Migraine is a frequent neurological condition manifested by several episodes of headache. Calcitonin gene-related peptide (CGRP) has been shown to play a key role in the pathophysiology of migraine. Galcanezumab is a monoclonal antibody that binds CGRP and inhibits its action, without affecting the CGRP receptor. The aim of this study is to carry out a systematic review and meta-analysis of all randomized placebo-controlled trials that evaluated the efficacy of galcanezumab (120 mg or 240 mg) for the management of migraine. We screened four databases (PubMed, SCOPUS, Embase, and Cochrane Central) from inception to October 10, 2020. Studies meeting the following criteria were included: (i) Patients: individuals with migraine, (ii) Intervention: galcanezumab at a dose of 120 mg or 240 mg, (iii) Comparator: placebo, (iv) Outcomes: prespecified efficacy and safety outcomes, and (v) Study design: randomized placebo-controlled trials. Efficacy outcomes included change in migraine headache days (MHDs), change in MHDs with acute medication use, patient global impression of severity (PGI-S) score, migraine-specific quality of life role function-restrictive domain (MSQ RF-R) score, and migraine disability assessment (MIDAS) score. Safety outcomes included frequency of injection-site pain, nasopharyngitis, and upper respiratory tract infection (URTI). Moreover, we used the Cochrane Collaboration's risk of bias tool to assess the risk of bias of the included studies. Review Manager Software, version 5.4.1, was used for statistical analysis. Mean difference and risk ratio with 95% confidence interval were used to analyze continuous and dichotomous outcomes, respectively. We used the fixed-effects and random-effects models to analyze homogeneous and heterogeneous data, respectively. A total of six studies comprising 4,023 patients were included in this systematic review and meta-analysis. When compared to placebo, both doses of galcanezumab were highly effective in decreasing MHDs (p<0.001), reducing MHDs with acute medication use (p<0.001), and improving the PGI-S score (p<0.001). On the other hand, MSQ RF-R and MIDAS scores were significantly enhanced only in the 240-mg dose group (p<0.001). With regard to side effects, the rates of injection-site pain and nasopharyngitis did not substantially differ between galcanezumab (inclusive of 120 mg and 240 mg) and placebo groups. Nonetheless, when compared to placebo, galcanezumab 120 mg, but not galcanezumab 240 mg, substantially correlated with a higher rate of URTI. Galcanezumab is clinically safe and efficient for the management of migraine, and the use of a higher dose increases its efficacy. Future research directions should be geared toward determining the optimal dose of galcanezumab in the management of patients with migraine. Moreover, head-to-head comparative studies between galcanezumab and other related anti-CGRP receptor monoclonal antibodies are warranted.

To evaluate the effectiveness of virtual reality-based rehabilitation compared to conventional rehabilitation methods in improving shoulder functions, range of motion (ROM), strength, and pain relief in patients recovering from rotator cuff repair. To assess the impact of virtual reality–based rehabilitation on rehabilitation adherence and patient satisfaction in postoperative rotator cuff repair recovery. A systematic literature search of PubMed, Cochrane Library, Dimensions AI, and Google Scholar was performed from inception to February 14, 2025. Studies involving patients who underwent rotator cuff repair and comparing virtual reality (VR)-based rehabilitation with standard physical therapy were included. Data were extracted and synthesized. Meta-analysis was conducted for outcomes reported by multiple studies, and risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool. Of 599 screened records, 6 studies (n ≈ 332 patients) met the inclusion criteria. There was no statistically significant difference between VR-based and conventional rehabilitation in reducing perceived pain and improving patient-reported functional outcomes. Importantly, VR-based therapy led to significantly greater improvement in shoulder abduction ROM than conventional rehabilitation. However, gains in shoulder flexion and external rotation were not significantly different between groups. Patient adherence and satisfaction varied with rehabilitation modality: home-based digital programs tended to improve adherence, while satisfaction depended on individual preferences for supervision. VR-based rehabilitation is a feasible alternative or adjunct to traditional physiotherapy after rotator cuff repair. It yields postoperative outcomes (pain relief, functional improvement, and strength recovery) comparable to standard rehabilitation, with a clear advantage in enhancing shoulder abduction ROM. Digital rehabilitation may improve patient compliance through greater engagement and accessibility, although integration of periodic clinician interaction may be necessary to maximize patient satisfaction. These findings support incorporating digital health technology into postoperative shoulder rehab protocols, tailored to individual patient needs.

Background: Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Methods: Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. Results: The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients’ overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Conclusions: Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.

Graves' disease (GD) is an autoimmune disease that is characterized by the presence of antibodies targeting the thyroid gland. Commonly, the disease presents with symptoms of thyrotoxicosis such as sweating, tremors, and weight loss; less frequently, patients with GD might also have urticaria. Urticaria is clinically defined as the presence of wheals, angioedema, or both. While its pathophysiology is not completely understood, urticaria is believed to be an immune-mediated response activating mast cells, leading to the release of histamine and cytokines. Although the association between urticaria and GD is well established, it is uncommon for GD patients to present with urticaria as their sole complaint. In this paper, we present a case of a previously healthy patient who originally presented to the dermatology clinic with urticaria alone; however, she developed thyrotoxic symptoms soon after. Furthermore, her treatment was complicated by developing an allergic reaction to carbimazole.

Objectives: To evaluate the outcomes of arthroscopic surgery for patients with shoulder impingement syndrome (SIS). Methods: A systematic search was conducted in PubMed, Web of Science, SCOPUS, and Science Direct for studies on the outcomes of arthroscopic surgery for SIS. Screening, data extraction, and quality appraisal were performed independently. Results: Eleven studies with a total of 782 patients were included. Arthroscopic subacromial decompression (ASAD) showed reduced pain and improved function regardless of age or chronicity, with high satisfaction rates and a low complication rate of 0-19.4%. Arthroscopic acromioplasty provided good short-term outcomes for refractory SIS and superior long-term outcomes compared to open surgery. Conclusion: ASAD is more effective than open or conservative treatment for recalcitrant SIS, though similar results can be attained with well-structured exercise therapy. Low complication rates associated with arthroscopy underscore its safety.