Taif Mansour Almaqboul

Background: Spinal tumors can lead to severe pain, neurological issues and spinal instability. Surgery and radiotherapy are often performed, but protecting the spinal cord during tumor management is still difficult. During surgery, intraoperative brachytherapy delivers radiation directly to the tumor or surgical bed. This review outlines the evidence available regarding its use, outcomes and complications in patients with spinal tumors. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted a systematic literature review in PubMed, ClinicalTrials.gov, the Cochrane Library, Scopus, and Google Scholar for studies published between 2000 and 2025. We included studies evaluating intraoperative brachytherapy for primary or metastatic spinal tumors. The outcomes included overall survival, pain control (Visual Analog Scale), local tumor recurrence, and neurological and functional outcomes. Data were synthesized narratively because substantial clinical and methodological heterogeneity was observed among the included studies. The risk of bias was assessed using the ROBINS-I tool. Results: Seven studies involving 301 patients were included. The studies evaluated different approaches, including permanent iodine-125 seed implantation, plaque-based irradiation, phosphorus-32 brachytherapy, 50-kV intraoperative radiotherapy, and kyphoplasty combined with intraoperative radio-therapy. Individual studies reported local control of 75% at 24 months and 72.9% at 3 years; another study reported 97.1%, 95.9%, and 94.2% at 6, 12, and 24 months, respectively. These are study-specific estimates and were not pooled. In one cohort, local control was reported per treated vertebra, whereas survival was reported per patient. All seven studies had a serious overall risk of bias, and the evidence was limited by small samples, non-randomized designs, and differences in interventions and outcome definitions. Conclusions: IOBT may be a local treatment option for selected patients, but the available evidence does not establish its independent benefit or superiority to contemporary postoperative stereotactic body radiotherapy (SBRT).

Background and Objectives: Rhinosinusitis contributes to the development of sleep-disordered breathing (SDB) by causing nasal obstruction and airway inflammation; however, the extent to which treatment improves these conditions remains unclear. To address this, this study systematically evaluated the impact of rhinosinusitis-directed therapy on nasal symptoms, endoscopic findings, and sleep-related respiratory parameters. Materials and Methods: Methodologically, this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was conducted across the PubMed, Medline, Web of Science, Science Direct, and Google scholar databases. Specifically, studies reporting pre- and post-treatment outcomes in patients with rhinosinusitis were included. Due to substantial clinical and methodological heterogeneity among the included studies, a quantitative meta-analysis was not performed; instead, findings were synthesized narratively. Results: Ultimately, fifteen studies met the inclusion criteria and demonstrated consistent improvements in sleep-related outcomes following the treatment of rhinosinusitis. Across the surgical and medical interventions, reductions in apnea-hypopnea index (AHI) and improvement in endoscopic findings were frequently reported. For instance, functional endoscopic sinus surgery (FESS) produced notable enhancements in sleep quality, daytime sleepiness, and sinonasal symptom scores in several studies, while biologic therapy and medical management also showed benefit in reducing nasal obstruction, rhinorrhea, and inflammatory markers. Conclusions: The available evidence suggests that rhinosinusitis treatment may be associated with improvements in measures of sleep-disordered breathing (SDB) and mucosal inflammation, although subjective nasal symptom outcomes were more variable across studies. Consequently, targeted sinonasal therapy may play an important role in reducing SDB burden, particularly in patients with inflammatory airway compromise.

Background: Stress hyperglycemia (SH), a transient elevation in blood glucose levels during acute stress such as stroke, has been increasingly recognized as a critical determinant of clinical outcomes. This review aims to evaluate the association between SH and clinical outcomes across different stroke subtypes and its role as a prognostic indicator. Methods: The current literature review was conducted through a comprehensive literature search of PubMed, Scopus, and Web of Science electronic databases. Initial title and abstract screening was conducted by two independent reviewers depending on the relevance to the topic of interest. Final study inclusion was based on the clinical relevance and agreement between reviewers. Results: Current evidence links SH with higher stroke severity (Higher national institutes of health stroke scale (NIHSS)), larger infarct volumes, increased risk of hemorrhagic transformation, and worse functional recovery (Lower modified rankin scale (mRS)), especially in ischemic stroke. In hemorrhagic stroke, SH is associated with hematoma expansion, perihematomal edema, and worsening neurological function. Although SH has been shown to be a reliable stroke outcome predictor, there is no scientific consensus regarding the most reliable measurement method. The use of absolute blood glucose values may not accurately reflect SH, particularly in diabetic patients, where chronic baseline hyperglycemia complicates interpretation. This underscores the necessity for individualized assessment rather than a uniform interpretation. Clinically, the early detection of SH may provide enhanced monitoring and supportive care; however, rigorous glucose management remains contentious due to the risk of hypoglycemia. Conclusions: This review synthesizes evidence from recent studies and supports SH as a prognostic marker of both short- and long-term adverse outcomes in stroke patients. Further research is warranted to evaluate the efficacy of targeted glycemic treatments on such outcomes.

Background: Migraine is a common neurological condition marked by unilateral recurrent pulsating headaches, often associated with systemic signs and symptoms. Recently, calcitonin gene-related peptide (CGRP) antagonists, including atogepant, an oral CGRP receptor antagonist, have emerged as effective and safe treatments. The current study sought to assess the efficacy and safety of atogepant for preventing episodic migraines in adults. Methods: A comprehensive search, following PRISMA guidelines, was conducted using PubMed, Web of Science, and Cochrane Library to identify randomized, double-blind, placebo-controlled trials published up to June 2024. Results: The studies included adult participants with episodic migraine treated with atogepant. The primary outcomes assessed were changes in mean monthly migraine days (MMDs) and monthly headache days (MHDs) over 12 weeks. Secondary outcomes included reduction in acute medication use, 50% responder rates, and adverse events. A meta-analysis using a random-effects model was performed to evaluate efficacy and safety. Six trials with 4569 participants were included. Atogepant significantly reduced mean monthly migraine days (MMDs) and monthly headache days (MHDs) compared to placebo at all doses (10 mg, 30 mg, 60 mg), with the 60 mg dose showing the greatest reduction (mean difference: −1.48 days, p < 0.001). Significant reductions in acute medication use and improved 50% responder rates were also observed for all doses. The safety profile of atogepant was favorable, with common adverse events being mild to moderate, such as constipation and nausea. There were no significant differences in serious adverse events between the atogepant and placebo groups. Conclusions: Atogepant is an effective and well-tolerated option for preventing episodic migraines, showing significant reductions in migraine frequency and acute medication use. However, further studies are necessary to assess its long-term safety and efficacy, especially at higher doses, and to investigate its potential role in personalized treatment strategies for migraine prevention.