Jinnah Sindh Medical University

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.

After open thoracic surgery, post-thoracotomy pain remains an important postoperative problem affecting nearly half of patients. It can give rise to respiratory problems, delayed rehabilitation, prolonged hospitalizations, and chronic post-thoracotomy pain syndrome. Despite the reality that opioids are currently the primary source of anesthesia after surgery, their consumption is restricted by complications, including prolonged dependency, tolerance, and respiratory impairment. To maximize recovery after the thoracotomy, this narrative review incorporates some of the most current studies on opioid-free strategies. In addition to local anesthetic techniques, which include thoracic epidural analgesia, paravertebral block, and erector spinae plane block, the current study highlights the effectiveness of non-opioid pharmaceutical agents, which include acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine-based, steroids, and intravenous lidocaine. Physical therapy, respiratory therapy, and psychological assistance are examples of complementary non-pharmacologic interventions that improve postoperative recovery. By integrating such techniques as Enhanced Recovery. After Surgery (ERAS) pathways, individualized multidisciplinary analgesic procedures that reduce opioid consumption, promote the recovery process, and perhaps decrease the probability of chronic postoperative pain.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition has emerged as an effective lipid-lowering strategy, particularly for patients with hypercholesterolemia not adequately managed with statins. Ongericimab is a novel monoclonal antibody targeting PCSK9. In this meta-analysis, we aim to evaluate the efficacy and safety of ongericimab in Chinese patients with hypercholesterolemia. A comprehensive literature search was conducted on PubMed, Embase, Scopus, and ClinicalTrials.gov from inception to November 2025, to identify studies assessing the lipid-lowering effects of ongericimab. Effect estimates and 95

Growth hormone deficiency (GHD) requires long-term hormone replacement therapy, most commonly through daily injections of recombinant human growth hormone (rhGH). Although effective, this daily regimen may lead to poor adherence, particularly in children. Somapacitan, a long-acting growth hormone analog administered once weekly, has emerged as a potential alternative. This systematic review and meta-analysis compares the efficacy, safety, and biochemical outcomes of once-weekly somapacitan with daily Norditropin in patients with GHD. Following PRISMA guidelines (PROSPERO: CRD420251118208), PubMed and CENTRAL were systematically searched up to August 2025. Randomized controlled trials comparing somapacitan with Norditropin in patients with GHD were included. Data were pooled using a random-effects meta-analysis in Review Manager 5.4, and risk of bias was assessed using the Cochrane RoB 2 tool. Ten randomized controlled trials involving 920 participants were included. Somapacitan and Norditropin demonstrated comparable outcomes in height velocity (MD = 0.12; 95

Aortic stenosis (AS) and hypertension (HTN) frequently co-exist in older adults, worsening disease progression and increasing mortality risk compared to either condition alone. To examine mortality trends and demographic-geographic disparities from comorbid AS and HTN in the U.S. from 1999–2020. Data were extracted from the CDC WONDER Multiple Cause of Death database. Crude and age-adjusted mortality rates (CMRs, AAMRs) per 100,000 were calculated. Joinpoint regression estimated annual (APC) and average annual percent change (AAPC). Trends were projected to 2030 using an autoregressive integrated moving average (ARIMA) model. Between 1999 and 2020, 100,507 deaths were attributed to comorbid AS and HTN. The overall AAMR significantly increased (AAPC: 5.01