INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of adjunct systemic corticosteroid therapy in patients admitted to the intensive care unit (ICU) with bacterial community-acquired pneumonia (CAP). METHOD: We searched MEDLINE, Embase and the Cochrane Library to identify randomised controlled trials (RCTs) published from the databases' inception to February 2024. All RCTs evaluating the effect of systemic corticosteroids on mortality, compared to standard of care among adult bacterial CAP patients admitted to ICU were included. Bayesian meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Independent authors reviewed each study for eligibility, extracted data and assessed risk of bias in duplicate, with discrepancies referred to senior reviewers. RESULTS: A total of 6 RCTs comprising 1585 patients were included for analysis. In ICU patients with severe CAP who were treated with corticosteroids, there was no significant reduction in hospital mortality (risk ratio [RR] 0.70, 95% confidence interval [CI] 0.39-1.14, certainty of evidence: ⊕⊕⊝⊝ low) or all-cause mortality (RR 0.68, 95% CI 0.34-1.22, ⊕⊕⊝⊝ low) compared with placebo. The use of corticosteroids showed a significant reduction in mechanical ventilation post-intervention (RR 0.58, 95% CI 0.37-0.86, ⊕⊕⊕⊕ high) compared with placebo. In a subgroup analysis of patients treated with hydrocortisone, hospital mortality was significantly reduced (RR 0.45, 95% CI 0.20-0.88, ⊕⊕⊝⊝ low) compared with placebo. There was no significant increase in gastrointestinal bleeding, secondary infections or hyperglycaemia in patients treated with corticosteroids. CONCLUSION Corticosteroids significantly reduced mechanical ventilation requirements, and hydrocor-tisone significantly reduced hospital mortality. Further work is required to determine whether other corticosteroids reduce mortality among ICU patients with CAP.
Humans ; Adrenal Cortex Hormones/therapeutic use* ; Bayes Theorem ; Community-Acquired Infections/mortality* ; Critical Illness ; Hospital Mortality ; Intensive Care Units ; Pneumonia, Bacterial/mortality* ; Randomized Controlled Trials as Topic ; Respiration, Artificial

BACKGROUND: Gluteus medius (GMeds), peroneus longus (PL), and tibialis anterior (TA) help in maintaining frontal stability of the lower extremity, particularly, the ankle. Muscle activation must be sufficient to prevent the occurrence of an ankle sprain. The purpose of this study is to compare the muscle activation of the GMeds, TA, and PL during drop landing on stable and unstable surfaces of physically active individuals. METHODS: Surface EMG (sEMG) was used to determine the muscle activation pattern of the GMeds, TA, and PL of fifteen (15) recreational athletes during drop landing. The mean percentage of maximum voluntary isometric contraction (%MVIC) was calculated for comparison. Wilcoxon signed-rank test was used to compare means. RESULTS: There were no statistically significant differences in the muscle activity of GMeds (p=0.69), TA (p=0.26), and PL (p=0.23) on stable and unstable surfaces. However, a small effect size showed that GMeds (d=0.30) has higher activation in the unstable surface while TA (d=0.28) and PL (d=0.17) have lower activation on unstable surface. CONCLUSION Landing surface does not significantly alter muscle activity of GMeds, TA, and PL. However, the magnitude of the difference in the mean %MVIC between groups shows the compensatory mechanism of the body when subjected to different surface conditions. This can be used when creating injury prevention programs of the lower extremity.