19 datasets, including >20,000 participants. TAK-003 showed an excellent safety profile, and the immunogenicity after two doses against the four DENV serotypes was ≥90% among both adults and children/adolescents who were either seronegative or seropositive at baseline. A single dose was able to elicit a high immunogenic response among adults (≥70%) and children/adolescents (≥90%). The primary two-dose immunization course halved the risk of all types of virologically confirmed dengue fever among seropositive children/adolescents, but seronegative minors were only protected against the diseases caused by DENV-1 and DENV-2. Overall, the results support the use of TAK-003 for the prevention of dengue fever in the pediatric population of endemic countries. Uncertainties remain on the use of a single vaccine dose in non-endemic countries.

Several vaccines against chikungunya fever have been developed and tested, and one has been recently licensed. We performed a meta-analysis to estimate the immunogenicity and safety of all chikungunya vaccines that have been progressed to clinical trial evaluation (VLA1553; mRNA-1388/VAL-181388; PXVX0317/VRC-CHKVLP059-00-VP; ChAdOx1 Chik; MV-CHIK). We included trials retrieved from MedLine, Scopus, and ClinicalTrials.gov. The outcomes were the rates of seroconversion/seroresponse and serious adverse events (SAEs) after the primary immunization course. We retrieved a total of 14 datasets, including >4000 participants. All candidate chikungunya vaccines were able to elicit an immunogenic response in ≥96% of vaccinated subjects, regardless of the vaccination schedule and platform used, and the seroconversion/seroresponse rates remained high 6 to 12 months after vaccination for most vaccines. Four of the five candidate vaccines showed a good overall safety profile (no data were available for ChAdOx1 Chik), with no significant increase in the risk of SAEs among the vaccinated, and a low absolute risk of product-related SAEs. Overall, the present findings support the potential use of the candidate vaccines for the prevention of chikungunya and the current indication for use in adult travelers to endemic regions of the licensed VLA 1553 vaccine. In order to extend chikungunya vaccination to a wider audience, further studies are needed on individuals from endemic countries and frail populations.

Background: Despite the fact that thiocolchicoside has been widely used in the treatment of musculoskeletal pain, its efficacy has never been systematically evaluated. We carried out a systematic review and meta-analysis of randomized clinical trials (RCTs) to appraise the existing evidence on the efficacy of thiocolchicoside for musculoskeletal pain management. Methods: The literature search was performed on multiple databases, extracting reports of RCTs evaluating the efficacy of thiocolchicoside compared to placebo or no exposure. The reduction in pain intensity was evaluated through between-groups mean differences (MDs) in Visual Analogue Scale (VAS) scores after the intervention. The pooled effect estimates were compared to a minimally important difference (MID) of 1 point on a scale from 0 to 10. Results: We retrieved eight RCTs, including a total of 1397 patients. All the included studies were determined as being at high risk of bias. Seven trials evaluated patients with acute low back pain. After 2–3 days of treatment, the pooled MD in VAS score was −0.49 (95%CI = −0.90; −0.09) compared to controls. After 5–7 days of treatment, the summary MD was −0.82 (95%CI = −1.46; −0.18). Conclusions: Although thiocolchicoside was found to significantly reduce patient-reported low back pain, the clinical impact was very small, as the pooled effect estimates were below the MID, and the overall certainty of evidence was very low. In light of the safety concerns raised by the European Medicine Agency, an in-depth analysis on the risk–benefit balance of thiocolchicoside is required.

Background: During the COVID-19 pandemic, paracetamol was widely recommended in different clinical settings, and sometimes advised over non-steroidal anti-inflammatory drugs (NSAIDs). These recommendations sparked a strong debate, with reports suggesting either potential benefits or harms for the individuals infected with SARS-CoV-2. As no systematic review is available, we performed a meta-analysis to estimate the impact of paracetamol on COVID-19 clinical outcomes compared to a placebo, no use, or NSAIDs. Methods: We searched PubMed, Scopus, Web of Science, and ClinicalTrials.gov for randomized trials or observational studies evaluating any COVID-19 clinical outcome. Data were combined using a generic inverse-variance approach. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to determine the certainty of evidence for each outcome. Results: One randomized trial and five observational studies, enrolling over 34,000 patients, were included. Overall, as compared to the patients using NSAIDs or receiving no treatment, the individuals who received paracetamol showed no significant differences in the risk of death (summary relative risks 0.93 and 0.91, respectively: both p > 0.05), need to transfer to the intensive care unit, need for respiratory support, or cardiovascular or renal complications. All studies showed a high risk of bias, with a low overall quality of evidence. Conclusions: This meta-analysis found no evidence of harmful or beneficial effects of paracetamol on main COVID-19-related outcomes. Also, the current literature does not provide sufficient data to support a preferential choice between paracetamol and NSAIDs for COVID-19 symptoms management. Further research is needed to confirm the present findings and provide critical insights on the policies to adopt in the case of future pandemics.

Background: Academic rankings may influence student enrolment, faculty recruitment, and funding opportunities, however their methodology is often criticized, primarily because it disregards financial efficiency. Methods: We analyzed the best 100 biomedical universities in three recognized international rankings (Times Higher Education, Quacquarelli-Symonds, and Shanghai), to investigate the association between expenditure and performance. Times, Q-S and SH overall quality scores, specific sub-scores, operating expenditures, and total students’ number were extracted from official websites. A global quality score was computed as weighted mean of the three scores, and a composite efficiency score was calculated dividing the average annual expenditure per student by the global quality score. Results: Despite a general alignment, the three rankings showed several discrepancies, highlighting the potential role of a composite quality score, which showed high internal validity and reliability. Sixteen of the 20 top academies were located in USA (n=12) or UK, but the median expense per student of USA universities (183,100 USD) was more than five times larger than the European, Australian (both 28,100 USD), or Canadian (25,000 USD) centers, which showed the best efficiency scores. Indeed, greater funding was significantly associated with a higher global quality score, as well as Times, SH, Q-S scores, and most sub-scores. Discussion and Conclusions: Considering the steep differences in funding that were detected between top-ranking universities and those just below the top 40, the proposed measure of efficiency may serve as a complementary metric to recognize and reward the academies that are able to maximize resources, still delivering high-quality education.

Topical corticosteroid phobia (TCP) is a widespread phenomenon that can reduce therapeutic adherence and worsen dermatological conditions. However, the underlying causes remain unclear. This study analyzed the prevalence and determinants of TCP through a cross‐sectional survey involving 194 patients with three dermatological conditions: psoriasis (PsO), vulvar lichen sclerosus (VLS), and atopic dermatitis (AD). TCP levels were assessed using the TOPICOP questionnaire; furthermore, other questionnaires were administered: NRS, BSI‐53, Brief‐IPQ, eHEALS, Sci‐Pop, and METER. Patients with AD exhibited the highest TCP levels, followed by those with PsO and, lastly, VLS patients. Longer disease duration correlated with higher TCP levels. Being single was associated with lower TCP levels. Patients screened positive for psychopathology had significantly higher levels of TCP and corticosteroid‐related worries compared to healthy controls. Regression models indicated that specific illness beliefs significantly predicted TCP levels, whereas general psychopathology did not. Thus, our findings highlight the role of specific illness beliefs in shaping TCP, rather than psychopathology. Higher TCP levels observed in AD patients may be linked to chronic‐relapsing nature of the disease. Understanding TCP is essential for developing targeted educational strategies and improving adherence to dermatological treatments, in order to enhance therapeutic outcomes. Excessive fear of corticosteroid use is frequent across various medical disciplines; particularly, TCP is a relevant issue in dermatology, since topical corticosteroids represent the first‐line treatment for most skin disorders. This attitude can lead to poor treatment adherence and, consequently, to suboptimal therapeutic outcomes. Understanding the underlying causes of TCP is important in order to develop targeted educational strategies, since it is up to healthcare providers to give patients explanations and reassurances about harmlessness of topical corticosteroids, if administered as indicated.