Objective: Tofersen, an antisense oligonucleotide, has recently received FDA and EMA approval for treating amyotrophic lateral sclerosis (ALS) in adults with SOD1 gene mutations. This systematic review and meta-analysis synthesized evidence on tofersen’s safety and efficacy in patients with SOD1-related ALS. Methods: A comprehensive search of three databases was conducted from inception through October 2024. Eligible studies included clinical trials, observational studies, and case studies. Meta-analyses were conducted using a random-effects model in RevMan. Results: Twelve studies involving 195 patients treated with tofersen met the inclusion criteria, comprising two randomized controlled trials (RCTs), five cohort studies, one case series, and four case reports. Tofersen demonstrated promising effects, notably reducing SOD1 levels in cerebrospinal fluid and neurofilament light chain (NfL) in plasma, a biomarker strongly correlated with ALS progression and survival. Meta-analysis of RCTs showed a significantly lower rate of decline in ALS Functional Rating Scale-Revised (ALSFRS-R) scores from baseline in the tofersen group compared to placebo (SMD = 0.44, 95% CI [0.05 to 0.83], P = 0.03) and a significant reduction in the decline of predicted Slow Vital Capacity (P = 0.005). In a pre-post meta-analysis of five studies, a significant decrease in ALS progression rate (ALSFRS-R decline rate) was observed (MD = -0.28, 95% CI [-0.40 to -0.15], P < 0.0001). Reported adverse events were consistent with ALS progression or procedural effects. Conclusion: Current evidence suggests that tofersen effectively reduces SOD1 and NfL levels and slow disease progression in SOD1 ALS, showing promise as a targeted therapeutic option.

Background: Language barriers in medical education, particularly in countries where foreign languages are used as the medium of instruction, pose significant challenges for domestic medical students. These barriers hinder academic performance, comprehension, and communication with patients, ultimately impacting the quality of healthcare delivery. Despite the prevalence of this issue, a comprehensive understanding of its effects remains underexplored. This systematic review aims to synthesize evidence on language barriers in medical education and propose strategies to address them. Methods: Following PRISMA guidelines, we conducted a systematic review of studies published up to March 21, 2024, using PubMed, Scopus, and Web of Science. Eligible studies focused on language barriers faced by medical, pharmacy, nursing, dental, or veterinary students in countries relying on foreign-language-based medical education. Data extraction included study characteristics, reported language barriers, and their impact on education and patient communication. Quality assessment was performed using the Mixed Methods Appraisal Tool. Results: From 5,410 citations, 49 studies involving over 14,500 students met the inclusion criteria. Most studies (n = 32) were conducted in Arab countries, with 15 in Saudi Arabia. Two key themes emerged: (1) Education and Academic Performance: Students frequently reported difficulties comprehending foreign-language textbooks, lectures, and assessments, leading to poor academic outcomes, increased stress, and higher dropout rates. (2) Communication Skills with Patients: Studying and training in a foreign language hindered students’ ability to communicate effectively with patients in their native language, impacting empathy, medical history collection, and overall patient care. Many studies highlighted students felt more confident and effective when using their native language during clinical interactions. Conclusion: Language barriers in foreign-language-based medical education significantly impede students’ academic performance and patient communication skills. Addressing these challenges through reforms, such as integrating native language instruction and supplemental language training, is crucial to enhancing medical education quality and ensuring effective healthcare delivery. Future research should explore innovative solutions, including bilingual education and AI-driven translation tools, to bridge these gaps.

Objectives: This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS). Methods: Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS. Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value. Meta-analysis was conducted using RStudio's "meta" package with a random-effects model. Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates. Results: Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis. The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%). Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively. Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean (P = 0.02). The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS. Conclusion: Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.

Objectives: We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes. Materials and methods: We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the “meta” package of RStudio software. Results: We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes. Conclusions: Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.

This study aimed to assess the perception of COVID-19 risk and the adherence to protective measures among medical students after vaccination. We conducted a cross-sectional survey on a convenience sample of students from all the 18 governmental medical schools in Egypt. A total of 2273 students participated in the online self-administered questionnaire. Around 8 in 10 (83.2%) students were fully vaccinated, of which 17.9% received the booster dose. Only 36.9% believed that COVID-19 is serious on the individual level. The majority (73.9%) strongly or slightly agreed they may become infected after vaccination if they do not follow the preventive measures. We observed a slow decline in the perceived risk of vulnerability and susceptibility to COVID-19 infection among students in parallel to a growing perception of self-efficacy and controllability. Less than one-third (28.9%) of students showed good adherence to protective measures. However, this was lower than the previously reported adherence in the same population before vaccination. Female students, those in the first academic year, those who did not contract COVID-19 infection before, and those with a higher perception of susceptibility and perceived controllability were more likely to perform better at protective measures.