Dow International Medical College

Ultrasound-guided regional anesthesia (UGRA) has changed how we manage pain by allowing doctors to visualize nerves and other structures in real time, making the process more accurate, effective, and safe while also reducing risk. This narrative review examines the latest advancements in UGRA techniques, evaluating their efficacy and safety, particularly for peripheral nerve and truncal plane blocks, their potential to diminish opioid consumption, and their clinical applications in perioperative care. This review followed the Scale for the Assessment of Narrative Review Articles (SANRA) quality assessment guidelines and searched six databases for studies published from January 2015 to October 2025, including trials, meta-analyses, cohort studies, reviews, and technical reports. This review aims to give doctors, anesthesia experts, and researchers the newest information and methods about UGRA, focusing on better ways to see needles and use additives like dexamethasone and dexmedetomidine to make regional anesthesia more effective and last longer, which can help lower opioid use and speed up recovery after surgery, while ultrasound guidance makes these techniques safer and more accurate. Another important finding is that real-time imaging and protocols help reduce safety concerns like toxicity, nerve damage, and infection. Artificial intelligence (AI) and robotics in UGRA enhance precision, safety, and recovery, paving the way for further standardization and accessibility.

Venous thromboembolism (VTE) remains a leading cause of preventable morbidity and mortality among hospitalized patients. Although pharmacological thromboprophylaxis is well established in inpatient care, initiation is frequently delayed until after hospital admission. The emergency department represents the first point of contact for many high-risk patients and a potential opportunity for earlier prevention. This systematic review and meta-analysis evaluated the effectiveness of emergency department-initiated thromboprophylaxis protocols in preventing VTE among high-risk adult patients. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review was conducted using MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to the most recent update. Eligible studies included randomized controlled trials and observational or quasi-experimental studies evaluating thromboprophylaxis initiated in, or directly facilitated by, the emergency department. Outcomes of interest included incidence of VTE, bleeding complications, mortality, length of stay, and process measures such as prophylaxis utilization and timeliness. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized trials and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-randomized studies. Due to substantial clinical and methodological heterogeneity, quantitative pooling was limited, and a structured narrative synthesis was performed. The review identified a heterogeneous body of evidence comprising prospective and retrospective cohorts, before-and-after implementation studies, and health information technology interventions. Emergency department-initiated or emergency department-facilitated protocols consistently increased appropriate thromboprophylaxis use and reduced delays to the first dose. In a subset of large protocol implementation studies, earlier initiation was associated with lower rates of symptomatic VTE without a corresponding increase in major bleeding. Mortality and length of stay outcomes were inconsistently reported, precluding definitive conclusions. The overall certainty of evidence was limited by observational designs, variability in patient populations, and inconsistent outcome definitions. Emergency department-initiated thromboprophylaxis protocols improve the timeliness and appropriateness of VTE prevention and may reduce symptomatic events without increasing bleeding risk in selected high-risk populations. These findings support the integration of structured thromboprophylaxis pathways into emergency care, while highlighting the need for high-quality prospective trials to define their impact on patient-centered outcomes.

Abstract Intermediate coronary stenoses (40–70% diameter narrowing) pose a diagnostic challenge, as angiography alone often leads to inappropriate revascularization. Whether fractional flow reserve (FFR) or intravascular ultrasound (IVUS) guidance yields superior outcomes remains unclear. This Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐compliant systematic review and meta‐analysis searched PubMed, Embase, ScienceDirect, and ClinicalTrials.gov from inception to November 2025. Eligible studies were RCTs or observational comparisons of FFR‐ or angiography‐derived FFR versus IVUS‐guided percutaneous coronary intervention (PCI) in intermediate or angiographically significant lesions with ≥12‐month follow‐up. Pooled risk ratios (RR) and mean differences were calculated using random‐effects models. Evidence certainty was graded using GRADE. Six studies (2 RCTs, 4 observational; n = 5050) were included. No significant difference was found in major adverse cardiac events (MACE: RR 1.17, 95% confidence interval [CI] 0.99–1.39; p = .06) or all‐cause mortality (RR 1.05, 95% CI 0.79–1.38; p = .74). Myocardial infarction rates were similar (RR 1.48, 95% CI 0.88–2.51; p = .14). Ischemia‐driven target vessel revascularization was significantly higher with FFR guidance (RR 1.43, 95% CI 1.07–1.91; p = .02). Mean stent length was numerically shorter with FFR (mean difference −2.07 mm, 95% CI −4.87 to 0.73; p = .15). Evidence certainty was moderate for MACE and target vessel revascularization, low for hard endpoints, and very low for stent length. In intermediate and angiographically significant coronary stenoses, FFR‐ and IVUS‐guided PCI showed comparable hard clinical outcomes, but IVUS was associated with reduced target vessel revascularization. These findings support individualized modality selection based on clinical context and operator expertise, with a potential role for hybrid approaches combining physiological assessment for deferral decisions and imaging for procedural optimization.

BACKGROUND:Laryngeal cancer (LC) represents one-third of all head and neck cancers, with global deaths rising by 36.7% between 1990 and 2021. Although mortality has declined over the past two decades, recent data indicate a potential slowdown in this progress. This study evaluated temporal trends in laryngeal cancer mortality in the United States. METHODS:LC mortality data from 1999 to 2024 were obtained from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage changes (APCs) with 95% confidence intervals (CIs) were calculated using Joinpoint regression analysis to assess temporal trends. RESULTS:Between 1999 and 2024, 129,275 LC-related deaths were recorded in the United States. The overall age-adjusted mortality rate (AAMR) declined from 3.76 to 2.25 per 100,000, with a significant decrease from 1999-2016 (APC: -2.75%; 95% CI, -2.92 to -2.58; p < 0.001), followed by a non-significant change from 2016-2024 (APC: -0.38%; 95% CI, -0.87 to 0.11; p = 0.12). Mortality was consistently higher in males than females, declining from 7.00 to 3.94 and 1.40 to 0.85 per 100,000, respectively. In 1999-2020 analyses, NH-Black individuals had the highest mortality, followed by NH-American Indian or Alaska Native and NH-White populations, with significant declines across all racial/ethnic groups (p < 0.001). Highest state-level AAMRs were observed in Kentucky, West Virginia, Louisiana, Tennessee, Ohio, and the District of Columbia (reported separately as a federal district). Mortality declined across all age groups and was consistently higher in non-metropolitan than metropolitan areas (all trend tests p < 0.05). CONCLUSION:LC mortality in the United States has declined since 1999, but the rate of decline has slowed in recent years. Marked disparities persist by sex, race/ethnicity, age, and geographic region, with higher mortality in males, NH-Black individuals, older adults, and non-metropolitan areas. These findings underscore the need for continued surveillance and targeted interventions.