Tagwa Kalool Fadlalla Ahmad

Non-muscle-invasive bladder cancer (NMIBC) continues to present substantial management challenges, largely due to its high likelihood of recurrence and the routine need for repeated surgical procedures. Standard approaches, including transurethral resection of bladder tumor (TURBT) followed by intravesical therapies such as Bacillus Calmette Guerin or chemotherapy, are effective for many patients but are often limited by toxicity, procedural burden, and variable durability of response. In this context, the recent Food and Drug Administration approval of Zusduri, an intravesical mitomycin hydrogel, represents a noteworthy advancement for adults with recurrent low-grade, intermediate-risk NMIBC. This formulation is designed to transition into a gel within the bladder, extending the drug’s urothelial contact time and enabling in-clinic administration without anesthesia. Results from key clinical trials, i.e., OPTIMA II and ENVISION, reported meaningful chemoablative activity, achieving complete response rates, with a sizable proportion of responders remaining disease-free after 1 year. Most adverse events were manageable and localized, although isolated severe effects were documented. Despite this progress, questions regarding long-term recurrence patterns, broader accessibility, and cost remain unanswered and require future investigation. As real-world data accumulate, mitomycin may emerge as an important addition to the therapeutic landscape, offering a non-surgical option that could lessen dependence on repeated operative interventions and improve convenience for patients with NMIBC.

Background: Triple oral therapy combining metformin, sodium-glucose cotransporter 2 inhibitor, and a dipeptidyl peptidase-4 inhibitor has been proposed as a synergistic approach to intensify glycemic control in patients with type 2 diabetes mellitus. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of triple therapy compared to dual therapy (metformin plus either sodium-glucose cotransporter 2 or dipeptidyl peptidase-4 inhibitor). Methods: Following preferred reporting items for systematic review and meta-analysis guidelines, we searched PubMed, Embase, Scopus, and Web of Science through January 2026. Studies included randomized controlled trials comparing triple versus dual therapy in adults with type 2 diabetes mellitus. Outcomes included hemoglobin A1c (HbA1c), fasting plasma glucose, body weight, achievement of HbA1c < 7%, and adverse events (AEs). Pooled standardized mean differences (SMDs) and risk ratios (RRs) were calculated using random-effects models. Results: Eight studies encompassing 2606 participants were included. Findings indicate triple therapy significantly reduced HbA1c levels compared to dual therapy, with a SMD of − 0.54 (95% confidence interval [CI]: −0.92 to −0.16; P = .005). Triple therapy resulted in greater reduction in fasting plasma glucose, with an SMD of −0.30 (95% CI: −0.62 to 0.01; P = .06). Patients on triple therapy were more likely to achieve HbA1c levels below 7% (RR: 2.02; 95% CI: 1.55–2.63; P < .0001). Weight reduction was modest, with an SMD: −0.14 (95% CI: −0.22 to −0.07; P = .0002). No significant differences were found in total AEs (RR = 0.97; P = .69) or hypoglycemia (RR = 1.32; P = .32), although there was higher discontinuation due to AEs (RR = 2.62; P = .03). Conclusion: Triple therapy offers superior glycemic control over dual therapy without major safety trade-offs, though tolerability may affect long-term adherence.

The COVID-19 pandemic caused by SARS-CoV-2 has had a significant global impact on the respiratory system and multiple organ systems, including the nervous system. Neurological manifestations associated with COVID-19 infection and its vaccines have been increasingly recognized, ranging from problems with smell and taste to more severe conditions such as encephalitis, stroke, and Guillain–Barré syndrome. This narrative review critically evaluates the neurological manifestations of COVID-19 infection and its vaccines, providing insights into potential pathophysiological mechanisms. A comprehensive literature search was conducted, and data were retrieved from various databases. The prevalence, types, and severity of neurological symptoms in COVID-19 patients were discussed. The possible mechanisms of neurological injury in COVID-19 were explored, including direct viral invasion, hypoxic brain injury, immune-mediated damage, and cerebrovascular injury. Furthermore, the review addressed the neurological complications associated with COVID-19 vaccination. While severe vaccine-related adverse effects remain rare, understanding their occurrence is essential for risk assessment and public health interventions. In conclusion, COVID-19 can affect the nervous system in various ways, leading to various neurological symptoms. Further research is necessary to enhance our understanding of these manifestations and develop effective preventive and treatment strategies to manage this global health crisis.

Background: The COVID-19 pandemic, resulting in approximately seven million deaths globally, underscores the urgency for effective treatments. Ivermectin, among several repurposed drugs, garnered interest due to its antiviral properties. However, conflicting evidence from observational studies and randomized controlled trials raised questions about its efficacy and safety. Method: This systematic review and meta-analysis followed MOOSE and PRISMA guidelines. Comprehensive searches were conducted in databases including Scopus, Embase, PubMed, and Web of Science up to April 2024. Data were extracted independently by two reviewers and analyzed using Comprehensive Meta-Analysis V3 software. Results: Across 33 studies encompassing 15,376 participants, ivermectin showed no significant impact on critical outcomes such as mortality [risk ratio (RR) 0.911, 95% confidence intervals (CI) 0.732–1.135], mechanical ventilation (RR 0.727, 95% CI 0.521–1.016), polymerase chain reaction conversion (RR 1.024, 95% CI 0.936–1.120), ICU admissions (RR 0.712, 95% CI 0.274–1.850), or hospitalization rates (RR 0.735, 95% CI 0.464–1.165) compared to controls. However, it significantly reduced time to symptom alleviation (standardized mean difference −0.302, 95% CI −0.587 to −0.018) and sustained symptom relief (RR 0.897, 95% CI 0.873–0.921). Adverse event (AE) rates were similar between the ivermectin and control groups (RR 0.896, 95% CI 0.797–1.007). Meta-regression indicated older age and diabetes as predictors of AEs. Conclusion: Despite its observed benefits in symptom management, ivermectin did not significantly influence critical clinical outcomes in COVID-19 patients. These findings highlight the importance of continued research to identify effective treatments for COVID-19, emphasizing the need for high-quality studies with robust methodology to inform clinical practice and public health policy effectively.

Purpose: Primary biliary cholangitis (PBC), an autoimmune liver disease, has the potential to advance to liver cirrhosis and result in fatality. Ursodeoxycholic acid (UDCA) is the first‐line treatment, while obeticholic acid (OCA) serves as a second‐line option because of moderate UDCA nonresponsiveness and cirrhosis‐related concerns. Additional therapies are necessary because of recent warnings regarding OCA usage in patients with cirrhosis. This study aimed to evaluate the efficacy and safety of peroxisome proliferator‐activated receptor (PPAR) agonists in PBC. Methods: We searched PubMed, Google Scholar, and the Cochrane Library until October 2023. We included all randomized controlled trials (RCTs) that studied the efficacy and safety of PPAR agonists in treating PBC. The primary outcome of interest was change in alkaline phosphatase (ALP) levels. In contrast, the secondary outcomes were changes in gamma‐glutamyl transferase (GGT), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), triglyceride levels, and pruritis. We used a random‐effects model to calculate the risk ratio (RR) and standardized mean difference (SMD) with 95% CI. Results: A total of eight RCTs ( n = 515) were eligible for the analysis. Pooled data showed beneficial effects of PPAR agonists compared with placebo for change in ALP level (SMD = −2.81, 95 % CI = −4.10 to − 1.51; p < 0.0001, I ² = 96 % ), GGT level (SMD = −1.29, 95 % CI = −2.09 to − 0.48; p = 0.002, I ² = 92 % ), TBil level (SMD = −0.77, 95 % CI = −1.32 to − 0.22; p = 0.006, I ² = 86 % ), and Tg level (SMD = −0.99, 95 % CI = −1.63 to − 0.35; p = 0.003, I ² = 83 % ). There was no significant difference between PPAR agonists and placebo for ALT level (SMD = −0.93, 95 % CI = −1.94 to 0.08; p = 0.07, I ² = 95 % ), AST level (SMD = −0.01, 95 % CI = −0.67 to 0.66; p = 0.99, I ² = 91 % ), and pruritus (RR = 0.77, 95 % CI = 0.29 to 2.06; p = 0.60, I ² = 34 % ). Conclusion: Our study found a superior efficacy of PPAR agonists compared with placebo for change in ALP, GGT, TBil, and Tg levels, highlighting the potentially beneficial effect of PPAR agonists on liver health.

Background and Objective: Staphylococcus aureus bloodstream infections pose a significant threat to public health and necessitate substantial healthcare resources. The optimal antimicrobial therapy for these infections remains a subject of debate. This systematic review and meta-analysis evaluated the efficacy and safety of early transition to oral antimicrobial therapy compared with continued intravenous (IV) therapy in patients with MRSA and MSSA bloodstream infections. Method: A PRISMA-guided systematic review and meta-analysis compared the early transition from intravenous to oral antibiotics with continued intravenous therapy in patients with S. aureus infections, utilizing relevant studies from the PubMed, Embase, Scopus, and Web of Science databases from August 2003 to June 2024. Results: This meta-analysis of 11 studies (N = 54–220, primarily male, age: mid-30s to early 70s) revealed a 71.6% higher risk of all-cause mortality for patients transitioned to early oral therapy than for those who continued IV therapy (RR: 1.716; 95% CI: 1.039–2.836; P = 0.035; I² = 44%). Treatment failure, rehospitalization rates, adverse events, and hospital stay lengths did not differ significantly between groups. Conclusion: Early oral antimicrobial therapy for S. aureus bloodstream infections significantly reduces mortality compared to prolonged intravenous treatment, without increasing the incidence of adverse events or the risk of rehospitalization, suggesting its safety and efficacy as an alternative therapeutic approach; however, further randomized controlled trials are necessary to corroborate these findings.

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Background: ChatGPT, a powerful AI language model, has gained increasing prominence in medicine, offering potential applications in healthcare, clinical decision support, patient communication, and medical research. This systematic review aims to comprehensively assess the applications of ChatGPT in healthcare education, research, writing, patient communication, and practice while also delineating potential limitations and areas for improvement. Method: Our comprehensive database search retrieved relevant papers from PubMed, Medline and Scopus. After the screening process, 83 studies met the inclusion criteria. This review includes original studies comprising case reports, analytical studies, and editorials with original findings. Result: ChatGPT is useful for scientific research and academic writing, and assists with grammar, clarity, and coherence. This helps non-English speakers and improves accessibility by breaking down linguistic barriers. However, its limitations include probable inaccuracy and ethical issues, such as bias and plagiarism. ChatGPT streamlines workflows and offers diagnostic and educational potential in healthcare but exhibits biases and lacks emotional sensitivity. It is useful in inpatient communication, but requires up-to-date data and faces concerns about the accuracy of information and hallucinatory responses. Conclusion: Given the potential for ChatGPT to transform healthcare education, research, and practice, it is essential to approach its adoption in these areas with caution due to its inherent limitations.

Background: Prescription writing is an important component of healthcare delivery and can directly influence patient safety and treatment outcomes. Prescription errors are common in developing countries because of the lack of national guidelines. This two-cycle clinical audit assessed the impact of educational interventions on improving prescription writing practices. Methods: A cross-sectional prospective clinical audit was conducted in the Out Patients Department (OPD) of the District Head Quarters (DHQ) Hospital in Bhimber, Azad Jammu, and Kashmir. A total of 100 randomly selected prescriptions were reviewed for each cycle from July to August 2023. We recorded compliance with WHO guidelines for prescription writing before and after the educational intervention. Microsoft Excel and SPSS version 25.0 were used for statistical analysis. Categorical variables were analyzed using frequencies and percentages. Results: An improvement in compliance was observed during the 2^nd audit cycle, after the educational intervention. The greatest improvement was observed in documenting the allergic status of patients (62%) and the direction of drug administration (40%). We also observed improvements in the treatment duration (>10%), patient weight, physician registration number, diagnosis, and follow-up advice. The legibility of prescriptions also improved during the 2nd audit cycle. Conclusion: This study shows that integrating an educational intervention into a clinical audit can improve prescription writing practices and ultimately result in better quality of care for patients.