Background: Charcot neuroarthropathy (CN) is a progressive, non-infectious disorder characterized by bone and joint destruction, most commonly seen in patients with diabetes and peripheral neuropathy, and can lead to joint instability, ulceration, osteomyelitis, and increased risk of amputation. The purpose of the study is to evaluate the effectiveness of Ilizarov-assisted ankle arthrodesis in achieving stable fusion and functional outcomes in patients with Charcot neuroarthropathy. Methods: This prospective observational study was conducted at the Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) along with selected private hospitals, Dhaka, Bangladesh, from January 2020 to December 2024, and included 15 patients with Charcot neuroarthropathy of the ankle. All patients underwent Ilizarov-assisted ankle arthrodesis, and outcomes including fusion, limb salvage, complications, and functional recovery (AOFAS score) were assessed over a mean follow-up of 24.5 ± 6.3 months. Results: Fifteen patients with Charcot neuroarthropathy underwent Ilizarov-assisted ankle arthrodesis. Ankle fusion was achieved in 80.0%, limb salvage in 86.7%, and limb shortening occurred in 73.3%. The most common complication was pin-tract infection (40.0%). Among surviving patients (n = 13), mean follow-up was 24.5 months, AOFAS scores improved from 36.8 to 68.9, and 69.2% achieved full weight-bearing. Conclusion: Ilizarov-assisted ankle arthrodesis provides reliable fusion, effective limb salvage, and meaningful functional improvement in patients with Charcot neuroarthropathy despite procedure-related complications.

Background: Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide, with intracranial haemorrhage and haematoma expansion representing critical determinants of poor outcomes. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated mortality benefits in extracranial trauma, but its efficacy in isolated TBI remains debated, particularly regarding optimal patient selection, timing, and dosing. Objective: To systematically synthesise the available evidence on the efficacy of TXA in reducing mortality and haematoma expansion in patients with isolated traumatic brain injury treated in emergency department or prehospital settings. Methods: A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus was conducted for the five-year period ending in 2026. Randomised controlled trials, cohort studies, nested substudies, and post hoc analyses evaluating intravenous TXA versus placebo, no TXA, or standard care in adult patients with isolated TBI were included. Primary outcomes were all-cause or head injury-related mortality and radiographic haematoma expansion. Risk of bias was assessed using Cochrane RoB 2 (RCTs) and ROBINS-I (non-randomised studies). Due to substantial heterogeneity, a narrative synthesis was performed. Results: Thirteen studies (n = 24,227 patients) met inclusion criteria, including four RCTs, one prospective cohort, three retrospective analyses, and five secondary/post hoc analyses. In mild-to-moderate TBI (GCS 9–15), TXA significantly reduced mortality (CRASH-3 subgroup: RR 0.78, 95% CI 0.64–0.95; Bian meta-analysis: RR 0.71, 95% CI 0.60–0.85). In severe TBI (GCS 3–8), no mortality benefit was observed in RCTs (RR 0.98, 95% CI 0.91–1.05), while observational studies suggested potential harm due to confounding by indication (Bossers: OR 4.49, 95% CI 1.57–12.87). Haematoma expansion was reduced with TXA in two small RCTs (mean expansion 1.5±1.1 mL vs 4.6±1.9 mL), though the CRASH-3 imaging substudy found no prevention of established haematoma expansion but did show reduced new haemorrhage in patients with reactive pupils (aRR 0.80, 95% CI 0.66–0.98). Early administration (within 2 hours) was consistently associated with improved outcomes. Thromboembolic events were not significantly increased with TXA. A novel imaging biomarker (≥3% voxels in 10–20 Hounsfield unit range) showed promise for predicting TXA responsiveness but requires prospective validation. Conclusions: TXA reduces mortality in isolated mild-to-moderate TBI when administered early (within 2 hours), with the strongest evidence supporting its effect in patients with reactive pupils and smaller baseline bleeding volumes. TXA does not improve survival in severe TBI, and observed harm signals are likely confounded. Emergency physicians should consider early TXA administration in mild-to-moderate TBI with intracranial haemorrhage, while severe TBI patients should follow standard protocols pending further research.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with post-traumatic seizures (PTS) representing a frequent and potentially devastating complication. While phenytoin has historically been the standard agent for early PTS prophylaxis, levetiracetam has emerged as an increasingly popular alternative despite limited high-quality comparative data. Objective: This systematic review aimed to summarize available evidence on the comparative effectiveness of levetiracetam and phenytoin for seizure prophylaxis following traumatic brain injury. Methods: A comprehensive literature search was performed across PubMed/MEDLINE, Embase, Scopus, and Web of Science for studies published within the last five years. Studies were included if they compared levetiracetam and phenytoin (or fosphenytoin) for PTS prophylaxis in TBI patients of any age. The primary outcome was incidence of early post-traumatic seizures (EPTS; ≤7 days post-injury). Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the Joanna Briggs Institute checklist for cross-sectional studies. Due to substantial heterogeneity, a narrative synthesis was conducted. Results: Six studies met inclusion criteria, comprising 65,446 TBI patients and 220 clinicians. Studies demonstrated that levetiracetam and phenytoin have comparable efficacy in preventing EPTS. After adjustment for confounders, no significant difference in seizure occurrence was observed between agents (p>0.05 for all comparative analyses). Prophylactic antiseizure medication overall significantly reduced EPTS incidence compared with no prophylaxis (9.6% vs. 32.1%; p<0.001). Neither drug effectively prevented late post-traumatic seizures (>7 days). Levetiracetam offered practical advantages including no requirement for routine serum monitoring, and demonstrated a favourable adverse effect profile, though one meta-analysis reported a modest mortality signal requiring further investigation. Risk of bias was low in two studies, moderate in four studies. Conclusion: Levetiracetam and phenytoin demonstrate comparable efficacy for early post-traumatic seizure prophylaxis after TBI. Neither agent prevents late seizures, supporting current guideline recommendations limiting prophylaxis to the first 7 days post-injury. Clinicians may reasonably choose either agent based on patient-specific factors, institutional protocols, and drug availability.

Background: Two classes of drugs, SGLT2i and GLP-1 RA, have revolutionized the management of type 2 diabetes mellitus (T2DM) from glycemic control to overall cardiorenal risk reduction. Though there was strong evidence from randomized controlled trials, there are still some aspects of their effectiveness in the real world that are not understood completely, such as their efficacy with combination therapy and outcomes in advanced chronic kidney disease (CKD). Methods: This systematic review followed PRISMA 2020 guidelines. A detailed literature review was carried out on PubMed/MEDLINE, Web of Science and Scopus for the articles published over a past 5 years. Studies were included if they involved adult patients with T2DM treated with SGLT2i, GLP-1 RA or both, and if they measured major adverse cardiovascular events (MACE) or renal events. Eleven observational studies (mainly retrospective cohort, with more than 700,000 patients) fulfilled the inclusion criteria. The ROBINS-I tool was used to assess the risk of bias. Results: Combination therapy with the two drugs showed additive cardiorenal benefit: A reduction in risk of MACE by 30% compared to GLP-1 RA (HR 0.70; 95% CI: 0.49–0.99) and by 29% compared to SGLT2i (HR 0.71; 95% CI: 0.52–0.98). Adding GLP-1 RA to SGLT2i was associated with a 27% lower risk of major adverse kidney events (HR 0.73; 95% CI: 0.69–0.77) and a 39% lower risk of end-stage kidney disease (HR 0.61; 95% CI: 0.47–0.78). SGLT2i was more renal protective in advanced CKD (stage 4–5), but both classes of drugs retained cardiovascular benefits. Significant increased mortality (HR up to 1.97) and cardiovascular events were seen with treatment discontinuation ≥180 days. Conclusion: SGLT2i and GLP-1 RA are consistently linked to better MACE and renal outcomes in T2DM patients and combination therapy provides additional protection. The results were very strongly in favor of the current guideline recommendations for these agents in high cardiorenal-risk patients. Studies aimed to assess combination therapy versus monotherapy in dedicated randomized controlled trials, especially in non-diabetic and advanced CKD populations are warranted.

This retrospective study, conducted at the Ultrasound Department of Al-Auda Medical Center in Hafr Al-Batin, KSA, evaluated the diagnostic performance and clinical utility of the Gynecologic Imaging-Reporting and Data System (GI-RADS) for the risk stratification of adnexal masses. Over a three-year period (December 2022 to December 2025), 300 patients presenting with suspected adnexal masses underwent standardized transabdominal and transvaginal sonography using high-resolution systems. The results indicate that the majority of adnexal masses were low-risk, with 51.7% categorized as GI-RADS 3 (Probably Benign) and 36.3% as GI-RADS 2 (Benign). Findings suspicious for malignancy were rare, with 8.0% classified as GI-RADS 4 and 2.0% as GI-RADS 5. Statistical analysis revealed highly significant associations ($p=0.000$) between GI-RADS stratification and parameters such as cystic content, internal vascularity, and the presence of ascites, with vascularity demonstrating the strongest correlation (Cramer’s V=0.458). Conversely, septal and wall thickness were not statistically significant discriminators in this cohort (p=0.088). In conclusion, the GI-RADS framework proved to be a reliable, standardized tool for characterizing adnexal lesions at our institution. The system effectively reduced diagnostic ambiguity, facilitating consistent clinical triage and communication between sonographers and clinicians. These findings support the widespread adoption of GI-RADS as a mandatory reporting standard to improve diagnostic accuracy, reduce unnecessary interventions for benign lesions, and prioritize urgent management for high-risk patients. This audit provides essential evidence-based justification for maintaining GI-RADS as the primary reporting protocol at Al-Auda Medical Center.

Background: Facial angioedema is a challenging for the medical profession, particularly in patients received cosmetic dermal fillers. Case presentation: A 43 years old fmale presented with one-year history of recurrent facial swelling after receiving unlabeled dermal fillers given by unlicensed esthetician. Her symptom improved with systemic steroid prescribed at private clinic. Dermatologic examination revealed nodular lesions on both cheeks measured 1-3 cm in diameter. Foreign body reaction to injectable filler was highlighted by plastic surgeon and surgical biopsy was advised. Upon allergy review, she reported associated symptoms of mild throat discomfort and occasional difficulty of swallowing. A diagnosis of idiopathic angioedema was raised. However, patient strongly believed that her facial swellings were related to her dermal fillers and reluctant to start antihistamines. Immunologic work up for idiopathic and congenital angioedema was unremarkable. She was labeled allergic to Chlorpheniramine in the past. This however, was excluded by supervised oral graded challenge performed in the allergy clinic. The patient was shortly admitted for of an episode of angioedema, upper gastrointestinal (GI) endoscopy was performed for other complaints of heart burn and mild difficulty of swallowing. Not surprisingly, laryngeal edema was pictured during the procedure, rapid urease test for (H. pylori) was positive. These finding have further supported the diagnosis of idiopathic angioedema. Patient has completed (H. Pylori) eradication therapy. Afterward, she was commenced on a combination H1 and H2 antihistamines, this has resulted in significant improvement of her facial angioedema and throat discomfort. Conclusion: Facial angioedema in patients received injectable dermal fillers may not necessarily be due to local adverse reaction, in certain clinical setting a diagnosis of idiopathic angioedema should be suggested. Therefore, consulting allergy specialist is essential in evaluating such patients.