St. George's University

Background:The Mediterranean diet (MD) and low-fat diet (LFD) were well-known dietary interventions for cardiovascular disease prevention. However, there is an ongoing debate about the relative efficacy of improving cardiovascular (CV) risk factors and clinical outcomes between the 2. This systematic review aims to evaluate and summarize findings from randomized controlled trials (RCTs) that directly compare the MD and LFD concerning CV risk factors and clinical outcomes.Methods:Per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive literature search was conducted across PubMed, Google Scholar, SCOPUS, Science Direct, and RCTs that compared MD and LFD in adults, and reported data on CV risk factors or clinical outcomes were included.Results:Our systematic review includes 11 RCTs with 5942 participants. MD significantly reduced the formation of procoagulant and prothrombotic microvesicles. Studies have also reported that MD has resulted in greater reductions in total cholesterol, cholesterol-high-density lipoproteins ratios, insulin levels, blood glucose levels, leukocyte count, and body mass index compared to LFD.Conclusion:MD demonstrates superior efficacy over LFD in improving CV risk factors and outcomes. These findings could support the preferential recommendation of MD over LFD for the secondary prevention of cardiovascular diseases. Further research should explore the long-term adherence and implementation of these dietary interventions in diverse populations.

Leadership in academic institutions and professional societies plays a critical role in shaping the future of scholarship, governance, and educational equity. However, a persistent trend, particularly in long-established organizations, reveals that retired faculty, such as professors emeriti, often fill executive leadership roles. While emeriti may continue to offer valuable mentorship and institutional memory, their appointment to decision-making positions raises significant structural and ethical concerns. This commentary critiques the reliance on retired academics for active leadership, highlighting key risks including diminished accountability, generational disconnection, ethical incongruence, and leadership bottlenecks that impede the advancement of early- and mid-career scholars. Drawing on governance literature and demographic data, the article calls for structural reforms that promote active, inclusive, and forward-looking leadership models. Practical recommendations include revising governance bylaws, establishing advisory roles for emeriti, and fostering intergenerational partnerships to ensure sustainable academic leadership. The future of academia cannot be led solely by the past. It must be shared by those actively engaged in its present with the assistance of those who have experience in such roles before retirement.

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.

Chemotherapy-Induced Cardiotoxicity (CIC) has become a growing concern in modern oncology. While chemotherapy remains one of the most effective treatments against cancer, its potential to harm the heart often limits its use. The underlying mechanisms involve oxidative stress, mitochondrial dysfunction, and inflammation, all contributing to the gradual weakening of cardiac muscle. As cancer survival improves, the burden of cardiovascular complications is more visible than ever, emphasizing the need for early recognition, prevention, and long-term management. This review draws upon published literature, recent clinical trials, and translational research to explore current understanding and future directions in CIC. Studies on anthracyclines and HER2 inhibitors were reviewed in depth, along with new data on diagnostic biomarkers, imaging techniques, and evolving therapeutic strategies. Particular attention was given to the role of pharmacogenomics, preventive interventions, and emerging therapies aimed at protecting or restoring cardiac function in patients undergoing chemotherapy. CIC can present as heart failure, arrhythmia, hypertension, myocardial ischemia, or thromboembolism. Factors such as age, obesity, cumulative drug exposure, and genetic predisposition significantly raise the risk. Recent advances have improved early detection-troponins, natriuretic peptides, and echocardiography with Global Longitudinal Strain (GLS) allow for identification before overt symptoms appear. Preventive strategies, including dose adjustments, liposomal formulations, and the cardioprotective agent dexrazoxane, have shown measurable benefits. Established cardiotoxicity can be managed with conventional heart failure medications, antihypertensives, and anticoagulants. Experimental approaches-ranging from mitochondrial stabilizers and histone deacetylase inhibitors to mesenchymal stem cell therapy-show promise in reversing cardiac injury. CIC reflects a complex interaction between cancer biology, treatment intensity, and patientspecific vulnerability. A proactive, multidisciplinary approach involving both oncologists and cardiologists is key to balancing cancer control with heart health. Lifestyle measures such as regular exercise and dietary optimization can further strengthen cardiovascular resilience. Advances in genetic testing, molecular imaging, and regenerative therapy are gradually shifting the field toward more personalized cardio-oncology care. Chemotherapy-induced cardiotoxicity continues to challenge clinicians striving for a cure without compromise. The future of cancer care lies in integrating precision medicine with preventive cardiology to minimize cardiac injury while maintaining therapeutic efficacy. Continued research into molecular targets, biomarkers, and cell-based therapies offers genuine hope for improving both survival and quality of life in cancer patients.

Anesthesia plays a critical role in modern surgical care by ensuring patient comfort, safety, and physiologic stability. However, the effects of anesthetic agents extend beyond sedation and analgesia and include important, yet often underrecognized, influences on perioperative glucose metabolism. This consideration is particularly relevant in patients with diabetes mellitus, a growing surgical population in whom perioperative hyperglycemia is strongly associated with increased risks of infection, delayed wound healing, cardiovascular complications, and prolonged hospital stay. This narrative review synthesized current clinical and mechanistic evidence regarding how commonly used anesthetic agents and techniques influence perioperative glucose homeostasis. Volatile anesthetics have been shown to impair pancreatic β-cell insulin secretion and promote peripheral insulin resistance through the effect on cellular ion channels, mitochondrial function, and stress hormone pathways, frequently resulting in intraoperative hyperglycemia. In contrast, propofol-based total intravenous anesthesia (TIVA) appears to exert comparatively milder effects on insulin dynamics in many clinical contexts. Adjunctive agents such as dexmedetomidine and clonidine may further stabilize glucose levels through sympatholytic and stress-attenuating mechanisms. Additionally, regional and neuraxial anesthesia consistently demonstrate an ability to blunt the neuroendocrine stress response to surgery, thereby promoting improved glycemic stability. By integrating physiologic mechanisms with clinical findings, this review highlights how anesthetic choice can meaningfully influence perioperative glucose trends. Understanding these interactions is essential for optimizing anesthetic planning, intraoperative monitoring, and glycemic management strategies in diabetic surgical patients.

Community health worker (CHW) programmes are central to primary healthcare (PHC) in sub-Saharan Africa (SSA). Yet who pays for them, how much, and whether funds favour vertical (single-disease) or horizontal (broader-focus) programmes remains unclear. This study examined trends in donor and government financing for CHW programmes across SSA. We conducted a secondary analysis of publicly available data. Organisation for Economic Co-operation and Development Creditor Reporting System (2002-2022) projects were screened and classified as vertical or horizontal through standard definitions and manual review. Government spending in 37 SSA countries (using WHO Global Health Expenditure Database (2016-2022) was estimated by applying maturity-based allocation percentages to preventive and outpatient curative functions. We described trends, donor composition, vertical-horizontal shares and the annual financing gap against published cost benchmarks. Between 2002 and 2022, global external assistance for CHW programmes totalled US$14.4 billion, SSA receiving 76% (US$11.0 billion). Of donor funds to SSA, 76.4% supported vertical programmes, although these made up fewer than 20% of projects; horizontal programmes received just 14.7%. Annual external assistance rose from ~US$0.28 billion (2016-2019) to ~US$1.83 billion (2020-2022), with over 90% directed to vertical or COVID-19-related efforts. Government spending across 37 SSA countries totalled ~US$1.4 billion (2016-2022). This represented less than 20% of total CHW funding but a greater share directed to horizontal services (54.6%). The annual financing gap remained between US$4.7 billion and US$4.3 billion. CHW financing in SSA is donor-dominant and vertically oriented; domestic allocations are limited but relatively more horizontal. Closing the funding gap will require larger, predictable government budgets for CHWs, better-aligned partner support and stronger expenditure tracking to sustain PHC and advance universal health coverage.