Muhammad Saqlain Mustafa

The number of spinal surgeries, including decompression and fusion procedures, has increased significantly. Despite the potential benefits, these surgeries can result in substantial blood loss, requiring perioperative blood transfusions. However, transfusions can pose risks, such as infections and thromboembolic events. This study aimed to compare the outcomes between transfusion and non-transfusion groups in spinal surgery patients, focusing on infection rates, DVT, mortality, and other complications. A systematic search was conducted across PubMed, Medline, Embase, and Scopus from inception to April 1, 2024, yielding 15 studies involving a total of 60,920 patients. These studies focused on adult patients undergoing spinal surgery for conditions such as tumors, trauma, infection, or congenital diseases, comparing those who received blood transfusions (PRBC, FFP, platelets, and allogeneic blood transfusions) to those who did not. Eligible studies reported outcomes such as mortality, ischemic events, surgery duration, pulmonary embolism, surgical site infections (SSI), and urinary tract infections (UTI). Statistical analysis was conducted using Comprehensive Meta-Analysis Version 3.3, applying a random-effects model. Outcomes were expressed as odds ratios (OR) for dichotomous variables and standard differences in means for continuous outcomes. The quality of studies was assessed using the Newcastle-Ottawa quality assessment scale. Heterogeneity was evaluated using I² statistics, and publication bias was assessed using funnel plots. Results indicated no significant difference in surgery duration between transfusion and non-transfusion groups. However, patients receiving transfusions experienced longer hospital stays (SMD: 1.462, p = 0.021) and higher odds of complications (OR: 3.11, p < 0.001). Moreover, the transfusion group exhibited elevated odds of mortality (OR: 3.96, p < 0.001), ischemic events (OR: 3.527, p < 0.001), respiratory complications (OR: 4.18, p < 0.001), renal complications (OR: 2.43, p < 0.001), pulmonary embolism (OR: 2.67, p = 0.012), deep vein thrombosis (OR: 2.737, p < 0.001), and thrombotic complications (OR: 5.232, p < 0.001). Additionally, the transfusion group had higher odds of surgical site infection (OR: 1.951, p < 0.001), while the non-transfusion group had decreased odds of urinary tract infection (OR: 2.960, p < 0.001). No significant difference was observed in respiratory tract infection (OR: 1.936, p = 0.09). Patients receiving blood transfusions had significantly higher odds of complications, including mortality, ischemic events, and thrombotic issues, as well as longer hospital stays. However, no significant difference was found in surgery duration between the transfusion and non-transfusion groups.

BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR), offering a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, the comparative safety and efficacy of these interventions remain subjects of ongoing investigation. AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis. METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) comparing TAVR and SAVR were identified from databases including PubMed, Scopus, and Web of Science up to May 31, 2024. Data were extracted on clinical outcomes, including mortality, procedural complications, and post-procedure adverse events. Risk ratios (RRs) with 95%CIs were calculated using a random-effects model. RESULTS A total of 10 RCTs were included. TAVR demonstrated a significantly lower risk of acute kidney injury (RR: 0.33; 95%CI: 0.25–0.44), major bleeding (RR: 0.37; 95%CI: 0.30–0.46), and new-onset atrial fibrillation (RR: 0.44; 95%CI: 0.34–0.57) compared to SAVR. However, TAVR was associated with higher risks of new permanent pacemaker implantation (RR: 3.49; 95%CI: 2.77–4.39), major vascular complications (RR: 2.47; 95%CI: 1.91–3.21), and paravalvular leaks (RR: 4.15; 95%CI: 3.14–5.48). Mortality at 30 days was comparable (RR: 0.95; 95%CI: 0.78–1.15), but long-term mortality was slightly higher with TAVR in some analyses (RR: 1.23; 95%CI: 1.01–1.49). Rates of stroke (RR: 0.97; 95%CI: 0.81–1.17) and myocardial infarction (RR: 0.91; 95%CI: 0.67–1.24) were similar between the groups. CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury, major bleeding, and new-onset atrial fibrillation, making it particularly advantageous for high-risk surgical candidates. However, higher risks of permanent pacemaker implantation, vascular complications, and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.

Background: Small vessel coronary artery disease presents challenges in percutaneous coronary intervention due to higher restenosis rates with traditional treatments. Drug-coated balloons (DCBs) offer a potential alternative, but their efficacy compared to drug-eluting stents (DES) remains debated. This meta-analysis aims to provide updated insights into the comparative outcomes of DCBs versus DES in small coronary artery disease. Main text: Following PRISMA guidelines, a systematic review identified seven randomized controlled trials (RCTs) comparing DCBs with DES for small vessel CAD. Data were extracted and pooled for analysis, assessing outcomes including target lesion revascularization (TLR), target vessel revascularization (TVR), mortality, myocardial infarction (MI), stent/vessel thrombosis, and major adverse cardiovascular events (MACE). Statistical analysis was performed using RevMan version 5.4, employing random-effects models and forest plots with odds ratios (OR) and 95% confidence intervals (CI). Among 1,808 patients across seven RCTs, no significant difference was found in TVR between DCB and DES over 3 years (OR = 0.95, 95% CI [0.58, 1.54], p = 0.82). While initial analyses favoured higher TLR incidence in DES, the trend shifted towards DCB over time, with a non-significant association favouring DCB at 3 years (OR = 0.51, 95% CI [0.26, 1.00], p = 0.05). DCB use was associated with significantly higher rates of MACE and MI at the 3-year mark (MACE: OR = 0.55, 95% CI [0.38, 0.79], p = 0.001; MI: OR = 0.35, 95% CI [0.17, 0.7], p = 0.003), while mortality rates converged between the two interventions over time. Vessel thrombosis rates were similar between DCB and DES. Conclusions: While DCBs may offer comparable efficacy to DES in terms of TVR and TLR over shorter durations, there is a concerning trend towards higher rates of MACE and MI associated with DCB use at the 3-year mark. Further research with larger sample sizes, longer follow-up durations, and consistent inclusion criteria is needed to elucidate the optimal treatment strategy for small vessel CAD. Until then, DES may be considered a safer option for managing small vessel CAD.

Background: Epilepsy poses significant challenges globally, with varied clinical, social, and economic impacts. Despite advances in treatment, epilepsy-related mortality remains a concern. This study aimed to analyze the demographic and regional distributions of epilepsy-related mortality in the United States (U.S.) from 1999 to 2020, identifying high-risk populations for targeted interventions. Methods: Data on death certificates were obtained from the 1999 to 2020 Centers for Disease Control and Prevention Wide-Ranging Online Study Epidemiologic Research (CDC-WONDER) database. We gathered data on demographics, place of death, and urban/rural classification. Mortality rates per 100,000 people were computed and classified according to state, year, sex, race/ethnicity, and urban/rural status. Trends were examined using Joinpoint regression. Results: A total of 12,573 deaths (age <35), 22,947 (35–64), and 21,782 (65+) were attributed to epilepsy. Mortality rates varied by age group, sex, race/ethnicity, and region. Trends showed significant increases, notably in middle-aged and older adults, with higher rates in males and nonHispani, African American populations. Conclusion: Epilepsy-related mortality exhibits demographic and regional disparities in the U.S. Understanding these patterns can guide targeted interventions to mitigate mortality risk.

Background This study compares Selective Amygdalohippocampectomy (SAHE) and Anterior Temporal Lobectomy (ATL) for temporal lobe epilepsy (TLE), focusing on seizure control and visual field deficits (VFD). While previous research suggests potential benefits of SAHE, this meta-analysis aims to clarify the comparative effectiveness of bothprocedures. Methods This study adhered to PRISMA guidelines, comparing seizure outcomes and VFDs between SAHE and ATL for temporal lobe epilepsy. Comprehensive data extraction and meta-analysis revealed comparable efficacy, with SAHE potentially offering advantages in VFD risk reduction. Quality assessment ensured methodological rigor. Results 29 studies comparing SAHE and ATL for TLE. Seizure freedom analysis encompassed 23 studies (n = 3238), showing no significant difference between SAHE and ATL (RR = 0.96, 95% CI = 0.89–1.03, P = 0.26). SAHE exhibited significantly lower visual field deficits (RR = 0.87, 95% CI = 0.78–0.97, P = 0.01). Subgroup analyses highlighted differences between transsylvian SAHE and ATL but not transcortical SAHE. No significant difference was found in seizure freedom between SAHE and ATL in patients with hippocampal sclerosis. Conclusions ATL is more effective than transsylvian SAHE in achieving seizure freedom. However, no significant difference in seizure freedom was observed between transcortical SAHE and ATL. There were no notable differences in seizure outcomes between the two techniques in patients with hippocampal sclerosis. In contrast, SAHE carries a lower risk of postoperative visual field deficits compared to ATL.

Tricuspid valve replacement (TVR) is required when repair is not feasible, and it continues to be a relatively high-risk procedure owing to the complex medical and/or surgical profile of patients. The choice between mechanical and biological prostheses for TVR remains a subject of debate owing to their distinct advantages and disadvantages. This study aimed to analyse and compare the clinical outcomes of these two types of prostheses in the tricuspid position. PubMed, EMBASE, Web of Science, and the COCHRANE library were searched from 1995 to April 2023 for studies comparing clinical outcomes of mechanical versus biological valves in the tricuspid position. Data on 30-day mortality, reoperations, 5-year valve failure rates, thrombotic/thromboembolic events, and long-term survival were extracted, pooled, and analysed. Forest plots were generated using a random-effects model. From an initial pool of 4716 citations, 37 studies meeting our inclusion criteria were assessed, collectively encompassing 8316 prostheses (3796 mechanical, 4520 bioprostheses). Our analysis revealed that mechanical valves exhibited a non-significant trend towards diminished 30-day mortality (RR = 0.85, 95% CI = 0.69–1.06). A distinct disparity emerged in valve durability, with mechanical valves demonstrating a significantly increased risk of 5-year valve failure (RR = 2.21, 95% CI = 1.38–3.56). Strikingly, mechanical valves displayed a substantial six-fold elevated risk of thrombotic events (RR = 6.29, 95% CI = 3.98–9.92). In contrast, the long-term survival and reoperation rates demonstrated no statistically significant differences between the two valve types. This systematic review and meta-analysis provides insights into the selection of mechanical and bioprosthetic valves for TVR. These findings highlight the potential advantages and disadvantages of mechanical and bioprosthetic valves in terms of early mortality, valve durability, and thrombotic risk. Our analysis provides clinicians with evidence-based guidance for optimizing outcomes in TVR, offering a foundation for informed decision-making in this intricate surgical landscape. Despite these insights, clinicians must overcome the limitations of retrospective studies, evolving healthcare, and anticoagulant disparities to ensure careful consideration in tricuspid valve replacement decisions.

Glioblastoma (GB), the most common malignant brain tumour, has a poor prognosis despite advances in treatment. Standard management involves surgery followe

Background: Chronic subdural hematoma (CSDH) is an important medical condition characterized by the accumulation of blood in the subdural space. Several methods have been explored, including surgical intervention and administration of tranexamic acid, which is a conservative treatment option. This meta-analysis aimed to assess the effectiveness and safety of tranexamic acid in CSDH management. Methods: A systematic literature search was performed according to the PRISMA and MOOSE guidelines. This study included cohort and randomized controlled trials involving adults with chronic subdural hematoma (CSDH) who were treated with intravenous tranexamic acid. The primary outcome measures were recurrence and adverse events. Results: Six studies encompassing 2024 participants were included. Studies have shown that tranexamic acid reduced recurrence rates (OR, 0.32; 95% CI: 0.27–0.38, p = 0.16; I2 = 0%), although the result was non-significant. However, the analysis of adverse events indicated a moderate level of heterogeneity (OR, 1.14; 95% CI: 0.60–2.15, p = 0.07; I2 = 57%), suggesting a potential safety concern. Conclusion: In conclusion, this meta-analysis suggests tranexamic acid (TXA) may reduce chronic subdural hematoma (CSDH) recurrence, though significance varied across studies. Adverse effects with TXA were similar to controls. Larger trials are needed to confirm TXA’s role in CSDH management.