Khalid Sarhan

Background: Headache disorders are among the most common neurological conditions globally, yet their impact on university students, particularly in low and middle-income countries, remains underrecognized. This study aimed to assess the prevalence and functional impact of headaches among university students. Methods: A cross-sectional study was conducted between Dec 2023 and Dec 2024 among undergraduate students at Delta University of Science and Technology in Egypt. Data was collected using a self-administered questionnaire, which included the demographic data and the Headache Impact Test (HIT-6) to evaluate the effect of headache on daily functions. Descriptive statistics were used to estimate the prevalence and to assess the severity of impact and to further study factors associated with headache impact a generalized mixed effect logistic regression model was used. A P-value of < 0.05 was considered statistically significant. Results: A total of 512 university students suffering from headache were included in the analysis. The prevalence of students reported experiencing headaches on the day of the questionnaire was 304 (59.4%). The mean of HIT score was 62.4 ± 6.4, with the majority of students 372 (72.6%) experiencing a severe impact from their headache. Notably, females reported experiencing higher rates of severe headache impact as compared to males ( p = 0.008). Despite this, only 140 (27.3%) students had previously sought medical attention for their headaches. Upon using a mixed-effects logistic regression model, stress and light sensitivity was attributed to higher HIT results. Conclusions: Headache disorders are highly prevalent among university students with the majority experiencing severe impact from their headache. Despite the high prevalence and impact very few students sought medical consultation. These findings underscore the need for targeted screening, awareness campaigns, and accessible headache management strategies for university students.

Objective Our goal is to conduct an investigation into the safety and efficacy of 𝛽3 agonist (Mirabegron) in patients with heart failure (HF) comparing it to placebo. Methods We searched internet databases for eligible randomized controlled trials (RCTs) up to April 1st, 2024. Heart rate, stroke volume, systolic blood pressure, cardiac index, and adverse events were the primary outcomes that were analyzed. Inverse variance was used to compute the risk ratio (RR) and pooled mean differences (MD), along with their 95% CI. Results Four studies were included in our paper with a total of 454 patients. The mirabegron group showed a statistically significant improvement compared to the placebo group in Cardiac index (MD: 0.28, [95% CI: 0.02 , 0.53], P = 0.03), but pooled analysis did not favor either of the two arms in heart rate, ejection fraction, stroke volume and systolic blood pressure (MD: 2.54, [95% CI: -1.05 , 6.13]), (MD: 2.40, [95% CI: -2.51 , 7.3]), (MD: 0.56, [95% CI: -2.45 , 3.56]), and (MD: 0.11, [95% CI:-0.15 , 0.38]) respectively. Furthermore, there were not significant variations between the two groups in adverse events, and serious adverse events (RR: 1.06, [95% CI: 0.87, 1.29]), and (RR: 1.06, [95% CI: 0.70, 1.60], p = 0.80) respectively. Conclusion The Cardiac index was considerably enhanced with Mirabegron, but all other effectiveness and safety outcomes were unchanged. Further RCTs for longer durations and on more diverse populations still need to be conducted.

Endovascular thrombectomy (EVT) is the standard of care in acute ischemic stroke (AIS), yet functional outcomes remain suboptimal. Normobaric hyperoxia (NBHO) is a potential neuroprotective strategy. This study is the first systematic review and meta-analysis to assess NBHO as a potential neuroprotective adjunctive to improve outcomes in EVT-treated patients. A comprehensive search of electronic databases, including PubMed, Scopus, Cochrane, and Web of Science, was performed in February 2025. The inclusion criteria targeted randomized controlled trials (RCTs) comparing NBHO and EVT to EVT alone or with sham oxygen therapy. Statistical analyses were performed using RevMan software. Four RCTs comprising 648 patients with AIS due to large vessel occlusion in the anterior circulation were included in the study. For the primary efficacy endpoint of excellent functional outcome, defined as the number of patients who had a Modified Rankin Scale (mRS) score of ≤ 1 at 90 days, the overall odds ratio with a subgroup based on the oxygen delivery duration at 2, 4, and 6 h was in favor of the NBHO group compared to the control (OR = 1.66, 95% CI [1.13, 2.45], P = 0.01, I2 = 0%). The subgroup of 4-hour oxygen delivery duration was the only significant subgroup (OR = 1.6, 95% CI [1.01, 2.51], P = 0.04). Safety outcomes showed no significant differences between the NBHO group and the control group across all reported measures. NBHO as an adjunct to EVT appears to be effective and safe. A 4-hour duration was found to be the most effective. Further RCTs are needed to confirm our results and establish the optimal treatment protocol. Graphical abstract

Background: Middle meningeal artery (MMA) embolization is an increasingly common procedure involved in the treatment of various vascular and neoplastic diseases. Understanding its anatomical nuances and clinical implications is fundamental in enhancing the safety of preoperative embolization. Methods: A systematic review following PRISMA guidelines was conducted to consolidate literature on the MMA anomalous variations. PubMed, Scopus, and Web of Science were systematically searched using our predefined criteria until 2025. Inclusion encompassed studies focusing on the clinical perspectives of MMA’s anomalous anatomy and endovascular implications. Results: Twelve articles met inclusion criteria, exploring the clinical significance of the MMA’s anatomical variations in various clinical situations. We identified 11 case reports, and we also reported the clinical significance of the cases identified among different case series for the treatment of CSDH and other involved pathologies. Anomalous variations of the MMA involving either its origin, branching or connections were detected clinically in about 43 patients in the literature. We identified the basilar artery as an origin of the MMA in 9 case reports. The ophthalmic origin of the MMA was reported in about 12 patients, while an accessory meningeal artery arising from an ophthalmic artery was only reported in two cases. Conclusion: Properly identifying the anomalous variants of the MMA is considerably valuable in preoperative planning and decision-making for the endovascular management of various pathologies involving the dura. To choose an appropriate tool and method of endovascular intervention, understanding the anatomical features and variability of the MMA is crucial.

Background: The temporalis muscle is commonly dissected and mobilized during craniotomy. Cosmetic and functional complications may arise from the improper handling of this muscle. Surgery for recurrent pathologies may be challenging due to adhesions and muscle damage. Material and methods: A systematic review following PRISMA guidelines was conducted to consolidate literature on the potential techniques used for preserving the temporalis muscle during neurosurgical interventions. PubMed, Scopus, and Web of Science were systematically searched using predefined criteria from inception to 2025. A qualitative synthesis was done summarizing the primary cranial pathology, type of surgical approach, the technical clue for temporalis muscle preservation, follow up and complications. Results: We included 27 eligible articles with a total number of 811 patients. About 508 (62.6%) of patients underwent pterional approach, while 150 (18.4%) patients had decompressive craniotomies. Aneurysm clipping was the surgical indication in 172 (21.2%) patients, while decompressive surgery was done for traumatic brain injuries in about 48 (5.9%) patients. Osteoplastic temporalis muscle flap was used in 178 (21.9%) patients, while some authors sutured the temporalis muscle to the cranioplasty plate in 79 (9.7%) patients. Fixation of the temporalis muscle to the bone using sutures through small holes was done in 100 (12.33%) patients. No chewing problems were recorded among all the patients analyzed. Temporalis muscle atrophy was observed in only 13 (1.6%) patients. Conclusion: Proper manipulation of the temporalis muscle during surgery is crucial for the vitality of its fibers and to prevent postoperative functional or cosmetic drawbacks.

Dissection methods are variable, and surgeons select the appropriate method based on its safety, efficiency and applicability. The water-jet dissection technique is a promising method that has been applied in different surgeries. We try to highlight the possible neurosurgical applications and evaluate the safety and efficacy of this technique. We conducted a comprehensive systematic review search in the following electronic databases: PubMed, Embase, Web of Science, and Cochrane Library from inception to January 2025. A qualitative synthesis was performed to summarize the findings on the efficacy, safety, and technical challenges of water-jet dissection in neurosurgery. A total of 401 patients were included in our review. Nine studies (351 patients) used the conventional water jet dissection technique, and 4 studies (50 patients) used the laser-based technique. Conventional water jet dissection has been employed in 183 cases involving glioma (52.1%), 32 cases involving meningioma (9.1%), 75 cases for other tumors (21.3%), 46 cases in epilepsy surgery (13.1%). Laser-based techniques have been less frequently used, with 10 cases reported for meningioma (12.3%), 25 cases for other tumors (30.8%), and 46 cases for vascular surgeries (56.7%). For conventional water-jet dissection, complications were observed, with vessel injury and wound infection/brain abscess occurring in 10 cases each (2.8%), post-operative edema in 3 cases (0.8%), air embolism in 1 case (0.3%), failed dissection in 13 cases (3.7%), other complications in 10 cases (2.8%), and no reported thermal injury. Only 3 (6%) complications were observed in the pulsed-based water-jet dissection technique. Water-jet dissection is a promising tool that can be used safely in neurosurgical interventions. However, precautions should be taken to minimize its potential risks and ensure optimal patient outcomes. Robust research in the form of randomized clinical trials and prospective case series should be recruited for further evaluation of this tool.