Ascites remains a significant challenge in patients with cirrhosis, posing difficulties in management and affecting prognosis. This review examines the current understanding of ascites, including its underlying mechanisms, symptoms, and treatment options, with a specific focus on the innovative Alfa Pump device. The review begins by discussing traditional approaches to managing ascites while also addressing their limitations and potential complications. It then explores the emergence of the Alfa Pump system, a novel implantable device designed to tackle refractory ascites by continuously draining fluid from the abdomen while minimizing circulatory issues. Through a synthesis of current literature and clinical evidence, this narrative review underscores the importance of a multidisciplinary approach in the management of ascites, with a particular emphasis on the evolving role of the Alfa Pump in improving outcomes and quality of life for patients with refractory ascites.

Background: In recent years, psychological stress has lead to increase in suicide cases readily among medical students of many countries. This study aims determine the prevalence of psychological stress, major depressive disorder, and suicidal ideation in Bachelor of Medicine and Bachelor of Surgery (MBBS) students of a government setup medical university in Pakistan. Methods: The data was gathered using a valid questionnaire containing 10 items Kessler psychological distress scale. The scale consists of the severity of the psychological distress from well, mild, moderate, and severe. Physical health questionnaire 2(PHQ2) was used for identifying the students with major depressive illness. Suicidal ideation was assessed using item no. 9 from PHQ9 questionnaire. Results: The overall prevalence of suicidal ideation, distress and major depression among 353 students of MBBS was 22.9%, 63.1%, 27.8% respectively. The students with major depression and moderate/severe distress are more probable to think about suicide. Moreover, Students who choose medicine under the family influence are more likely to have suicidal ideation. Besides this, we found that particularly females experience higher psychological distress as compared to males. Conclusion: In the overall study, it is identified that suicidal ideation is strongly correlated to depression and distress. However, controlling these factors at an early stage can prevent the suicidal thoughts, which inevitably can reduce the suicide attempts not only in medical students but could also be valuable for students of different fields.

Background: In recent years, psychological stress has lead to increase in suicide cases readily among medical students of many countries. This study aims determine the prevalence of psychological stress, major depressive disorder, and suicidal ideation in Bachelor of Medicine and Bachelor of Surgery (MBBS) students of a government setup medical university in Pakistan. Methods: The data was gathered using a valid questionnaire containing 10 items Kessler psychological distress scale. The scale consists of the severity of the psychological distress from well, mild, moderate, and severe. Physical health questionnaire 2(PHQ2) was used for identifying the students with major depressive illness. Suicidal ideation was assessed using item no. 9 from PHQ9 questionnaire.11,17 Results: The overall prevalence of suicidal ideation, distress and major depression among 353 students of MBBS was 22.9%, 63.1%, 27.8% respectively. The students with major depression and moderate/severe distress are more probable to think about suicide. Moreover, Students who choose medicine under the family influence are more likely to have suicidal ideation. Besides this, we found that particularly females experience higher psychological distress as compared to males. Conclusion: In the overall study, it is identified that suicidal ideation is strongly correlated to depression and distress. However, controlling these factors at an early stage can prevent the suicidal thoughts, which inevitably can reduce the suicide attempts not only in medical students but could also be valuable for students of different fields.

Background and Aims: Finerenone, a nonsteroidal MR antagonist (MRA), enhances renal and cardiovascular outcomes in patients with type 2 diabetes (T2DM). Finerenone’s safety and effectiveness in renal function are debatable. This meta-analysis evaluates the efficacy and safety of treatments for patients with diabetic kidney disease. Methods: To find relevant RCTs, the databases PubMed, Embase, and Google Scholar were searched. Finerenone’s effects were quantified using estimated pooled mean differences (MDs) and relative risks with 95% confidence intervals (CIs). Results: This meta-analysis combines seven double-blind trials involving patients with CKD and type 2 diabetes who were randomly assigned to finerenone or placebo. The primary efficacy time-to-event outcomes were cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization, kidney failure, a sustained 57% decrease in estimated glomerular filtration rate from baseline over 4 weeks, or renal death. In this meta-analysis of 39,995 patients, treatment with Finerenone was associated with a lower risk of death due to cardiovascular and renal outcomes than placebo (RR = 0.86 [0.80, 0.93] p=0.0002; I2= 0%) and (RR = 0.56 [0.17, 1.82] p=0.34; I2= 0%), respectively. Finerenone treatment was also associated with a marginally lower risk of serious adverse events (RR = 0.95 [0.92, 0.97] p 0.0001; I2= 0%), but no overall difference in the risk of adverse events was found between the two groups (RR = 1.00 [0.99, 1.01] p=0.56; I2= 0%). Conclusion: The administration of finerenone decreases the likelihood of end-stage kidney disease, renal failure, cardiovascular death, and hospitalization. Therefore, we propose that patients with T2DM and CKD undergo finerenone therapy. Keywords: Diabetes, Chronic kidney disease, CKD, Cardiovascular disease, Finerenone, Non-steroidal Mineralocorticoid receptor antagonist, Meta-analysis.

Barrett’s esophagus (BE), the intestinal metaplasia arising from chronic gastroesophageal reflux disease, is the principal identifiable precursor of esophageal adenocarcinoma (EAC), whose incidence rose from 0.4 to 2.8/100,000 person-years between 1975 and 2017 and whose prognosis, once symptomatic, remains poor. Because outcomes depend on intercepting the metaplasia–dysplasia–carcinoma sequence, diagnostic accuracy is decisive. White-light endoscopy with Seattle-protocol biopsy remains the reference standard, yet it is constrained by the following three interrelated weaknesses: sampling error, as random forceps biopsies interrogate only about 3.5% of the Barrett’s mucosa; poor reproducibility of dysplasia grading, with interobserver agreement of only κ 0.24–0.27 for the pivotal distinction of low-grade dysplasia; and a substantial burden of missed disease, with roughly one-quarter of EACs diagnosed within a year of an index endoscopy reported as nondysplastic. This review synthesizes the technologies converging to address these gaps. Advanced imaging, encompassing high-definition endoscopy, narrow-band imaging, acetic acid chromoendoscopy, and the optical-biopsy platforms confocal laser and volumetric laser endomicroscopy, raises dysplasia yield by approximately 34% over standard white-light examination. Image-enhanced endoscopy improves targeted detection while remaining complementary to structured biopsy sampling. Molecular, genetic, and epigenetic biomarkers, notably DNA-content abnormalities, p53 immunohistochemistry, and multi-gene methylation panels, add an objective read on progression risk. Their pairing with non-endoscopic sampling, including Cytosponge-TFF3, capsule endoscopy, exhaled volatile organic compounds, and circulating microRNA liquid biopsy, is reshaping screening at population scale, while artificial intelligence standardizes interpretation and narrows the expert–nonexpert gap. Together these advances point toward a risk-stratified, multimodal paradigm, though prospective validation and cost-effectiveness evidence remain prerequisites for guideline adoption.