Background To estimate the diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance in different regions, a meta-analysis was carried out. Methods Several databases were searched for relevant studies up to March 3, 2019. A bivariate random-effects model was used to estimate the diagnostic accuracy. Results We identified 97 studies involving 26,037 samples for the diagnosis of rifampicin resistance. The pooled sensitivity, specificity and AUC of Xpert MTB/RIF for rifampicin resistance detection were 0.93 (95% CI 0.90–0.95), 0.98 (95% CI 0.96–0.98) and 0.99 (95% CI 0.97–0.99), respectively. For different regions, the pooled sensitivity were 0.94(95% CI 0.89–0.97) and 0.92 (95% CI 0.88–0.94), the pooled specificity were 0.98 (95% CI 0.94–1.00) and 0.98 (95% CI 0.96–0.99), and the AUC were 0.99 (95% CI 0.98–1.00) and 0.99 (95% CI 0.97–0.99) in high and middle/low income countries, respectively. The pooled sensitivity were 0.91 (95% CI 0.87–0.94) and 0.91 (95% CI 0.86–0.94), the pooled specificity were 0.98 (95% CI 0.96–0.99) and 0.98 (95% CI 0.96–0.99), and the AUC were 0.98 (95% CI 0.97–0.99) and 0.99 (95% CI 0.97–0.99) in high TB burden and middle/low prevalence countries, respectively. Conclusions The diagnostic accuracy of Xpert MTB/RIF for rifampicin resistance detection was excellent.

Background To estimate the association between the administration of corticosteroids and all-cause mortality of hospitalized patients with severe/critical Corona Virus Disease 2019 (COVID-19). Methods We conducted this study at six tertiary hospitals in the area of Chongqing, China. Clinical records from all consecutive adult subjects admitted with SARS-CoV-2 infection from 1 November 2022 to 20 January 2023 were retrospectively reviewed. In-hospital and 28-day mortality were analyzed before and after propensity score matching (PSM). Logistic regression model and cox regression model was used to further examine the relationship between corticosteroid treatment and the risk of mortality. Results A total of 406 severe and critically ill COVID-19 patients were included in this study. They were divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%) according to corticosteroids use (0.5-1mg/kg/d methylprednisolone or any corticosteroid at equivalent dose, no more than 10 days). Corticosteroid treatment did not reduce in-hospital mortality in overall cohorts (36.4% vs.28.0%) and matched cohorts (32.5% vs.34.5%). Univariate analysis showed that the 28-day mortality in the corticosteroids group was significantly higher than that in the non-corticosteroids group [hazard ratio (HR), 0.706; 95% CI, 0.507–0.983; p = 0.039] in the overall population. When the multivariate analysis was further used to control confounders, the results showed that corticosteroids were not associated with improved 28-day mortality (HR, 1.121; 95% CI, 0.641–1.959; p = 0.689). With PSM, similar results were obtained with univariate and multivariate analysis. Conclusions Corticosteroids in hospitalized patients with severe/critical COVID-19 did not reduce mortality in the overall population.

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Background: N-acetylcysteine (NAC) prevents acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, the value of N-acetylcysteine (NAC) inhalation in the treatment of an AECOPD requiring hospitalization still remains unclear. The present study was designed to evaluate the clinical efficacy of NAC inhalation in patients with AECOPD requiring hospitalisation. Methods: In this single-center, retrospective cohort study, all patients with AECOPD requiring hospitalisation between October 2016 and October 2021 were included. The primary outcome was the length of hospital stay. The change in the spirometric parameter, including the post-bronchodilator forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), forced expired flow at 50% of vital capacity (FEF 50%), mean forced expiratory flow between 25% and 75% of vital capacity (FEF 25-75%), residual volume/total lung capacity (RV/TLC), and arterial blood gas tensions over the first 7 days of the admission, the incidence of adverse events (AEs) were calculated to estimate the differences between the two groups. Results: A total of 1257 patients were enrolled in this study. Of these, 202 propensity score–matched patients (101 in the NAC group and 101 in the Non-NAC group) were included in the final analyses. The mean length of hospital stay was 8.4 days (95% CI 7.6 to 8.4) days for the NAC group and 9.2 days (95% CI 8.6 to 9.4) for the Non-NAC group (p = 0.044). The improvement rates in partial arterial oxygen pressure (PaO2), partial pressure of carbon dioxide (PaCO2) and spirometric parameter, including FEV 1, FVC, FEF 50%, FEF 25-75%, and RV/TLC were significantly higher in NAC group than in Non-NAC group. No differences between groups were observed in adverse effects, self-reported symptomatic improvement from admision to day 5, mechanical ventilation rates during hospitalization, exacerbation and rehospitalisation rates within one month of discharge.Conclusion：NAC inhalation can markedly shorten the length of hospital day, improve pulmonary function, raise PaO2 and decrease PaCO2 in patients with AECOPD requiring hospitalization, which may be a safe and effective supplementary treatment in AECOPD patients.