Rawalpindi Medical University

Abstract Background Traditional nasal packing following septoplasty imposes significant patient morbidity, including pain, obligate oral breathing, and sleep disruption. Negative pressure drainage (NPD) represents a mechanistically distinct alternative, but no synthesis of comparative evidence existed prior to this review. Methods A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing NPD with nasal packing following septoplasty was conducted in accordance with PRISMA 2020 (PROSPERO: CRD420261297218). PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to January 2026. Primary outcome was postoperative pain. Secondary outcomes included nasal obstruction, complications, treatment efficacy, and cost-effectiveness. Risk of bias was assessed using RoB 2. Results Four RCTs comprising 315 patients were included, between 2014 and 2025. Risk of bias was rated as some concern in all the studies. NPD demonstrated a statistically significant reduction in postoperative pain at 24 h (MD = -2.36, 95% CI: -4.10 to -0.62), exceeding the minimum clinically important difference, though substantial heterogeneity was present (I² = 95.2%). NPD was associated with significantly lower nasal obstruction scores in the immediate postoperative period. Adhesion rates trended lower with NPD (2.8% vs. 6.5%; RR = 0.50, 95% CI: 0.14 to 1.83) without reaching significance. Overall treatment effectiveness was comparable between groups (RR = 1.07, 95% CI: 0.99 to 1.16). NPD was associated with substantially lower per-patient costs in one study. Conclusion NPD offers clinically meaningful early postoperative pain and comfort advantages over traditional nasal packing with equivalent efficacy and an acceptable safety profile. The evidence base remains limited to four single-country trials, and adequately powered RCTs are needed before definitive practice recommendations can be made.

Edaravone dexborneol (ED), a combination of edaravone and ( +)-borneol, offers antioxidant and anti-inflammatory neuroprotection in acute ischemic stroke (AIS). Prior meta-analyses were limited by small sample sizes, inclusion of observational studies, and lack of subgroup evaluations. To assess the efficacy and safety of ED in AIS, including patients undergoing endovascular thrombectomy (EVT). We systematically reviewed randomized controlled trials (RCTs) up to February 2026 using PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov. The primary outcome was excellent functional recovery (mRS 0–1 at 90 days). Secondary outcomes included mRS 0–2 and 3–6, NIHSS changes, mortality, hemorrhagic complications, cognitive and functional measures, and adverse events. Risk of bias and certainty of evidence were evaluated using RoB 2 and GRADE. Eight RCTs (n = 4,197) were included. ED significantly improved mRS 0–1 (RR = 1.14; 95

Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs, the three-pronged Franseen-tip needle demonstrates strong diagnostic performance, though direct head-to-head comparisons with other FNB designs remain limited. This meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251123856). Eligible studies enrolled patients with solid pancreatic lesions who underwent EUS-guided FNB, directly compared the Franseen-tip with other FNB needles. Six databases were systematically searched through July 2025, and study selection, data extraction, and risk of bias assessment (QUADAS-2 tool) were performed independently by two reviewers. Pooled estimates were generated using random-effects and bivariate hierarchical models. Sixteen studies (2,010 Franseen vs. 2,811 comparator) were included. Bivariate analysis showed that sensitivity and specificity of the Franseen needle were comparable to newer-generation comparator needles (sensitivity 91.3

Diabetic ketoacidosis (DKA) increasingly occurs in patients with end-stage renal disease (ESRD), in whom standard management strategies may not be appropriate. Prior studies evaluating outcomes of DKA in ESRD are limited and yield inconsistent results. We compared in-hospital outcomes and healthcare utilization among patients hospitalized with DKA with and without ESRD using a national database. We performed a retrospective cohort study using the National Inpatient Sample (2016–2022) of adult hospitalizations with a primary diagnosis of DKA, comparing patients with and without ESRD. Propensity score matching was used to balance demographics and comorbidities; multivariable regression was used to estimate adjusted odds ratios (aORs) for in-hospital mortality, major in-hospital complications, length of stay, and inflation-adjusted hospitalization costs. After propensity score matching, 78,470 hospitalizations were included (39,235 with ESRD and 39,235 without ESRD). In-hospital mortality was similar between patients with and without ESRD (0.9

Robotic-assisted laparoscopic hysterectomy has gained widespread adoption for benign gynecologic diseases despite its higher cost and ongoing debate over its clinical superiority compared to conventional laparoscopy. Although many comparative studies exist, no meta-analysis has exclusively synthesized randomized controlled trial evidence with a comprehensive GRADE certainty assessment of all clinically relevant, perioperative outcomes. This systematic review and meta-analysis was prospectively registered (PROSPERO ID: CRD420251183072). We systematically searched major databases from inception through November 1, 2025, for randomized controlled trials comparing robotic total laparoscopic hysterectomy (R-TLH) with conventional total laparoscopic hysterectomy (C-TLH) for benign indications. Two independent reviewers screened the studies, extracted the data, and assessed the risk of bias using the RoB 2 tool. Random-effects meta-analyses were performed for operative duration, estimated blood loss, conversion to laparotomy, length of hospital stay, and perioperative complications. Heterogeneity was quantified using I² statistics, and comprehensive sensitivity analyses were conducted to assess the robustness of the results. The certainty of the evidence for each outcome was evaluated using the GRADE approach. Four trials (N = 375 patients) met the inclusion criteria, with 185 and 190 patients in the R-TLH and C-TLH groups, respectively. The total operative time did not differ significantly between the R-TLH and C-TLH groups (mean difference [MD] 11.79 min, 95