Elrazi University

BACKGROUND:Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure and after myocardial infarction (MI), but patients with cardiogenic shock (CS) have been excluded from major trials. We therefore evaluated the association between discharge SGLT2 inhibitor prescription and 1-year outcomes in survivors of acute myocardial infarction (AMI) complicated by CS. METHODS:This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models. RESULTS:Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629-1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients. CONCLUSIONS:In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.

BACKGROUND:Multiple rib fractures cause substantial morbidity through severe pain, impaired ventilation, and pulmonary complications. While open rib fixation is well established, thoracoscopic fixation may reduce soft-tissue trauma and enhance recovery, but comparative evidence remains unclear. This systematic review and meta-analysis aimed to compare thoracoscopic versus open fixation for multiple rib fractures in terms of effectiveness and safety outcomes. METHODS:We conducted a systematic literature search across PubMed, Scopus and Web of Science to retrieve comparative studies comparing thoracoscopic fixation versus traditional open fixation for multiple rib fractures regarding pain, perioperative outcomes and safety outcomes. Risk of bias of included studies was assessed using the ROBINS-I tool. A meta-analysis was conducted using a random-effects model in R (version 4.5.0). RESULTS:Nine comparative studies were identified (total participants = 751). Meta-analysis revealed that thoracoscopic fixation was associated with improved postoperative pain compared with open fixation. Pain was significantly lower with thoracoscopy on postoperative day (POD) 1 (SMD= -1.12, 95% CI -1.64 to -0.61) and POD7 (SMD= -1.90, 95% CI -3.08 to -0.73), while POD3 was not significant (SMD= -1.49, 95% CI -3.52-0.54). Thoracoscopy reduced incision length (MD= -4.19 cm) and blood loss (MD= -18.56 mL) and shortened hospital stay (MD= -2.05 days), with no difference in operative time (MD= 9.66 min). Pleural effusion was less frequent (OR 0.32, 95% CI 0.10-1.00) on thoracoscopic fixation. CONCLUSION:There may be clinically significant benefits of thoracoscopic rib fixation over open fixation for multiple rib fractures. These benefits may include less early postoperative pain, smaller incisions, less blood loss, shorter hospital stays, and no increase in operative time. Overall complication rates were similar, but thoracoscopic fixation was associated with fewer pleural effusions. Due to significant heterogeneity and the predominance of observational studies, there is a need for more rigorous prospective trials.

Introduction Congenital hemangiomas (CHs) are rare benign vascular tumors that are fully developed at birth and distinct from infantile hemangiomas in their biology and natural history. Although typically localized to the head, neck, and extremities, CHs occurring in unusual anatomical sites or presenting with functional impairment remain a clinical challenge. Case Presentation We describe two pediatric cases of congenital hemangioma in rare anatomical regions. Case 1 A 5-year-old female with a giant CH of the right gluteal and knee regions, complicated by recurrent ulceration, bleeding, infection, and transfusion-dependent anemia. A staged surgical excision (knee, then gluteal) was performed, followed by six months of propranolol. At one-year follow-up, she remains complication-free. Case 2 A 3-year-old female with a congenital hemangioma of the lower lip and oral mucosa, noted at birth, presenting with feeding difficulty but no bleeding or infection. Clinical and imaging findings confirmed a high-flow lesion without deep extension. Surgical excision was performed and the child recovered uneventfully. Conclusion Congenital hemangiomas in uncommon anatomical sites may present with significant complications or functional impairment. Staged or definitive surgical excision, supplemented by propranolol therapy when indicated, provides excellent outcomes.

e22002 Background: CD19-directed chimeric antigen receptor T-cell (CAR-T) therapies have improved outcomes for patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Direct comparisons between approved products—axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel)—remain limited, complicating evidence-based selection in clinical practice. Methods: We performed a PRISMA-compliant systematic review and meta-analysis of randomized clinical trials and real-world studies (through March 2025) evaluating long-term efficacy and safety of commercially available CD19 CAR-T therapies in adults with R/R DLBCL. PubMed, Embase, Cochrane Library, and conference abstracts were searched. Pooled estimates were calculated using random-effects models. Results: Twenty-five studies (4,067 patients; median follow-up 24.6 months) were included. The pooled overall response rate (ORR) was 74% (95% CI, 69–79%), with a complete response (CR) rate of 52% (95% CI, 43–60%). Axi-cel showed the highest ORR (77%; 95% CI, 72–81%) and CR rate (47%; 95% CI, 45–50%). Pooled 1-year progression-free survival (PFS) was 43% (95% CI, 37–49%), and 1-year overall survival (OS) was 66% (95% CI, 59–73%). Safety profiles differed significantly: axi-cel was associated with the highest incidence of immune effector cell-associated neurotoxicity syndrome (ICANS; 34%), while liso-cel had the lowest (9%; 95% CI, 6–13%). Rates of cytokine release syndrome were comparable across products. Conclusions: All approved CD19 CAR-T therapies provide meaningful clinical benefit in R/R DLBCL, but with distinct efficacy–toxicity profiles. These findings support a personalized approach to product selection, integrating patient comorbidities, disease aggressiveness, and institutional experience. Pooled efficacy outcomes of CD19 CAR-T therapies. Outcome Axi-cel (95% CI) Tisa-cel (95% CI) Liso-cel (95% CI) Overall Pooled (95% CI) Overall response rate (ORR), % 77% [72–81] 54% [45–64] 74% [68–79] 74% [69–79] Complete response (CR), % 47% [45–50] 42% [38–46] 49% [46–51] 52% [43–60] 1-year PFS, % 45% [42–47] 28% [25–32] 26% [23–28] 43% [37–49] 1-year OS, % 65%[63–68] 56%[51–60] 55%[52–58] 66%[59–73] CI, confidence interval; ORR, overall response rate; CR, complete response; PFS, progression-free survival; OS, overall survival. Interpretation: The overall pooled estimates (right column) represent a weighted average across all included studies and patient populations. The superior ORR/CR with axi-cel and the favorable safety profile of liso-cel (see main text) underscore the need for treatment personalization.

Abstract Background and aims Intracranial hemorrhage (ICrH) is a serious neurosurgical emergency with high mortality and morbidity. The best time for surgery is a crucial management problem. Various studies show inconsistent findings for mortality, functional recovery, and complications from ultra-early (<6 hours) to delayed (>7 days) surgery. This network meta-analysis aimed to determine the etiology-specific optimal surgical time for ICrH to guide evidence-based clinical decision-making. Methods A comprehensive search of PubMed, Scopus, WOS, and the Cochrane Library was performed. Twenty-eight studies involving 5,919 participants were included. Data were analyzed using random-effects models in R software, with subgroup analyses based on the time windows and type of hemorrhage. Results Surgery conducted within 24 hours markedly decreased the likelihood of unfavorable GOS ratings (OR: 0.53, 95% CI: 0.31–0.92) and rebleeding (OR: 0.55, 95% CI: 0.37–0.80). The network meta-analysis demonstrated that surgery within 48 hours is the most effective optimal period for decreasing mortality (P-score = 0.99). Nonetheless, paired comparisons indicated non-significant effects (OR = 0.94, 95% CI: 0.51–1.72), suggesting that there must be etiology-specific interpretation. Early intervention (≤72 hours) proved most advantageous in aSAH, while ultra-early surgery (<6 hours) in traumatic ICH resulted in increased mortality. Postponement of surgery beyond seven days led to inferior functional recovery. Conclusions Early surgical intervention, especially within 24–48 hours, improves prognosis in many ICH cases. The optimal timing depends on the bleeding type. These findings resolve past disagreements by showing that timing and pathology affect therapy outcomes. More tailored scheduling and high-quality RCTs are needed to improve clinical guidelines. Conflict of interest Nada Mostafa Al-dardery: nothing to disclose. Dina Essam Abo-elnour: nothing to disclose. Alyaa Khaled Madech: nothing to disclose. Shahd Alqato: nothing to disclose. Suhel F. Batarsch: nothing to disclose. Mariam A. Abusalah: nothing to disclose. Amr Diaaeldin Sayed Mahmoud: nothing to disclose. Wesal Nasr Mahmoud: nothing to disclose. Abdulrhman M Khaity: nothing to disclose.