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Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are the major types of demyelinating disorders of the central nervous system (CNS). Demyelinating disorders impact women disproportionately and frequently present during reproductive years. These conditions can cause significant neurological disability and psychosocial challenges, especially for women. Because they often present during reproductive years, clinicians frequently manage contraception, pregnancy, and the postpartum period alongside disease control. Sex-specific evidence, therefore, becomes especially important for treatment decisions. Despite this, sex-specific differences in epidemiology, immunopathology, clinical features, and therapeutic response remain inconsistently addressed in both clinical practice and research. In this review, we synthesize current evidence on the factors underlying the female predominance observed in MS, NMOSD, and MOGAD, and discuss the clinical consequences of these findings. We investigate the influence of sex hormones, X-chromosome–mediated immune regulation, and immunological changes associated with pregnancy and the postpartum period, as well as disease-specific mechanisms. We also examine how these factors affect diagnosis, prognosis, therapeutic decision-making, pregnancy management, and quality of life. Finally, we highlight important gaps in knowledge and underscore the necessity for a sex-informed approach to the diagnosis, management, and research of autoimmune demyelinating diseases.
Sodium–glucose cotransporter 2 inhibitors (SGLT2 inhibitors) and non-steroidal mineralocorticoid receptor antagonists (nsMRAs) exert complementary renoprotective effects in chronic kidney disease (CKD). However, the efficacy and safety of nsMRA plus SGLT2 inhibitor combination therapy compared with SGLT2 inhibitor monotherapy in patients with albuminuria remain uncertain. We systematically searched for randomized controlled trials (RCTs) comparing nsMRA plus SGLT2 inhibitor therapy with SGLT2 inhibitor monotherapy in adults with CKD with albuminuria. Outcomes included changes in albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), serum potassium, categorical ACR response (≥ 30
There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy. We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4. Five RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95
Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare lung disorder characterized by autoantibodies against Granulocyte–Macrophage Colony-Stimulating Factor (GM-CSF). Whole-lung lavage is the conventional treatment, but it does not address the underlying pathophysiology. This systematic review and meta-analysis aims to further evaluate the effects of inhaled GM-CSF on gas exchange, oxygenation, and lung volume. We conducted a systematic review and meta-analysis following PRISMA guidelines. A literature search was performed across PubMed, Embase, and the Cochrane Library from inception to October 2025. Randomized Controlled Trials (RCTs) comparing inhaled GM-CSF to a control in adult patients with aPAP were included. The primary outcomes assessed pulmonary gas exchange, oxygenation, and lung volume, while exercise capacity and dyspnea levels were secondary outcomes. Statistical analyses were performed using Review Manager (RevMan) version 5.4.1 and R version 4.5.2, with heterogeneity assessed using I2 statistics. Four phase III RCTs comprising 402 patients (224 inhaled GM-CSF, 178 control) with ≥ 25 weeks of follow-up were included. Inhaled GM-CSF significantly enhanced DLCO
Rotational thromboelastometry (ROTEM) offers rapid, point-of-care assessment of hemostasis and is increasingly used in massive bleeding [1,2]. However, its high capital and reagent costs limit widespread adoption in low- and middle-income countries like India. This study evaluated the diagnostic performance and turnaround time (TAT) of ROTEM compared with conventional coagulation tests (CCT) and explored the feasibility and cost implications of replacing or supplementing CCT with ROTEM in massive bleeding. In this exploratory cross-sectional study, ROTEM assays (EXTEM, INTEM, FIBTEM) were performed in adult patients in parallel with PT, aPTT, fibrinogen, and platelet count. Correlation and diagnostic performance were assessed using Pearson correlation and ROC analysis. TAT for ROTEM and CCT was compared. Contextual cost and feasibility analysis used locally available device and reagent price ranges and published economic evaluations of viscoelastic hemostatic assays. A total of 109 patients were included. Trauma was the most common indication. Mean TAT for ROTEM was significantly lower than CCT (11.2 ± 2.4 v/s 33.5 ± 5 min). FIBTEM parameters A5, A10 and MCF correlated excellently with fibrinogen (r values of 0.858, 0.856,0.855) while EXTEM A5, A10 and MCF correlated strongly with platelet counts (r values of 0.558,0.554, 0.528). In contrast, PT showed only moderate correlations with CT and CFT of EXTEM (r = 0.472, 0.403), and so is APTT with CT and CFT of INTEM (r = 0.452, 0.377). EXTEM versus fibrinogen ROC curve AUC for A5, A10, and MCF EXTEM were 0.812, 0.813 and 0.810 with cut-offs around 35–56.5 mm, yielding sensitivities and specificities in the 70–74
