Background: Major Depressive Disorder (MDD) and Treatment-Resistant Depression (TRD) are debilitating psychiatric conditions associated with significant psychosocial and economic burdens. Conventional antidepressants, particularly SSRIs and SNRIs, often produce inadequate responses and cause sexual dysfunction, contributing to poor adherence and diminished quality of life. Aim: This review aims to evaluate the clinical efficacy, safety, and sexual side effect profile of intranasal esketamine (Spravato) in the treatment of MDD and TRD, highlighting its potential advantages over traditional antidepressants. Methods: A narrative literature review was conducted using PubMed, ScienceDirect, Cochrane Library, and Google Scholar. Clinical trials, meta-analyses, and systematic reviews published between 2000 and 2025 were included. Keywords used included “Spravato”, “esketamine”, “treatment-resistant depression”, and “sexual dysfunction.”. Results: Clinical trials such as TRANSFORM-2, SUSTAIN-1, and ASPIRE I/II demonstrate that esketamine provides rapid antidepressant effects—often within hours—and improves remission and response rates in TRD. Its NMDA receptor antagonism promotes synaptogenesis and neuroplasticity, distinguishing it mechanistically from monoaminergic antidepressants. Compared to SSRIs/SNRIs, Spravato exhibits a significantly lower incidence of treatment-emergent sexual dysfunction (TESD), with less than 1% of patients reporting such side effects. However, the drug’s use is constrained by dissociative symptoms, blood pressure changes, and its mandatory in-clinic administration due to REMS (Risk Evaluation and Mitigation Strategy) requirements. Conclusion: Spravato (esketamine) is an innovative and effective treatment option for TRD and severe MDD, offering rapid symptom relief and a favorable sexual side effect profile. Despite logistical and financial limitations, it represents a critical advancement in personalized psychiatry, especially for patients unresponsive to conventional therapy.

Thalassemia syndromes, inherited disorders marked by reduced hemoglobin production, pose a significant global health challenge, particularly in regions with high rates of consanguineous marriages. α- and β-Thalassemia vary in severity, ranging from asymptomatic carriers to severe anemia requiring lifelong transfusions. Consanguinity, common in areas like Southeast Asia, the Mediterranean, and Africa, significantly contributes to the high prevalence of β-thalassemia in countries such as Pakistan and India, where rates can reach up to 73%. This cultural practice, deeply rooted in family ties and tradition, complicates public health efforts focused on prevention and management. Current treatment strategies rely heavily on supportive care, including regular blood transfusions and iron chelation therapy, with curative options limited by donor availability and economic constraints. Preventive efforts highlight the importance of mandatory premarital and prenatal screening, genetic counseling, and public education to reduce hereditary transmission of thalassemia. Despite progress in genomic medicine, there remain challenges in delivering comprehensive genetic services in affected regions. Addressing the complex relationship between genetic predisposition, cultural customs, and healthcare access is crucial to mitigating the prevalence and impact of thalassemia globally.

Background: Chronic kidney disease (CKD) affects over half a billion people globally and significantly increases the risk of cardiovascular complications, particularly in those with type 2 diabetes mellitus (T2DM). Although semaglutide, a glucagon‐like peptide‐1 receptor agonist, has shown favourable cardiorenal effects in T2DM patients, prior meta‐analyses were limited by small sample sizes and few studies. This updated meta‐analysis includes both diabetic and non‐diabetic CKD patients, incorporates recently published RCTs and addresses gaps in the literature to enhance result generalizability. Methods: MEDLINE, Embase and Cochrane CENTRAL were searched from inception to May 2025 following PRISMA and AMSTAR guidelines. Studies comparing semaglutide with placebo or standard care in adults (≥ 18 years) with CKD, with or without T2DM were included. Primary outcomes included cardiovascular mortality, major adverse cardiovascular events (MACE), major kidney‐related adverse events, nonfatal myocardial infarction and nonfatal stroke. Risk of bias was assessed using Cochrane RoB 2.0. Results: Five RCTs involving 12,785 participants were included. The findings showed that semaglutide substantially decreased major kidney‐related adverse events (defined as a composite outcome encompassing the onset of kidney failure (including long‐term dialysis, kidney transplantation or a sustained eGFR reduction to < 15 mL/min/1.73 m ² ), a sustained 50% or greater reduction in eGFR from baseline, or death due to kidney‐related causes) (RR: 0.79; 95% CI: 0.71–0.87; p < 0.00001; I ² = 0%), cardiovascular mortality (RR: 0.74; 95% CI: 0.62–0.88; p = 0.0008; I ² = 36%) and MACE (defined as a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) (RR: 0.78; 95% CI: 0.70–0.87; p < 0.00001; I ² = 0%). Conclusion: Semaglutide demonstrates a favourable safety profile and significant cardiorenal benefits in CKD patients, with or without T2DM. Further research is needed to confirm its effects in non‐diabetic CKD populations. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD420251019235

Euglycemic diabetic ketoacidosis (euDKA) is an uncommon but potentially life‐threatening complication that may arise in patients treated with incretin‐based therapies or Sodium–Glucose Cotransporter‐2 (SGLT2) inhibitors. We report a 41‐year‐old female with Type 1 Diabetes Mellitus (T1DM) who developed severe euDKA after initiating tirzepatide for weight loss while on empagliflozin and basal–bolus insulin therapy. She presented with severe vomiting and profound metabolic acidosis (pH 6.96, bicarbonate 1.5 mmol/L) despite only modest hyperglycemia (glucose 190–200 mg/dL). The severity of acidosis necessitated intubation and intravenous bicarbonate therapy. Laboratory findings revealed elevated amylase (688 U/L), suggesting possible tirzepatide‐associated pancreatic stress. No infection or other precipitating factor was identified. The patient recovered after intensive insulin and fluid replacement. This case highlights the risk of severe euDKA with the administration of tirzepatide in T1DM, particularly in combination with an SGLT2 inhibitor. Clinicians should keep a high index of suspicion for ketoacidosis in such patients despite normal or mildly elevated glucose levels and inform them of early detection of symptoms and sick day management.

Prolonged armed conflict has raised significant concern about the mental health of military personnel and veterans. Conditions such as post-traumatic stress disorder and depression affect approximately 14–16% of U.S. service members deployed to Afghanistan and Iraq. Other prevalent mental health issues include suicide, traumatic brain injury, substance use disorder, and aggression. Despite the availability of mental health services, stigma remains a major barrier to care, with nearly 60% of affected personnel avoiding treatment. This review examines how stigma influences help-seeking behavior in military populations. A systematic search of PubMed and Scopus was conducted using terms such as “stigma,” “health care-seeking behavior,” “military personnel,” and “mental health,” limited to English-language studies published between January 2000 and November 2024. Additional data were obtained from cited references and recent conference materials. The findings indicate that stigma in the military manifests in three main forms: public, self-, and institutional stigma, each of which contributes uniquely to reluctance toward seeking care. There is a consistent negative correlation between stigma and treatment seeking. Programs emphasizing education, peer support, and leadership engagement have shown promise in improving attitudes. Initiatives such as the Real Warriors Campaign and evidence-based treatments like Trauma-Informed Guilt Reduction contribute to reducing stigma and promoting recovery. A multifaceted approach involving policy reform, anti-stigma training, and culturally competent interventions is essential to improving mental health outcomes and service engagement among military members.