Muhammad Suhaib Hanif

Background: Ischemic heart disease (IHD) and, at its progression, ischemic cardiomyopathy are leading causes of cardiovascular mortality globally. Despite progress in prevention and treatment, large disparities still exist by age, gender, race, and geography, especially among older adults. Methods: We analyzed deaths related to cardiomyopathy in older adults with IHD in the United States (1999–2024), focusing on demographic and regional differences. Centers for Disease Control and Prevention WONDER Multiple Cause of Death data were used, including individuals aged ≥65 years with IHD listed as a primary or contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was used to calculate annual percent changes (APCs) across demographic and geographic strata. Results: From 1999 to 2024, AAMRs have fallen from 39.3 to 14.1 per 100 000. A significant drop was recorded between 2002 and 2018 (APC: −4.94%; P = 0.004), with a plateau observed from 2018 to 2024. Male mortality was twice as high as that of females (18.7 vs. 10.0 in 2024). NH Black populations had the highest mortality rate in 1999 (42.7), which narrowed by 2024 (17.4); however, disparities continued. Geographically, the South and non-metropolitan areas exhibited the greatest mortality, with slower reductions. One significant shift in trends was in the type of place of death, with a decrease in hospital deaths and an increase in deaths at home and in hospices. Conclusion: Persistent disparities between sexes, races, geographic regions, and levels of urbanization underscore the need for specific and targeted public health interventions, equal access to care, and refocusing cardiovascular health initiatives on high-risk participants. Graphical abstract available at: https://links.lww.com/MS9/B434

Background: Cutaneous aging is characterized by progressive degradation of the extracellular matrix, manifesting as diminished hydration, loss of elasticity, and increased wrinkle depth. While oral hydrolyzed collagen peptides (HCPs) are increasingly utilized as systemic nutricosmetics, previous evidence syntheses have been limited by severe methodological heterogeneity and the inability to account for highly influential statistical outliers. This updated systematic review and meta‐analysis evaluated the clinical efficacy of oral collagen peptides for skin rejuvenation using an advanced statistical framework. Methods: A comprehensive literature search was conducted on PubMed (MEDLINE), Cochrane Library, and Google Scholar from inception to November 2025. Randomized controlled trials evaluating oral collagen supplementation in healthy adults were included. Data were synthesized using random effect models. To differentiate true clinical signals from statistical artifacts, analyses were reinforced with multilevel meta‐analysis, leave‐one‐out sensitivity testing, and dose–response spline regressions. Results: Thirty‐five randomized controlled trials comprising 2534 participants were included. Primary analysis revealed that oral collagen supplementation yielded statistically significant improvements in instrumental measures of skin hydration (SMD = 0.44; 95% CI: 0.15–0.73), skin elasticity (SMD = 0.62; 95% CI: 0.15–1.10), and barrier function via reduced transepidermal water loss (SMD = −0.39; 95% CI: −0.62 to −0.16). Efficacy appeared predominantly time‐dependent rather than dose‐dependent, with elasticity and barrier improvements requiring at least 12 weeks of supplementation. Conversely, rigorous sensitivity and multilevel analyses demonstrated that apparent improvements in structural parameters, specifically skin wrinkles, roughness, and dermal density, were statistical artifacts driven by high‐leverage outliers and severe inter‐study heterogeneity. Conclusion: Oral collagen peptide supplementation is an effective functional systemic moisturizer that produces significant time‐dependent improvements in cutaneous hydration, elasticity, and barrier retention. However, current evidence from trials of standard duration remains limited and inconsistent regarding structural anti‐aging effects, including macroscopic wrinkle reduction and dermal densification, and the existing data are simply not robust enough to support definitive conclusions in these domains.

Cancer remains the second leading cause of death in the United States (U.S.), with increasing incidence among younger adults. Sepsis, a life-threatening organ dysfunction caused by infection, frequently complicates cancer due to disease-related and treatment-induced immunosuppression. Understanding cancer–sepsis mortality trends is essential for identifying high-risk populations and improving prevention and clinical management strategies. We analyzed U.S. mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database to identify deaths among adults aged ≥ 25 years in which both cancer (International Classification of Diseases, Tenth Revision C00–D48) and sepsis (International Classification of Diseases, Tenth Revision A41) were listed on the same death certificate, representing concomitant cancer–sepsis mortality. Age-adjusted mortality rates per 100,000 population were calculated and temporal trends were assessed using Joinpoint regression. Statistical significance was set at P < .05. From 1999 to 2023, a total of 20,108,555 U.S. adults aged 25+ died from cancer complicated by sepsis. From 1999 to 2023, the average annual percentage change (AAPC) decreased by 1.09% (95% confidence interval, −1.33–−0.84%). Rates fell from 417.6 per 100,000 in 1999 to 322.0 in 2023, showing a steady decline until 2018 (annual percent change [APC]: −1.32%), a brief rise from 2018 to 2021 (APC: 2.17%), and a significant drop from 2021 to 2023 (APC: −3.65%). Mortality was highest in men (AAPC: −1.33%) and Black or African American individuals (AAPC: −1.68%), as well as in nonmetropolitan areas (AAPC: −0.60%) and the Southern U.S. (AAPC: −1.02%). Most age groups experienced significant declines, particularly middle-aged adults, while the youngest (25–34) and oldest (85+) age groups showed minimal long-term change. All racial and ethnic groups showed improvement, although American Indian or Alaska Native trends remained largely flat until a notable decline (APC: −8.26% from 2021 to 2023). Most deaths occurred in hospitals (38%) or at home (35%), with fewer in nursing homes, hospices, or other settings. Concomitant cancer–sepsis mortality declined overall in the U.S. from 1999 to 2023, but substantial disparities persist by sex, race/ethnicity, geography, and urbanization, reflecting inequities in access to oncology care, critical care, and timely sepsis management.

Background: Meningiomas are the most common primary intracranial tumors in the United States, comprising nearly 41% of central nervous system tumors. While the majority are benign, atypical (World Health Organization Grade II) and malignant (Grade III) subtypes are clinically significant due to their aggressive biology, higher recurrence, and increased mortality risk. Despite their burden, national mortality trends and demographic disparities in meningioma-related deaths remain underexplored. Methods: We conducted a population-based analysis of meningioma-related mortality among U.S. adults aged ≥65 years from 1999 to 2023 using the centers for disease control and prevention (CDC) wide-ranging online data for epidemiologic research (WONDER) database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by age, sex, race/ethnicity, region, and urbanization. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) with 95% confidence intervals (CIs). Results: From 2000 to 2023, 28,875 meningioma-related deaths were recorded, with higher mortality in males (65.6%) compared to females (34.4%). The overall AAMR declined from 3.79 in 2000 to 2.44 in 2009 (APC −3.86; 95% CI −5.07 to −2.63; P < 0.001), plateaued through 2017, and subsequently rose to 2.77 in 2023 (APC 3.34; 95% CI 1.13–5.60; P = 0.005). Men experienced an initial decline followed by stabilization, while women showed a late increase after 2014. NonHispanic Whites and Blacks demonstrated biphasic patterns, with recent increases after earlier declines. Geographic variation was also evident, with the highest AAMRs in the District of Columbia and the lowest in Arkansas. Conclusion: Meningioma-related mortality in the United States declined substantially in the early 2000s but has shown an upward trend in recent years, with disparities across sex, race/ethnicity, and region. These findings highlight the need for continued surveillance and targeted public health strategies to address high-risk populations and mitigate the rising mortality associated with aggressive meningioma subtypes.

Rationale: Acute limb ischemia is a vascular emergency that occurs when blood flow to a limb suddenly decreases, putting the limb at risk if not treated promptly. Acute limb ischemia accounts for 11% of all vascular emergencies, among which arm ischemia is relatively rare. It is caused by occlusion of the brachial artery, most commonly by vascular thromboembolism. We report a female patient with left upper limb ischemia induced by occlusion of the brachial artery. Patient concerns: We report a 45-year-old female who presents with an acute onset of severe pain, numbness, and pallor in her left arm. Pulse was absent, and muscle power was decreased on physical examination. The patient’s past medical history was significant for chronic hypertension controlled with medication. Diagnoses: The diagnosis of acute left arm ischemia was confirmed based on the history of hypertension and Doppler ultrasound, which showed occlusion of the left brachial artery due to atherosclerotic changes. Interventions: The patient was initially treated with heparin and analgesics for pain control. Embolectomy was performed under local anesthesia, and a proximal longitudinal incision was made. The brachial artery was exposed, the proximal artery was clipped, the radial and ulnar arteries were cleared using a Fogarty balloon catheter, and the arteriotomy was closed with Prolene 6/0. Hemostasis was secured, and the skin was closed with Prolene 3/0. The patient was given Augmentin 1-g tablet “Quaque Die” means once daily (QD), heparin injection QD, Tonoflex P injection QD, and Loprin 75-mg tablet QD. Outcomes: During the 8-week follow-up period, all patient symptoms improved. The peripheral pulse was present; there were no paresthesia or numbness, except for mild pain in her left thumb due to ischemia. This was a postoperative complication due to the lodging of an embolic fragment from surgery. Lessons: Early diagnosis and prompt surgical intervention in brachial artery occlusion are essential to prevent complications such as gangrene, even in patients without overt vascular risk factors.

Background: Surgical site infections (SSIs) are significant postoperative complications in gynecologic and obstetric surgeries. Preoperative vaginal antisepsis is vital for prevention. This review compares the efficacy and safety of chlorhexidine gluconate (CHG) vs. povidone-iodine (PI) for vaginal antisepsis in preventing postoperative infections. Materials and Methods: A systematic search of major databases was conducted through 8 Ja-nuary 2025. Randomized controlled trials (RCTs) comparing CHG and PI for vaginal antisepsis during urogynecologic procedures were included. Meta-analyses were performed using random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs). The GRADE approach assessed the certainty of evidence. The primary outcome was SSIs; secondary outcomes included febrile morbidity, hospital stay, antiseptic-related side effects, and wound complications. Results: Twelve RCTs, including 4936 participants, were analyzed. The results showed that CHG significantly reduced compared to PI (RR: 1.71; 95% CI: 1.30–2.26; I ² = 17%; high-certainty evidence). Subgroup analyses showed higher SSI risk with PI in upper/lower-middle-income countries (RR: 1.79; 95% CI: 1.17–2.74) and high-income countries (RR: 1.66; 95% CI: 1.08–2.56). PI was also associated with increased risks of superficial SSIs (RR: 1.57), deep SSIs (RR: 2.35), and readmissions (RR: 1.59). Conclusion: CHG was superior to PI in preventing SSIs in gynecologic and obstetric surgeries. With high-quality evidence supporting its use, CHG is recommended for vaginal preparation. Future research should explore cost-effectiveness and long-term outcomes.