Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College (NHLMMC), is a Municipal Medical College located in Ahmedabad, Gujarat, India affiliated with the Gujarat University. The Medical College was established by the Ahmedabad Municipal Corporation (AMC) in 1963, which became only the second Municipal Corporation in India to establish its own Medical College.
OBJECTIVES:Balancing oxygen requirements, neurologic outcomes, and systemic complications from transfusions in traumatic brain injury (TBI) patients is challenging. This review compares liberal and restrictive transfusion strategies in TBI patients. DATA SOURCES:Electronic databases were searched from inception to October 2024. STUDY SELECTION:We included randomized controlled trials comparing liberal and restrictive transfusion strategies in TBI patients. DATA EXTRACTION:Data were extracted by two reviewers using predefined forms. DATA SYNTHESIS:We included five studies with 1,533 patients: 769 (50.2%) in the liberal transfusion group and 764 (49.8%) in the restrictive group. There were no significant differences between groups favorable Glasgow Outcome Scale (risk ratio [RR], 1.16; 95% CI, 1.00-1.34), although a leave-one-out analysis demonstrated significance in this endpoint (RR, 1.24; 95% CI, 1.06-1.45). No significant difference was found regarding hospital mortality (RR, 0.98; 95% CI, 0.76-1.27), mortality at follow-up (RR, 1.03; 95% CI, 0.82-1.28), mortality in the ICU (RR, 1.00; 95% CI, 0.73-1.37), infection rates (RR, 1.08; 95% CI, 0.95-1.23), thromboembolic events (RR, 1.79; 95% CI, 0.74-4.31), hospital length of stay (LOS) (mean difference [MD], -1.45; 95% CI, -4.85 to 1.96), or ICU LOS (MD, -0.47; 95% CI, -3.84 to 2.91). The liberal transfusion strategy group had a significantly higher prevalence of acute respiratory distress syndrome (RR, 1.78; 95% CI, 1.06-2.98) and received more blood units per patient (MD, 2.62; 95% CI, 1.90-3.33). CONCLUSIONS:Our findings suggest that a liberal transfusion strategy results in better neurologic outcomes than a restrictive approach. Future research should examine the complication profile and the effects of using a 9 g/dL threshold. We advocate for revising current guidelines to establish 9 g/dL as the standard threshold for transfusions in TBI patients.
The diagnostic criteria for Multiple sclerosis (MS) have undergone several revisions over the past two decades. This narrative review highlights evolution and key changes to the McDonald criteria since its introduction in 2001. This was one of the first criteria to incorporate evidence on MRI to diagnose MS in addition to clinical diagnosis. Subsequent revisions in 2005 and 2010 refined the requirements for lesion dissemination in space and time. The 2017 McDonald criteria improved sensitivity by including cerebrospinal fluid oligoclonal bands as evidence of dissemination in time. The most recent update was proposed in 2024 and presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Annual Meeting 2024, American Academy of Neurology (AAN) Annual Meeting 2025, and the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting 2025, which introduced novel biomarkers such as kappa free light chains, and imaging features such as the central vein sign and paramagnetic rim lesions. Inclusion of the optic nerve as a fifth topography and permitting MS diagnosis in selected cases of radiologically isolated syndrome has expanded diagnostic horizons. These updates aim to facilitate early diagnosis and treatment initiation in MS. However, they also raise concerns about overdiagnosis and the need for careful clinical correlation. Future directions include biomarker standardization and validation across diverse populations.
Accurate cardiovascular disease (CVD) risk prediction is critical for preventive decision-making. While traditional tools like the Framingham Risk Score (FRS) and Coronary Artery Calcium Score (CACS) are widely used, newer artificial intelligence (AI)-based models such as AICVD and Reti-CVD offer promising alternatives. However, comparative data across traditional, radiological, and AI-based tools remain limited. This study aimed to compare the predictive efficacy of traditional, radiological, and AI-driven CVD risk tools through a network meta-analysis. A systematic search of PubMed, Embase, Cochrane Library, and Google Scholar identified four observational studies comparing predictive tools in adults for ischemic CVD outcomes. Tools assessed included FRS, QRISK3, CACS, CIMT, baPWV, AICVD, and Reti-CVD. Primary outcomes were risk stratification accuracy and the incidence of ischemic CVD events during follow-up (up to 11 years). A network meta-analysis using random effects models was performed in R. A total of four observational studies with 53,641 participants were included. AICVD demonstrated the highest predictive efficacy, with an 86
This systematic review and meta-analysis aimed to evaluate sex-based differences in surgical outcomes among patients with infective endocarditis (IE). A comprehensive search of three major medical databases identified ten studies encompassing 16,763 patients who underwent valvular surgery for IE. Of these, 70.8% were male (n = 11,873), and 29.2% were female (n = 4890). Female patients were generally older at the time of surgery. The most common causative pathogen was Staphylococcus aureus (28.4%), followed by Streptococcus (22.5%) and Enterococcus (4.1%). Females demonstrated lower aortic valve involvement (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.67-0.96) but higher mitral valve involvement (RR: 1.30, 95% CI: 1.17-1.45, p < 0.001). They also had a reduced prevalence of Streptococcus (RR: 0.89, 95% CI: 0.81-0.98, p = 0.02) and Enterococcus (RR: 0.71, 95% CI: 0.62-0.82, p = 0.03) infections and a lower risk of abscess formation (RR: 0.87, 95% CI: 0.76-0.99, p = 0.03) compared to males. There was a significant difference in the in-hospital mortality between female and male patients (RR: 1.30, 95% CI: 1.04-1.61, p = 0.02). No significant sex-related differences were observed in the duration of hospitalization. However, significant sex-related differences were observed in the incidence of postoperative stroke (RR: 1.10, 95% CI: 1.02-1.20, p = 0.02). In summary, female patients undergoing surgery for IE face a higher risk of both in-hospital mortality and postoperative stroke compared to males, underscoring clinically meaningful sex-based disparities in short-term surgical outcomes. These findings emphasize the need for further studies to clarify these observations. (PROSPERO Registration: CRD42024602013).
Introduction: Pre-emptive analgesia is a form of pain management that seeks to prevent alterations in the way the body processes incoming pain signals. Gabapentin is a compound that exhibits structural similarities to gamma-aminobutyric acid. It has been found to possess powerful pain-relieving properties and can also help prevent seizures. Additionally, it is purported to have greater efficacy in reducing the neuropathic component of acute nociceptive pain following surgical procedures. Aim: The purpose of the study was to assess the efficacy of gabapentin and placebo in providing pre-emptive analgesia for postoperative pain management among patients undergoing elective abdominal hysterectomy under spinal anesthesia. Materials and Methods: A single-blind randomised controlled trial was conducted among patients undergoing elective abdominal hysterectomy who had American Society of Anesthesiologists (ASA) physical status I-II. Sixty-eight participants, aged between 35 and 70 years, were randomised into two groups: group G (n=34) was administered 600 mg of gabapentin in tablet form, whereas group P (n=34) received a placebo, two hours prior to the surgery. Participants were assessed for vital signs and pain using the Visual Analogue Score (VAS), while the level of sedation was determined using the Ramsay Sedation Score (RSS). An injection of Diclofenac 75 mg intravenously was administered as an analgesic on an as-needed basis. The requirement for analgesia was monitored over the next 24 hours. Statistical analysis was performed using the independent Student’s t-test, Mann-Whitney U Test, and Chi-square test. Results: Both groups were comparable with respect to demographic profile (age, ASA physical status) and haemodynamic variables {pulse rate, Mean Arterial Pressure (MAP), Peripheral Oxygen Saturation (SpO2)}, with a p-value>0.05. The mean duration of the first rescue analgesic requirement for group G (12.82±4.50 hours) was significantly higher than for group P (8.58±2.54 hours), with a p-value of 0.002. The mean duration of the second and third rescue analgesic requirement for group G was 13.50±2.97 hours and 21±3.00 hours, respectively, while for group P it was 15.78±3.20 hours and 22±2.08 hours, respectively. Therefore, group G experienced a significantly longer duration of analgesia, as evidenced by the mean duration of the first rescue analgesic requirement. No significant side effects were observed in either group. Conclusion: Gabapentin 600 mg when used as a pre-emptive analgesic provides analgesic effects and reduces the requirement for rescue analgesia while maintaining stable haemodynamics perioperatively. Therefore, it serves the purpose of multimodal analgesia for improved anaesthetic management.
