Nishtar Medical University

Glioblastoma (GBM) remains the most common and lethal primary central nervous system tumor, with a median survival of only 14.6 months under standard care. The tumor’s characteristic "Warburg effect"—a dependency on aerobic glycolysis for energy—creates a metabolic vulnerability. This review evaluates the efficacy and safety of the ketogenic diet (KD) as an adjunctive metabolic therapy aimed at exploiting this glucose dependency. This PRISMA-compliant systematic review updates clinical evidence by synthesizing data from databases from 2000 to September 2025. We searched PubMed, Embase, Cochrane, and Web of science for human studies assessing the ketogenic diet (KD) in glioblastoma and high-grade gliomas. Primary outcomes included overall survival (OS), progression-free survival (PFS), feasibility, and adverse events. Study quality was assessed using Joanna Briggs Institute tools. Prospero registration: CRD420251232650. Forty-one studies were included, ranging from randomized trials to case series and abstracts, utilizing interventions such as the classic 4:1 ketogenic diet, Modified Atkins Diet, and calorie restriction. Adherence was high (> 75

Heart failure is a major global health burden, with high rates of hospitalization and mortality despite advances in medical therapy. Seasonal influenza is a well-established trigger for heart failure decompensation, acting through systemic inflammation, increased metabolic demand, endothelial dysfunction, prothrombotic states, and pulmonary congestion. These mechanisms contribute to higher risks of hospitalization, major adverse cardiovascular events, and death in patients with heart failure. Accordingly, major cardiovascular societies and public health organizations recommend annual influenza vaccination for all patients with heart failure. This review summarizes the biological rationale, clinical evidence, and implementation challenges surrounding influenza vaccination in heart failure. Observational studies consistently associate vaccination with lower mortality and reduced heart failure hospitalizations, though residual confounding remains a concern. More recent randomized and pragmatic trials, including large cardiovascular outcome studies and the dedicated PANDA-II trial, provide stronger evidence of benefit, demonstrating reductions in mortality and readmissions, particularly when vaccination is initiated during hospitalization for acute heart failure. Meta-analyses further support a protective effect against major cardiovascular events. Despite robust evidence and clear guideline endorsement, vaccination uptake remains suboptimal worldwide. Integrating influenza vaccination into routine and inpatient heart failure care represents a low-cost, scalable strategy with meaningful potential to improve clinical outcomes.

Both lung cancer and diabetes are the leading causes of death worldwide. These two conditions commonly coexist, especially in older patients, and result in worsening of prognosis and lower survival rates. Very limited scientific data are available about their correlation. Studying the mortality trends using data from Centers for Disease Control and Prevention Wide-Ranging Online Data of Epidemiologic Research (CDC WONDER) can help us in designing better health policies and treatment strategies. We analyzed the US mortality data from 1999 to 2023 using the CDC WONDER dataset. The ICD-10 codes were used. For lung cancer, it is C34, and for diabetes, they are E10-14. Temporal trends were analyzed by using joinpoint regression (V5.4.0) and a p value < 0.05 was considered statistically significant. From 1999 to 2023, a total of 174,418 deaths were reported in the United States. Most of them occurred at home (39.6