American University of Antigua

Postpartum depression (PPD) is a debilitating complication of childbirth and is associated with significant consequences for maternal well-being and infant development. Current pharmacological treatments have many limitations, including a delayed onset of action, variable response rates, and concerns about tolerability, underscoring the need for novel therapeutic approaches. Zuranolone has recently emerged as a novel oral therapy specifically for the treatment of PPD and represents a potential turning point in the management of PPD. This narrative review outlines the evolving evidence base for zuranolone, including current understanding of its efficacy and tolerability, and explores practical considerations for its use. The potential role of zuranolone within the broader treatment landscape is discussed, alongside key uncertainties regarding duration of effect, longer-term outcomes and accessibility. By synthesising available literature and identifying key knowledge gaps, this review aims to clarify the evolving role of zuranolone in the treatment of PPD, while highlighting priorities for future research and clinical practice.

Inflammasome activation, particularly through the NLRP3 complex, plays a central role in the progression of diabetes mellitus and its major co-morbidities, including nephropathy, neuropathy, retinopathy, cardiovascular dysfunction, and metabolic liver disease. This systematic review aimed to synthesise contemporary evidence on inflammasome signalling mechanisms in diabetes and its complications and the modulatory effects of dietary phytochemicals and nutraceuticals on these pathways. Following PRISMA guidelines, a systematic search was conducted across PubMed (n = 158), Scopus (n = 144), Web of Science (n = 126), and Google Scholar (n = 180) from inception to July 2025. Preclinical in vivo studies (rodent models of type 1 and type 2 diabetes, high-fat diet models, STZ—and alloxan-induced models), in vitro experiments (pancreatic β-cells, hepatocytes, renal and vascular cells), and a limited number of clinical studies evaluating circulating inflammasome markers in human diabetic cohorts. Study selection followed PRISMA guidelines, and only studies reporting explicit NLRP3, ASC, caspase-1, IL-1β or IL-18 outcomes were included. A total of 139 studies were included. Diabetes consistently generated NLRP3 inflammasome activation across models via hyperglycaemia-driven oxidative stress, mitochondrial dysfunction, TXNIP up-regulation, and lipid-mediated metabolic stress. Phytochemicals such as curcumin, quercetin, resveratrol, berberine, sulforaphane, and flavonoid-rich extracts exhibited inhibitory effects on these pathways by diminishing ROS generation, inhibiting NF-κB priming, augmenting AMPK signaling, preserving mitochondrial integrity, and downregulating downstream IL-1β/IL-18 release. Data from several organ systems indicates a uniform trend of inflammasome inhibition and enhanced metabolic or vascular results. Available literature indicates that phytochemicals exert reproducible, mechanistically coherent inhibition of NLRP3 inflammasome activation in both preclinical and limited clinical settings. These findings highlight the therapeutic potential of dietary bioactives as adjunct modulators of inflammation-driven diabetic complications.

Background Opioid use disorder (OUD) remains a major public health challenge, with substantial morbidity, mortality, and healthcare costs. Emergency departments (EDs) represent critical intervention points for initiating evidence-based treatment. While ED-initiated buprenorphine improves treatment engagement, its economic value relative to referral-based care requires further evaluation. Methods We developed a decision-analytic Markov cohort model to assess the cost-effectiveness of ED-initiated buprenorphine with rapid primary care follow-up (ED-BUP) compared with referral alone in adults with OUD. The model used monthly cycles over a 5-year time horizon from a healthcare sector perspective. Clinical inputs were derived from randomized and observational studies. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness. Uncertainty was assessed using one-way deterministic and probabilistic sensitivity analyses with 1,000 Monte Carlo simulations. Results ED-BUP was associated with lower costs (−$225 per patient) and greater effectiveness (+ 0.012 QALYs) compared with referral alone, indicating that the intervention is dominant. Probabilistic sensitivity analysis showed that ED-BUP was cost-effective in 97% of simulations at a willingness-to-pay threshold of $100,000 per QALY and 99% at $200,000 per QALY. Sensitivity analyses confirmed robustness of results across key model parameters. Conclusions ED-initiated buprenorphine with rapid follow-up is a cost-effective strategy for managing OUD, improving health outcomes while reducing healthcare costs. These findings support broader implementation of ED-based treatment as part of public health and health system strategies to address the opioid crisis.

Background: Extreme weather events driven by climate change are becoming increasingly frequent and severe globally, posing unprecedented pressure on health systems, especially on their emergency departments (EDs). The ED operates as the key link between acute impacts on public health caused by disasters and a wider healthcare sector response. Therefore, measuring surge capacity becomes an important aspect of assessing health system resilience to climate change. While there is a wealth of scientific literature on climate and health, to date no systematic review has established the relationship between disaster surge research and the documented patient-level outcomes linked to ED overcrowding in the context of different disaster types. Objective: The objective of this study was to conduct a systematic review of peer-reviewed articles assessing the impact of climate-related disasters – heat waves, floods and tropical cyclones, wildfires, compound events, and other types of weather events – on ED surge capacity and documenting the effects on patient-level measures such as deaths, length of stay (LOS) and time to treatment (TT2Tx). Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines, with searches performed across MEDLINE, Scopus, and Web of Science, alongside structured grey literature sources (WHO, IPCC, CDC, ACEP). In the preliminary search, 1,847 articles were identified, of which 312 duplicates were removed, and 1,535 abstracts excluded. From 68 full texts reviewed, 35 articles met all inclusion criteria. Results: There is consistent evidence of an association between climate-related disasters and ED surge in four main types of disasters. Heatwaves result in double the number of ED visits due to heat illnesses, while in the 2003 heatwave in Europe there were over 70,000 additional deaths recorded. In the aftermath of weather-related disasters, ED utilization increases by 1.22% during the first week following the event, with increased mortality persisting up to six weeks later. In the event of wildfire smoke exposure, there is a 57.1% rise in the number of asthma-related ED visits. Climate-related disasters independently cause an increased mortality rate in patients requiring hospital admission due to ED overcrowding by at least 5%, along with delay in critical interventions for sepsis, stroke, and acute myocardial infarction. There is limited evidence from low- and middle-income countries. Conclusions: Climate-related disasters are consistently associated with increased emergency department workload and measurable deterioration in patient outcomes, including increased mortality, delays in care, and prolonged hospital stays. These findings underscore the need to integrate climate-informed surge planning into emergency care systems and strengthen health system resilience through anticipatory, data-driven preparedness strategies.

Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial colorectal neoplasms, offering superior en bloc resection rates compared with conventional endoscopic mucosal resection (EMR). While ESD has been the standard of care in East Asian countries for over two decades, its adoption in Western countries has been considerably slower, hampered by the steep learning curve, prolonged procedural times, limited training infrastructure, and differences in disease epidemiology. However, recent years have witnessed a paradigm shift, with growing evidence from Western multicenter studies demonstrating outcomes that increasingly approach those reported from high-volume Eastern centers. The landmark RESECT-COLON randomized trial provided level-1 evidence supporting the superiority of ESD over piecemeal EMR for large colorectal polyps. Concurrently, novel training paradigms, technological innovations including traction-assisted devices and artificial intelligence (AI)-guided systems, and evolving societal guidelines from the American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) are accelerating Western adoption. This state-of-the-art review comprehensively examines the current landscape of colorectal ESD in Western practice, highlighting the evolution of outcomes, training pathways, guideline recommendations, technological advances, and future directions. We provide a critical appraisal of the East-West outcome gap and discuss strategies to bridge this divide, positioning colorectal ESD as an increasingly viable first-line therapy for appropriate lesions in Western endoscopy centers.