Serum uric acid: an independent risk factor for cardiovascular disease in Pakistani Punjabi patients.

BACKGROUND: It is well-known that serum uric acid (SUA) can increase the risk of hypertension, diabetes, obesity and dyslipidemia. However, its independent association with the risk of cardiovascular diseases (CVD) is controversial particularly in different populations. Hence, this study was aimed to assess an independent association of SUA with CVD risk in a Punjabi Pakistani cohort. METHODS: This is a retrospective observational study in which 502 human subjects having CVD, hypertension and/or diabetes were grouped based on SUA levels as normouricemia (n = 266) and hyperuricemia (n = 236). Role of SUA was assessed in increasing the risk of CVD independent of other key confounding factors (i.e. age, gender, dyslipidemia, hypertension, diabetes, dietary and life-style habits). All clinical and biochemical data were analyzed in SPSS (ver. 20). RESULTS: Subjects aged 55 ± 13 years were of both genders (males: 52%). SUA levels were significantly different among clinical subtypes of CVD [i.e. acute coronary syndrome (ACS), myocardial infarction (MI) and heart failure (HF)]. Spearman correlation showed a significantly positive association between CVD and SUA (rho = 0.149, p < 0.001). Multivariate logistic regression of SUA quartiles showed that hyperuricemia is associated with CVD [3rd quartile: OR: 1.78 (CI: 1.28-2.48), p = 0.001 and 4th quartile: OR: 2.37 (CI: 1.72-3.27), p < 0.001]. Moreover, this association remained significant even after adjusting for confounding factors. CONCLUSION: This study showed that SUA is positively associated with CVD, thus it can act as an independent risk factor for CVD.

Mitral valve repair and replacement in infectious endocarditis: a systematic review and meta-analysis of clinical outcome.

BACKGROUND: Infective endocarditis (IE) poses significant clinical challenges, often necessitating surgical intervention for improved patient outcomes. The choice between mitral valve repair (MVP) and mitral valve replacement (MVR) is crucial in managing IE. This systematic review and meta-analysis aims to compare the effectiveness of MVP and MVR in treating IE, focusing on outcomes such as postoperative bleeding, mortality, recurrent endocarditis, and stroke. MAIN TEXT: A comprehensive literature search was conducted following PRISMA guidelines. Studies directly comparing MVP and MVR in IE patients were included. Data extraction and quality assessment were performed, and meta-analysis was conducted using RevMan software. Thirty-two studies involving 82,123 patients were included. MVP was associated with significantly lower rates of postoperative bleeding (OR: 0.58, 95% CI: 0.40-0.84) and reduced long-term mortality (OR: 0.40, 95% CI: 0.32-0.51) compared to MVR. However, MVR showed lower rates of recurrent endocarditis. MVP was also associated with a decreased likelihood of postoperative stroke (OR: 0.52, 95% CI: 0.40-0.68).2, 4 CONCLUSIONS: MVP demonstrates advantages over MVR in reducing postoperative bleeding, long-term mortality, and stroke risk in IE patients. However, individual patient factors and surgical expertise must be considered in treatment decisions. Further research, including randomized controlled trials, is needed to validate these findings and refine treatment algorithms for IE management.

Impact of Cachexia on Chemotherapy Efficacy and Survival in Pancreatic Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVE: Pancreatic cancer (PC) is a significant cause of cancer-related mortality, with limited curative options and high rates of cachexia, a debilitating syndrome associated with poor prognosis. While previous research has linked sarcopenia to poor outcomes in PC, the correlation between cachexia and treatment outcomes remains underexplored. This meta-analysis aims to investigate the association between cachexia and overall survival and time to treatment failure in advanced PC patients undergoing first-line chemotherapy. METHOD: A systematic search of electronic databases was conducted following PRISMA guidelines. Eligible studies compared cachexic and non-cachexic PC patients, reporting outcomes of observed survival or time to treatment failure. Data extraction and analysis were performed using Comprehensive Meta-Analysis Version 3.3, employing random-effects models and sensitivity analyses to assess heterogeneity and bias. RESULTS: Seven observational studies involving 2834 PC patients were included. The incidence of cachexia was 45% (95% CI: 0.27-0.65), with a higher prevalence in East Asian populations. Cachexic patients experienced significantly earlier treatment failure (SDM: -2.22, 95% CI: -2.6 to -1.7, P = 0.0001) and higher mortality risk (HR: 2.02, 95% CI: 1.17-3.48, P = 0.011) compared to non-cachexic patients. Overall survival was lower in cachexic patients (SDM: -2.34, 95% CI: -3.7 to -0.90, P = 0.001), with considerable heterogeneity across studies. Meta-regression analysis revealed significant differences between countries but insignificant correlations with age. CONCLUSION: Cachexia is associated with reduced overall survival, early chemotherapy failure, and elevated mortality in advanced PC patients undergoing first-line chemotherapy. Recognition and management of cachexia are crucial for optimizing treatment outcomes and improving patient survival. Future research should focus on prospective studies to better understand the impact of cachexia on treatment response and develop tailored interventions to mitigate its adverse effects.

Pancreatic cancer (PC) presents a formidable challenge due to its limited treatment options and association with cachexia, a debilitating condition linked to poor prognosis. This meta-analysis investigates the relationship between cachexia and treatment outcomes in advanced PC patients undergoing first-line chemotherapy. Seven observational studies encompassing 2834 patients were analyzed, revealing a 45% incidence of cachexia, notably higher in East Asian populations. Cachexic patients exhibited earlier treatment failure and higher mortality risk compared to non-cachexic counterparts. Their overall survival was significantly reduced, although with notable heterogeneity across studies. Meta-regression analysis highlighted variations between countries but found no significant correlation with age. The findings underscore the importance of recognizing and addressing cachexia to optimize treatment outcomes and enhance patient survival. Future research should emphasize prospective studies to further elucidate cachexia's impact on treatment response and develop tailored interventions to alleviate its adverse effects.

MRI recovery with self-calibrated denoisers without fully-sampled data.

OBJECTIVE: Acquiring fully sampled training data is challenging for many MRI applications. We present a self-supervised image reconstruction method, termed ReSiDe, capable of recovering images solely from undersampled data. MATERIALS AND METHODS: ReSiDe is inspired by plug-and-play (PnP) methods, but unlike traditional PnP approaches that utilize pre-trained denoisers, ReSiDe iteratively trains the denoiser on the image or images that are being reconstructed. We introduce two variations of our method: ReSiDe-S and ReSiDe-M. ReSiDe-S is scan-specific and works with a single set of undersampled measurements, while ReSiDe-M operates on multiple sets of undersampled measurements and provides faster inference. Studies I, II, and III compare ReSiDe-S and ReSiDe-M against other self-supervised or unsupervised methods using data from T1- and T2-weighted brain MRI, MRXCAT digital perfusion phantom, and first-pass cardiac perfusion, respectively. RESULTS: ReSiDe-S and ReSiDe-M outperform other methods in terms of peak signal-to-noise ratio and structural similarity index measure for Studies I and II, and in terms of expert scoring for Study III. DISCUSSION: We present a self-supervised image reconstruction method and validate it in both static and dynamic MRI applications. These developments can benefit MRI applications where the availability of fully sampled training data is limited.

Analyzing and evaluating the prevalence and metabolic profile of lean NAFLD compared to obese NAFLD: a systemic review and meta-analysis.

Background: Non-alcoholic fatty liver disease (NAFLD) is a common liver condition affecting 25%-40% of the worldwide population. NAFLD is traditionally related to obesity and metabolic disorders. NAFLD can also affect non-obese individuals, termed "lean NAFLD" (LN), who exhibit a paradoxical combination of physical leanness and metabolic obesity. Factors contributing to LN remain unclear, necessitating further research. This analysis aims to understand LN's prevalence and metabolic characteristics compared to obese NAFLD (ON) populations. Methods: This meta-analysis searched various databases until August 1, 2023. Inclusion criteria involved observational studies comparing LN with overweight/obese NAFLD. Data extraction included baseline characteristics, disease occurrence, metabolic profile, and clinical parameters-statistical analysis employed calculating risk ratios (RR) and standard mean differences. Results: Twenty-five studies were analyzed. LN is associated with lower prevalence in both NAFLD (RR 0.27, 95% confidence interval (CI) 0.14-0.52, p = <0.0001) and total (RR 0.27, 95% CI 0.15-0.51, p < 0.0001) population. LN had lower diabetes mellitus (RR 0.78, 95% CI 0.71-0.87, p < 0.00001), dyslipidemia (RR 0.87, 95% CI 0.79-0.95, p = 0.002), hypertension (RR 0.80, 95% CI 0.74-0.87, p < 0.00001), and metabolic syndrome (RR 0.45, 95% CI 0.31-0.64, p < 0.00001) compared to those with ON. The LN group's lipid profile, blood pressure, and other clinical parameters were favorable compared to ON. Conclusion: The prevalence of NAFLD among lean and non-lean individuals varies by region. Our analysis revealed that LN is associated with lower metabolic diseases, fasting blood sugar, blood pressure, and a more favorable lipid profile compared to ON.

NAFLD prevalence and its characteristics among obese vs lean population Non-alcoholic fatty Liver Disease (NAFLD) is a prevalent liver condition affecting a substantial portion of the global population, commonly linked to obesity and metabolic disorders. However, a subset of individuals with NAFLD, termed "lean NAFLD" (LN), challenges the conventional association by presenting with physical leanness despite metabolic obesity. The factors contributing to this condition are not well understood, prompting this meta-analysis to explore the prevalence and metabolic characteristics of LN compared to obese NAFLD (ON) populations. The study, conducted through August 1st, 2023, analyzed 25 studies meeting inclusion criteria, which involved observational studies comparing LN with Overweight/Obese NAFLD. Data extraction included baseline characteristics, disease occurrence, metabolic profiles, and clinical parameters. Statistical analysis utilized risk ratios (RR) and standard mean differences. The results indicated that LN is associated with a significantly lower prevalence in both the NAFLD and general populations. LN demonstrated lower occurrences of diabetes (DM), dyslipidemia, hypertension, and metabolic syndrome compared to ON. Additionally, the LN group exhibited a more favorable lipid profile, blood pressure, and other clinical parameters in comparison to the ON group. In conclusion, the prevalence of NAFLD varies among lean and non-lean individuals across different regions. The meta-analysis revealed that LN is linked to a lower occurrence of metabolic diseases, lower fasting blood sugar levels, lower blood pressure, and a more favorable lipid profile compared to those with ON. These findings contribute valuable insights into the distinct metabolic characteristics of LN, shedding light on potential avenues for further research and clinical considerations in the understanding and management of NAFLD.

Assessing the effectiveness of greater occipital nerve block in chronic migraine: a systematic review and meta-analysis.

BACKGROUND & AIMS: Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. METHODS: A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. RESULTS: Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. CONCLUSION: The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management.

Synergistic effects of herpes oncolytic virus and cyclophosphamide for recurrent malignant glioma: a narrative review.

Gliomas, comprising nearly 80% of brain malignancies, present a formidable challenge with glioblastomas being the most aggressive subtype. Despite multidisciplinary care, including surgery and chemoradiotherapy, the prognosis remains grim, emphasizing the need for innovative treatment strategies. The blood-brain barrier complicates drug access, and the diverse histopathology hinders targeted therapies. Oncolytic herpes viruses (oHSVs), particularly HSV1716, G207, and rQNestin34.5v, show promise in glioma treatment by selectively replicating in tumor cells. Preclinical and clinical studies demonstrate the safety and efficacy of oHSVs, with T-Vec being FDA-approved. However, challenges like viral delivery limitations and antiviral responses persist. The combination of oHSVs and combining cyclophosphamide (CPA) addresses these challenges, demonstrating increased transgene expression and viral activity. The immunosuppressive properties of CPA, particularly in metronomic schedules, enhance oHSV efficacy, supporting the development of this combination for recurrent malignant gliomas. CPA with oHSVs enhances viral oncolysis and extends survival. CPA's immunomodulatory effects, suppressing regulatory T cells, improve oHSV efficiency. While obstacles remain, this synergistic approach offers hope for improved outcomes, necessitating further research and clinical validation.

Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis.

BACKGROUND: Appendicitis is a common surgical emergency with diverse clinical presentations, making its diagnosis challenging. Laparoscopic appendectomy has become the standard treatment, with various methods for appendiceal stump closure, including polymeric clips and endoloops. This study aims to compare the efficacy and safety of polymeric clips compared with endoloops in laparoscopic appendectomy. METHODS: A systematic review and meta-analysis were conducted followingPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Scopus, and Embase were searched for studies up to March 25, 2024. RESULTS: In total, 13 studies, including 6 randomized controlled trials, were analyzed. Polymeric clipping demonstrated significantly shorter surgical time compared with the endoloop (standardized mean difference 0.37, 95% confidence interval 0.22-0.53, P < .00001), with no difference in hospital stay or overall complications. However, the endoloop was associated with a greater incidence of intra-abdominal abscess (risk ratio 3.53, 95% confidence interval 1.56-8.00, P = .003). Other outcomes, including time from instrument application to appendiceal cutting, ileus, and surgical-site infection, showed no significant differences between the 2 techniques. CONCLUSION: Polymeric clipping appears to be superior to endoloop in terms of shorter surgical time and lower risk of intra-abdominal abscess formation in laparoscopic appendectomy for uncomplicated appendicitis. However, both techniques have similar outcomes regarding hospital stay and overall complications. Further research addressing study limitations and exploring patient-centered outcomes is warranted to guide clinical practice.

Neuroendoscopic versus Craniotomy Approach in Supratentorial Hypertensive Intracerebral Hemorrhage: An Updated Meta-Analysis.

BACKGROUND: Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuroendoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compared the effectiveness of NES versus craniotomy in treating ICH. METHODS: A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials or observational studies for confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using meta-analysis software. RESULTS: The analysis included 26studies (N = 3237 patients). NES was associated with significantly lower mortality compared with craniotomy (odds ratio 0.45, 95% confidence interval [CI] 0.33 to 0.60, P < 0.00001). Hematoma evacuation rates were higher with NES (standardized mean difference 1.505, 95% CI 0.835 to 2.160, P < 0.00001). NES also showed better functional outcomes (odds ratio 3.31, 95% CI 1.78 to 6.17, P = 0.0002) and reduced blood loss (standardized mean difference -3.06, 95% CI -3.979 to -2.141, P = 0.000). Additionally, NES was associated with shorter hospital and intensive care unit stays, shorter operative times, and fewer complications such as infection and rebleeding. CONCLUSIONS: NES is a promising alternative to craniotomy for treating ICH, offering advantages in terms of reduced mortality, improved functional outcomes, and fewer complications. Future studies should explore advances in neuroendoscopic techniques to optimize patient outcomes further.

Exploring the antimicrobial efficacy of Manuka honey against multidrug-resistant and extensively drug-resistant Salmonella Typhi causing septicemia in Pakistan.

Aim: To determine the efficacy of manuka honey against multidrug-resistant (MDR) and extensively drug-resistant (XDR) clinical strains of Salmonella Typhi.Materials & methods: Clinical isolates were processed using the Bactec blood culture system, identification and antibiogram by Vitek 2 and antibiotic resistance genes through polymerase chain reaction (PCR). Microbroth dilution assays evaluated the antibacterial activity of manuka honey.Results: MDR and XDR-S. Typhi was susceptible to azithromycin. These strains carried the H58, gyrA, gyrB, blaCTX-M-15 , and blaTEM-1 genes. At 100% honey, the zone of inhibition for MDR (15-23 mm) and XDR (15-24 mm) strains. 18/50 MDR and 14/50 XDR strains inhibited at 3.125 v/v% killed at 6.25 v/v% concentration respectively.Conclusion: Manuka honey could be an alternative option for treating S. Typhi infections.

Typhoid fever is a life-threatening bacterial infection caused by the Salmonella Typhi. These bacteria are transmitted through contaminated water and food and cause fever, abdominal pain, headache, vomiting, and diarrhea mainly in children under 5. There are around 9 million people get infected with S. Typhi, with an increased death of 1,10,000 annually. Bees that collect nectar from the blossoms of the Manuka tree in Australia and New Zealand produce a type of honey known as manuka honey. This honey is famous for its antibacterial activity, and potential health benefits. Therefore, we aimed to determine its antibacterial activity against S. Typhi. Our finding shows that the commonly available antibiotics did not kill S. Typhi because their DNA was drug-resistant. After applying the manuka honey, these bacteria were killed and given a clear zone ranging from 15­24mm on the agar plate. Further analysis revealed that at low concentrations of manuka honey, 3.1% and 6.25%, most of the S. Typhi stopped growing and killed, respectively. This study suggested that manuka honey, which is affordable and readily available, could be used as a treatment option to treat infections produced by these harmful bacteria after further analysis.

Using the role model approach to optimise caregiver administration of sulfadoxine-pyrimethamine amodiaquine to children aged 3-59 months in Burkina Faso, Chad and Togo: findings from an evaluation.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is a World Health Organization-recommended intervention for the prevention of malaria among children at high risk in areas with seasonal transmission. During the coronavirus disease 2019 (COVID-19) pandemic, SMC drug distribution was rapidly adapted to reduce contact and mitigate the risk of transmission between communities and community distributors, with caregivers administering doses. To address the challenges and find local solutions to improve administration and adherence, the role model approach was designed, implemented and evaluated in selected communities of Burkina Faso, Chad and Togo. This paper describes the results of this evaluation. METHODS: Focus group discussions were held with primary caregivers in all three countries to understand their perceptions of the approach's acceptability and feasibility. In Burkina Faso and Togo, household surveys assessed the characteristics of caregivers reached by role model activities. Key indicators on SMC coverage and adherence allowed for an assessment of caregiver engagement outcomes related to participation in activities. Statistical associations between participation in study's activities and caregiver beliefs related to SMC had been tested. RESULTS: The majority of caregivers believed the approach to have a positive effect on drug administration, with most adopting the promoted strategies. Greater involvement of fathers in drug administration and acknowledgement of their joint responsibility was a notable positive outcome. However, several barriers to participation were noted and there was criticism of the group approach. In Burkina Faso and Togo, end-of-round survey results revealed that 98.4% of respondents agreed the approach improved their knowledge and skills in malaria prevention, while 100% expressed a desire to continue practicing the behaviours learned. However, there was a relatively low level of awareness of the approach among communities. Participation was strongly associated with participants' self-reported belief in ease of remembering to administer, and ease of administering, SMC medicines. CONCLUSION: Caregivers perceived the role model approach to be beneficial in aiding drug administration, with other positive impacts also reported. Replication and scale-up should utilize the most popular communication channels and existing community structures to ensure activities are promoted effectively. A mixture of group and one-on-one approaches should be used where appropriate and feasible.

SNN4Agents: a framework for developing energy-efficient embodied spiking neural networks for autonomous agents.

Recent trends have shown that autonomous agents, such as Autonomous Ground Vehicles (AGVs), Unmanned Aerial Vehicles (UAVs), and mobile robots, effectively improve human productivity in solving diverse tasks. However, since these agents are typically powered by portable batteries, they require extremely low power/energy consumption to operate in a long lifespan. To solve this challenge, neuromorphic computing has emerged as a promising solution, where bio-inspired Spiking Neural Networks (SNNs) use spikes from event-based cameras or data conversion pre-processing to perform sparse computations efficiently. However, the studies of SNN deployments for autonomous agents are still at an early stage. Hence, the optimization stages for enabling efficient embodied SNN deployments for autonomous agents have not been defined systematically. Toward this, we propose a novel framework called SNN4Agents that consists of a set of optimization techniques for designing energy-efficient embodied SNNs targeting autonomous agent applications. Our SNN4Agents employs weight quantization, timestep reduction, and attention window reduction to jointly improve the energy efficiency, reduce the memory footprint, optimize the processing latency, while maintaining high accuracy. In the evaluation, we investigate use cases of event-based car recognition, and explore the trade-offs among accuracy, latency, memory, and energy consumption. The experimental results show that our proposed framework can maintain high accuracy (i.e., 84.12% accuracy) with 68.75% memory saving, 3.58x speed-up, and 4.03x energy efficiency improvement as compared to the state-of-the-art work for the NCARS dataset. In this manner, our SNN4Agents framework paves the way toward enabling energy-efficient embodied SNN deployments for autonomous agents.

ChatGPT in medicine: A cross-disciplinary systematic review of ChatGPT's (artificial intelligence) role in research, clinical practice, education, and patient interaction.

BACKGROUND: ChatGPT, a powerful AI language model, has gained increasing prominence in medicine, offering potential applications in healthcare, clinical decision support, patient communication, and medical research. This systematic review aims to comprehensively assess the applications of ChatGPT in healthcare education, research, writing, patient communication, and practice while also delineating potential limitations and areas for improvement. METHOD: Our comprehensive database search retrieved relevant papers from PubMed, Medline and Scopus. After the screening process, 83 studies met the inclusion criteria. This review includes original studies comprising case reports, analytical studies, and editorials with original findings. RESULT: ChatGPT is useful for scientific research and academic writing, and assists with grammar, clarity, and coherence. This helps non-English speakers and improves accessibility by breaking down linguistic barriers. However, its limitations include probable inaccuracy and ethical issues, such as bias and plagiarism. ChatGPT streamlines workflows and offers diagnostic and educational potential in healthcare but exhibits biases and lacks emotional sensitivity. It is useful in inpatient communication, but requires up-to-date data and faces concerns about the accuracy of information and hallucinatory responses. CONCLUSION: Given the potential for ChatGPT to transform healthcare education, research, and practice, it is essential to approach its adoption in these areas with caution due to its inherent limitations.

Design and Development of a Self-nanoemulsifying Drug Delivery System for Co-delivery of Curcumin and Naringin for Improved Wound Healing Activity in an Animal Model.

The present study endeavored to design and develop a self-nanoemulsifying drug delivery system to improve the solubility and dermatological absorption of curcumin and naringin. Curcumin and naringin-loaded self-nanoemulsifying drug delivery system formulations were developed using aqueous phase titration. Phase diagrams were used to pinpoint the self-nanoemulsifying drug delivery system zones. Tween 80 and Labrasol (surfactants), Transcutol (cosurfactant), and cinnamon oil were chosen from a large pool of surfactants, cosurfactants, and oils based on their solubility and greatest nano-emulsion region. Fourier transform infrared spectroscopy, zeta sizer, and atomic force microscopy were used to characterize the optimized formulations and test for dilution and thermodynamic stability. The optimized curcumin-naringin-self-nanoemulsifying drug delivery system demonstrated the following characteristics: polydispersity index (0.412 ± 0.03), % transmittance (97%), particle size (212.5 ± 05 nm), zeta potential (- 25.7 ± 1.80 mV) and having a smooth and spherical droplet shape, as shown by atomic force microscopy. The ability of their combined formulation to cure wounds was tested in comparison to pure curcumin suspension, empty self-nanoemulsifying drug delivery system, and standard fusidic acid. Upon topical administration, the optimized curcumin-naringin-self-nanoemulsifying drug delivery system demonstrated significant wound healing activity in comparison with a pure curcumin suspension, empty self-nanoemulsifying drug delivery system, and standard fusidic acid. Based upon this result, we assume that skin penetration was increased by using the optimized curcumin-naringin-self-nanoemulsifying drug delivery system with enhanced solubility.

Knowledge, attitude, and practice of artificial intelligence among medical students in Sudan: a cross-sectional study.

Introduction: In this cross-sectional study, the authors explored the knowledge, attitudes, and practices related to artificial intelligence (AI) among medical students in Sudan. With AI increasingly impacting healthcare, understanding its integration into medical education is crucial. This study aimed to assess the current state of AI awareness, perceptions, and practical experiences among medical students in Sudan. The authors aimed to evaluate the extent of AI familiarity among Sudanese medical students by examining their attitudes toward its application in medicine. Additionally, this study seeks to identify the factors influencing knowledge levels and explore the practical implementation of AI in the medical field. Method: A web-based survey was distributed to medical students in Sudan via social media platforms and e-mail during October 2023. The survey included questions on demographic information, knowledge of AI, attitudes toward its applications, and practical experiences. The descriptive statistics, χ2 tests, logistic regression, and correlations were analyzed using SPSS version 26.0. Results: Out of the 762 participants, the majority exhibited a basic understanding of AI, but detailed knowledge of its applications was limited. Positive attitudes toward the importance of AI in diagnosis, radiology, and pathology were prevalent. However, practical application of these methods was infrequent, with only a minority of the participants having hands-on experience. Factors influencing knowledge included the lack of a formal curriculum and gender disparities. Conclusion: This study highlights the need for comprehensive AI education in medical training programs in Sudan. While participants displayed positive attitudes, there was a notable gap in practical experience. Addressing these gaps through targeted educational interventions is crucial for preparing future healthcare professionals to navigate the evolving landscape of AI in medicine. Recommendations: Policy efforts should focus on integrating AI education into the medical curriculum to ensure readiness for the technological advancements shaping the future of healthcare.

Safety and efficacy of resmetirom in the treatment of patients with non-alcoholic steatohepatitis and liver fibrosis: a systematic review and meta-analysis.

Introduction: Non-alcoholic fatty liver disease (NAFLD), spanning from non-alcoholic steatohepatitis (NASH) to liver fibrosis, poses a global health challenge amid rising obesity and metabolic syndrome rates. Effective pharmacological treatments for NASH and liver fibrosis are limited. Objective: This study systematically reviews and meta-analyzes the safety and efficacy of resmetirom, a selective thyroid hormone receptor-ß agonist, in NASH and liver fibrosis treatment. By analyzing data from clinical trials, we aim to offer evidence-based recommendations for resmetirom's use in managing these conditions and identify avenues for future research. Methods: Electronic databases (PubMed, Scopus, Science Direct, Google Scholar, ClinicalTrials.gov, and Cochrane CENTRAL) were systematically searched, supplemented by manual screening of relevant sources. Only English-language randomized controlled trials were included. Data extraction, risk of bias assessment, pooled analyses, and meta-regression were performed. Results: Three randomized controlled trials involving 2231 participants were analyzed. Resmetirom demonstrated significant reductions in hepatic fat fraction [standardized mean difference (SMD) -4.61, 95% CI -6.77 to -2.44, P < 0.0001], NASH resolution without worsening fibrosis [risk ratio (RR) 2.51, 95% CI 1.74-3.64, P = 0.00001), and liver fibrosis improvement (RR 2.31, 95% CI 1.20-4.44, P = 0.01). Secondary outcomes showed significant improvements in lipid profiles, liver enzymes, and NASH biomarkers with resmetirom treatment. Meta-regression revealed associations between covariates and primary outcomes. Conclusion: Resmetirom exhibits promising efficacy in reducing hepatic fat, improving NASH resolution, and ameliorating liver fibrosis with a favorable safety profile. Further research is warranted to validate findings and optimize therapeutic strategies for NASH and liver fibrosis management.

Ferric carboxymaltose for iron deficiency in patients with heart failure: a systematic review and meta-analysis.

Aim: Iron deficiency (ID) is associated with heart failure (HF) in a considerable proportion of patients. To improve the quality of life, lower the frequency of hospitalizations, and lower mortality rates of chronic HF patients (HF), this meta-analysis will look into the role of iron supplementation using ferric carboxymaltose (FCM). Methods & results: From inception until 1 October 2023, we conducted a thorough literature search of electronic databases for peer-reviewed publications. Around 5229 HF patients were included, of which 2691 received FCM while 2538 received placebo. Conclusion: FCM reduces HF-related hospitalizations but doesn't improve overall or cardiovascular mortality in those with HF and ID. The overall results support FCM's role in managing iron deficiency in heart failure.

Heart failure (HF) patients often suffer from iron deficiency (ID), worsening their symptoms and quality of life. Intravenous iron therapy, like ferric carboxymaltose (FCM), has been studied for its benefits in HF. This meta-analysis looked at existing research and found that FCM treatment reduced hospitalizations for HF but didn't significantly impact overall mortality. Although FCM improves patients' lives, more research is needed to understand its long-term effects fully. This study highlights the importance of addressing ID in HF management and supports FCM therapy as a beneficial option for HF patients.