Umair Ali

Ultrasound-guided regional anesthesia (UGRA) has emerged as a new technical approach to provide real-time visualization of the needle pathway to minimize the risk of trauma to surrounding structures, notably vessels and nerves. This review will examine the basic concepts of UGRA and describe how regional anesthetic methods are categorized by region. Additionally, it explores technological approaches, offers block-specific insights, and discusses their clinical practice indications, such as postoperative pain management, as well as emergency physicians’ use of these techniques to treat severe conditions like fractures, trauma, and muscular injuries, or even as an adequate substitute for procedural sedation. UGRA is also being used more frequently in obstetrics to relieve pain during labor and delivery because of its broad safety and effectiveness. Although UGRA increases block accuracy and safety, there are risks such as hematoma, nerve damage, and local anesthetic systemic toxicity (LAST). Careful dosing, monitoring, sterile technique, and preparedness to handle emergencies – including lipid rescue therapy for LAST – are all necessary components of safe practice. On the other hand, artificial intelligence (AI), simulation, portable ultrasonography, augmented reality, and robotics are improving UGRA by enhancing accuracy, safety, training, and access, and making operations more effective and accessible. The implementation of UGRA is constrained by institutional hurdles, costs, and skill requirements; consistent training and credentialing are essential to increase proficiency and safety. UGRA promotes healing, reduces opioid use, and improves pain management. Although there are risks, safety and accessibility are enhanced by careful technique, monitoring, and advances such as portable ultrasonography and AI. Standardized training is necessary for optimal use.

Multiple carboxylase deficiency (MCD) is a rare, treatable inborn error of biotin metabolism that may present in children in the first year of life with life‐threatening metabolic crises. We report a 4‐month‐old child presenting with persistent seizures, eczematous rash near the orifices, unjustified loss of hair with baldness, and severe metabolic acidosis, initially mimicking septicemia. Urine organic acid investigation showed elevated levels of 3‐hydroxyisovaleric acid, 3‐methylcrotonylglycine, 3‐hydroxypropionic acid, methylcitrate, and lactate that lead towards MCD. This diagnosis remains unconfirmed, as confirmatory testing (serum biotinidase activity and genetic analysis) was not available at our center. Early initiation of biotin (10 mg/day) led to rapid clinical and biochemical recovery. This particular case depicts the importance of biotin‐responsive metabolic disorders in the first year of a child presenting with the classic triad of seizures, dermatitis, and alopecia with metabolic acidosis. Early recognition and prompt initiation of biotin therapy can result in rapid clinical recovery. Timely diagnosis is crucial to prevent avoidable morbidity and long‐term neurological sequelae. This case highlights the importance of considering MCD in children. In the first year of life, unexplained metabolic acidosis as timely treatment can be lifesaving.

One of the most significant clinical challenges in breast cancer is late recurrence, especially in estrogen receptor-positive disease. The biochemical causes of long-term dormancy are still not fully understood, and conventional surveillance frequently lacks sufficient sensitivity to reliably predict relapse. The objectives of this review are to: (1) investigate the molecular connections among immunosenescence, chronic inflammation, and tumor dormancy; (2) critically assess new therapeutic and diagnostic strategies; and (3) pinpoint methodological and translational gaps for further investigation. By combining geroscience and oncologic biology, this narrative review critically summarizes contemporary research on immunological senescence, tumor dormancy, and chronic inflammation published between 2015 and 2025. For preclinical, translational, and clinical research, databases such as PubMed and Scopus were examined, with a focus on mechanistic insights, liquid biopsy technologies, and experimental therapy approaches. Using combinations of phrases like “breast cancer recurrence,” “tumor dormancy,” “immunosenescence,” “inflammaging,” “liquid biopsy,” and “senolytics,” a focused literature search was carried out across PubMed and Scopus for research published between January 2015 and September 2025. Original English-language studies, reviews, and meta-analyses that addressed the molecular, translational, or clinical aspects of immunological aging and dormancy met the inclusion criteria. When preclinical research was pertinent to human pathology, it was included. Non-peer-reviewed commentary, conference abstracts without complete data, and research unrelated to breast cancer were the exclusion criteria. Although causality has not been established, there is evidence that immunosenescence and inflammation may create suitable habitats for dormant micrometastases. While liquid biopsy platforms for detecting minimal residual disease (MRD) provide earlier relapse signals, they have questionable clinical usefulness, analytical limitations, and confounding issues related to clonal haematopoiesis. Senolytics, epigenetic modulators, and “awaken-and-kill” immunotherapies are examples of experimental approaches that show promise but also have unidentified hazards, such as off-target toxicity and unintentional acceleration of metastases. Crucially, the majority of mechanistic insights derive from studies in young murine models, which restricts their applicability to aging human populations. Equity issues remain poorly understood, particularly in environments with limited resources. Rethinking late recurrence as a chronic inflammation and aging ailment offers a unifying theory, but it must be interpreted carefully. Translation necessitates rigorous MRD-linked trial designs, prospective validation in diverse and elderly cohorts, and a methodical assessment of both safety and efficacy. Adopting these strategies too soon could backfire if limitations and confounders are not critically evaluated.

Total hip arthroplasty (THA) is linked to considerable hemorrhage. Although tranexamic acid (TXA) lowers the risk of transfusion, its widespread use may have adverse side effects, particularly in individuals with prothrombotic conditions or renal impairment. New technologies, such as patient-specific stratification and viscoelastic testing [like rotational thromboelastometry (ROTEM)], are designed to enhance the use of TXA. The purpose of this study is to assess the effectiveness, safety, and potential application of a precision-based TXA approach in THA that integrates personalized risk assessment and real-time hemostatic monitoring. The study employed an overview of post-2021 literature to investigate the pharmacokinetic, immunologic, and hemostatic profiles of TXA in THA. Risk-based dosage adjustments and ROTEM-guided algorithms received particular attention. There is proof that customized TXA procedures, directed by risk scores, renal function evaluations, and viscoelastic assays, can maximize bleeding control without raising the risk of thromboembolic or infectious consequences. In selected low-risk primary THA populations, oral regimens demonstrate non-inferiority. Transfusion and antifibrinolytic methods can be improved with the use of ROTEM. There is a need for a change in THA treatment towards precise TXA delivery. ROTEM can be used to reduce problems and customize perioperative therapy when combined with renal and thrombotic profiling.

Acne vulgaris is a chronic inflammatory disease and is one of the leading causes of dermatological morbidities among young adults. Doxycycline is widely recommended as first-line therapy for moderate to severe acne; however, its use is limited. To systematically compare the efficacy and safety of oral azithromycin pulse therapy versus doxycycline in patients with moderate to severe acne vulgaris. This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search on different databases was performed. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models based on heterogeneity. A total of 23 comparative studies comprising 2,769 patients were included. Pooled analysis demonstrated a statistically significant improvement in global acne severity favoring azithromycin (GAGS reduction: MD 1.81; 95% CI 1.28-2.34; I² = 0%). Azithromycin achieved a significantly greater reduction in non-inflammatory lesion counts (MD -7.56; 95% CI -14.33 to -0.79). No significant differences were observed in inflammatory lesion reduction (MD 1.08; 95% CI -0.03 to 2.18). Oral azithromycin pulse therapy appears to have similar efficacy, better tolerability, and fewer side effects as compared to doxycycline.

Background: Hepatocellular carcinoma (HCC) is one of the most common causes of malignancy, and recurrence rates are 50–70% even with curative resection, which indicates the necessity to employ an efficient perioperative systemic treatment. Aim: To conclude, regarding the mechanistic rationale and clinical evidence for perioperative camrelizumab (PD-1 inhibitor) and rivoceranib (VEGFR2 inhibitor) in resectable HCC, it is crucial to review CARES-009 and related information to inform clinical practice and research priorities. Results: Camrelizumab overturns T-cell exhaustion, whereas rivoceranib normalizes tumor vasculature and alleviates hypoxia, creating immuno-angiogenic synergy. In CARES-009, perioperative camrelizumab combined with rivoceranib was superior to surgery for event-free survival and primary pathological response in intermediate/high-risk resectable HCC. The favorable antitumor activity and favorable safety profile are supported by evidence from CARES-310 and other immunotherapy-TKI trials in advanced HCC. Translational research demonstrates that immune-angiogenic signatures and circulating tumor DNA can be used to risk-stratify. However, existing evidence is scarce due to poor overall survival outcomes, cohorts mostly driven by hepatitis B virus, and various regional differences in costs and access to drugs. Conclusion: Perioperative camrelizumab plus rivoceranib is a biologically rational and clinically promising agent that can be used to decrease recurrence in high-risk patients who have undergone resection of HCC. Nevertheless, these should be routinely introduced once mature survival, biomarker, real-world, and economic data are available. Once again, current use is best utilized in clinical trials or structured registry models.

Background: Tirzepatide, a dual GIP/GLP-1 receptor agonist, demonstrates substantial glycemic and weight benefits versus GLP-1 receptor agonists in indirect comparisons, but direct comparative safety evidence versus dulaglutide remains limited. We evaluated comparative safety (primary outcome: overall adverse events) and efficacy. Methods: Following PRISMA 2020 (prospectively registered: PROSPERO CRD420251276594), we searched MEDLINE, Embase, Scopus, and CENTRAL (inception–31 December 2025) for randomized controlled trials (≥26 weeks) comparing once-weekly tirzepatide with dulaglutide in adults with type 2 diabetes. Three trials (N = 13,590 participants) were included. Dichotomous outcomes were pooled using random-effects models (risk ratios [RRs], 95% confidence intervals [CIs]). GRADE assessed certainty of evidence. Results: Overall adverse event incidence did not differ significantly (RR 1.04 [0.98–1.10]; I² = 36%; moderate-certainty evidence). Discontinuation due to adverse events was consistently higher with tirzepatide (RR 1.32 [1.20–1.45]; I² = 0%; high-certainty evidence), representing a 32% increased risk across all populations. Categorical HbA1c target achievement was analyzed in two trials; the third trial reported HbA1c as a continuous outcome only. At the primary threshold (HbA1c < 7.0%), tirzepatide was consistently superior with no heterogeneity (RR 1.48 [1.33–1.64]; I² = 0%; p < 0.00001). Across all thresholds combined, heterogeneity was extreme (I² = 92%), limiting confidence in any pooled summary estimate; the greatest instability occurred at the strictest threshold (HbA1c < 5.7%; I² = 98%; p = 0.40). Tirzepatide showed greater HbA1c target attainment in treatment-naive patients receiving dulaglutide 0.75 mg, whereas the glycemic advantage was smaller in patients with established cardiovascular disease receiving dulaglutide 1.5 mg. Categorical weight-loss outcomes were analyzed in two trials; tirzepatide was associated with greater weight-loss threshold achievement (RR 8.80 [4.04–19.17]; very low-certainty evidence), although interpretation is limited by substantial heterogeneity and restricted generalizability. Serious adverse events were not significantly different (RR 0.82 [0.47–1.43]; I² = 42%). Conclusions: Overall adverse events were similar between treatments, but tirzepatide consistently increased discontinuation risk, indicating a clinically important tolerability-persistence trade-off. Glycemic efficacy was highly population-dependent: benefits were consistent at the primary HbA1c target (2 = 0%) in early-stage disease, whereas the advantage was smaller in long-standing disease with established cardiovascular disease. Tirzepatide may be favored when glycemic or weight efficacy is prioritized in earlier-stage disease, provided tolerability is proactively managed. Dulaglutide remains appropriate when persistence is threatened by tolerability concerns or cardiovascular risk reduction is the primary goal.

Auditory-driven analgesia through music exposure is emerging as a biologically measurable modulator of pain memory rather than a distraction-based coping tool alone. Latest 2025 neurochemical mapping shows that structured music stimuli activate mesolimbic dopamine release, reduce amygdalar pain-trace reconsolidation, and gate nucleus accumbens–periaqueductal gray pain-memory coupling. These effects reshape nociceptive recall strength without pharmacologic replacement, supporting early auditory therapy integration alongside standard analgesic frameworks.

Pharmacogenomics is now an essential part of precision medicine, as it describes how genetic differences at the individual level influence drug responses. Its combination enables a transition from trial-and-error prescriptions to predictive, genotype-directed treatment, thereby enhancing the safety and accuracy of treatment. Rapid genomic testing, AI-driven prediction of drug-gene interactions, and clinical decision-support systems have advanced, increasing their uptake in psychiatry, cardiology, and oncology. New methods, such as polygenic pharmacogenomic scoring and population-specific genomic maps, are even more personalized. Together, these advances make pharmacogenomics a central figure with the potential to shape the future of personalized, effective, and innovative healthcare.

Pioglitazone, a thiazolidinedione, acts through peroxisome proliferator-activated receptor gamma (PPAR-gamma) and is an established insulin sensitizer used in type 2 diabetes. Many cardio-protective aspects of pioglitazone are being actively researched. The drug modulates neurohormonal pathways and improves diastolic dysfunction in hypertensive patients. In diabetic patients, pioglitazone has been shown to reduce hyperperfusion injury post-STEMI. It also exerts positive effects on cardiac and vascular remodeling. Despite its cardioprotective effects, studies have shown that weight gain and oedema are among the most serious implications of the drug, specifically limiting its role in patients with heart failure. Hence, further studies are required to demonstrate the effect of pioglitazone among patients with heart failure.