King Edward Medical University

Background: Stroke remains a leading cause of long-term disability, which affects motor function, balance, coordination, and daily activities. Virtual reality-based physiotherapy has emerged as an innovative approach, offering immersive, task-oriented rehabilitation environments. Objective: To review and synthesize recent evidence (2019-2025) on the effectiveness of VR-based physiotherapy in improving functional recovery among stroke patients. Methodology: This review employed a structured narrative synthesis guided by PRISMA to ensure transparent and systematic reporting of evidence on Virtual Reality–based physiotherapy in stroke rehabilitation. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, PEDro, and the Cochrane Library identified studies published between January 2019 and June 2025. Free-text keywords and MeSH terms related to stroke, Virtual reality rehabilitation, physiotherapy, and functional recovery were combined using Boolean operators. Citations were managed and deduplicated in reference software, followed by title, abstract, and full-text screening per PRISMA criteria. Eligible studies included randomised controlled trials, controlled trials, and systematic reviews examining virtual reality interventions and functional outcomes such as motor recovery, balance, gait, and ADLs. Non-English papers, cognitive-only virtual reality studies, abstracts, and mixed populations without stroke-specific data were excluded. Data were extracted using a standardized template covering study design, virtual reality type, intervention dosage, and outcomes. Methodological quality was appraised (PEDro for trials), enabling a rigorous qualitative synthesis of contemporary evidence. Results: Evidence consistently demonstrates that virtual reality-based rehabilitation improves motor function, postural control, and functional independence compared with conventional therapy alone. Meta-analyses report superior gains in upper limb recovery, dexterity, and task performance when VR is used adjunctively. Improvements in balance, gait, and daily activities are also reported, alongside enhanced motivation, therapy adherence, and psychological well-being. Conclusion: Virtual reality-based physiotherapy is an effective adjunct to conventional stroke rehabilitation, enhancing recovery, engagement, and quality of life.

Autoimmune cardiovascular disease (CVD) includes myocarditis, coronary microvascular dysfunction (CMD), and heart failure with preserved ejection fraction (HFpEF). Traditional risk scores often overlook these conditions despite their links to high morbidity. Recent research highlights the significance of immunophenotyping, such as clonal hematopoiesis of indeterminate potential (CHIP), type I interferon activity, Th17/Treg imbalance, and cardiac autoantibodies, to improve risk assessment and guide treatment. This review combines mechanistic and clinical data connecting these immune signatures to endothelial dysfunction, arrhythmias, and fibrotic remodeling. It underscores the atherogenic role of CHIP and its influence on HFpEF prognosis, the vasculopathy driven by type I interferon signaling in CMD, and autoimmunity in myocarditis mediated by Th17 dominance. Cardiac-specific autoantibodies, like anti-heart and v1-adrenergic receptor antibodies, serve as early prognostic markers. Moreover, integrating immune biomarkers with advanced imaging techniques, such as cardiac magnetic resonance and positron emission tomography, could enhance risk stratification and therapy monitoring. Current immunomodulating treatments, including TNF and IL-6 inhibitors, provide cardiovascular benefits, while glucocorticoids and JAK inhibitors carry dose-related risks. In the future, personalized algorithms that incorporate CHIP genotyping, interferon scoring, and continuous biomarker and imaging assessments may transform autoimmune CVD management. This review highlights these translational insights and research priorities to bridge the gap between immune dysregulation and cardiovascular outcomes.

Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are standard treatments for Multivessel Coronary Artery Disease (MVD). Their long-term comparative effectiveness remains debated. A systematic review and meta-analysis of randomized and observational studies was conducted, including patients with MVD followed for ≥5 years. Data were pooled using randomor fixed-effects models, depending on the level of heterogeneity. Thirteen studies met the inclusion criteria. CABG was associated with reduced all-cause mortality (RR 0.82, 95% CI 0.72-0.91) and fewer repeat revascularizations (RR 1.98, 95% CI 1.74-2.26) compared with PCI. Stroke risk was slightly higher after CABG. Findings suggest CABG provides superior survival and event reduction in long-term follow-up, particularly in higher-risk subgroups. However, the modestly increased stroke risk highlights the need for individualized decision-making, taking into account patient comorbidities, anatomy, and surgical suitability. CABG offers long-term survival and durability advantages over PCI in MVD, while PCI remains suitable for patients with lower-risk anatomy or when surgery is contraindicated.

BACKGROUNDBilirubin-induced neurologic dysfunction (BIND) remains a serious complication of severe neonatal hyperbilirubinemia, especially in resource-limited settings. While total serum bilirubin (TSB) is widely used for risk stratification, the bilirubin/albumin (B/A) ratio has been proposed as a surrogate for free bilirubin, the neurotoxic fraction.AIMTo compare the diagnostic accuracy of the B/A ratio vs TSB for predicting acute BIND in neonates.METHODSWe conducted a systematic review and meta-analysis of observational studies evaluating the B/A ratio and TSB for predicting BIND in neonates (≥ 35 weeks' gestational age). Data sources included PubMed, EMBASE, Cochrane Central, and Google Scholar. Pooled standardized mean difference (SMD), sensitivity, specificity, and heterogeneity (I2) were calculated using a bivariate random-effects model. Meta-regression was used to assess whether biomarker type (B/A vs TSB) explained performance differences. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.RESULTSFive studies involving a total of 1022 neonates were included, with a male-to-female ratio of approximately 57:40. The SMD for B/A ratio was 1.71 (95%CI: 1.00–2.41, P < 0.0001), and for TSB it was 1.68, both showing strong associations with BIND. Meta-regression revealed no significant difference in predictive value between the two biomarkers (P = 0.96).CONCLUSIONBoth TSB and the B/A ratio are comparably effective in predicting BIND. While the B/A ratio may provide incremental value in specific clinical contexts, current evidence supports continued reliance on TSB for routine risk stratification.

Older adults with acute coronary syndrome (ACS) face high risks of recurrent ischemia, mortality, and bleeding complications from antiplatelet therapy. The safety and efficacy of ticagrelor versus clopidogrel in this vulnerable population remain uncertain due to their underrepresentation in clinical trials. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to October 2025 for randomized controlled trials and cohort studies comparing ticagrelor versus clopidogrel in ACS patients aged ≥70 years. Outcomes included myocardial infarction (MI), stroke, major bleeding, all-cause death, cardiovascular (CV) death, and the composite of CV death/MI/stroke. Hazard ratios (HRs) or risk ratios with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed via I2 statistics. Five studies (2 randomized controlled trials and 3 cohort studies) with 22,806 participants were included. Ticagrelor significantly reduced the risk of MI (HR 0.84, 95% CI 0.75-0.95, P = 0.004) and the composite endpoint of CV death, MI, or stroke (HR 0.85, 95% CI 0.74-0.98, P < 0.05). No significant differences were found between ticagrelor and clopidogrel in stroke incidence, major bleeding, or all-cause mortality. Heterogeneity was substantial for certain outcomes, particularly bleeding and mortality. In patients aged ≥70 years with ACS, ticagrelor was associated with reduced MI and composite ischemic events compared with clopidogrel, while no statistically significant differences in bleeding events or mortality were observed. However, substantial heterogeneity and reliance on observational data for some outcomes warrant cautious clinical interpretation.

Diabetic ketoacidosis (DKA) is a severe diabetes complication managed with fluids, insulin and electrolyte correction. This review evaluates the debated effectiveness of bicarbonate therapy on DKA outcomes. Following PRISMA guidelines, we systematically reviewed studies on bicarbonate therapy in DKA. We searched PubMed, Google Scholar, the Cochrane Library and ClinicalTrials.gov (as of August 2024), including studies on patients with DKA. Meta-analysis was conducted using RevMan. Bias risk was assessed with the Newcastle-Ottawa Scale (NOS) for cohort studies, Cochrane's ROB-2 for RCTs and the Joanna Briggs Institute (JBI) Scale for case series. Prospero ID: CRD42024581810. Eight studies, including 646 patients, met the inclusion criteria. Participants' mean ages spanned from approximately 9.7 years to 45.8 years. Bicarbonate therapy did not significantly improve pH levels (mean difference = -0.02, 95% CI [-0.13, 0.09], p = 0.7), time to resolution of acidosis (mean difference = 0.09 h, 95% CI [-2.6, 2.79], p = 0.95) or potassium levels (mean difference = -0.10, 95% CI [-0.49, 0.29], p = 0.61). Bicarbonate therapy was associated with a marginally longer duration of hospital stay (mean difference = 13.63 h, 95% CI [0.23, 27.03], p = 0.05), although the overall effect size was small. No significant difference was observed in the incidence of hypoglycemia (odds ratio = 2.62, 95% CI [0.59, 11.63], p = 0.20). High heterogeneity was observed across most outcomes, mainly due to variability in study protocols and patient populations. Bicarbonate therapy provided no meaningful clinical benefit in the routine management of DKA and was associated with potential harm, including worsened hyperglycemia. Consistent with current guidelines, its use should be restricted to cases of severe acidemia (pH < 6.9). Further high-quality studies are needed to clarify its role in extreme acidosis and to explore alternative buffering strategies.

Acute lupus pneumonitis is a rare but potentially life-threatening pulmonary manifestation of systemic lupus erythematosus, often presenting with nonspecific respiratory symptoms. We report a case of a 48-year-old female who presented with fever, dyspnea, and pleuritic chest pain. High-resolution computed tomography of the chest revealed bilateral pleural effusions. Autoimmune serologic testing showed strongly positive antinuclear antibody and anti-double-stranded DNA antibodies. After exclusion of infectious and alternative autoimmune etiologies, a diagnosis of acute lupus pneumonitis was made. The patient showed marked clinical improvement following systemic corticosteroid therapy. This case emphasizes the importance of early recognition and prompt immunosuppressive treatment to improve clinical outcomes.

Introduction: HbA1c is a widely used in diabetes mellitus, both for diagnosis and monitoring. However, the reliability of HbA1c can be significantly compromised by hemoglobinopathies, particularly thalassemia, and interfere with assay accuracy. This narrative review highlights the current evidence by comparing the accuracy of HbA1c measurements in diabetics with hemoglobinopathies. Methods: Literature review was performed using Google Scholar, Embase, PubMed, Springer Nature Link, MDPI, and Taylor & Francis to identify studies comparing diagnostic performance of HbA1c in diabetics patients with & without thalassemia with quantitative glycemic markers measurement i.e. HbA1c, fructosamine, Glycalated Albumin (GA), Fasting Plasma Glucose (FPG) &/or Oral Glucose Tolerance Test (OGTT). Primary endpoint was diagnostic accuracy. Initially we identified 126 articles from January 2020 to June 2025. We identified 12 studies for review after including cross-sectional, cohort, comparative analytical, case control and retrospective studies. Also our inclusion criteria was studies measuring accuracy of glycemic markers between diabetic & non-diabetic patients with thalassemia, hemoglobin H & other hemoglobin variants. We exclude studies involving non-diabetic population, without comparison group, not assessing glycemic markers, conference abstracts, editorials, in-vitro, and non-English articles. Results: A consistent trend showed that HbA1c values were significantly affected in hemoglobinopathies, leading to false positive or negative diagnoses. This diagnostic variability continue to show significant discrepancies in HbA1c among thalassemia patients when compared with more reliable fructosamine or Fasting Plasma Glucose (FPG) values. Interestingly, incidental discovery of hemoglobin variants through unexpected HbA1c readings, highlighting a clinical opportunity for early detection of underlying hematologic conditions. Overall, the findings strongly suggest that while HbA1c remains a cornerstone of diabetes diagnosis, its diagnostic accuracy is compromised in the presence of hemoglobinopathies. Conclusions: Clinicians should exercise caution when interpreting hbA1c results in Thalassemia and other hemoglobinopathy patients. Alternative markers such as glycated albumin, fructosamine, FPG or OGTT should be considered.

Hypertriglyceridemia (HTG) increases cardiovascular and pancreatitis risk. Antisense oligonucleotide (ASO) therapies like volanesorsen and olezarsen target ApoC-III mRNA to reduce ApoC-III, enhancing lipoprotein lipase activity and lowering triglycerides (TGs). This meta-analysis evaluates the efficacy and safety of these ASOs in severe HTG. A systematic review (PROSPERO: CRD42024577110) was conducted following PRISMA, sourcing studies from PubMed, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov until July 2024. Randomized controlled trials (RCTs) involving severe HTG (≥200 mg/dL) treated with volanesorsen or olezarsen vs. placebo were included. Data were synthesized using a random effects model in RevMan 5.4, and bias was assessed with the Cochrane tool. Of 31 identified articles, 9 RCTs (341 patients treated with ASOs, 209 controls) were included. ASOs significantly reduced TG levels [mean difference (MD): -53.72; 95% confidence interval (CI): -77.04 to -30.40; p<0.00001]. Reductions were also seen in very low-density lipoprotein cholesterol (MD: -55.76; p<0.00001), ApoC-III (MD: -74.78; p<0.00001), and APOB48 (MD: -69.45; p<0.00001). Olezarsen uniquely reduced APOB (MD: -15.60; p<0.00001). Non-high-density lipoprotein cholesterol (HDL-C) decreased (MD: -23.25; p<0.00001), while HDL-C increased (MD: +42.14; p<0.00001). Volanesorsen was linked to higher low-density lipoprotein-cholesterol (MD: +62.74; p=0.004). For safety, local injection reactions, thrombocytopenia, and nausea were more common with volanesorsen. Acute pancreatitis occurred only in the placebo group (relative risk: 0.15; p=0.0004), indicating ASO protection. This meta-analysis confirms that ASOs effectively lower TGs and improve lipid profiles in severe HTG.

The mcr gene family, responsible for plasmid-mediated resistance to colistin, poses a growing threat to public health by reducing the efficacy of colistin, a critical last-resort antibiotic for multidrug-resistant Gram-negative bacteria. The mcr-1 gene, discovered in 2015, marked a significant shift in understanding colistin resistance, and subsequent mcr variants (mcr-2 to mcr-10) have emerged globally. These genes alter lipid A in bacterial cell membranes, decreasing colistin's binding and efficacy. The mcr genes are typically located on mobile plasmids, facilitating horizontal gene transfer across bacterial species. Our review examines the evolution, genetic mechanisms, and structural characteristics of the mcr gene family, discussing their spread across human, animal, and environmental contexts. In this review, we highlight the clinical implications of mcr-mediated resistance, noting the co-occurrence of mcr with other antimicrobial resistance determinants, which complicates treatment options. Additionally, it explores detection methods, global epidemiology, and potential strategies to combat mcr resistance, including the development of inhibitors and CRISPR-based gene editing. Our review concludes that combating mcr-mediated colistin resistance requires global surveillance, coordination across sectors, and continued research to stop its spread and impact.