Intravenous alteplase (ALT) is the standard treatment for acute ischemic stroke (AIS). However, recent trials comparing other tissue plasminogen activators (tPAs) like tenecteplase (TNK) and reteplase with ALT have yielded conflicting results. This necessitated a network meta-analysis to compare the efficacy and safety of various tPAs in AIS patients. We searched MEDLINE, Embase, and CENTRAL (until September 15, 2024) for randomized controlled trials (RCTs) comparing TNK or reteplase (any dose) with ALT (0.9 mg/kg) in AIS patients. A frequentist network meta-analysis was performed using risk ratio (RR) and 95 % CI for each comparison, and P-scores ranked treatments. Analyses were done using R Software 4.4.1. Sixteen RCTs (9259 patients, 62.1 % males) were included. Reteplase 18+18 mg significantly improved excellent functional recovery (mRS 0-1) (RR: 1.13; p < 0.01) and independent ambulation (mRS 0-2) at 3 months (RR: 1.07; p < 0.01) compared to ALT. The 0.25 mg/kg TNK group also showed improved functional recovery (mRS 0-1) (RR: 1.06; p < 0.01). For safety, 0.1 mg/kg TNK was associated with a higher incidence of symptomatic intracranial hemorrhage (s-ICH) (RR: 7.27; p < 0.01). No significant differences in ICH or all-cause mortality were found between ALT and other treatments. Reteplase 18+18 mg ranked highest for functional recovery (P-score=0.9638) and ambulation (P-score=0.9749), while ALT ranked highest for s-ICH (P-score=0.8060). No significant differences were observed between reteplase and TNK. Reteplase 18+18 mg and TNK 0.25 mg/kg demonstrated higher efficacy and comparable safety to ALT. Larger trials are needed to further explore these agents as alternatives to ALT.

Viral hepatitis (VH) remains a leading cause of preventable mortality in the United States (US). Despite advancements in antiviral therapies, disparities in VH-related mortality persist across demographic, racial, and geographic groups. This study analyzes trends in VH-related mortality among US adults between 1999 and 2020 to identify high-risk subgroups and inform public health interventions. This retrospective cohort study analyzed VH-related deaths among US adults (≥25 years). Data were obtained from the CDC WONDER database, with cases identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes B15–B19. Age-adjusted mortality rates (AAMRs) were calculated per 1,00,000 individuals and stratified by age, gender, race and geographical location. Temporal trends in mortality were analyzed by estimating annual percentage changes (APCs) in the AAMRs using the joinpoint regression model. A total of 3,59,035 VH-related deaths were recorded among US adults during 1999 to 2020 with a cumulative overall AAMR of 7.36 (95% CI: 7.33–7.38). Overall, the AAMRs increased significantly from 1999 to 2013 (APC: +3.21; P < .01), followed by a significant decline until 2020 (APC: −5.61; P < .01). Men exhibited higher AAMRs than women, with middle-aged adults (45–64 years) most affected compared to young (25–44 years) and older adults (65 to 85+ years). Non-Hispanic (NH) American Indians/Alaska experienced the highest AAMRs followed by NH Blacks/African Americans, Hispanics, NH Asians/Pacific Islanders and NH Whites populations. Geographically, mortality rates were higher in urban areas than in rural areas, in the Western region relative to other regions and in the District of Columbia compared to other states. Significant disparities in VH-related mortality persist across demographic and geographic subgroups, with particularly higher rates among men, NH American Indian/Alaska Native population, middle-aged adults, and residents of urban and Western US regions. Targeted public health strategies are essential to address these inequities and improve outcomes.

Background: Cubitus varus deformity is a common complication of untreated elbow fractures in children but is rare and challenging to treat in adults. This study presents the first documented case of correcting cubitus varus deformity in an adult. Case presentation: A 26-year-old male laborer presented with a deformed left elbow and impaired limb function due to a childhood fall. Clinical examination revealed a 30-degree cubitus varus deformity (Grade IV), confirmed by X-rays of the limb showing malunion with increased Baumann’s and metaphyseal–diaphyseal angle. The surgical intervention involved a dome osteotomy using a triceps-splitting approach under general anesthesia. The deformity was corrected by manipulating the distal fragment in the coronal and sagittal planes and fixing it with a dynamic compression plate and interfragment screw. Postoperative care included immobilization in a long arm cast and progressive rehabilitation. Clinical discussion: This case demonstrates the effectiveness of dome osteotomy in correcting adult cubitus varus deformity. The technique provides precise correction by targeting the center of rotation of angulation, ensuring superior bone contact and stability. It also minimizes periosteal dissection, reducing the risk of thermal necrosis and preserving bone length. As compared to other osteotomy techniques, dome osteotomy allows for correction in multiple planes and achieves better functional and cosmetic outcomes, despite being technically demanding. Conclusion: Dome osteotomy is an effective surgical option for correcting cubitus varus deformity in adults, providing excellent functional and aesthetic results. This case highlights the importance of precise preoperative planning and meticulous surgical execution for optimal outcomes in patients with complex deformities.

Background and Aims: Families of children with special needs face sustained emotional, psychological, and social challenges that can profoundly influence both caregiver well‐being and child health outcomes. Primary care clinicians are uniquely positioned to address these needs longitudinally, yet the psychosocial dimensions remain under‐recognized in routine practice. This review aims to synthesize existing evidence on caregiver burden and identify opportunities for enhanced primary care engagement. Methods: A narrative review was conducted using PubMed, PsycINFO, and Google Scholar to identify articles on “caregiver burden,” “special needs children,” and “primary care support.” Eligible studies included peer‐reviewed research, reviews, and guidelines addressing psychosocial outcomes and primary care interventions. Literature was analyzed through a primary care perspective, emphasizing caregiver mental health, family functioning, and healthcare system navigation. Results: Evidence consistently demonstrates high rates of caregiver stress, anxiety, depression, and burnout, compounded by marital strain, role imbalance, and financial burden. Key risk factors include socioeconomic disadvantage, fragmented care coordination, and lack of culturally responsive support. Protective factors encompass strong social networks, access to multidisciplinary care, and proactive primary care engagement. Despite existing guidelines advocating family‐centered models, gaps persist in systematic screening, timely referral pathways, and integration of psychosocial interventions into primary care workflows. Conclusion: The emotional and psychological health of families raising children with special needs is integral to optimal child outcomes. Primary care must evolve toward comprehensive, family‐centered frameworks that embed mental health screening, caregiver support, and coordinated interprofessional care into routine practice. Addressing these gaps will require policy alignment, workforce training, and targeted research to operationalize psychosocial support as a core element of pediatric primary care.

Background: Despite traumatic brain injury (TBI) being a leading cause of disability worldwide, it often results in long-term neurocognitive deficits. While conventional treatment options remain limited, hyperbaric oxygen therapy (HBOT) has been proposed as a potential adjunctive intervention due to its ability to enhance oxygen delivery and reduce inflammation. We performed a systematic review and meta-analysis to evaluate the efficacy of HBOT in improving neurocognitive outcomes for TBI patients. Methods: PubMed, Embase, and Cochrane Central databases were searched for studies on HBOT efficacy in neurocognitive deficits in TBI. Statistical analysis was performed using RevMan v.5.4. A random-effects model was applied to pool mean differences (MDs) and 95% confidence intervals ( P < 0.05). Risk of Bias 2 (RoB-2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tools were used to assess the risk of bias in included randomized controlled trials (RCTs) and non-randomized studies (NRSs), respectively. Results: Across four studies (250 patients; mean age 25 years, 43% female), HBOT significantly improved multiple neurocognitive domains in TBI patients. The most pronounced improvements were observed in memory (MD 10.13, P < 0.00001) and attention (MD 7.99, P < 0.00001), with additional benefits in general cognition scores (MD 7.47, P = 0.003), executive function (MD 7.16, P = 0.002), information processing speed (MD 7.48, P = 0.01), and motor skills (MD 5.19, P < 0.00001). RCTs had a low risk of bias, while NRSs had a moderate risk of bias due to confounding. Conclusion: HBOT demonstrates potential in mitigating neurocognitive impairments associated with TBI. Proposed mechanisms underlying its effects include enhanced oxygenation, reduced inflammation and expression of matrix metalloproteinase, decreased brain swelling, and improved outcomes. However, larger trials with standardized protocols are needed to establish the optimal therapeutic role of HBOT in TBI management.

Background and Aims: Hughes‐Stovin Syndrome (HSS) is an extremely rare vasculitic disorder characterized by a combination of pulmonary artery aneurysms and deep venous thrombosis (DVT). Often considered a variant or incomplete form of Behçet's disease (BD), it presents diagnostic and therapeutic challenges due to its overlap with other conditions and the lack of standardized criteria. This narrative review aims to describe the epidemiology, pathophysiology, clinical presentation, diagnostic process, treatment strategies, and clinical outcomes associated with HSS. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar. The search included the terms “HSS” OR “pulmonary artery aneurysm” AND “Behçet's disease.” Relevant literature was selected for inclusion based on thematic relevance and clinical importance. Only English‐language articles focusing on human subjects were included, with an emphasis on case reports, series, reviews, and expert opinions. Literature on Behçet's disease was also reviewed for comparative purposes. The reference lists of key articles were manually searched for additional sources. No publication date restrictions were applied. The final search was completed on April 6, 2025. Results: Fewer than 100 cases of HSS have been published in the English‐language literature to date. It primarily affects young adult males and typically presents with hemoptysis, chest pain, and venous thrombosis. Diagnosis is clinical and radiological, with CTPA being the preferred imaging modality. Immunosuppressive therapy remains the cornerstone of management, though there is no consensus on treatment protocols. The use of anticoagulation is controversial due to the risk of aneurysmal rupture. Conclusions: HSS presents significant diagnostic and therapeutic challenges due to its rarity and clinical overlap with other vasculitides. Bridging the current gaps in clinical knowledge will require global collaboration to establish consistent diagnostic standards, deepen our understanding of its underlying mechanisms, and develop evidence‐based treatment protocols.