Mass vaccination campaigns are being run all over the globe to combat the ongoing COVID-19 pandemic. There have been several reports of immune thrombocytopenic purpura (ITP) occurrence following COVID-19 vaccination. However, ITP due to the Pfizer-BioNTech vaccine has been rarely reported, and a causal link has not been identified. The pathophysiology behind immune thrombocytopenia is similar to heparininduced thrombocytopenia. The management is also similar to other secondary immune thrombocytopenia. We present a case of a 67-year old female diagnosed with immune thrombocytopenia following Pfizer-BioNTech vaccination. The treatment was resistant to high-dose steroids, intravenous immunoglobulin (IVIG), and rituximab and eventually responded to a thrombopoietin-stimulating agent.

Background The current guidelines recommend targeted temperature management (TTM) as part of the post-resuscitation care for comatose patients following out-of-hospital cardiac arrest. These recommendations are based on the weak evidence of benefit seen in the early clinical trials. Recent large multicentered trials have failed to show a meaningful clinical benefit of hypothermia, unlike the earlier studies. Thus, to fully appraise the available data, we sought to perform this systematic review and meta-analysis of randomized controlled trials. Methods We searched four databases for randomized controlled trials comparing therapeutic hypothermia (32–34 °C) with normothermia (≥36 °C with control of fever) in adult patients resuscitated after out-of-hospital cardiac arrest. Independent reviewers did the title and abstract screening, full-text screening, and extraction. The primary outcome was mortality six months after cardiac arrest, and secondary outcomes were neurological outcomes and adverse effects. Relevance for patients Six randomized controlled trials were included in this review. There was no significant difference between the hypothermia and normothermia groups in mortality till 6 months follow up after out-of-hospital cardiac arrest (OR 0.88, 95% CI 0.67–1.16; n = 3243; I 2 = 51%), or favorable neurological outcome (OR 1.31, 95% CI 0.93–1.84; n = 3091; I 2 = 68%). Rates of arrhythmias were notably higher in the hypothermia group than the normothermia group (OR 1.43, 95% CI 1.20–1.71; n = 3029; I 2 = 4%). However, odds for development of pneumonia showed no significant differences across two groups (OR 1.13, 95% CI 0.98–1.31; n = 3056; I 2 = 22%). Therefore, targeted hypothermia with a target temperature of 32–34 °C does not provide mortality benefit or better neurological outcome in patients resuscitated after the out-of-hospital cardiac arrest when compared with normothermia.

Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a newer method for managing severe acute respiratory distress syndrome (ARDS) and ARDS refractory to conventional management. However, its current role in the management of ARDS is not clear. Therefore, we conducted this metaanalysis to compare the mortality rates of ECMO over conventional management in ARDS.Methods: PubMed, PubMed Central, Embase, and Scopus were searched using appropriate keywords. We selected studies in adults with ARDS that compared the outcomes of patients treated with ECMO vs. conventional management. Cochrane Risk of Bias (RoB) 2.0 and the JBI (Joanna Briggs Institute) quality assessment tools were used for assessing the risk of bias in RCTs and observational studies, respectively. The I 2 statistic was used to evaluate heterogeneity, and quantitative synthesis was performed using fixed or random effects to pool studies based on heterogeneities. Meta-analysis was conducted using Revman 5.4.Result: Twelve studies were included in this meta-analysis. As compared to the conventional management (mechanical ventilation: MV), patients treated with ECMO had lower odds of 30-days mortality (OR, 0.56; 95% CI, 0.37 to 0.84) and 90 days mortality (OR, 0.59; 95% CI, 0.41 to 0.85). However, there was no significant difference between in-hospital mortality (OR, 0.75; 95% CI, 0.40 to 1.41) and intensive care unit (ICU) mortality (OR, 1.00; 95% CI, 0.36 to 2.79). Similarly, length of hospital stays (LOS) (MD, 3.92; 95% CI, -6.26 to 14.11) did not show statistically significant differences across the two groups. However, the average ICU stay (ICU LOS) was 7.28 days longer in the ECMO group compared with the MV group (MD, 7.28; 95% CI, 2.55 to 12.02).Conclusion: Twenty-eight days and 90-days mortality were decreased in patients managed with ECMO compared with the MV group. Also, ICU LOS was found to be longer in the ECMO group. Furthermore, no statistical difference was found between the two groups for in-hospital mortality and hospital LOS.

Parkinson's disease (PD), a neurodegenerative disorder, is caused due to the loss of dopaminergic neurons in substantia nigra pars compacta, and it mainly affects the motor function of the diseased individual. The most effective treatment for PD to date is levodopa, the precursor molecule for dopamine which ultimately helps overcome the loss of dopamine in the brain. However, long-term levodopa therapy significantly impairs patients' quality of life by causing various disabling motor and non-motor complications. We conducted this study intending to review the available literature that has compared the efficacy and safety of continuous subcutaneous apomorphine infusion (CSAI) with other available treatment options like deep brain stimulation, intestinal levodopa gel, and oral dopaminergic agents. We searched PubMed, Embase, and Scopus databases using the appropriate search strategy. The studies which compared the safety and efficacy of continuous subcutaneous apomorphine infusion to other available treatment options in advanced Parkinson's disease were included in our study. The bias assessment of the studies was done using Cochrane Risk of Bias 2.0 tool for randomized controlled trials, Risk of Bias In Non-Randomized Studies -of Interventions (ROBINS-I) tool for non-randomized interventional studies, and Joanna Briggs Institute Critical Appraisal tools (JBI) for cohort studies. We included eight articles in our systematic review including a randomized controlled trial. None of the included studies had a high risk of bias. We found that in patients with advanced Parkinson's, CSAI demonstrated definite improvement in off-time duration. CSAI has also been shown to improve various non-motor functions, including neuropsychiatric problems in these patients. CSAI has demonstrated safety and efficacy in patients with advanced Parkinson's disease. However, the decision-making is multifactorial. Hence, further studies are required that directly compare the available treatment options with one another and study their overall effects on patients' quality of life.

Despite all the advances in the treatment and management of chronic obstructive pulmonary disease (COPD), COPD readmissions remain a major challenge nationwide. Increasing evidence suggests that palliative care involvement with a holistic approach towards end-of-life care can significantly improve outcomes related to the quality of life and survival for late-stage cancers and chronic progressive illnesses like COPD, chronic heart failure, and end-stage renal disease. Some studies have attempted to evaluate an association between the involvement of palliative care and readmission reduction, the effect of which remains elusive, especially with regards to COPD readmissions. This review examined the existing literature to analyze the relationship between palliative care involvement for COPD patients and its effect on COPD readmissions.