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Streptococcus pneumoniae is a leading cause of bacterial meningitis worldwide. Conventional microbiological assays take several days and require the use of various drugs for empirical treatment. Rapid antigen tests in cerebrospinal fluid (CSF) may be useful to triage pneumococcal meningitis immediately. To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis. Data sources Cochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteria All types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. Participants Patients with suspected meningitis. Tests Rapid antigen tests in CSF. Reference standards One or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of bias The methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesis We used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture. Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4–100%) and 98.2% (95% CI, 96.9–98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6–79.9%) and 100% (95% CI, 99.7–100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries. Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests. [ABSTRACT FROM AUTHOR]

Comment & Response B To the Editor b We have some concerns about the recent study[1] that reported that 0.05% atropine lowered the incidence of myopia in healthy children compared with placebo. First, the authors found no significant difference in the incidence of myopia between 0.01% atropine eyedrops and placebo and postulated that 0.01% atropine might not yield therapeutic benefits. In the pilot study, the myopia incidence rates for 0.05% atropine, 0.01% atropine, and placebo were 6.6%, 14.6%, and 20.0%, respectively. [Extracted from the article]

Objectives: Lymphovascular invasion (LVI) is a critical risk factor for lymph node metastasis (LNM), which requires additional surgery after endoscopic resection of T1 colorectal cancer (CRC). However, the impact of additional staining on estimating LNM is unclear. This systematic review aimed to evaluate the impact of additional staining on determining LNM in T1 CRC. Methods: We searched five electronic databases. Outcomes were diagnostic odds ratio (DOR), assessed using hierarchical summary receiver operating characteristic curves, and interobserver agreement among pathologists for positive LVI, assessed using Kappa coefficients (κ). We performed a subgroup analysis of studies that simultaneously included a multivariable analysis for other risk factors (deep submucosal invasion, poor differentiation, and tumor budding). Results: Among the 64 studies (18,097 patients) identified, hematoxylin–eosin (HE) and additional staining for LVI had pooled sensitivities of 0.45 (95% confidence interval [CI] 0.32–0.58) and 0.68 (95% CI 0.44–0.86), specificities of 0.88 (95% CI 0.78–0.94) and 0.76 (95% CI 0.62–0.86), and DORs of 6.26 (95% CI 3.73–10.53) and 6.47 (95% CI 3.40–12.32) for determining LNM, respectively. In multivariable analysis, the DOR of additional staining for LNM (DOR 5.95; 95% CI 2.87–12.33) was higher than that of HE staining (DOR 1.89; 95% CI 1.13–3.16) (P = 0.01). Pooled κ values were 0.37 (95% CI 0.22–0.52) and 0.62 (95% CI 0.04–0.99) for HE and additional staining for LVI, respectively. Conclusion: Additional staining for LVI may increase the DOR for LNM and interobserver agreement for positive LVI among pathologists. [ABSTRACT FROM AUTHOR]

Preprocedural, real-time, and computer-aided three-dimensional ultrasound has been widely used for neuraxial puncture; however, the optimal guidance is unclear. We examined the comparative efficacy of three ultrasound guidance and anatomical landmarks for neuraxial puncture in adults. We searched for randomised controlled studies comparing the efficacy of ultrasound guidance and anatomical landmarks for neuraxial puncture in adults using electronic databases and unpublished studies. The primary outcomes were first-pass success and patient satisfaction. A random-effects network meta-analysis (NMA) was used. We identified 74 eligible studies (7090 patients). Preprocedural ultrasound and real-time ultrasound-guided neuraxial puncture improved first-pass success compared with anatomical landmarks (risk ratio [RR] 1.6; 95% credible interval [CrI] 1.3–1.9; RR 1.9; 95% CrI 1.3–2.9, respectively, moderate confidence). Computer-aided ultrasound-guided neuraxial puncture also increased first-pass success (RR 1.8; 95% CrI 0.97–3.3, low confidence), although estimates were imprecise. However, real-time ultrasound-guided neuraxial puncture resulted in minimal difference in first-pass success compared with preprocedural ultrasound (RR 1.2; 95% CrI 0.8–1.8, moderate confidence). Preprocedural ultrasound improved patient satisfaction slightly compared with anatomical landmark use (standardised mean differences 0.28; 95% CrI 0.092–0.47, low confidence). This NMA provides evidence supporting ultrasound-guided neuraxial puncture compared with use of anatomical landmarks, including indirect comparisons. Among the three ultrasound guidance methods, preprocedural ultrasound appears to be a better adjunctive option. [ABSTRACT FROM AUTHOR]

Accurate disclosure of financial conflicts of interest (COI) among clinical practice guideline (CPG) developers is critical to ensure the quality of CPGs. However, there is limited evidence on the impact of underreporting COIs on the quality of CPGs. This study aimed to examine the proportion of underreported COI disclosures in the development of Japanese CPGs and to estimate the association between underreported COIs and CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II. Twenty-three Japanese CPGs published in 2019 and their 1114 developers were included in the study. The results show that underreporting of COIs occurred in 52% of the included CPGs and 8% of all CPG developers. Underreporting COI disclosures was negatively associated with low-quality CPG (Odds ratio [OR], 0.57; 95% confidence interval [CI]: 0.11, 3.04). On the other hand, CPGs that had more than 13% of CPG developers with voting rights on recommendation decisions and underreporting of COI disclosures were positively associated with low quality (OR, 1.78; 95% CI: 0.25, 12.45). For individual CPG developers with voting rights for recommendation decisions, the presence of a COI was positively associated with low quality (OR, 1.11; 95% CI: 0.71, 1.75). This study demonstrates that the involvement and underreporting of COIs did not seriously distort the CPG development process. However, the COI-related factors of CPG developers with voting rights for recommendation decisions may be associated with low CPG quality. [ABSTRACT FROM AUTHOR]

Case reports have been used in clinical medicine since ancient times and can contribute to identifying new conditions and recognizing unusual presentations of known diseases. They provide valuable details and examples that can improve the diagnostic process. Case reports can illustrate the diagnostic process, highlight pitfalls in diagnosis, and draw attention to unusual presentations of diseases. Learning from case reports can help clinicians achieve diagnostic excellence by avoiding future misdiagnoses and addressing diagnostic errors in uncommon and atypical presentations. [Extracted from the article]