Background: Growing antibiotic resistance and the limited availability of key components in standard Helicobacter pylori treatments have driven the search for effective alternatives. Minocycline, with its broad-spectrum activity and favorable pharmacokinetics, has emerged as a promising substitute. This meta-analysis compares the safety and efficacy of minocycline-containing bismuth quadruple therapy (MBQT) to conventional first-line BQT regimens, incorporating data from the recent study by Lin et al. Methods: The inclusion criteria were randomized controlled trials (RCTs) with a target population of both treatment-naïve and previously treated patients diagnosed with Helicobacter pylori (H. pylori) infection. The intervention received by eligible patients was a minocycline–bismuth quadruple therapy (MBQT) regimen containing bismuth, minocycline, proton pump inhibitors (PPI), and any additional antibiotic with a minimum period of 2 weeks of administration. We excluded study designs other than RCT and clinical trials that include patients without confirmed H. pylori infection, animal populations, in vitro experiments, and reports of other outcomes that did not include a minimum intervention duration of 2 weeks. A comprehensive literature search was conducted on PubMed, EMBASE, Cochrane Library, and ScienceDirect from inception to 20 May 2025. After screening via Rayyan, data were extracted on an Excel spreadsheet. Quality was assessed using the Cochrane RoB 2.0 tool. Eligible randomized controlled trials (RCTs) were included and analyzed using RevMan 5.4. Outcomes assessed were intention-to-treat and per-protocol eradication rates. Adverse effects were compared among therapies. A random-effects model was used; an I² < 50% and p-value < 0.05 indicated homogeneity and significant results respectively. Results: Five RCTs with 7 interventions involving 2812 patients were included. The pooled odds ratio (OR) for MBQT in intention-to-treat (ITT) analysis was 1.25 (95% CI: 0.96–1.61), showing a non-significant trend. No heterogeneity was detected (I² = 0.0%). In the modified ITT (mITT) analysis (2 studies), MBQT showed higher eradication (OR: 1.70, 95% CI: 0.00–1042.90), but wide CI and high heterogeneity (I² = 70.7%) limited interpretation. All studies were included in the per-protocol (PP) analysis, which showed a statistically significant improvement with MBQT (OR: 1.67, 95% CI: 1.14–2.45) and low heterogeneity (I² = 5.2%), suggesting consistent results. Although not statistically significant, MBQT was associated with a slightly lower rate of adverse events compared to standard therapy (OR: 0.81, 95% CI: 0.59–1.12). I² = 50.6% showed moderate heterogeneity in safety outcomes. Discussion: the number of included RCTs was modest, with only five studies meeting eligibility criteria, and only two contributing to the modified intention-to-treat analysis. The risk-of-bias assessment showed variation in methodological quality across the included studies. Several studies exhibited high risk judgments in critical domains. particularly randomization, deviations from intervention, and selective reporting. Patients who completed the treatment benefited more from MBQT, which also had a comparable safety profile to conventional BQT regimens. In the treatment of H. pylori infection, MBQT may be considered a safe alternative for first-line treatment.

Background Heart failure remains a major complication following myocardial infarction, affecting up to 30% of survivors within the first year. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits in established heart failure, but their role in preventing new-onset heart failure post-myocardial infarction remains uncertain. We aimed to evaluate the efficacy and safety of SGLT2 inhibitors for heart failure prevention in post-myocardial infarction patients without established heart failure. Methods We searched PubMed (n = 284), Embase (n = 1,735), Cochrane Central (n = 440), and Scopus (n = 853) from inception to January 15, 2025, for randomized controlled trials comparing SGLT2 inhibitors with placebo in adults with acute myocardial infarction but no established heart failure, with a minimum 6-month follow-up. The primary outcome was heart failure hospitalization. We performed random-effects meta-analysis with the Hartung-Knapp adjustment using R version 4.3.0. We conducted trial sequential analysis and Bayesian sensitivity analyses. This review was registered with PROSPERO (CRD420251080192). Results Three trials enrolled 11,015 patients (EMPACT-MI: n = 6,522; DAPA-MI: n = 4,017; EMMY: n = 476). Two trials (n = 10,539) provided time-to-event data for heart failure hospitalization. SGLT2 inhibitors showed a 22% reduction in heart failure hospitalization (HR 0.78, 95% CI 0.54–1.13), though this did not reach conventional statistical significance (p = 0.075) with the Hartung-Knapp method. Sensitivity analysis using fixed-effect modeling yielded HR 0.78 (95% CI 0.63–0.97, p = 0.028). No heterogeneity was observed (I²=0%). Trial sequential analysis indicated only 1.7% of required information size has been accrued. Bayesian analysis indicated 97.7% probability of benefit (posterior HR 0.814, 95% CrI 0.666–0.996). SGLT2 inhibitors were well-tolerated with no excess serious adverse events (18.7% vs 17.2%) or diabetic ketoacidosis in non-diabetic patients. Conclusions SGLT2 inhibitors showed a consistent but statistically non-significant reduction in heart failure hospitalization following myocardial infarction in patients without established heart failure. While the direction and magnitude of effect align with established benefits in other populations, larger trials are needed to confirm these findings and establish SGLT2 inhibitors' role in post-myocardial infarction care.

Background: Jute mill workers are chronically exposed to dust, repetitive motions, and poor ergonomics, placing them at risk of occupational illnesses. This study aimed to assess the prevalence and associated factors of respiratory and musculoskeletal disorders (MSDs) among workers in a large jute mill in Bangladesh. Methods: A cross-sectional study was conducted from January to June 2023 at Alhaj Jute Mills Ltd. in Sharisabari, Jamalpur. A total of 250 production workers were selected using systematic random sampling. Data were collected through interviewer-administered questionnaires (ATS-DLD-78 and SNMQ), physical assessments, and spirometry following ATS/ERS guidelines. Multivariable Poisson regression was used to identify factors associated with respiratory and musculoskeletal morbidity. Results: Among 250 respondents, 58.4% reported chronic respiratory symptoms, with 40.8% showing obstructive patterns on spirometry. Musculoskeletal disorders were reported by 63.2% of workers, predominantly affecting the lower back (42.0%) and shoulders (29.6%). A dual burden of both conditions was observed in 38.8% of participants. Significant predictors of respiratory symptoms included employment duration ≥10 years (aPR: 1.42), high-dust department (aPR: 1.31), smoking (aPR: 1.37), and lack of PPE use (aPR: 1.82). High ergonomic risk (REBA score ≥8) was the strongest predictor of MSDs (aPR: 1.68). Conclusion: Respiratory and musculoskeletal disorders are highly prevalent among jute mill workers in Bangladesh, with nearly 4 in 10 workers affected by both. Prolonged exposure, poor ergonomic conditions, and lack of protective equipment were key risk factors. Immediate interventions focused on dust control, PPE enforcement, and ergonomic improvements are essential to reduce the occupational health burden in this sector.

Rationale: Kartagener syndrome, a variant of primary ciliary dyskinesia, is defined by chronic sinusitis, bronchiectasis, and situs inversus. While recurrent infections are seen, a combination of thromboembolic disease, pulmonary mycetoma, cardiac dysfunction, and serological evidence of autoimmune disorders is very uncommon. Patient concerns: A 27-year-old man with Kartagener syndrome and situs inversus totalis complaining of worsening dyspnea, chest pain, fever, hemoptysis, and ankle swelling. His past medical history included episodes of deep vein thrombosis, recurrent pulmonary embolism, and chronic productive cough. Diagnoses: Radiologic studies showed dextrocardia, a right upper lobe cavitary lesion indicative of pulmonary mycetoma, hepatic congestion, and ascites. The echocardiogram demonstrated severe dysfunction of both left and right ventricles, a thrombus in the right ventricle, mild-moderate pericardial effusion, and an ejection fraction of about 40%. BNP was elevated, and U1-ribonucleoprotein antibodies were positive, implying a probable overlap of autoimmune disease, but diagnostic criteria were not fulfilled. Interventions: He was prescribed appropriate heart failure management, anticoagulant therapy, antifungals, and multidisciplinary treatment of other issues. Outcomes and Lessons: The patient underwent adequate management of his cardiopulmonary, infectious, and thromboembolic complications. The existence of a causal link between these diseases could not be found. This case underscores the need for a multidisciplinary approach in evaluating patients with a combination of congenital and acquired systemic diseases. The association of Kartagener syndrome, pulmonary mycetoma, thromboembolic tendency, right ventricular thrombus formation, cardiac dysfunction, and positive U1-RNP is an unusual combination and calls for proper evaluation.

Background The comparative clinical outcomes of everolimus-eluting stents (EES) versus biolimus-eluting stents (BES) remains uncertain despite widespread use. This study conducted a systematic review and meta-analysis of randomized controlled trials comparing contemporary drug-eluting stent platforms. Methods We searched MEDLINE, Embase, CENTRAL, and Scopus through May 2025 for randomized trials comparing EES with BES in patients undergoing percutaneous coronary intervention. The primary outcomes were major adverse cardiac events (MACE) and device-oriented composite endpoint (DOCE) at the longest follow-up. Secondary outcomes included all-cause mortality, target lesion revascularization (TLR), and stent thrombosis. Random-effects meta-analysis was performed using risk ratios (RR) and 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. The GRADE approach evaluated the certainty of evidence. Results Thirteen trials randomizing 27,071 patients (12,226 EES; 14,845 BES), with follow-up 9-120 months, were included. EES demonstrated a trend toward reduced MACE compared with BES (9.7% vs 10.3%; RR 0.93, 95% CI: 0.87-1.00; p=0.053; I²=0%) with an absolute risk reduction of 0.7% (number needed to treat=142). DOCE showed similar results (RR 0.94, 95% CI: 0.88-1.01; p=0.10; I²=0%). No significant differences were observed for all-cause mortality (RR 0.96, 95% CI: 0.88-1.05; p=0.37), TLR (RR 0.95, 95% CI: 0.86-1.05; p=0.36), or stent thrombosis (RR 0.93, 95% CI: 0.69-1.23; p=0.60), all with I²=0%. Subgroup analysis by follow-up duration showed consistent results (p-interaction=0.88). No publication bias was detected. GRADE assessment indicated moderate certainty evidence for most outcomes. Conclusions In this meta-analysis, EES showed a trend toward reduced MACE compared with BES, though not reaching statistical significance. The remarkable homogeneity and small absolute differences suggest both platforms provide excellent outcomes. Both stent platforms remain appropriate first-line options for percutaneous coronary intervention. Registration PROSPERO CRD42025108092