Mandy Elewa

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major global pathogen with increasing resistance to conventional antibiotics. LL-37 and its derivative peptides have shown promising in vivo antibacterial activity. This study evaluated whether these peptides improve bacterial clearance, wound healing, and survival compared with controls in animal models of MRSA infection. Methods: The literature search was last updated on 21 April 2026. A systematic search of PubMed, Scopus, and Embase was conducted to identify preclinical studies assessing the antibacterial activity of LL-37 and its derivatives in MRSA animal infection models. Guided by PRISMA, 1,014 unique records were screened after removing 368 duplicates; 23 studies met the inclusion criteria, and 16 were included in the qualitative synthesis. Four studies (one comprising three independent experiments) provided sufficient data for meta-analysis. Extracted variables included sample size, bacterial counts (mean ± SD), and intervention/control details. Standardized mean differences (Hedges' g) were calculated using a random-effects model, and study quality was assessed using SYRCLE's risk-of-bias tool. Results: The meta-analysis of bacterial clearance pooled data from six independent experimental results (n = 44 animals). LL-37 and its derivatives achieved markedly greater bacterial eradication than controls, yielding a pooled standardized mean difference (SMD) of -7.86 (95% CI: -9.40 to -6.33; P < 0.001). All studies favoured LL-37, with no confidence intervals crossing zero. Heterogeneity was negligible (I² = 0%, τ² < 0.0001, P = 0.645), and the prediction interval (-9.74 to -5.99) indicated consistently large effects across similar experimental contexts. For wound healing (binary outcome), pooled analysis showed that LL-37 significantly increased complete wound closure rates compared with controls, with a pooled risk ratio (RR) of 1.25 (95% CI: 1.16-1.36). The pooled proportion of healed wounds was 89.3% in the LL-37 groups versus 70.0% in controls, indicating a clinically relevant improvement. Conclusions: LL-37 and its derivative peptides demonstrate robust antibacterial activity and significantly enhance wound healing in MRSA-infected animal models. The large and consistent effects observed across studies support their advancement toward translational research and early-phase clinical trials for potential human therapeutic use.

The morbidity and mortality associated with heart failure with reduced ejection fraction (HFrEF) remain high despite significant advances in treatment. Current guideline-directed medical therapies (GDMT) primarily target neurohormonal pathways. However, traditional positive inotropes, which enhance contractility, are limited by adverse events including increased myocardial oxygen consumption and arrhythmogenesis. Omecamtiv Mecarbil (OM) is a first-in-class selective cardiac myosin activator that addresses this gap by directly targeting the cardiac sarcomere. OM binds to cardiac myosin, stabilizing it in a force-generating state, thereby prolonging systolic ejection time and improving contractility without increasing intracellular calcium or heart rate. The Phase III GALACTIC-HF trial, which enrolled over 8,200 patients with HFrEF, reported an 8% relative risk reduction in the composite endpoint of heart failure events or cardiovascular death (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.86-0.99, P = 0.025). This benefit was primarily driven by a reduction in heart failure hospitalizations, with no significant difference in cardiovascular mortality. Subgroup analysis revealed that the clinical benefit was most pronounced in patients with a left ventricular ejection fraction (LVEF) of ≤ 28%. OM was generally well-tolerated, with a safety profile comparable to placebo, though it possesses a narrow therapeutic window, with higher plasma concentrations associated with an increased risk of ischemic events. In summary, OM represents a novel, mechanistically distinct therapeutic option for symptomatic HFrEF patients, particularly those with severe systolic dysfunction, who remain at high risk despite optimized GDMT.

Colorectal cancer is the second leading cause of cancer-related deaths worldwide and the third most common type of cancer overall. Colorectal cancer can be avoided with regular screening and lifestyle modifications. This study aimed to identify the barriers to screening for colorectal cancer and to evaluate the public’s awareness and knowledge of the disease’s symptoms and risk factors. A cross-sectional study was conducted across nine countries from February 1, 2024, through April 3, 2024, targeting individuals aged 18 years and older. Data were collected using an online self-administered questionnaire in collaboration with national leaders and local team members in each country. Logistic regression analyses were employed to examine factors associated with participants’ knowledge, awareness, and screening barriers. Among the 13,030 participants, awareness of CRC symptoms was highest for “lump in the abdomen” (70%) and lowest for “back pain” (39%). The most recognized risk factor was “history of bowel disease” (71%), whereas the least recognized was “low fruit/vegetable intake” (33%). The primary barrier to screening was the belief in low personal risk due to the absence of symptoms (63%). Multivariate logistic regression identified working in the healthcare sector as the strongest predictor of high knowledge (aOR = 2.70, 95% CI: 2.50–2.94) relative to non-healthcare participants. Higher knowledge was also significantly associated with male sex, older age (25–49 years), and university-level education (all p < 0.001). Colorectal cancer usually goes unnoticed until it reaches an advanced stage, when treating it becomes far more difficult. These findings underscore an urgent need for targeted, culturally sensitive public health campaigns across the region to address knowledge gaps and mitigate barriers, particularly the prevalent misconception of asymptomatic low risk. These include avoiding risk factors, maintaining a healthy lifestyle, and participating in screening programs to detect disease early.

AI-driven triage presents a transformative opportunity to address persistent challenges in pediatric emergency care, from overcrowding and waiting times to human error and outcome disparities. This narrative review demonstrates that AI systems can achieve high accuracy in predicting critical outcomes, with pooled AUROCs of 0.87 for hospital admission, 0.93 for ICU admission, and 0.93 for mortality, significantly outperforming traditional triage scales, while observational studies report associations with improved efficiency, reduced triage errors, and enhanced resource allocation. However, publication bias favoring positive results affects the available evidence, and studies reporting no benefit or performance degradation exist. The promise of AI is tempered by significant challenges: performance varies across pediatric subgroups, the risks of perpetuating and amplifying bias remain inadequately addressed, and workflow integration and medico-legal liability require careful navigation. AI augments clinical judgment, guided by robust governance frameworks, fairness auditing, and human oversight for more equitable emergency care.

Fever is a prevalent clinical manifestation in pediatrics, representing a significant proportion of emergency department (ED) visits worldwide. While fever is often benign and self-limiting, it can also indicate life-threatening infections requiring immediate intervention, particularly in neonates and immunocompromised children. This comprehensive review delves into the intricate pathophysiology of fever, exploring its dual role as a protective immune mechanism and a potential physiological risk. It critically examines diagnostic challenges, evidence-based management strategies, and global disparities in fever treatment. Special emphasis is placed on parental perceptions, the overuse of antipyretics, and the emerging role of artificial intelligence in fever diagnosis. Future directions include refining diagnostic biomarkers, implementing digital health tools, and advancing antimicrobial stewardship to curb antibiotic resistance. By improving clinical decision-making and public awareness, this review aims to optimize the management of febrile children worldwide and enhance patient outcomes.

Background Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal multi-systemic vascular dysplasia caused by gene mutations that lead to recurrent epistaxis and other serious complications including mucocutaneous telangiectasias, gastrointestinal bleeding, and arteriovenous malformations. Treatment is limited to symptomatic relief with no approved standard therapy. Bevacizumab is a monoclonal antibody used primarily in treating metastatic malignancies and ophthalmology. Several studies have shown that bevacizumab is effective in the treatment of HHT-related epistaxis with a high safety profile. Purpose This systematic review and network meta-analysis aims to explore the efficacy and safety of bevacizumab in the treatment of HHT epistaxis. Methods A comprehensive literature search was done in many databases, including PubMed, Web of Science, Scopus, and the Cochrane Library. We conducted our network meta-analysis using R version 4.2.2 and R Studio version 2022.07.2. Dichotomous data was analyzed as risk ratio and 95% confidence interval and continuous data as mean difference and 95% confidence interval. Results We included four randomized clinical trials in our network meta-analysis. Different doses of bevacizumab failed to yield any statistically significant difference in reducing the epistaxis severity score, the number of epistaxis episodes, the duration of epistaxis, or improving hemoglobin levels compared to placebo or other comparators. The pooled effect sizes for all outcomes were homogenous. Conclusion Bevacizumab failed to show any significant difference compared to tranexamic acid, estriol, or placebo. These findings underscore the challenges in addressing HHT-related symptoms and highlight the ongoing need for innovative and more effective interventions.

Background and Aim: Severe alcoholic hepatitis (SAH) is a serious condition with few treatments. By modifying the gut–liver axis, fecal microbiota transplantation (FMT) was proposed as a treatment for SAH. The purpose of this meta‐analysis was to evaluate the efficacy of FMT versus the standard of care (SOC) in improving SAH patient survival rates.Methods: A thorough search of electronic databases was conducted till September 2023. The survival rates of SAH patients undergoing FMT versus SOC were compared. Using Review Manager 5.4, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.Results: The meta‐analysis consisted of six studies with a total of 371 patients with SAH. Patients who received FMT had significantly higher survival rates at 1 and 3 months compared to those who received SOC, with pooled OR of 2.91 (95% CI: 1.56–5.42, P = 0.0008) and 3.07 (95% CI: 1.81–5.20, P < 0.0001), respectively. However, the survival advantage disappeared after 6 months (OR: 2.96, 95% CI: 0.99–8.85, P = 0.05) and 1 year of follow‐up (OR: 1.81, 95% CI: 0.44–7.46, P = 0.41).Conclusion: This meta‐analysis highlights the potential of FMT to significantly improve short‐term survival rates in SAH patients. However, the survival benefit did not last 6–12 months. These findings call for additional research into the effectiveness of FMT over the long term, along with strategies for extending the survival benefit.