Ahmed W. Hageen

Background and Aim: This network meta‐analysis addresses the limited dose‐specific comparative evidence by evaluating different doses of tirzepatide (TZP) versus dulaglutide (DULA) for glycemic control, weight loss, and safety in type 2 diabetes mellitus (T2DM). Methods: Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM. Efficacy outcomes included body weight change (Weeks 12 and 16) and mean HbA1c change (Weeks 12 and 24). Safety outcomes included mortality, cardiovascular events, and adverse events (AEs). SUCRA ranking was used and analysis performed in RStudio (v4.5.1). Results: Four RCTs comprising 14,348 participants contributed to a seven‐node network. However, Nicholls et al. 2025 had the majority of sample size ( n = 13,165). TZP 15 mg achieved the greatest reduction in body weight at Week 16 (mean difference [MD] vs. TZP 5 mg: −2.68 kg; 95% CI −4.98 to −0.38), while TZP 1 mg (MD: 4.39 kg; 95% CI 1.28 to 7.51) and DULA 0.75 mg (MD: 3.10 kg; 95% CI 0.25 to 5.96) were associated with smaller reductions relative to TZP 5 mg. TZP 15 mg also produced the largest HbA1c reduction at Week 24 (MD vs. TZP 5 mg: −0.40%; 95% CI −0.62 to −0.19), compared with TZP 10 mg (MD: −0.23%; 95% CI −0.44 to −0.02) and DULA 1.5 mg (MD: 0.67%; 95% CI 0.25 to 1.09). No significant differences were observed between treatments for all‐cause mortality or major cardiovascular events. Gastrointestinal AEs were more frequent with higher TZP doses, especially TZP 15 mg vs. TZP 5 mg for nausea, while serious AEs and severe hypoglycemia were similar across doses. Conclusion: Higher TZP doses potentially improve efficacy, while lower TZP/DULA doses enhance tolerability, supporting individualized T2DM care. However, these findings should be interpreted cautiously because several comparisons are indirect, many participants had not reached their maintenance dose, several safety outcomes were based on limited event counts, and significant inconsistency was observed for early body‐weight outcomes.

We aim to compare the impact of left atrial appendage closure vs. medical therapy on clinical outcomes in patients with atrial fibrillation, focusing on key clinical outcomes relevant to thromboembolic prevention. We conducted a PRISMA‐guided systematic review and meta‐analysis of studies comparing LAAC with medical therapy in AF adults. PubMed, Embase, Scopus, ClinicalTrial. gov, and Cochrane Library were searched from inception to March 2026. Outcomes included all‐cause mortality, any stroke, ischemic stroke, hemorrhagic stroke, major bleeding, systemic embolism and cardiac death. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random‐effects models. Reconstructed individual patient‐level survival data from published Kaplan–Meier curves were used for time‐to‐event analyses. Trial sequential analysis (TSA) assessed the conclusiveness of cumulative evidence. Six randomized controlled trials involving 7004 patients were included. LAAC demonstrated comparable outcomes to medical therapy for all‐cause mortality, any stroke, major bleeding, systemic embolism, and cardiac death. There was a non‐significant trend toward increased ischemic stroke and reduced hemorrhagic stroke with LAAC. Reconstructed time‐to‐event analyses showed similar cumulative incidence of stroke and bleeding outcomes over follow‐up. TSA demonstrated that the required information size was not reached for any major endpoint, indicating that current evidence remains underpowered and additional randomized trials are needed. LAAC provides similar overall efficacy and safety compared with medical therapy for stroke prevention in AF but should currently remain reserved for selected patients rather than replacing oral anticoagulation broadly. Further adequately powered trials with longer follow‐up are required.

Background and aim: Sex-related differences in outcomes after catheter ablation for atrial fibrillation (AF) remain incompletely understood, particularly regarding long-term arrhythmia recurrence and procedural safety. Current guidelines do not provide sex-specific recommendations. This systematic review and meta-analysis aimed to evaluate sex-based differences in efficacy, safety, and long-term outcomes following AF catheter ablation. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines and the Cochrane Handbook, with prospective registration in PROSPERO (CRD420251168422). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2025. Only studies adjusting for baseline differences using propensity score–based methods were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a restricted maximum likelihood random-effects model. Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated using GRADE. Results: A total of 21 studies involving 103,619 patients undergoing AF ablation were included, of whom approximately 32% were female. There were no significant sex-based differences in AF recurrence at 1 year (RR 1.22, 95% CI [0.78, 1.91], I ² = 51.5%, τ²=0.0814, p = 0.3807), AF / atrial tachycardia (AT) recurrence at 1 year (RR 1.13, 95% CI [0.91, 1.39], I ² = 0%, τ²=0, p = 0.2659), AT / atrial flutter (AFL) / AT recurrence at 1 year (RR 1.03, 95% CI [0.68, 1.58], I ² = 79%, τ²=0.1067, p = 0.8744), early all-cause mortality (RR 1.07, 95% CI [0.50, 2.29], I ² = 0%, τ²=0, p = 0.8575), 1-year all-cause mortality (RR 0.49, 95% CI [0.14, 1.67], I ² = 56.4%, τ²=0.6668, p = 0.2523), follow-up stroke/TIA (RR 1.12, 95% CI [0.72, 1.76], I ² = 0%, τ²=0, p = 0.6107), follow-up repeat ablation (RR 1.03, 95% CI [0.86, 1.22], I ² = 0%, τ²=0, p = 0.7755). However, women had a higher risk of AF / AT recurrence at 2 years (RR 1.22, 95% CI [1.04, 1.42], I ² = 0.0%, τ²p = 0.0120), early complication rate (RR 1.37, 95% CI [1.10, 1.70], I ² = 59.6%, τ²=0.0368, p = 0.0051), early cardiac tamponade (RR 2.46, 95% CI [1.49, 4.07], I ² = 0.0%, τ²=0, p = 0.0004), and follow-up cardiac failure (RR 2.80, 95% CI [1.45, 5.38], I ² = 0%, τ²=0, p = 0.0020). Conclusion: Catheter ablation yields similar short-term rhythm control and mortality in women and men with AF. However, women have higher early procedural complications and worse long-term outcomes, including increased 2-year AF/AT recurrence and heart failure, highlighting the need for tailored strategies and closer follow-up in female patients.

Background: Extended‐duration anticoagulation reduces recurrent venous thromboembolism (VTE) in cancer and non‐cancer patients. Reduced‐dose direct oral anticoagulants (DOACs) may be safer if they match efficacy with less bleeding risk. We conducted a systematic review and meta‐analysis of trials comparing reduced‐dose and extended‐dose DOACs. Methods: Randomized controlled trials comparing reduced‐dose with extended‐dose anticoagulation for secondary VTE prevention were systematically reviewed. Primary outcomes included recurrent symptomatic VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT). Secondary outcomes included bleeding, adverse events, and all‐cause mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random‐effects models. Subgroup and leave‐one‐out sensitivity analyses explored heterogeneity and robustness. All analyses were conducted in R (version 4.3.1). Results: Six RCTs ( n = 9382) were included. Reduced‐dose anticoagulation showed no statistically significant difference in recurrent VTE (RR 0.98, 95% CI 0.72–1.33), PE (RR 0.96, 95% CI 0.61–1.50), or DVT (RR 0.86, 95% CI 0.56–1.32) compared with extended‐dose therapy. Major bleeding was significantly reduced (RR 0.68, 95% CI 0.48–0.98), as were clinically relevant non‐major bleeding and any bleeding. All‐cause mortality did not differ significantly. Heterogeneity was low to moderate across outcomes, and sensitivity analyses confirmed the stability of results. Conclusion: Reduced‐dose anticoagulation demonstrated similar efficacy with improved safety compared with extended‐dose therapy. These findings support individualized dose reduction strategies after extended anticoagulation. Trial Registration: ClinicalTrials.gov identifier: CRD420251081952

Colonoscopy is a vital procedure for colorectal cancer screening and intervention; however, it can be uncomfortable for patients, particularly older people and those with diverticular disease. In our systematic review and meta-analysis, we aimed to evaluate the impact of abdominal compression devices (ACDs) on patient comfort and procedural efficiency during colonoscopy. A literature search was performed in PubMed, Web of Science, Scopus, Cochrane Central, and Embase from inception to April 2025. A risk of bias assessment was performed by using the Cochrane tool for assessing risk of bias in randomized trials, version 2 (ROB2). Data analysis was conducted using R version 4.2.2 and RStudio version 2022.07.2. Our comprehensive search across multiple databases yielded 16 randomized controlled trials involving 3098 participants. Our analysis revealed that ACDs significantly reduced cecal intubation time (mean difference: −2.20, 95% confidence interval [CI]: −3.50 to −0.90; P = 0.009), manual pressure application (risk ratio [RR]: 0.54, 95% CI: 0.39 to 0.76; P = 0.003), and the need for patient repositioning (RR: 0.55, 95% CI: 0.48 to 0.64; P > 0.001). Additionally, ACDs were associated with lower visual analog scale pain scores, indicating enhanced patient satisfaction. However, no significant differences in complete colonoscopy rates or cecal intubation lengths were found. Our findings suggest that ACDs can optimize colonoscopy procedures, improve patient comfort, and reduce staff workload, warranting their integration into routine practice. Future studies should focus on standardizing ACD applications and exploring long-term outcomes to further enhance the benefits of this approach in clinical settings.

Introduction: Leukemia and ischemic heart disease (IHD) are major U.S. mortality causes. This study analyzes national mortality trends from 1999 to 2020 to assess the impact of public health efforts in leukemia-associated IHD mortality rates.Methods: This retrospective study analyzed death certificate data from the CDC-WONDER database spanning 1999 to 2020, focusing on leukemia (ICD-10: C91–C95) and ischemic heart disease (ICD-10: I20–I25) as multiple causes of mortality in the U.S. population. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 population were calculated. JoinPoint analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC).Results: From 1999 to 2020, there were 53,603 deaths from combined leukemia and ischemic heart disease among U.S. adults aged 25+, with the AAMR declining from 1.39 to 1.09 per 100,000 (AAPC= -1.30%; 95% CI: -1.90 to -0.68; P= 0.000034). A significant decrease occurred from 1999 to 2018 (AAMR: 1.39 to 0.95; APC= -2.1894%; 95% CI: -2.3995 to -1.9788, P < 0.000001), followed by a period where the trend shifted upward which is statistically significant for the certain subgroups, except men and older adults. Men had higher AAMR than women (1.87 vs. 0.62). Regional AAMRs were highest in the Midwest (1.3). Non-Hispanic Whites had the highest AAMR (1.25). Adults 65+ had a CMR of 5.27 vs. 0.26 for ages 45–64.Conclusion: Significant health disparities exist, as mortality from combined leukemia and IHD is highest among men, older adults, rural populations, and non-Hispanic White individuals.

Venous thromboembolism (VTE) poses a significant clinical burden, ranking as the third primary contributor to cardiovascular-related mortality. While extended anticoagulation reduces recurrence, it raises bleeding risks. Reduced-dose direct oral anticoagulants (DOACs) may offer an optimal balance by preventing VTE recurrence while minimizing hemorrhage. This meta-analysis evaluated the efficacy and safety of reduced-dose DOACs for secondary VTE prevention. We established a thorough systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches through March 20, 2025. Dichotomous data were pooled utilizing risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), implemented with R version 4.3. Our analysis included three randomized controlled trials encompassing 8615 patients. Reduced-dose anticoagulation was associated with a statistically significant decrease in the incidence of major bleeding (RR: 0.49 [95% CI: 0.29–0.81]; P < 0.01), clinically relevant nonmajor bleeding (RR: 0.72 [95% CI: 0.58–0.89]; P < 0.01), and all-cause mortality (RR: 0.66 [95% CI: 0.46– 0.97]; P = 0.03). However, there were no significant differences between the two groups in the incidence of recurrent VTE (RR: 0.98 [95% CI: 0.66–1.48]; P = 0.94), recurrence of nonfatal pulmonary embolism (RR: 1.09 [95% CI: 0.59–2.03]; P = 0.78), fatal pulmonary embolism recurrence (RR: 0.66 [95% CI: 0.19–2.34]; P = 0.52), and deep vein thrombosis recurrence (RR: 1.14 [95% CI: 0.62–2.09]; P = 0.68). Similarly, there were no significant differences in the incidence of any adverse events (RR: 1.01 [95% CI: 0.98– 1.05]; P = 0.51) and serious adverse events (RR: 0.92 [95% CI: 0.83–1.02]; P = 0.11). This meta-analysis demonstrated that reduced-dose DOACs offer an effective approach for extended VTE prophylaxis, significantly reducing major bleeding risks without compromising protection against recurrent thrombosis. Notably, the data indicate a potential mortality benefit, solidifying their role in long-term management. These findings advocate for individualized therapy tailored to patient risk profiles, prioritizing an optimal efficacy-safety balance. Further large-scale randomized controlled trials are needed to validate long-term outcomes, refine dosing strategies, and define patient subgroups that derive the maximal benefit.