Background: Propofol has been the gold standard for anesthesia induction and maintenance due to its rapid onset and favorable pharmacokinetic properties. However, the search for alternative agents with improved safety and efficacy has led to the emergence of ciprofol (HSK3486), a structural analog of propofol. This systematic review and meta-analysis aim to comprehensively assess the safety and efficacy of ciprofol compared to propofol for anesthesia induction and maintenance in adult patients undergoing surgical procedures. Methods: This study included only double-arm RCTs in which participants were aged eighteen or older undergoing surgery. For the statistical analysis of the extracted data, we employed RevMan 5.4.1. Results: Ciprofol demonstrated a promising trend of higher anesthesiologists’ satisfaction during the induction phase (MD 0.14, 95%, CI − 0.28 to 0.56, p = 0.51), whereas Propofol was favored during maintenance. Propofol also exhibited advantages with a shorter time to successful anesthesia induction (MD 0.08 min, 95% CI 0.00 to 0.15, p = 0.04), and quicker attainment of full alertness (MD 0.11 min, 95% CI − 1.29 to 1.52, p = 0.87), suggesting its efficiency in clinical practice. Importantly, there were no significant disparities in the success rate of anesthesia. Conclusion: Both ciprofol and propofol demonstrate comparable efficacy and safety for anesthesia induction and maintenance in adult patients undergoing surgery. While propofol provides a faster onset of induction, ciprofol exhibits advantages in terms of pain management. Clinicians should consider these findings when selecting anesthetic agents, and tailoring choices to individual patient needs and clinical scenarios.

The atrioventricular block (AVB) is a conduction system problem that results from the impairment in the transmission of an impulse from the atria to the ventricle, the disease has many etiologies. This article aimed to evaluate the efficacy and safety of dual and single-chamber pacemakers in patients with SSS and AVB. An electronic search of PubMed (Medline), EMBASE, and Google Scholar was performed from 2000 till August 15th, 2022. Retrieved articles were exported to Endnote Reference Library Software, where duplicate studies were removed from the list, and only articles meeting the eligibility criteria of this study were selected. RevMan 5.4 and STATA 16 software were used for the analysis. The modified Cochrane Collaboration's risk of bias and New-castle Ottawa scale were used for quality assessment of RCTs and observational studies respectively. This study is composed of 8953 patients with sick-sinus syndrome and atrioventricular block. A total of thirteen outcomes are included in this meta-analysis, out of which atrial fibrillation significantly favored dual chamber [OR = 1.29; 95 % CI = 1.05-1.59; P = 0.01 I² = 29 %] and overall complications [OR = 0.48; 95 % CI = 0.29-0.77; p = 0.03 I² = 0 %] and pneumothorax [OR = 0.31; 95 % CI = 0.10-0.93; p = 0.04, I² = 0 %] were satisfied by single-chamber pacing. This study concluded that neither single-chamber nor dual-chamber pacemakers are superior to each other, but they are unique in their own ways as the results of this study manifest remarkable reduction in atrial fibrillation rates and pneumothorax using dual-chamber and single-chamber pacemakers respectively.

Objective: The study design included the double-blind, parallel, randomized controlled trial. The aim of this randomized controlled trial was to compare the efficacy and safety of sertraline and escitalopram in participants with moderate to severe major depressive disorder (MDD). Methods: The study was conducted in South Asian participants. A total of 744 participants with moderate to severe MDD were randomly assigned to receive either sertraline or escitalopram for 8 weeks. Drug dosages and titration schedules were based on the recommendations of the prescribing information for each product and according to the judgment of the clinicians involved in the study. The primary outcome measures were changes from baseline on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the clinical global impression (CGI) scale as well as the frequency of adverse events in both groups. Baseline MADRS scores in the escitalopram and sertraline groups were 28.2±0.47 (mean±SD) and 29.70±0.46 (mean±SD) respectively, and was no variability in the baseline assessments. Changes in MADRS as well as CGI scales at the end of the study were significant only for the sertraline group whereas they remained statistically nonsignificant for the escitalopram group. Results: The results of the study showed that sertraline was more efficacious than escitalopram in reducing depression rating scales such as MADRS and CGI, and that participants subjectively felt better regarding their symptoms in the sertraline group. Sertraline displays enhanced safety or tolerability than other groups of antidepressants, which frequently cause high levels of drowsiness, dizziness, blurred vision, and other undesirable effects. Adverse events were seen in both groups, but delayed ejaculation was the most frequent adverse event seen in both groups. However, a greater number of participants reported having nausea and insomnia in the sertraline group compared to the escitalopram group. Conclusion: Our study clearly highlights that there is a statistically significant difference in efficacy between sertraline and escitalopram at the doses used in our study. Sertraline was able to significantly lower the depression rating scales like MADRS and CGI in participants with moderate to severe MDD. Participants subjectively felt better regarding their symptoms in the sertraline group. The most frequent adverse event in both groups was delayed ejaculation. From an efficacy standpoint, sertraline was more efficacious than escitalopram. The study indicates that the prevalence of depressive disorders in South Asia is comparable to the global estimate, and Bangladesh and India has higher proportions of people with depressive disorders in South Asia. Additionally, females and older adults (75–79 years) have the highest burden of depressive disorders across all countries in the region. This study’s limitation included the absence of a placebo arm. An additional limitation of the current study was the lack of an evaluation of inter-rater reliability and the research sample could not have been uniform in terms of the kind of depressive disorders and bipolarity.

Poliomyelitis, commonly known as "polio" is a paralytic and perilous disease caused by the poliovirus. Due to its highly contagious nature, the virus was a challenge to the world in the late 1980s. Since 1988, the collective work of the Global Polio Eradication Initiative (GPEI), Centre for Disease Control and Prevention (CDC), and World Health Organization (WHO) through immunizations, communication awareness, and monitoring have helped the world exonerate polio. This article aims to review on challenges and future recommendations for polio eradication in Pakistan. The mission of polio-free Pakistan was Herculean. It confronted enormous challenges in different ways but came out with positive results. In 2019, with only two remaining polio-endemic countries, Pakistan and Afghanistan, GPEI launched an "Endgame strategy 2019-2023," aiming to eradicate polio globally, focusing on polio-endemic countries. The plan emphasizes the early detection of polio cases for complete eradication and to restrict the spread of polio. Pakistan has achieved a milestone in combating polio despite having a web of factors that have thwarted Pakistan's polio eradication efforts, but this is not the end. The struggle continues until we get an internationally verified certification of a polio-free nation; WHO has designed a multidisciplinary strategy for 2022-2026 to end this polio.