Abbottabad International Medical College

Post-transplant hypertension is common in kidney transplant recipients and contributes to cardiovascular risk and allograft dysfunction. Most available data come from studies where the primary indication for SGLT2 inhibitor use was post-transplant diabetes mellitus or cardiorenal protection, with blood pressure assessed as a secondary outcome. To systematically evaluate the impact of SGLT2 inhibitors on blood pressure, metabolic and renal outcomes, and safety in kidney transplant recipients. PubMed, Embase, and Scopus clinical trial registries were systematically searched from inception to October 20, 2025. Randomized controlled trials and observational studies were included. Primary outcomes were changes in systolic and diastolic blood pressure at 3, 6, and 12 months. Secondary outcomes included body weight, glycated hemoglobin (HbA1c), renal function, and adverse events. Twelve studies comprising 1,292 participants were included. In controlled difference-in-differences analyses (5 studies), SGLT2 inhibitors showed no significant blood pressure reductions versus control at any time point. Exploratory single-arm analyses suggested within-group systolic blood pressure reductions at 3 and 6 months; however, these estimates are at high risk of bias and cannot establish treatment effect. Exploratory single-arm analyses suggested modest short-term reductions in systolic blood pressure and suggested metabolic effects with an acceptable safety profile. However, controlled difference-in-differences analyses showed no significant blood pressure reductions versus control. Most available evidence derives from studies in which SGLT2 inhibitors were not initiated specifically for blood pressure control. Dedicated randomized controlled trials are required to determine their role in the management of post-transplant hypertension.

Endoscopic radial artery harvesting (ERAH) is a minimally invasive alternative to open radial artery harvesting (ORAH) for coronary artery bypass grafting (CABG), though concerns persist regarding graft patency and neurological outcomes. PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched through February 21, 2026. Randomized controlled trials and propensity-matched observational studies were included. Risk of bias was assessed using ROB 2 and the Newcastle-Ottawa Scale; certainty of evidence was evaluated using GRADE. Pooled risk ratios and mean differences with 95

Orthopaedic trauma surgery is associated with significant perioperative morbidity, prolonged hospital stays, and increased healthcare costs. Enhanced Recovery After Surgery (ERAS) protocols have shown benefits in elective procedures; however, their role in orthopaedic trauma remains unclear. This study aimed to evaluate the efficacy of key ERAS related components in this setting. A systematic search of PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing ERAS related components with standard care in adult orthopaedic trauma patients were included. The primary outcome was hospital length of stay (LOS), while secondary outcomes included postoperative pain, functional recovery, deep vein thrombosis (DVT), blood transfusion requirement, postoperative haemoglobin, and infection rates. Data were analysed using RevMan 5.4.1, with risk of bias and evidence certainty assessed using Cochrane RoB 2.0 and GRADE approaches. Five RCTs involving 423 patients were included. ERAS related components significantly reduced length of hospital stay (MD: −2.56 days; 95

Abstract Introduction Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure cases, with increasing evidence highlighting right ventricular (RV) dysfunction as a key contributor to functional limitations and adverse outcomes. Objective This review examines the pathophysiology, diagnosis, prognosis, and treatments for RV dysfunction in HFpEF, advocating for its inclusion in clinical evaluation and risk stratification. Methods A search of PubMed and Scopus (2015-2024) identified 74 studies on RV dysfunction in HFpEF, focusing on systematic reviews, meta-analyses, and original research. Results RV dysfunction occurs in 19-33% of HFpEF patients, worsening prognosis and increasing mortality, morbidity, and hospitalisations. Key mechanisms include RV-pulmonary artery uncoupling, impaired diastolic function, and comorbidities. Advanced imaging and echocardiographic indices aid diagnosis, while new treatments like SGLT2 inhibitors, interatrial shunt devices, and exercise training offer potential benefits.

BACKGROUND:Factor XI/XIa inhibitors are emerging anticoagulants with potential to reduce bleeding complications in atrial fibrillation (AF) patients. This meta-analysis evaluated their efficacy and safety compared to direct oral anticoagulants (DOACs) and explored dose optimization. METHODS:A systematic search of PubMed, Cochrane, and Embase was conducted through March 2025 following PRISMA guidelines. Randomized controlled trials (RCTs) comparing Factor XI/XIa inhibitors with DOACs in AF patients were included. Outcomes assessed were major bleeding, stroke, systemic embolism, all-cause and cardiovascular mortality and serious adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a Mantel-Haenszel random-effects model. Heterogeneity was evaluated with the I² statistic, and evidence certainty assessed by the GRADE approach. Trial Sequential Analysis (TSA) was performed. RESULTS:Three RCTs including 16,772 patients (mean age 73 years, CHA₂DS₂-VASc 3.9-5) were analyzed. Factor XI/XIa inhibitors significantly reduced major bleeding (RR: 0.41, 95% CI: 0.36-0.46, I² = 0%) compared to DOACs. However, stroke risk was increased (RR: 3.42, 95% CI: 2.62-4.46), particularly with asundexian 50 mg (RR: 4.02). No significant differences were observed in all-cause mortality (RR: 0.82) or cardiovascular death (RR: 1.05). Systemic embolism risk was higher (RR: 4.26), while serious adverse events were comparable (RR: 0.95). TSA indicated encouraging safety outcomes but highlighted the need for further large-scale studies. CONCLUSION:Factor XI/XIa inhibitors lower major bleeding risk in AF patients but increase stroke and systemic embolism rates without impacting mortality.