Background and objectives: Artificial intelligence (AI) is a cutting-edge technology affecting all eras of science and technology and medicine, which is not an exception. Medical writings play a significant role in improving health standard and patient outcomes owing to their global dissemination. AI has widely affected medical writings. This study aims to determine the knowledge, attitude, and practices among the doctors of Khyber Pakhtunkhwa (KPK) regarding the use of artificial intelligence (AI) in medical writings. Medial writings cover a broad horizon of writings ranging from simple medical reports and prescription and extending to impactful article writings and evidence-based research papers as well as figure and graph generation for these papers using the input data. Materials and methods: It is a questionnaire-based cross-sectional study involving convenience non-probability sampling. The questionnaire contained a total of 29 items with subsequent portions of knowledge assessment containing 11 items, the attitude assessment comprised 10 items, and the practice assessment involved eight items. Being the first study of its kind, a conservational approach was adopted for sample size determination, and initially, the calculated sample was 385 using an online sample size calculator. The final sample size adopted was 500 to avoid any discrepancies owing to small sample size. The study setting was KPK, a province of Pakistan, and the study population was the medical doctors practicing in KPK. SPSS 28 was used for data analysis. Frequency, percentage, correlation, and regression analysis were used. Results: Out of 500 respondents, 135 were females and 365 were males. The overall data suggest a high level of knowledge regarding AI in medicine (91.2%). The use of AI was about 30.6%, highlighting a gap that needs to be addressed. The majority of doctors agreed on the impact of AI in medical writing (92.5%), indicating a positive attitude toward promotion within the community. The Pearson coefficient showed statistically significant values. Regression analysis with P-value < 0.001 also supported the hypothesis. Conclusion: The study revealed a positive perception of AI in medical writing, recognizing its potential for efficiency and quality improvement. However, respondents expressed concerns about AI authorship, ethics, privacy, and bias, leading to low adoption. The findings underscore the necessity for education, training, and clear guidelines to responsibly integrate AI into medical writing, ensuring ethical use and advancing the field with informed practices.

Introduction and importance: Kounis syndrome or “allergic angina” or “allergic myocardial infarction” is acute coronary syndrome that results from hypersensitivity reactions. It may also result from interventions involving the use of iodinated contrast media in patients with previous coronary artery disease. Early treatment and diagnosis prevent severe cardiovascular implications. Case presentation: We present the case of a 57-year-old male patient with a history of ischemic heart disease who developed Type II Kounis syndrome during a scheduled coronary angioplasty. On administration of iodinated contrast (Visipaque), the patient suddenly experienced anaphylactic shock, diffuse coronary vasospasm, ST elevation, and acute left ventricular failure. Although he did not have any known history of previous allergies, the clinical presentation was consistent with acute hypersensitivity reaction superimposed on atherosclerotic disease. Immediate treatment with intravenous adrenaline, corticosteroids, antihistamines, and hemodynamic stabilization resulted in rapid clinical stabilization. Clinical discussion: Coronary angiography was found to reveal complete reversal of coronary spasm after treatment. Follow-up laboratory tests demonstrated a stark rise in the concentration of serum tryptase during the acute attack, followed by normalization, which confirmed mast cell activation. The patient was discharged in stable condition with cardiology and allergology follow-up, including contrast allergy test. Conclusion: Kounis syndrome is an uncommon but life-threatening condition to be remembered in patients with pre-existing coronary artery disease undergoing contrast-related procedures and developing features of anaphylaxis. This case report highlights the clinical presentation of Type II Kounis syndrome, and awareness and multidisciplinary approach need to be increased for optimal outcome. Highlights:

Introduction: Dandy-Walker malformation (DWM) is a rare congenital anomaly of the posterior fossa characterized by vermian hypoplasia, cystic dilation of the fourth ventricle, and hydrocephalus. Occipital encephalocele, a neural tube defect involving herniation of meninges and brain tissue, is an uncommon association with DWM, occurring in less than 5 % of cases. The coexistence of these anomalies presents significant diagnostic and management challenges. Case presentation: We report the case of a one-month-old female infant of Pakistani origin who presented with a large occipital cystic swelling since birth and poor feeding. Clinical examination revealed macrocephaly, a soft and transilluminating occipital cyst, decreased muscle tone, and diminished reflexes. Neuroimaging confirmed features of DWM, including vermian hypoplasia, a posterior fossa cyst communicating with the fourth ventricle, and hydrocephalus, along with a large occipital encephalocele communicating with the cyst. The patient underwent surgical excision of the encephalocele, followed by ventriculoperitoneal shunting for hydrocephalus. Postoperative recovery was stable, with resolution of hydrocephalus following shunt placement. Discussion: The patient was discharged with recommendations for regular follow-up to monitor neurological development and potential complications. DWM associated with occipital encephalocele is an extremely rare condition that requires early diagnosis and multidisciplinary management. Conclusion: Surgical intervention, including encephalocele excision and cerebrospinal fluid diversion, plays a crucial role in improving outcomes. Long-term follow-up is essential to assess neurological development and manage potential complications. This case highlights the importance of timely intervention and individualized treatment strategies for such complex congenital anomalies. Highlights:

Myeloproliferative neoplasms (MPNs) are a group of blood cancers characterized by the clonal proliferation of hematopoietic stem cells. These diseases are driven by acquired genetic mutations that activate the JAK-STAT signaling pathway, leading to abnormal cell proliferation and differentiation. Dysfunction of mitochondria, involving increased production of reactive oxygen species (ROS), mutations within its DNA, and alterations in its dynamics, significantly contributes to the development and progression of MPNs. This dysfunction promotes clonal expansion of abnormal blood cells and hinders their programmed cell death (apoptosis). However, targeting mitochondrial pathways offers a promising therapeutic approach. For instance, strategies that include the use of mitochondria-targeted antioxidants to counteract oxidative stress, inhibitors of mitochondrial metabolism to disrupt energy production in MPN cells, and interventions that modulate mitophagy (the process of removing damaged mitochondria) and mitochondrial dynamics. Indeed, achieving specific drug delivery, overcoming therapeutic resistance, and minimizing side effects are at the top of the list. This mini-review highlights the promise of innovative therapeutic approaches, such as gene editing technologies and RNA-based therapies, in addressing mitochondrial dysfunction. Furthermore, it underscores the critical importance of personalized medicine strategies in optimizing the efficacy and safety of mitochondrial-targeted treatments. Future research directions encompass further refinement of these strategies, validation of biomarkers for patient selection, and the development of effective combination therapies. By emphasizing the critical role of mitochondrial dysfunction in the pathogenesis of MPNs, this review provides a framework for improving clinical outcomes and developing novel therapeutic strategies that target these underlying metabolic abnormalities.

Introduction: Air pollution (AP) contributes to over 4.2 million premature deaths annually, with approximately 20% linked to cardiovascular disease (CVD)-related deaths. Despite robust scientific evidence, information-seeking behavior remains poorly characterized. This study applies an infodemiological approach to assess global information-seeking behavior related to AP and its cardiovascular implications. Methods: A retrospective analysis was conducted using Google Trends data from June 2020 to June 2025. Five AP-related search terms (e.g., “air pollution,” “PM₂.₅,” “air quality index,” “environmental pollution,” and “mask”) and five CVD-related search terms (e.g., “cardiovascular disease”, “heart disease,” “heart attack,” “chest pain,” and “high blood pressure”) were analyzed globally. Pearson correlation coefficients, partial correlation analysis controlling for pandemic-related confounding, and time-series approaches including ARIMAX modeling and Granger causality testing were applied to assess temporal and correlational patterns in information-seeking behavior. Results: Global information-seeking behavior showed marked variability across AP and CVD search terms. AP showed moderate positive correlations with “CVD”, “heart disease”, and “high blood pressure” (r = 0.275;0.295;0.386, p < 0.01). “Environmental pollution” showed a moderate correlation with “heart disease” (r = 0.417, p < 0.01) and “blood pressure” (r = 0.315, p < 0.01). Technical AP indicators showed weak or negative zero-order associations with most CVD terms; however, sensitivity analysis controlling for pandemic-related confounding revealed complete directional reversal for PM₂.₅, with partial correlations becoming significantly positive, indicating that original negative associations were pandemic-driven artefacts. Search volumes were highest for Chest Pain and High Blood Pressure, with low global engagement for PM₂.₅ and AQI. Twenty-seven countries, including Pakistan, India, and Australia, demonstrated concurrent AP and CVD information-seeking behavior. Conclusion: This analysis indicates moderate information-seeking behavior in the association between AP and CVD, with geographic variation. Findings highlight the need for targeted public health communication strategies that translate AP risk into accessible cardiovascular health messages.

Background: Hypoplastic left heart syndrome (HLHS) is a severe congenital heart defect requiring complex surgical interventions, including the Norwood, Glenn, and Fontan procedures. This narrative review aims to explore the long-term neurodevelopmental outcomes of children with HLHS following surgical palliation with potential risk factors. Objectives: This review synthesizes current evidence on long-term ND outcomes in children with HLHS after surgical palliation and identifies key risk factors, assessment tools, and emerging neuroprotective strategies. Methods: A comprehensive literature review was conducted, focusing on the interplay of altered fetal circulation, impaired cerebral oxygenation, and extensive medical interventions on neurodevelopment. We conducted literature search of full-text, peer-reviewed English articles published between 2000 and 2024 using PubMed, Scopus, and Google Scholar with the terms “hypoplastic left heart syndrome,” “surgical palliation,” “neurodevelopmental outcomes,” and “children.” Results: Evidence indicates that children with HLHS face significant risks for cognitive, motor, behavioral, and adaptive impairments. Assessment tools such as the Bayley Scales of Infant and Toddler Development, MRI, and EEG are essential for early detection and ongoing monitoring. Discussion: A multidisciplinary approach involving pediatric cardiology, neurology, and developmental therapy is crucial for managing HLHS and addressing neurodevelopmental issues. Early intervention can improve outcomes, guided by diagnostic tools like MRI, EEG, and the Bayley Scales. There is a need for more research on neuroprotective strategies and perioperative management to reduce brain injury and enhance long-term developmental outcomes in children with HLHS. Conclusion: Children with HLHS face significant ND challenges due to a complex interplay of physiological and medical factors. A multidisciplinary approach with early intervention is critical. Emerging strategies, such as maternal hyperoxygenation, merit further investigation regarding their feasibility, cost, and ethical considerations.