OBJECTIVE:Endovascular aortic aneurysm repair (EVAR) traditionally relies on iodinated contrast media (ICM), which can be problematic in patients with renal insufficiency or iodine allergy. Carbon dioxide (CO2) has emerged as a valuable alternative to mitigate these risks. This systematic review with meta-analysis aims to evaluate the safety and effectiveness of CO2 angiography in EVAR. METHODS:A literature search was conducted using PubMed, Cochrane Library, Scopus and ISI databases to identify studies published up to May 2026 that assessed CO2 angiography use in EVAR. The primary endpoint of safety was acute kidney injury (AKI) occurrence. Effectiveness was evaluated based on technical success rates. The incidence of acute kidney injury was pooled using a random-effects meta-analysis, with sources of heterogeneity explored via meta-regression. RESULTS:Eight studies involving 1699 patients were included, with 581 undergoing EVAR with CO2 angiography and 1118 receiving ICM. There was no statistical difference regarding AKI between the EVAR cohort assessed with CO2 angiography and the ICM angiography cohort, with an overall AKI risk ratio of 0.65 (95% CI: 0.27-1.56) (I2=0%). CO2 angiography is associated with longer procedural times and higher radiation exposure in some studies. The intraoperative endoleak detection rate was similar or slightly higher in the CO2 group. No significant differences in mortality rates were observed between the groups. CONCLUSIONS:CO2 angiography shows comparable safety and effectiveness to ICM in EVAR procedures. However, risk-reduction of AKI was not statistically different between ICM and CO2.
To compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling in patients suffering with non-resolving vitreous hemorrhage and tractional retinal detachment. Fifty-seven patients (57 eyes) suffering from PDR were randomly assigned to undergo PPV with ILM peeling (n = 26) or without ILM peeling (n = 31). Outcomes assessed over a 6-month follow-up included best-corrected visual acuity (BCVA), need for additional anti-VEGF injections, frequency of reoperations, central macular thickness (CMT), development of epiretinal membrane (ERM), macular traction, and vascular parameters derived from OCT imaging. Both groups showed statistically significant improvements in BCVA postoperatively (p < 0.001), with no significant difference between them (p = 0.846). The ILM peeling group required fewer repeat anti-VEGF injections (7.7
Abstract Background and aims New-onset postoperative atrial fibrillation (POAF) complicates up to 50% of post-cardiac surgery patients. Despite POAF’s high incidence, there are no clear guidelines regarding optimal anticoagulation and stroke prophylaxis regimen. Despite warfarin being the standard of care, its narrow therapeutic window and monitoring burdens are significant drawbacks. We investigated whether Direct Oral Anticoagulants (DOACs) provide a safe and effective alternative in this high-risk population. Methods A systematic search of major databases was conducted up to December 2025. Analysis was performed using the Mantel-Haenszel method with a random-effects model on RevMan. Results The analysis incorporated 36,825 patients from 13 studies (2 randomized-controlled trials + 11 observational studies). Analysis revealed no significant difference in stroke risk between Warfarin and DOACs [Relative Risk (RR) for warfarin: 1.22; 95% Confidence interval (CI): 0.96, 1.55; I^2 = 0%]. Trial sequential analysis (TSA) confirmed that the cumulative Z-curve remained within the non-significance zone, approaching the required information size and establishing the futility of further superiority testing. Furthermore, no significant differences were observed in the risk of all-cause mortality, readmission, systemic embolism, transient ischemic attack, major bleeding, gastrointestinal bleeding, or minor bleeding between warfarin and DOACs. Besides, there was no significant difference in post-operative length of stay between the two arms. Conclusions DOACs demonstrated an efficacy and safety profile comparable to warfarin for POAF. Reinforced by Trial Sequential Analysis and low heterogeneity despite mixed study designs, these results support DOACs as a non-inferior standard of care, allowing for simplified postoperative anticoagulation without compromising clinical outcomes. Conflict of interest Mazen Negmeldin Yassin: nothing to disclose. Zeyad Bady: nothing to disclose. Ahmed Talkhan: nothing to disclose. Mohammad Al Diab Al Azzawi: nothing to disclose. Mahmoud Mohamed Lasheen: nothing to disclose. Muhammad Youssef: nothing to disclose. Basma Kamel: nothing to disclose. Basel Ayoub: nothing to disclose. Mahmoud Refaey: nothing to disclose. Mahmoud Mohamed: nothing to disclose. Yusof M. Omar: nothing to disclose. Ahmed Nasreldein: nothing to disclose.
Abstract Background Vestibular migraine (VM) is a common cause of recurrent vertigo and is often challenging. While pharmacological therapy remains the mainstay, vestibular rehabilitation therapy (VRT) has been proposed as an adjunct. This study aimed to evaluate the effect of combined VRT and medical therapy compared to medical therapy alone on VM symptoms, vestibular, and audiological outcomes. Methods This prospective study was conducted on 42 adult patients diagnosed with VM. Patients were divided into two equal groups: Group A received topiramate 25 mg for 3 months, while Group B received topiramate for 1 month followed by 2 months of customized VRT. Clinical symptoms and vestibular assessments (VNG, vHIT) were assessed before and after treatment. Disability and quality of life were assessed using the Dizziness Handicap Inventory (DHI) and Headache Impact Test (HIT-6). Results Both groups demonstrated significant improvement in migraine-related symptoms, headache frequency, and vertigo attacks (p < 0.05). Group A showed greater reduction in symptom severity, DHI, and HIT-6 scores compared to Group B (p < 0.05). Vestibular outcomes showed partial improvements, with Dix-Hallpike responses significantly reduced only in Group B. Conclusion Topiramate monotherapy provided superior symptomatic and quality-of-life improvement compared to sequential topiramate-VRT therapy. VRT may be useful for patients with persistent imbalance, but its added benefit over medications alone was limited in this cohort.
