• Vagal nerve stimulation (VNS) has the potential to alleviate persistent long COVID symptoms. • The sensory receptors on the vagus nerve can be activated by the cytokine storm associated with COVID-19, contributing to the “involuntary sickness response” that leads to chronic symptoms in long COVID. • Non-invasive VNS techniques (nVNS) provide safe options for managing persistent COVID-19 symptoms with minimal side effects. • The current evidence for VNS as a potential treatment for long COVID is limited and largely based on small pilot studies, underscoring the need for future research to evaluate its effectiveness.

Aortic valve stenosis in patients with chronic liver diseases, particularly liver cirrhosis and End-Stage Liver Disease, poses significant management challenges due to the interplay between cardiovascular and hepatic dysfunction. This systematic review and meta-analysis compared the safety and efficacy of Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement in this high-risk population. An extensive search of PubMed, Embase, and Web of Science (inception to January 5, 2025) identified 11 retrospective studies comprising 19,097 patients. Risk ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals, were calculated using random-effects models. The analysis revealed that TAVR significantly reduced hospital mortality (RR 0.36, 95 % CI: 0.30-0.42; I² = 7.6 %), acute kidney injury (RR 0.51, 95 % CI: 0.33-0.78; I² = 57.2 %), bleeding (RR 0.33, 95 % CI: 0.28-0.39; I² = 0.0 %), stroke (RR 0.35, 95 % CI: 0.23-0.51; I² = 6.1 %), and blood transfusion (RR 0.48, 95 % CI: 0.40-0.57; I² = 7.6 %). TAVR was also associated with shorter hospital stays (MD -6.77 days, 95 % CI: -9.17 to -4.38; I² = 97.5 %). No significant differences were observed in vascular complications requiring surgery or hospital charges and post-operative infections. These findings suggest TAVR offers significant advantages over SAVR in reducing complications such as mortality, acute kidney injury, and bleeding in patients with liver disease. However, further randomized trials are necessary to confirm long-term outcomes and establish optimal treatment strategies for this high-risk population.

The aim of the study was to determine national estimates for the percentage of all readmissions with demographic features, length of stay (LOS), cost analysis, comorbidities, complications, overall and gender-specific mortality and complications of transcutaneous tricuspid valve replacement/repair (TTVR) vs. open surgical tricuspid valve replacement/repair (open TVR). Data were extrapolated from the Nationwide Readmissions Database (NRD) 2015-19. Of the 75,266,750 (unweighted) cases recorded in the 2015 - 2019 dataset, 429 had one or more of the percutaneous approach codes as per the ICD-10 dataset, and 10,077 had one or more of the open approach codes. Overall, the number of cases performed each year through open TVR was higher than TTVR, but there was an increased trend towards the TTVR every passing year. TTVR was performed more in females and advanced age groups than open TVR. The LOS and cost were lower in the TTVR group than in open TVR. Patients undergoing TTVR had more underlying comorbidities like congestive heart failure, hypertension, and uncomplicated diabetes mellitus. Overall mortality was 3.49% in TTVR vs. 6.09% in open TVR. The gender-specific analysis demonstrated higher female mortality in the open TVR compared to TTVR (5.45% vs. 3.03%). Male mortality was statistically insignificant between the two groups (6.8% vs. 4.3%, P-value = 0.15). Patients with TTVR had lower rates of complications than open TVR, except for arrhythmias, which were higher in TTVR. Patients undergoing open TVR required more intracardiac support, such as intra-aortic balloon pump (IABP) and Impella, than TTVR. TTVR is an emerging alternative to open TVR in patients with tricuspid valve diseases, especially tricuspid regurgitation. Despite having more underlying comorbidities, the TTVR group had lower in-hospital mortality, hospital cost, LOS, and fewer complications than open TVR.

A nuclear protein in testis (NUT) midline carcinoma arises from squamous cells and is often located in the head, neck, and lungs. This report focuses on the negative p63 mutation and older age at the diagnosis of a NUT carcinoma, which has significant prognostic implications. A 62-year-old patient presented initially with a three-year history of recurring frontal headaches, intermittent nasal bleeding, and a sensation of a nasal cavity mass. An incisional biopsy revealed a poorly differentiated NUT carcinoma in the left maxillary sinus. A functional endoscopic sinus surgery was performed, but the cancer recurred. As a result, a total maxillectomy was performed, and the patient was declared cancer-free with no evidence of residual disease. This is a rare instance of a p63-negative midline NUT cell carcinoma (NCC) in an elderly patient, which could potentially contribute to a more favourable prognosis and longer survival compared to other reported cases.

Postoperative sore throat (POST) is a common complication after endotracheal intubation, occurring in 30-50 % of patients. While lidocaine (local anesthetic) and dexamethasone (anti-inflammatory) are used individually to prevent POST, their combined efficacy remains unclear. This meta-analysis synthesizes evidence from randomized controlled trials to determine whether Intravenous dexamethasone-lidocaine combination is more effective than dexamethasone alone in reducing POST incidence. A systematic search was conducted across PubMed, Embase, and Web of Science to identify studies comparing the effect of dexamethasone with and without lidocaine on the incidence of POST, cough, and hoarseness. Statistical analysis was performed on RevMan. Data were pooled using a random-effects model (Mantel-Haenszel method), with results reported as risk ratios (RR) and 95 % confidence intervals (CIs); heterogeneity was assessed using the I² statistic. A p-value less than 0.05 was considered statistically significant. We use Gradpro GDT and Trial sequential analysis to assess the certainty and reliability of evidence, respectively. Our search retrieved 116 articles, of which 31 were duplicates. At the end of the selection process based on prespecified eligibility criteria, three randomized controlled trials were included in the final meta-analysis. Dexamethasone-lidocaine significantly reduces the incidence of POST compared to dexamethasone alone, with a (RR: 0.53; 95 % CI: 0.37-0.75; P = 0.0003, I² = 0 %). The meta-analysis showed no statistically significant difference in postoperative cough (RR: 0.81; 95 % CI: 0.41-1.61; P = 0.55, I² = 24 %) and hoarseness (RR: 0.60; 95 % CI: 0.29-1.22; P = 0.16, I² = 24 %) between the dexamethasone-lidocaine combination and dexamethasone alone. Non-significance doesn't prove groups are comparable; wide confidence intervals suggest a potentially meaningful difference in cough incidence. GRADE assessment analysis showed high evidence for POST and cough but showed moderate evidence for hoarseness and cough. Trial sequential analysis showed insufficient evidence to conclude that Dexamethasone-lidocaine reduces the incidence of POST. The dexamethasone-lidocaine combination suggests a clinically meaningful reduction in POST compared to dexamethasone alone, with consistent effects across studies. While not impacting hoarseness and cough, these robust findings support adopting this readily available, cost-effective strategy to enhance recovery after intubation. The combination's benefit on the most common postoperative complications justifies its inclusion in airway management protocols. Further trials are needed to support and enhance the reliability of this current evidence.

According to published descriptions, one of the most incapacitating forms of orofacial pain is trigeminal neuralgia (TN). At its core, trigeminal neuropathic pain (TN) is still a clinical diagnostic that has to be differentiated from other forms of TN and face pain linked to other neuralgias or headache disorders. Imaging can only help with the cause of the pain, whether it’s a vascular origin or not. It is becoming more and more evident that there is no one-size-fits-all medication or surgical procedure that can effectively treat every patient with trigeminal neuralgia (TN). This is probably because TN is a diverse collection of conditions that all present with face discomfort. Medical therapy using anticonvulsants like carbamazepine is still the first-line treatment for TN. If this doesn't work for the patient, surgical treatments are available. Microvascular decompression is often a safe, efficient operation with results that are both rapid and long-lasting. Patients who may benefit from percutaneous techniques such as radiofrequency ablation, glycerol ablation, balloon compression, or a combination, include those who cannot undergo general anesthesia or whose medical conditions prohibit a suboccipital craniectomy. Radiosurgery may be a great option for patients with bleeding diathesis brought on by blood-thinning medications who are not eligible for invasive procedures or who do not want to undergo open surgical procedures, as long as the patient is aware that achieving maximum pain relief may take several months. In conclusion, peripheral neurectomies persist in offering a low-cost and resource-saving substitute for pain management to those residing in areas with restricted financial and healthcare resources. In the end, developing a better understanding of the molecular processes behind trigeminal neuralgia will lead to new, less intrusive, and more effective treatments.