Kamal Kandel

Background: Magnetic resonance imaging (MRI) has a central role in acute ischemic stroke (AIS) and transient ischemic attack (TIA) diagnosis; however, conventional high-field MRI remains limited by infrastructure requirements, patient transport, and restricted accessibility. Low-field and portable MRI systems have emerged as potential solutions for point-of-care neuroimaging in emergency, intensive care, and resource-limited settings. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from inception through May 2026. Studies evaluating low-field or portable MRI systems (≤0.55 T) in adults with AIS, TIA, sub-acute ischemic stroke, or suspected stroke were included. Diagnostic accuracy, feasibility, safety, workflow, and clinical utility outcomes were extracted. Risk of bias was assessed using QUADAS-2. Results: Eleven studies encompassing portable and low-field MRI platforms ranging from 0.064 T to 0.55 T were included. Portable MRI demonstrated feasibility in bedside ICU and emergency department settings without major device-related adverse events. Diagnostic performance varied by field strength, lesion size, and imaging protocol. Conclusions: Low-field and portable MRI show promising diagnostic potential for AIS and TIA, particularly when conventional MRI is unavailable, delayed, or impractical. However, current evidence is limited by small, predominantly single-center studies with substantial risk of bias, and further prospective multicenter validation is required before these technologies can be incorporated into routine clinical decision-making.

PSMA-RADS version 1, introduced by Rowe et al. in 2017, provides a framework for classifying PSMA-targeted PET scans and individual findings based on their likelihood of representing prostate cancer. The system was optimized for findings outside the prostate and was structured as a five-point scale (Rowe et al., Eur Urol 73:485–487, 2018. https://doi.org/10.1016/j.eururo.2017.10.027. In 2022, an updated PSMA-RADS version was proposed to refine category definitions, address limitations of the initial version, and enhance its role in guiding clinical decisions. The framework includes both lesion-level and patient-level classifications, offering confidence and probability scores in support of clinical decision-making (Leung et al., EJNMMI Res. https://doi.org/10.1186/S13550-022-00948-1). This article aims to explore the changes introduced in the updated scale and evaluate their impact on clinical management. It is intended to inform abdominal and general radiologists about recent developments in PSMA-targeted imaging to support multidisciplinary collaboration and patient care.

Background: A conservative strategy is the primary modality of treatment for acute pancreatitis of which fluid replacement is an important component. Since the results regarding early aggressive versus moderate fluid replenishment for acute pancreatitis are inconsistent, we sought to compare outcomes between the two resuscitation strategies in our meta‐analysis.Methods: We searched MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov for all available randomized controlled trials (RCTs) assessing outcomes for patients treated with aggressive fluid replacement compared to moderate fluid replacement. Our primary outcome was all‐cause mortality.Results: Our meta‐analysis included 6 RCTs involving a total of 632 patients. Our results showed that aggressive fluid resuscitation increased the risk of all‐cause mortality as compared to moderate fluid replacement (RR 2.40, CI: 1.38–4.19). For all of our secondary outcomes which included the development of organ failure, severe pancreatitis, pancreatic necrosis, clinical improvement, development of SIRS, persistent SIRS, and length of hospital stay, the results indicate that there was no significant difference between the two groups.Conclusions: Aggressive fluid resuscitation is associated with higher mortality as compared to moderate fluid replacement in patients with acute pancreatitis. RCTs with larger sample sizes are needed to provide greater statistical power and establish more definitive conclusions.

The efficacy and safety profile of mavacamten, a cardiac myosin inhibitor for the treatment of hypertrophic cardiomyopathy (HCM) is not well-established, prompting the need for an updated meta-analysis. The authors conducted an extensive search across multiple electronic databases, including Embase, MEDLINE (via Pubmed), and CENTRAL, to identify randomized controlled trials (RCTs) assessing the efficacy and safety of mavacamten in HCM. Review Manager 5.4 (Revman) was employed to pool risk ratios (RR) and mean differences (MD). Our literature search yielded 4 RCTs with a total of 503 patients. Mavacamten was found to be associated with higher rates of greater than or equal to 1 New York Heart Association (NYHA) class improvement (RR 2.20, 95% CI: 1.48–3.28; I²=51%) and change from baseline in the Kansas City Cardiomyopathy Questionnaire- Clinical Summary Score (KCCQ-CSS) (MD 7.50, 95% CI: 3.44–11.55; I² =50%). Mavacamten was also associated with improved resting left ventricular outflow tract (LVOT) gradient (MD −38.33, 95% CI: −49.38 to −27.28; I² =75%), Valsalva LVOT gradient (MD −48.08, 95% CI: −62.21 to −33.96; I² =78%), post-exercise LVOT gradient (MD −37.1, 95% CI: −44.37 to −29.84; I² =0%), LVMI (MD −16.91, 95% CI: −28.29 to −5.54; I² =88%), and lower rates of septal reduction therapy (SRT) (RR 0.30, 95% CI: 0.22–0.40; I² =0%). There were no significant differences between mavacamten and placebo regarding the composite functional outcome, greater than or equal to 1 treatment-emergent adverse event, greater than or equal to 1 serious adverse event, and atrial fibrillation. The authors; findings suggest that mavacamten contributes to improvements in NYHA class, KCCQ-CSS scores, and LVOT gradients while reducing the incidence of SRT in patients with HCM.

Objective: To evaluate the effect of vitamin D supplementation on cardiovascular outcomes. Methods: After searching different databases, we retrieved and included randomized controlled trials on long-term supplementation of vitamin D (≥1-year intervention) and reporting cardiovascular outcomes. We calculated risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes. Results: Compared to the control group, the vitamin D group was not associated with a statistically significant decrease in the incidence of major adverse cardiovascular events (MACE) [risk ratio=0.99; 95% CI: 0.94–1.03]. We found no difference between the vitamin D group and the control group for the outcomes of incidences of myocardial infarction, heart failure, coronary revascularization, cardiovascular death, and all-cause mortality. The heterogeneity was low for all outcomes. Conclusion: According to our meta-analysis, vitamin D supplementation did not reduce major adverse cardiovascular events, other cardiovascular parameters, and all-cause mortality.

Background: Albumin acts as a scavenger of reactive oxygen species and an inhibitor of inflammatory processes that underlie hepatic encephalopathy (HE). However, the role of albumin in hepatic encephalopathy is not well-established. The authors performed this meta-analysis to evaluate the efficacy and safety of albumin in the management of hepatic encephalopathy. Methods: The authors carried out an extensive search across multiple databases, including MEDLINE (via PubMed), Embase, CENTRAL, and various trial registries, to identify randomized controlled trials (RCTs) evaluating the impact of albumin administration in HE. The authors used a random-effects model for analyses and presented dichotomous outcomes and continuous outcomes as relative risk and mean difference, along with corresponding 95% CIs, respectively. Heterogeneity was assessed using both the I² index and χ² test. Results: Our meta-analysis included 4 RCTs involving 306 patients. Our primary outcomes, mortality, and persistence of HE were reported by all four studies. Albumin was found to significantly decrease mortality in patients with HE [risk ratio (RR) 0.52, 95% CI 0.32–0.83; I2 =0%]. Persistence of HE was found to be comparable between the two groups (RR 0.83, 95% CI 0.68–1.00; I2 =24%). There was no significant difference between the albumin and control groups regarding length of hospital stay (MD −1.55, 95% CI −3.5 to 0.14; I2 =41%), adverse events (RR 1.00, 95% CI 0.87–1.16; I2 =0%), and severe adverse events (RR 0.89, 95% CI 0.59–1.35). Conclusion: Albumin administration in patients with hepatic encephalopathy decreases mortality but does not significantly impact the persistence of HE. Further high-quality, large-scale randomized controlled trials are needed to provide conclusive evidence.

Objective: The purpose of this study is to find out the level of awareness and acceptance of artificial intelligence (AI) in Pakistan’s medical community so as to comment on its future in our healthcare system. Methods: A survey consisting of 15 close-ended questions was conducted. The questions inquired about awareness about AI and discovered the opinions of healthcare professionals regarding its benefits and expected problems. The data were analyzed using SPSS version 26, and descriptive statistics for percentage and frequency were computed. χ² test was used to analyze the subgroups (Significant p value <0.05). Results: A total of 351 participants were included in this study. General familiarity with AI was low. Only 75 (21.3%) participants answered that they had good familiarity with AI, and only 56 (16%) of them had good familiarity with the role of AI in medicine. One hundred sixty-eight (47.9%) participants disagreed that AI would out-compete the physician in the important traits of professionalism. Only 71 (20.2%) participants believed AI to be diagnostically superior to the physician. Two hundred fourteen (61.0%) were worried about completely trusting AI in its decisions, and 204(58.1%) believed that AI systems lacking human traits would not be able to mirror the doctor-patient relationship. Two hundred sixty-one (74.4%) participants believed that AI would be useful in Administrative tasks. A majority, 162 (46.2%), do not believe that AI would replace them. Finally, a huge majority of participants [225 (64.1%)] demanded the integration of AI in Pakistan’s healthcare system. Conclusion: This study suggests that a majority of healthcare professionals in Pakistan do not believe that they are sufficiently aware of the role of AI in healthcare. This was corroborated by their answers to various questions regarding the capabilities of AI. This study indicates the need for a more comprehensive ascertainment of healthcare professionals’ perceptions regarding the role of Artificial Intelligence in medicine and bridging the gap between doctors and technology to further promote a patient-centred approach to medicine.

Key Clinical Message: This unique case report of primary Sjogren's syndrome (pSS) shows bilateral ptosis and significant periorbital edema, compromising vision. To avoid misleading diagnosis, antibody tests must be evaluated and interpreted in the context of clinical findings. Primary Sjögren's syndrome is an idiopathic, autoimmune disorder involving the lacrimal and salivary glands characterized by both localized and systemic manifestations including xerostomia and keratoconjunctivitis sicca. Myasthenia Gravis (MG) is also an autoimmune disorder characterized by the development of auto‐antibodies against nicotinic acetylcholine receptors that causes decreased muscle response to stimulation. It usually presents with ptosis and generalized body weakness. Ophthalmological involvement is common in both disorders but ptosis is very rarely seen in pSS. We report the case of a 27‐year‐old woman presenting to our clinic with the complaint of ptosis and eyelid swelling. She also had a positive anti‐acetylcholine receptor antibody test and her initial presentation mimicked Myasthenia Gravis. Her autoimmune workup revealed a positive titer of Anti Ro SSA antibodies. Myasthenia Gravis was ruled out on electrodiagnostic studies which showed no decremental response, and pSS was confirmed on lip biopsy. Our case highlights that it is important to interpret the antibody test results in the context of clinical findings as we can have spurious results in autoimmune diseases. Autoimmune conditions can have varying presenting complaints hence, clinical judgment should always overrule diagnostic investigations and should thus guide patient management.

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