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Objectives: The objective of this study was to study the alteration in levels of testosterone, luteinising hormone (LH), follicle-stimulating hormone (FSH) and prolactin in male cancer patients’ post-chemotherapy who have been started on drugs causing grade III or more haematological toxicity requiring granulocyte colony-stimulating factor support. Materials and Methods: An open-labelled prospective single-centre study for the assessment of Gonadal dysfunction in male cancer patients on chemotherapy from August 2010 to October 2012. Results: Patients had a significant alteration in testosterone (23% n = 11), LH (52.08% n = 25), FSH (83.3% n = 40) and prolactin levels (22.92% n = 11) post-chemotherapy, which was statistically significant (P < 0.05). The high dose, as well as the low dose Cisplatin group, were associated with substantial gonadal dysfunction in testicular tumour patients. Hence, regimens using low-dose cisplatin at the cost of compromising the cure rate for the motive of preservation of fertility are not warranted. There was no statistically significant difference found in alteration in mean testosterone, mean LH or mean FSH Prolactin levels among cisplatin, cyclophosphamide or combined cisplatin and cyclophosphamide chemotherapy group, at least in the initial weeks of post-chemotherapy. Conclusion: There is a significant gonadal dysfunction in cancer patients receiving cytotoxic chemotherapy. Hence, increasing awareness to prevent, detect and treat expected long-term toxicities is crucial. Prechemotherapy cryopreservation of semen and assisted reproductive technologies are good options to describe the rate of involuntary infertility without affecting the survival of patients by decreasing doses of chemotherapy.

IntroductionThis systematic literature review and pairwise meta-analysis evaluated the comparative effectiveness of mRNA-1273 versus BNT162b2 in patients with at least one underlying medical condition at high risk for severe COVID-19.MethodsMEDLINE, Embase, and Cochrane databases were searched for relevant articles from January 1, 2019 to February 9, 2024. Studies reporting effectiveness data from at least two doses of mRNA-1273 and BNT162b2 vaccination in adults with medical conditions at high risk of developing severe COVID-19 according to the US Centers for Disease Control and Prevention were included. Outcomes of interest were SARS-CoV-2 infection (overall, symptomatic, and severe), hospitalization due to COVID-19, and death due to COVID-19. Risk ratios (RRs) were calculated with random effects models. Subgroup analyses by specific medical conditions, number of vaccinations, age, and SARS-CoV-2 variant were conducted. Heterogeneity between studies was estimated with chi-square testing. The certainty of evidence was assessed using the Grading of Recommendations, Assessments, Development, and Evaluations framework.ResultsSixty-five observational studies capturing the original/ancestral-containing primary series to Omicron-containing bivalent original-BA4-5 vaccinations were included in the meta-analysis. mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.79–0.92]; I2 = 92.5%), symptomatic SARS-CoV-2 infection (RR, 0.75 [95% CI, 0.65–0.86]; I2 = 62.3%), severe SARS-CoV-2 infection (RR, 0.83 [95% CI, 0.78–0.89]; I2 = 38.0%), hospitalization due to COVID-19 (RR, 0.88 [95% CI, 0.82–0.94]; I2 = 38.7%), and death due to COVID-19 (RR, 0.84 [95% CI, 0.76–0.93]; I2 = 1.3%) than BNT162b2. Findings were generally consistent across subgroups. Evidence certainty was low or very low because sufficiently powered randomized controlled trials are impractical in this heterogeneous population.ConclusionMeta-analysis of 65 observational studies showed that vaccination with mRNA-1273 was associated with a significantly lower risk of SARS-CoV-2 infection and COVID-19-related hospitalization and death than BNT162b2 in patients with medical conditions at high risk of severe COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-025-03117-7.

We present the case of a 60-year-old male patient admitted to our intensive care unit after a high-velocity car accident. On-site clinical examination revealed normal consciousness with no focal deficits. Chest X–Ray was suggestive of right pneumothorax with pneumomediastinum and extensive subcutaneous emphysema. CT scan revealed right pneumothorax, pneumomediastinum, extensive subcutaneous emphysema and extradural pneumorachis. A right tube thoracostomy was done and the patient was placed on High flow nasal cannula at 40 lpm and 100% FiO2. There was a gradual resolution of pneumothorax and all the extra-alveolar air including pneumorachis by the 7th day. The patient was discharged in a clinically stable condition. Keywords: Pneumothorax, Pneumomediastinum, Pneumorachis

ABSTRACTBackgroundThe mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against SARS-CoV-2 infection in phase 3 clinical trials, including among older adults. To inform COVID-19 vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults.MethodsWe systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022 and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19‒related hospitalization, and COVID-19‒related death following ≥2 vaccine doses. Random-effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-squared testing. Evidence certainty was assessed per GRADE framework.Results24 non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), COVID-19‒related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) and COVID-19‒related death (RR 0.80 [95% CI 0.64‒0.99]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes (I2>75%) except death (I2=0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized-controlled trial data.ConclusionMeta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections; hospitalizations; and deaths with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥50 years.SUMMARY POINTSThe COVID-19 pandemic has disproportionately affected older adults, as this population is generally more susceptible to infection and severe outcomes due to immune senescence and underlying comorbidities.The 2 available mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against SARS-CoV-2 infection in phase 3 clinical trials, including among older adults.To inform COVID-19 vaccine selection, this systematic literature review and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 among older adults in real-world settings.Vaccination with homologous primary or booster mRNA-1273 was associated with significantly lower risk of infection (including asymptomatic, symptomatic, and severe infections), hospitalization, and death due to COVID-19 than vaccination with BNT162b2 in older adults aged ≥50 years.

Karyomegalic interstitial nephritis is a rare progressive renal disease. We report a 36-year-old male patient who developed kidney failure due to this condition, underwent kidney transplantation from his sister, and developed the same condition in the graft. Genetic testing of the donor revealed autosomal recessive compound heterozygous mutation of Fanconi anemia-associated nuclease1 (FAN1) gene. Karyomegalic interstitial nephritis is most probably donor derived in our patient. It should not be mislabeled as viral nephropathy.

PurposeGiven between-country differences in healthcare systems, treatment costs, and disease management guidelines, country-specific cost-effectiveness analyses are important. This study evaluated the cost-effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI and UMEC/VI among patients with symptomatic chronic obstructive pulmonary disease (COPD) at risk of exacerbations from a Spanish healthcare system perspective.Patients and MethodsBaseline data and treatment effects from the IMPACT trial were populated into the validated GALAXY COPD progression model. Utilities were estimated using Spanish observational data. Direct healthcare costs (2019 €) were informed by Spanish public sources. A 3% discount rate for costs and benefits was applied. The time horizon and treatment duration were 3 years (base case). One-way sensitivity, scenario, and probabilistic sensitivity analyses were performed.ResultsFF/UMEC/VI treatment resulted in fewer exacerbations over 3 years (4.130 vs 3.648) versus FF/VI, with a mean (95% confidence interval [CI]) incremental cost of €444 (€149, €713) per patient and benefit of 0.064 (0.053, 0.076) quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €6887 per QALY gained. FF/UMEC/VI was a dominant treatment strategy versus UMEC/VI, resulting in fewer exacerbations (4.130 vs 3.360), with a mean (95% CI) incremental cost of –€450 (–€844, –€149) and benefit of 0.054 (0.043, 0.064) QALYs. FF/UMEC/VI was cost-effective versus FF/VI and UMEC/VI across all analyses.ConclusionFF/UMEC/VI was predicted to be a cost-effective treatment option versus FF/VI or UMEC/VI in symptomatic COPD patients at risk of exacerbations in Spain, across all scenarios and sensitivity analyses.

Objective: The aim of the study was to analyze the role of autonomic activity by heart rate variability (HRV) during different phases of menstrual cycle in subject with premenstrual syndrome (PMS). Methods: This cross-sectional study was conducted in SRM medical college hospital and research center for 6 months (November 2017 to April 2018). Sixty young female subjects with regular menstrual history aged between 18 and 25 years of age were recruited in this study after obtaining ethical committee clearance. The subjects were categorized into mild and moderate PMS according to Premenstrual Syndrome Scale. This study includes 30 subjects in each category. HRV was done by Physiopac, the “Medicaid” system during the various phases of the menstrual cycle. Statistical analysis was done by t-test (paired and independent sample test). Results: The mean heart rate (<0.005), low frequency (LF) power normalized unit (n.u) (<0.001), and LF high frequency (HF) ratio (<0.001) were significantly increased in the luteal phase whereas the mean RR interval (<0.008), standard deviation of normal to the normal (<0.05), RMSSD (<0.037), HF power n.u (0.054), and total power (<0.055) were significantly reduced in the luteal phase of moderate PMS when compared to the luteal phase of mild PMS. Conclusion: Disturbances in the balance of autonomic function in the late luteal phase might be responsible for the psychological and somatic changes in women with PMS.