Background The periprocedural management of antithrombotic medications in patients with chronic subdural hematoma (cSDH) after middle meningeal artery embolization (MMAE) or surgical evacuation is uncertain.Methods A systematic review was conducted across Medline, Embase, and Web of Science databases. We pooled proportions and risk ratios (RRs) for the meta-analysis with the corresponding 95% CIs. Systemic and intracranial (including recurrence) bleeding complications and thromboembolic events were evaluated.Results Of the 16 included studies with 4606 patients, 1784 were receiving antithrombotic medications. Antithrombotic therapy was resumed in 1231 patients (69.0%). Bleeding complications were similar between patients in whom antithrombotic therapy was resumed (14.1%, 95% CI 9.7% to 20.2%) and in those in whom it was discontinued (15.4%, 95% CI 7.4% to 29.3%). After MMAE, patients had similar rates of bleeding events (12.1%, 95% CI 4.9% to 27.0%) to patients with overall treated cSDH, and recurrence (RR 2.28, 95% CI 0.46 to 11.37) and reoperation (RR 1.07, 95% CI 0.40 to 2.917) risks were similar between the resumed and discontinued groups. Thromboembolic complications were significantly higher in the discontinued group (12.6%, 95% CI 6.5% to 23.0%) than in the resumption group (3.5%, 95% CI 1.8% to 6.9%). Earlier resumption (1 week to 1 month) was associated with a lower thromboembolic risk without increasing bleeding complications.Conclusions Post-procedural antithrombotic resumption may reduce thromboembolic events without significantly increasing bleeding risk. Early resumption of antithrombotics post-MMAE appears to be safe, although further data are required to confirm this observation. Future studies should aim to better define patient characteristics influencing decision-making in this context.
Antibiotic resistance has spread globally among bacterial pathogens, becoming a significant challenge to public health. Bacterial cells have an enormous capability to acquire various antibiotic resistance mechanisms. The effectiveness of many antibiotics relies on the intracellular redox balance and the bacteria's ability to mount stress responses. Glutathione (GSH) is an intracellular tripeptide antioxidant that significantly contributes to maintaining optimal redox balance, which may impact bacterial survival during antibiotic treatment. Neutralizing oxidative stress caused by antibiotics can reduce their effectiveness. However, alterations of the redox balance of GSH can impair normal cellular metabolism, making cells vulnerable. Altering the redox balance, either by depleting or increasing levels of GSH, can enhance the effectiveness of antibiotics. The influence of GSH on antibiotics varies depending on the bacterial species and the class of antibiotics used. Due to the vital role of GSH in antibiotic effectiveness, targeting bacterial GSH metabolism can be used as an adjunctive approach to overcome antibiotic resistance. This review summarizes the relationship between GSH and antibiotic susceptibility and resistance in bacteria.
Effective pain management is essential in trauma care, as it reduces suffering and prevents long-term complications. However, prehospital analgesia is often inadequate, particularly in challenging environments such as alpine rescue settings, where establishing intravenous access can be difficult. Oral transmucosal fentanyl citrate (OTFC) offers a fast-acting, needle-free alternative, but has rarely been studied in civilian prehospital settings, particularly among paediatric and elderly populations. This study aimed to evaluate the feasibility, effectiveness and safety of OTFC for prehospital analgesia in a civilian mountain rescue context, covering all age and sex groups. This retrospective observational cohort study included all trauma patients treated with oral transmucosal fentanyl citrate (OTFC). Patients experiencing severe pain (NRS ≥ 4) and lacking intravenous access were eligible. OTFC was administered by trained emergency medical services providers. Data on demographics, pain scores and adverse events were prospectively recorded using a standardised digital protocol. The primary outcome was pain reduction, as measured by the Numeric Rating Scale (NRS); safety was assessed by recording adverse events. Statistical analysis included paired and unpaired tests, ANOVA and non-parametric equivalents, as appropriate. Significance was set at p < 0.05. A total of 365 patients (60.5
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition in which early identification and intervention significantly improve developmental outcomes. The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), is commonly used in primary care settings for early screening; however, real-world data on its performance in Saudi primary care, particularly within military healthcare systems, remain limited. The purpose of this study is to evaluate the outcomes of ASD screening using M-CHAT-R/F among toddlers attending the Well-Baby Clinics (WBCs) at the Armed Forces Hospital in Dhahran, including the positive screening rate, reported ASD diagnoses, associated demographic factors, and monthly trends in screening yield. A retrospective cross-sectional study was conducted at the Family Medicine Department WBCs of the Armed Forces Hospital in Dhahran. All toddlers aged 16–30 months who underwent ASD screening between January 2024 and July 2025 were included. Demographic data and M-CHAT-R/F results were extracted from electronic medical records. Screening followed the standardized two-stage M-CHAT-R/F protocol, including the structured Follow-Up Interview for medium-risk initial scores. Screen-positive children were referred to pediatric specialists, and ASD diagnosis status was determined based on medical record documentation or caregiver report. Data were analyzed using SPSS version 22.0. Chi-square and independent t-tests were used to assess associations, with significance set at p < 0.05. A total of 742 toddlers were screened (51.9
Background The COVID-19 pandemic exposed vulnerabilities in global health systems, highlighting the need for resilience in governance, leadership, and response mechanisms. Brazil's Unified Health System (SUS) is one of the largest health systems in the world and due to its decentralised and fragmented model could provide learnings to other health systems. Objective This research explores governance for health system resilience to the COVID-19 pandemic in Brazil’s Unified Health System (SUS), focusing on leadership and governance structure, legislation and regulation, information and intelligence, and accountability, integrity and trust. Methods A qualitative approach was employed, including document analysis, focus groups and interviews with 35 national, state and local health experts. Data were analysed by the inductive approach to examine the system’s response, and recovery, and learning phases. Results In the absence of strong federal leadership, state and municipal governments played pivotal roles in managing the crisis. This decentralisation enabled more flexible and region-specific responses. Furthermore, legislative flexibility, as demonstrated by the rapid vaccine approval processes and local production efforts, underpinned timely public health interventions. Information and intelligence systems were also crucial in providing reliable health data, particularly from independent consortia, which countered misinformation and helped maintain public trust. Accountability mechanisms, supported by national health councils, were instrumental in ensuring the implementation of public health measures, despite political and structural challenges. Conclusions Decentralised governance, adaptable legal frameworks, transparent communication, and robust accountability are essential for building resilient health systems capable of responding to future global health crises.
