Preovulatory follicular dynamics and ovulatory events following the use of GnRH 84 h after medroxyprogesterone acetate sponge removal in postpartum buffaloes.

Herein, we evaluated the effects of Gonadotropin hormone-releasing hormone (GnRH) administration 84 h after medroxyprogesterone acetate (MAP) sponge removal on follicular growth, ovulation timing, and pregnancy per artificial insemination (AI) in cosynchronized postpartum Nili Ravi buffaloes. In this study, 58 Nili Ravi postpartum buffaloes (DIM = 103 ± 1.64) were randomly divided into two treatment groups (n = 29/treatment): GnRH-TAI-84 and TAI-84. All buffaloes were administered a MAP sponge for seven days. Upon MAP sponge removal, all the subjects received prostaglandin F2α (PGF2α), and Timed AI (TAI) was performed 84 hours after sponge removal. In the GnRH-TAI-84 group, the buffaloes received GnRH alongside insemination, whereas in the TAI-84 group, the buffaloes were inseminated without GnRH administration. Follicle diameter and blood estradiol levels were measured every 6 h from 72-108 h after MAP sponge removal. The animals were checked for pregnancy using ultrasonography 40 days after AI. Animals subjected to the GnRH-TAI-84 protocol had a higher follicular growth rate and preovulatory follicle size than those in the TAI-84 group. The follicular diameter was also larger in animals that received GnRH-TAI-84 than in those that received TAI-84 90 and 96 h after MAP sponge removal. Buffaloes in the GnRH-TAI-84 group had lower estradiol concentrations at 90, 96, 102, and 108 h than those in the TAI-84 group. Ovulation in GnRH-TAI-84 buffaloes occurred 11 h earlier than that in buffaloes from the TAI-84 group. A shorter interval between AI and ovulation in GnRH-TAI-84 buffaloes (14 h vs. 25 h) led to greater pregnancies per AI (62% vs. 17%) compared to buffaloes from the TAI-84 group.

Homozygous mutation in MCM7 causes autosomal recessive primary microcephaly and intellectual disability.

BACKGROUND: Minichromosomal maintenance (MCM) complex components 2, 4, 5 and 6 have been linked to human disease with phenotypes including microcephaly and intellectual disability. The MCM complex has DNA helicase activity and is thereby important for the initiation and elongation of the replication fork and highly expressed in proliferating neural stem cells. METHODS: Whole-exome sequencing was applied to identify the genetic cause underlying the neurodevelopmental disease of the index family. The expression pattern of Mcm7 was characterised by performing quantitative real-time PCR, in situ hybridisation and immunostaining. To prove the disease-causative nature of identified MCM7, a proof-of-principle experiment was performed. RESULTS: We reported that the homozygous missense variant c.793G>A/p.A265T (g.7:99695841C>T, NM_005916.4) in MCM7 was associated with autosomal recessive primary microcephaly (MCPH), severe intellectual disability and behavioural abnormalities in a consanguineous pedigree with three affected individuals. We found concordance between the spatiotemporal expression pattern of Mcm7 in mice and a proliferative state: Mcm7 expression was higher in early mouse developmental stages and in proliferative zones of the brain. Accordingly, Mcm7/MCM7 levels were detectable particularly in undifferentiated mouse embryonal stem cells and human induced pluripotent stem cells compared with differentiated neurons. We further demonstrate that the downregulation of Mcm7 in mouse neuroblastoma cells reduces cell viability and proliferation, and, as a proof-of-concept, that this is counterbalanced by the overexpression of wild-type but not mutant MCM7. CONCLUSION: We report mutations of MCM7 as a novel cause of autosomal recessive MCPH and intellectual disability and highlight the crucial function of MCM7 in nervous system development.

"Extending the Technology Acceptance Model (TAM) to Predict University Students' Intentions to Use Metaverse-Based Learning Platforms".

Metaverse, which combines a number of information technologies, is the Internet of the future. A media for immersive learning, metaverse could set future educational trends and lead to significant reform in education. Although the metaverse has the potential to improve the effectiveness of online learning experiences, metaverse-based educational implementations are still in their infancy. Additionally, what factors impact higher education students' adoption of the educational metaverse remains unclear. Consequently, the aim of this study is to explore the main factors that affect higher education students' behavioral intentions to adopt metaverse technology for education. This study has proposed an extended Technology Acceptance Model (TAM) to achieve this aim. The novelty of this study resides in its conceptual model, which incorporates both technological, personal, and inhibiting/enabling factors. The empirical data were collected via online questionnaires from 574 students in both private and public universities in Jordan. Based on the PLS-SEM analysis, the study identifies perceived usefulness, personal innovativeness in IT, and perceived enjoyment as key enablers of students' behavioral intentions to adopt the metaverse. Additionally, perceived cyber risk is found as the main inhibitor of students' metaverse adoption intentions. Surprisingly, the effect of perceived ease of use on metaverse adoption intentions is found to be insignificant. Furthermore, it is found that self-efficacy, personal innovativeness, and perceived cyber risk are the main determinants of perceived usefulness and perceived ease of use. While the findings of this study contribute to the extension of the TAM model, the practical value of these findings is significant since they will help educational authorities understand each factor's role and enable them to plan their future strategies.

Impacts of the COVID-19 pandemic on household food waste behaviour: A systematic review.

Food waste has adverse economic, social, and environmental impacts and increases the prevalence of food insecurity. Panic buying at the beginning of the COVID-19 outbreak raised serious concerns about a potential rise in food waste levels and higher pressure on waste management systems. This article aims to investigate the impact of COVID-19 on food waste behaviour and the extent to which it occurs using the systematic review method. A total of 38 articles were identified and reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The findings showed that the COVID-19 pandemic led to reductions in household food waste in most countries. Several changes in shopping and cooking behaviours, food consumption, and managing inventory and leftovers have occurred due to COVID-19. Based on these insights, we predicted that some desirable food-management habits would be retained, and others would roll back in the post-COVID-19 world. The review contributes to the food waste literature by offering a comprehensive overview of behavioural changes during the COVID-19 pandemic and future research directions.

The Role of Oxidative Stress and Antioxidant Balance in Pregnancy.

It has been widely known that oxidative stress disrupts the balance between reactive oxygen species (ROS) and the antioxidant system in the body. During pregnancy, the physiological generation of ROS is involved in a variety of developmental processes ranging from oocyte maturation to luteolysis and embryo implantation. While abnormal overproduction of ROS disrupts these processes resulting in reproductive failure. In addition, excessive oxidative stress impairs maternal and placental functions and eventually results in fetal loss, IUGR, and gestational diabetes mellitus. Although some oxidative stress is inevitable during pregnancy, a balancing act between oxidant and antioxidant production is necessary at different stages of the pregnancy. The review aims to highlight the importance of maintaining oxidative and antioxidant balance throughout pregnancy. Furthermore, we highlight the role of oxidative stress in pregnancy-related diseases.

Glycated haemoglobin association with severity of thrombus burden in non-diabetic versus diabetic patients with ST-elevation myocardial infarction.

OBJECTIVE: To determine and compare the relationship between glycated haemoglobin level on admission and the angiographic thrombus burden in diabetic and non-diabetic patients with ST-segment elevation myocardial infarction. METHODS: The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from June 2018 to July 2019, and comprised patients presenting with ST-elevation myocardial infarction. Demographic details and self-reported duration of diabetes was recorded. The thrombus burden was assessed on angiography classifying 0 = no thrombus, 1 = possible thrombus, 2 = small thrombus, 3 = moderate thrombus, 4 = large thrombus, and 5 = total occlusion. The data was analysed using SPSS 21. RESULTS: Of the 212 patients, 173(81.6%) were men, and 75(35.4%) had body mass index ≥30kg/m2. The overall mean age of the sample was 54.62±11.75 years. Known diabetic cases were 82(38.7%) and 20(24.4%) were insulin-dependent. Mean glycated haemoglobin level was 7.18±2.03% and 96(45.3%) patients had the critical value >6.5%. Pre-procedure thrombus score in 118(55.7%) patients was 3 and 4 and 57(26.9%) had total occlusion. A significant relationship between glycated haemoglobin level and thrombus score was found in the overall sample as well as in diabetic and non-diabetic groups (p<0.001). CONCLUSIONS: Increased glycated haemoglobin level was found to have a positive correlation with thrombus score in both diabetic and non-diabetic patients.

The effect of GnRH administration/insemination time on follicular growth rate, ovulation intervals, and conception rate of Nili Ravi buffalo heifers in 7 -day-CIDR Co-synch.

The present study aimed to compare two different insemination times (72 vs 84 h) associated with an ovulation induction (GnRH) in a 7-day CIDR Co-synch to improve the conception rate of Nili Ravi buffalo heifers. Forty Nili Ravi buffalo heifers were randomly separated into two treatments based on artificial insemination (AI) timing (72 vs 84 h). All heifers were subjected to controlled internal drug release (CIDR), containing 1.38 g of progesterone for 7 days. On CIDR removal, both treatments received 150 µg of prostaglandin intramuscularly. In 7-day CIDR Co-synch (n = 20), animals were injected 100 µg of GnRH administration intramuscularly and inseminated concurrently at 72 h after CIDR removal. The remaining half (n = 20) were injected and inseminated concurrently at 84 h of CIDR removal. Pregnancy diagnosis was performed on day 40 of timed artificial insemination (TAI) with ultrasound. The follicular growth rate between 72 h after PGF2α/CIDR removal to pre-ovulatory follicle in 7-day CIDR Co-synch was more (0.102 ± 0.005 mm vs 0.079 ± 0.003 mm; P = 0.01) at 84 than 72 h. The interval from GnRH administration/TAI to ovulation was high (26.8 ± 1.64 h vs. 15.1 ± 1.25 h, P = 0.01) in 72 than 84 h. Conception rates were considerably higher in buffalo heifers inseminated at 84 h (65%) than 72 h (25%) in 7-day CIDR Co-synch protocol. In conclusion that in Nili Ravi buffalo heifers, GnRH administration/TAI after 84 h of CIDR removal allows greater follicular growth rate and shortens interval from AI to ovulation compared to the GnRH administration/TAI after 72 h of CIDR removal in 7-day CIDR-Co-synch protocol.

In Vitro Grown Micro-Tissues for Cardiac Cell Replacement Therapy in Vivo.

BACKGROUND/AIMS: Different approaches have been considered to improve heart reconstructive medicine and direct delivery of pluripotent stem cell-derived cardiomyocytes (PSC-CMs) appears to be highly promising in this context. However, low cell persistence post-transplantation remains a bottleneck hindering the approach. Here, we present a novel strategy to overcome the low engraftment of PSC-CMs during the early post-transplantation phase into the myocardium of both healthy and cryoinjured syngeneic mice. METHODS: Adult murine bone marrow mesenchymal stem cells (MSCs) and PSC-CMs were co-cultured on thermo-responsive polymers and later detached through temperature reduction, resulting in the protease-free generation of cell clusters (micro-tissues) composed of both cells types. Micro-tissues were transplanted into healthy and cryo-injured murine hearts. Short term cell retention was quantified by real-time-PCR. Longitudinal cell tracking was performed by bioluminescence imaging for four weeks. Transplanted cells were further detected by immunofluorescence staining of tissue sections. RESULTS: We demonstrated that in vitro grown micro-tissues consisting of PSC-CMs and MSCs can increase cardiomyocyte retention by >10fold one day post-transplantation, but could not fully rescue a further cell loss between day 1 and day 2. Neutrophil infiltration into the transplanted area was detected in healthy hearts and could be attributed to the cellular implantation rather than tissue damage exerted by the transplantation cannula. Injected PSC-CMs were tracked and successfully detected for up to four weeks by bioluminescence imaging. CONCLUSION: This approach demonstrated that in vitro grown micro-tissues might contribute to the development of cardiac cell replacement therapies.

Practice of breastfeeding and Immunisation in a periurban community in Pakistan.

OBJECTIVE: To assess the practice of breastfeeding and immunisation in a peri-urban community and correlate it with maternal care during pregnancy of the index child. METHODS: This community-based, cross-sectional survey was conducted at Shifa Tameer-e-Millat University and Shifa College of Medicine, Islamabad, Pakistan, from June 2014 to January 2016, using a self-generated questionnaire. Systemic random sampling method was used to collect data. SPSS 21 was used to analyse the data and to find associations between maternal care and practices of breastfeeding. RESULTS: There were 1,275 participants in the study. The mean age of the participants was 31.61±8.026 years and the mean number of family members was 7.28±3.42. Overall, 1,121(87.9%) women had exclusively breastfed all their children while 906(71.1%) women had their children fully vaccinated. The mean duration of exclusive breastfeeding was 5.30±1.31 months while the mean duration of mixed breastfeeding was 16.70±8.62 months. Mothers who were given prenatal care were 2.60 and 2.91 times more likely to do exclusive breastfeeding and immunisation, respectively, compared to women who were not given prenatal care (p<0.05). CONCLUSIONS: There is a dire need to focus more on routine services compared to massive immunisation and breastfeeding campaigns.

Safe drinking water and sanitary measures: A cross-sectional study in peri-urban community of Islamabad.

OBJECTIVE: To assess sources of drinking water and its methods of disinfection, sanitary situation and waste disposal methods. METHODS: This cross-sectional study was conducted over a period of 6 months from April 2015 to September 2015 in the village of Nurpur Shahan, a peri-urban slum area of Islamabad, Pakistan. Systemic random sampling method was employed to gather data from an adult household member aged between 18 and 45 years through a structured questionnaire. SPSS 21 was used for data analysis.. RESULTS: A total of 2,078 households were included in the study. The mean age of the participants was 31.5±8.17 years. Moreover, 1,600(77%) residents did not disinfect drinking water. Boiling was the most common 378(18.2) method of disinfection. Majority of the households 1,936(93.2%) had latrine inside their houses. The most common mode of waste disposal was burning 951(45.8%), followed by dumping 601(28.9%) and throwing away in the street 415(20%). CONCLUSIONS: Most participants did not disinfect drinking water.

Comparison of patients satisfaction levels in public and private tertiary care centres.

The purpose of our study was to compare patient satisfaction level among tertiary public and private hospitals. We carried out a multi-centre cross-sectional study using Patient SatisfactionQuestionnaire-18 to assess patient satisfaction in a major private and public hospital in Islamabad. Out of 1301 participants, 636 (48.9%) patients were at the public hospital, while 665(51.1%) were at the private hospital. Time spent with doctor, communication, accessibility and convenience component score was significantly higher in patients at the private hospital (p<0.05 each). Interpersonal manner component score was higher at the public hospital (p<0.05). Female patients, patients admitted in medical specialty and patients admitted in private hospitals had higher patient satisfaction score

The effects of gait training with body weight support (BWS) with no body weight support (no-BWS) in stroke patients.

The purpose of this study was to measure the clinical outcomes for patients with stroke after gait training with body weight support (BWS) and with no body weight support (no-BWS).Experimental group was trained to walk by a BWS system with overhead harness (BWS group), and Control group was trained with full weight bearing walk on their lower extremities. Treatment session comprised of six weeks training. Treatment outcomes were assessed on the basis of Timed 10 Meter Walk Test, Timed Get Up and Go Test and Dynamic Gait Index. There was a significant (P<0.05) difference in BWS and NBWS for Dynamic Gait Index, Timed Get Up and Go Test, Timed 10 Meter Walk Test (Self-Selected Velocity), and Timed 10 Meter Walk Test (Fast-Velocity). Training of gait in stroke patients while a percentage of their body weight supported by a harness, resulted in better walking abilities than the Training of gait while full weight was placed on patient's lower extremities.

Quality of life of Pakistani medical students studying in a private institution.

OBJECTIVE: To find the quality of life of medical students using a World Health Organisation questionnaire. METHODS: The cross-sectional study was conducted in February 2015 at Shifa College of Medicine, Islamabad, Pakistan, and comprised students studying in an integrated medical education system. The shortened version of World Health Organisation Quality of Life questionnaire comprising 26 items was used. Consecutive non-probability sampling was used to collect data which was analysed using SPSS 21. RESULTS: Out of 417 medical students, 185(44.4%) were male and 232(55.6%) were female. Of them, 165(39.6%) were in pre-clinical years, while 252(60.4%) were in clinical years. Overall, 347(83.2%) students rated their quality of life as "good" or "very good". Environmental domain had the highest mean score of 70.43±16.38 while Psychological Health domain had the lowest mean score of 66.48±15.64. CONCLUSIONS: Medical education affects students' health, thus their quality of life varies. Identification of this is very important, since long-term stress can induce some permanent personality changes in individuals.

Role of sodium-restricted dietary approaches to control blood pressure in Pakistani hypertensive population.

OBJECTIVE: To assess the change in systolic and diastolic blood pressure in post-interventional phase through dietary approaches to stop hypertension/salt-restricted diet. METHODS: This randomised controlled clinical study was conducted from February 2014 to March 2015 at the Armed Forces Institute of Cardiology, Rawalpindi, and Ali Medical Centre, Islamabad, Pakistan, and involved hypertensive patients and matching controls. The control group followed routine diet while the intervention group was given a diet plan containing 1,500mg of sodium providing 2,000 calories. Both groups were advised not to consume sodium-rich foods. Paired sample t-test was applied to determine the change in blood pressure among the groups at two different occasions. RESULTS: Of the 1,492 participants, 710(47.6%) were controls and 782(52.4%) were in the interventional group. Overall, 417(27.9%) participants got their blood pressure checked less than twice in six months, while 409(27.4%) had it done on a regular basis. Moreover, 941(63.1%)) subjects had a family history of high blood pressure and 149(10.0%) participants did not exercise at all. The overall mean age was 53.42±9.302 years. Mean systolic blood pressure and diastolic blood pressure after five weeks was 126.33±3.35 and 84.40±3.04mmHg in the intervention group, and128.41±3.52 and 84.04±2.953mmHg in the control group. Changes in blood pressure between the two groups were minimal but statistically significant (p<0.05). CONCLUSIONS: A diet which is restricted in salt, rich in fruits, vegetables, and low-fat dairy foods and reduced saturated and total fat can substantially lower blood pressure. Such a diet offers an additional nutritional approach to the prevention and treatment of hypertension.

Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons.

OBJECTIVE: To determine within-rater and between-rater reliability of the universal goniometer (UG) for measuring active cervical range of motion (ACROM) in asymptomatic healthy subjects. METHODS: Nineteen healthy subjects were tested in an identical seated position. Two raters used UG to measure active cervical movements of flexion, extension, right side flexion, left side flexion, right rotation and left rotation. Each motion was measured twice by each of the two raters and was re-measured all over again after one week. Data analysis was performed using the intraclass correlation coefficient (ICC). RESULTS: The results demonstrated excellent within-session (ICC2,1 = 0.83 to 0.98) and between-session (ICC2,2 = 0.79 to 0.97) intra-rater reliability and excellent inter-rater reliability (ICC2,2 = 0.79 to 0.92). CONCLUSION: Considering above results it is concluded that UG is a reliable tool for assessing ACROM in a clinical setting for healthy subjects.

Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains.

BACKGROUND: Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures. MATERIALS AND METHODS: 126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p < 0.05 was taken to indicate significance. RESULTS: 60 Patients completed the trial in each group. The mean ages were 28.77 ± 6.72 in the TG group and 29.83 ± 6.30 in the POP group (p = 0.034). There was a slight female predominance. Right and left ankles were equally involved in the TG group, while left ankles were mainly involved in the POP group. Mean differences in VAS and KS between the two groups were statistically significant at the end of the study. The mean number of painkillers used by the patients in the TG group was higher than the number used in the POP group (p < 0.001). The mean number of days taken off work was 4.18 ± 1.73 days in the TG group, and 6.25 ± 2.73 days in the POP group (p < 0.001). The mean number of sleepless nights was higher in the POP group. CONCLUSION: The results of our study indicate that functional treatment provides better functional support and pain reduction than a below-knee POP cast. LEVEL OF EVIDENCE: Level I.

Rotavirus vaccine--a new hope.

Diarrhoea due to Rotavirus is the leading cause of mortality among children less than 5 years of age in developing countries. Though Rotavirus vaccine has been approved by FDA since 2006 it has not been incorporated in the EPI schedule of Pakistan. Objective of our study was to explore the clinical efficacy, cost effectiveness and safety of Rotavirus vaccine in infants and children against diarrhoea caused by Rotavirus. Online search yielded a total of 103 articles out of which 31 articles were included for perusal. Newly-developed vaccines have been found to have combined efficacy of 61.2-64.6% in African Countries and 82.1-84.7% in Europe and Latin America against Rotavirus-induced diarrhoea. Rotavirus vaccine is a very effective option in terms of efficacy, cost and safety against viral diarrhoea caused by Rotavirus. Consideration should be given to include this vaccine in EPI programme of developing countries.

Advances in Diagnostic Modalities for Helicobacter pylori Infection.

Helicobacter pylori (H. pylori) infection is a widespread global health issue with a varying prevalence influenced by geography, socioeconomic status, and demographics. In the U.S., the prevalence is lower, though certain groups, such as older adults and immigrants from high-prevalence regions, show higher rates. The decrease in infection rates in developed countries is due to improved sanitation, antibiotics, and healthcare, whereas developing countries continue to experience high rates due to poor living conditions. H. pylori infection can be asymptomatic or cause symptoms like dyspepsia, abdominal pain, bloating, nausea, and loss of appetite. Pathophysiologically, H. pylori contribute to conditions such as gastritis, peptic ulcers, and gastric cancer through mechanisms including urease production and the release of virulence factors, leading to chronic inflammation and an increased cancer risk. Diagnostic methods for H. pylori have progressed significantly. Non-invasive techniques, such as serological assays, stool antigen tests, and urea breath tests, are practical and sensitive. Invasive methods, including endoscopic biopsy and molecular diagnostics, are more definitive but resource intensive. Recent advancements in diagnostic technology, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), biosensor technology, and next-generation sequencing (NGS), promise improved speed, accuracy, and accessibility. These innovations are expected to enhance the detection and management of H. pylori, potentially reducing the global disease burden. This review aims to discuss these diagnostic modalities with a focus on further advances under investigation.

Metabolic Dysfunction-Associated Steatohepatitis and Progression to Hepatocellular Carcinoma: A Literature Review.

The prevalence of metabolic-associated fatty liver disease (MAFLD) is increasing globally due to factors such as urbanization, obesity, poor nutrition, sedentary lifestyles, healthcare accessibility, diagnostic advancements, and genetic influences. Research on MAFLD and HCC risk factors, pathogenesis, and biomarkers has been conducted through a narrative review of relevant studies, with a focus on PubMed and Web of Science databases and exclusion criteria based on article availability and language. Steatosis marks the early stage of MASH advancement, commonly associated with factors of metabolic syndrome such as obesity and type 2 diabetes. Various mechanisms, including heightened lipolysis, hepatic lipogenesis, and consumption of high-calorie diets, contribute to the accumulation of lipids in the liver. Insulin resistance is pivotal in the development of steatosis, as it leads to the release of free fatty acids from adipose tissue. Natural compounds hold promise in regulating lipid metabolism and inflammation to combat these conditions. Liver fibrosis serves as a significant predictor of MASH progression and HCC development, underscoring the need to target fibrosis in treatment approaches. Risk factors for MASH-associated HCC encompass advanced liver fibrosis, older age, male gender, metabolic syndrome, genetic predispositions, and dietary habits, emphasizing the requirement for efficient surveillance and diagnostic measures. Considering these factors, it is important for further studies to determine the biochemical impact of these risk factors in order to establish targeted therapies that can prevent the development of HCC or reduce progression of MASH, indirectly decreasing the risk of HCC.

Cryptococcosis and Cryptococcal Meningitis: A Narrative Review and the Up-to-Date Management Approach.

Cryptococcosis is a fungal infectious disease that enormously impacts human health worldwide. Cryptococcal meningitis is the most severe disease caused by the fungus Cryptococcus, and can lead to death, if left untreated. Many patients develop resistance and progress to death even after treatment. It requires a prolonged treatment course in people with AIDS. This narrative review provides an evidence-based summary of the current treatment modalities and future trial options, including newer ones, namely, 18B7, T-2307, VT-1598, AR12, manogepix, and miltefosine. This review also evaluated the management and empiric treatment of cryptococcus meningitis. The disease can easily evade diagnosis with subacute presentation. Despite the severity of the disease, treatment options for cryptococcosis remain limited, and more research is needed.