No abstract

Community-acquired pneumonia is a leading cause of morbidity and mortality throughout the world, which incurs significant healthcare costs. The aim of his meta-analysis is to assess the clinical efficacy and safety of a novel non-fluorinated quinolone, nemonoxacin, compared with levofloxacin in treating communityacquired pneumonia (CAP). A recursive literature search was conducted using PubMed, Google Scholar, and Scopus up to August 2022. All randomized clinical trials comparing nemonoxacin to levofloxacin for community-acquired pneumonia were included. The patients selected for this study had mild to moderate CAP. Each individual received treatment with either nemonoxacin (500 mg or 750 mg) or levofloxacin (500 mg) for a duration of 3-10 days. Four randomized control trials with a total of 1955 patients were included. Nemonoxacin and levofloxacin were found to have similar clinical cure rates in the treatment of CAP. There were no significant differences reported in the treatment-emergent adverse events between the two drugs (RR=0.95, 95% CI: 0.86, 1.08, I 2 =0%). However, the most frequent symptoms exhibited were gastrointestinal system-related. Both the dosages (500 mg and 750 mg) of nemonoxacin were found to have similar efficacy as that of levofloxacin. Our meta-analysis indicates that nemonoxacin is a well-tolerated and effective antibiotic therapy for the treatment of community-acquired pneumonia (CAP), with clinical success rates comparable to those of levofloxacin. Furthermore, the adverse effects associated with nemonoxacin are generally mild. Therefore, both the 500 mg and 750 mg dosages of nemonoxacin can be recommended as appropriate antibiotic therapy regimens for the treatment of CAP.

Respected Editor, Endoscopic Retrograde Cholangiopancreatography (ERCP) is an invasive medical procedure commonly used to identify and treat biliary system and pancreatic disorders. It is the combination of both endoscopic and radiologic imaging techniques that, although widely used, and usually a safe procedure, it can rarely lead to life threatening complications including but not limited to pancreatitis, cholangitis, hemorrhage and perforation leading to pneumoperitoneum. The occurrence of free air in the peritoneal cavity post-ERCP is a rare event (< 1%), which is usually the result of duodenal or ductal perforation related to therapeutic ERCP with sphincterotomy.[1] Our discussion is based on the incidence of pneumoperitoneum occurring in patients post ERCP. According to a case report, a 29- year- old female was diagnosed with postpartum jaundice and biliary stones. Consequently, she was investigated using ERCP and treated with biliary stenting and bile flow restoration. Post ERCP, the patient developed severe epigastric pain radiating to the right shoulder and x-ray revealed air under the diaphragm, i.e. pneumoperitoneum.[2] In another report, a 72 year old woman who underwent ERCP to treat biliary stricture and provide stenting was found to have pneumobilia and pneumoperitoneum due to rupture of intrahepatic bile ducts during ERCP.[3] Another case has been reported with the same issue in which an 84 year old known case of pancreatic carcinoma with hepatic and lung metastasis underwent multiple ERCPs due to obstructive jaundice, performed an urgent CT scan, the very next day, which showed the presence of free air in the peritoneal cavity.[4] Therefore, in light of the cases mentioned above-, physicians should be mindful of this rare, life- threatening complication of ERCP and take great care and warn the patient before performing the procedure. A useful strategy to combat this complication, a nasogastric tube for bowel decompression immediately after ERCP can greatly reduce the chances of developing a pneumoperitoneum.

Dear sir, The on-going discussion on fixed dosing or personalized dosing of pembrolizumab has created great chaos among the patients of metastatic non-small cell lung cancer (NSCLC). Below mentioned are few points in this regard, Delta variant has affected economies of Asian countries in multiple ways. Personalized and six week dosing of pembrolizumab can be beneficial in this regard. A study conducted by DANIAL A. GOLDSTEIN and co-authors, compared fixed dosing of pembrolizumab with personalized dosing. They have concluded the result that personalized dosing can save upto 24.0% of annual savings in US that is equal to 0.825 billion dollar [1]. These results are supported by another study in which Q6W dosing of pembrolizumab is compared with Q3W dosing. The study states that 400 mg Q6W dosing of pembrolizumab leads to results that are very similar to 200mg Q3W dosing regimen [2]. Another study proposed weight based as well as six weeks dosing of pembrolizumab for the ease of cancer patients [3]. As pembrolizumab is approved for patients with stage III resected melanoma therefore delaying its therapy may have similar effects on overall survival [4]. Keeping all these point in view we would like to suggest that it would be better if doctors from now onwards suggest Q6W dosing of pembrolizumab instead of Q3W dosing as well as personalized dosing should be promoted as compared to fixed dosing as this well help in lowering down the financial as well as health burden on patients with metastatic non-small cell lung cancer (NSCLC). Continue...

Dear Madam, Pembrolizumab side effects have affected 60% of the patients. Some f side effects include thyroid dysfunction, hepatitis and pneumonitis and Auto- immune diabetes which can prove to be dangerous in pandemic times [1]. If not kept in check, endocrine dysfunction can belife- threatening. Recent studies showed that Pembrolizumab, when administered to patients previously on Ipilimumab can aggravate autoimmune diabetes. [2] Another case reported that a 70 years old patient was found suffering from liver and lung malignancies and later diagnosed with induced Diabetic ketoacidosis and isolated adrenocorticotrophic hormone deficiency after being administered with both Ipilimumab and Pembrolizumab as part of treating the malignancies [3]. Another study which was conducted recently showed that within 3 months of administering PD?1/PD?L1 inhibitor, the patients developed Type 1 Diabetes rapidly along with a higher incidence of ketoacidosis. [4] In light of the above evidence, health care professionals should be aware of this rare, life-threatening side effect of Pembrolizumab. Strict monitoring of patients’ blood glucose levels to whom Pembrolizumab is being administered should be done along with the history of any other PD-1/PD-L1 inhibitor that was administered before. Keywords: Pembrolizumab, Immunotherapy, Endocrine dysfunction, Type I diabetes.