Lahore General Hospital is a public sector teaching hospital located on Ferozepur Road in Lahore, Punjab, Pakistan. It is affiliated with Ameer-ud-Din Medical College, Lahore.
Several parts of the world grow stevia (Stevia rebaudiana Bertoni), a perennial shrub belonging to the composite family. Because it contains steviol glycosides, which are 100–300 times sweeter than sucrose, it is well known for its sweetness. This review article aims to integrate existing research to provide an exhaustive overview of stevia, including its origins, nutritional composition, and health implications, thereby augmenting the existing body of knowledge in this domain. It has been used as a sweetener and sugar substitute in the food and pharmaceutical industries. Stevia is also useful in the management of an array of medical conditions due to its high nutritional and phytochemical content. A thorough examination of Stevia’s phytochemical composition discloses a diverse range of pharmacologically active substances, comprising steviol glycosides, flavanols, and Phenolic acids.
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and is associated with a markedly increased risk of thromboembolic stroke, primarily originating from the left atrial appendage (LAA). Percutaneous left atrial appendage occlusion (LAAO) is an established alternative for stroke prevention in patients with contraindications to long-term oral anticoagulation. Transesophageal echocardiography (TEE) has traditionally guided LAAO, but intracardiac echocardiography (ICE) is increasingly adopted to facilitate conscious sedation and operator-controlled imaging. Comparative real-world safety and effectiveness data between ICE and TEE remain limited. We conducted a retrospective, multicenter cohort study using the TriNetX Research Network, comprising 112 healthcare organizations. Adult patients with atrial fibrillation who underwent percutaneous LAAO guided exclusively by ICE or TEE were identified. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included pericardial effusion, stroke/cerebrovascular accident (CVA), major bleeding, acute kidney injury (AKI), device-related complications, and all-cause hospitalization or emergency department encounters, assessed at 30 and 365 days. Propensity score matching (1:1) was performed using demographics, comorbidities, medications, prior procedures, and laboratory values. Risk ratios, absolute risk differences, Kaplan-Meier analyses, and multivariable Cox proportional hazards models were used to compare outcomes. Among 10,629 eligible patients, 3,930 underwent ICE-guided LAAO and 6,699 underwent TEE-guided LAAO. After propensity score matching, 3,442 patients remained in each cohort with well-balanced baseline characteristics. At 30 days, all-cause mortality was numerically lower with ICE than TEE (0.4
This systematic review and meta-analysis evaluated the comparative effectiveness and safety of robotic-assisted versus manual total hip arthroplasty by analysing 15 comparative studies. A comprehensive literature search was conducted across multiple databases from January 2010 to December 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing robotic-assisted and conventional manual total hip arthroplasty in primary procedures were included, with data extracted on operative time, perioperative complications, implant dislocation rates, and functional outcomes using the Harris Hip Score. Meta-analysis revealed that robotic-assisted total hip arthroplasty required significantly longer operative times compared with manual techniques, with a mean difference of 8.43 minutes. However, robotic-assisted procedures demonstrated a clinically meaningful 51% reduction in overall perioperative complications compared with manual techniques, with low heterogeneity among studies. This reduction may result from enhanced precision in component positioning, real-time haptic feedback preventing inadvertent bone resection, and improved soft tissue preservation. No significant differences were observed between groups with regard to implant dislocation rates or Harris Hip Score outcomes, suggesting that enhanced surgical precision does not necessarily translate into superior short-term functional outcomes. These findings indicate that while robotic-assisted total hip arthroplasty offers potential advantages in reducing complications, the increased operative time and substantial capital investment require careful consideration. The technology may be particularly beneficial for high-risk patients or complex cases. Future research should focus on long-term outcomes, cost-effectiveness analyses, and identification of specific patient subgroups who may derive maximum benefit from robotic assistance, to inform appropriate clinical utilisation of this technology.
BACKGROUND:Stroke remains a leading cause of mortality and long-term disability in the Middle East and North Africa (MENA) region. The substantial burden of stroke in low- and middle-income countries, where 75% of stroke-related deaths and 81% of disability-adjusted life years occur, underscores the critical need for region-specific adaptations of acute stroke care guidelines to address critical regional challenges while maintaining evidence-based core principles of care. METHODS:We adapted evidence from multiple international guidelines (AHA/ASA 2019-2023, ESO 2021-2023, NICE 2019-2022, Chinese Stroke Association 2022) and recent meta-analyses using MENA-SINO's systematic seven-step framework including comprehensive evidence review, multidisciplinary expert panel input from 45 experts across 22 MENA countries, regional implementation barrier assessment, and formal modified Delphi consensus procedures achieving > 85% agreement. Recommendations employ modified Class of Recommendation, Level of Evidence, Resource-Limited designations, and Expert Opinion statements following AGREE II standards. KEY RECOMMENDATIONS:Our regional roadmap emphasizes ten cornerstone concepts: (1) tiered stroke care systems with telemedicine networks; (2) rapid reperfusion protocols for IV thrombolysis within 4.5 hours and mechanical thrombectomy within 6-24 hours based on imaging; (3) resource-stratified care; (4) culturally sensitive decision-making frameworks; (5) aggressive secondary prevention targeting regional risk factor patterns; (6) standardized quality metrics across diverse systems; (7) comprehensive workforce development programs; (8) appropriate technology integration; (9) region-specific emergency response systems;and (10) sustainable phased implementation strategies. CONCLUSION:These guidelines provide the first comprehensive, resource-stratified framework for acute ischemic stroke management across the MENA region, with practical adaptations addressing diverse healthcare settings while preserving essential evidence-based care components.
