The majority of approved therapies for many diseases are developed to target their underlying pathophysiology. Understanding disease pathophysiology has thus proven vital to the successful development of clinically useful medications. Stroke is generally accepted as the leading cause of adult disability globally and ischemic stroke accounts for the most common form of the two main stroke types. Despite its health and socioeconomic burden, there is still minimal availability of effective pharmacological therapies for its treatment. In this review, we take an in-depth look at the etiology and pathophysiology of ischemic stroke, including molecular and cellular changes. This is followed by a highlight of drugs, cellular therapies, and complementary medicines that are approved or undergoing clinical trials for the treatment and management of ischemic stroke. We also identify unexplored potential targets in stroke pathogenesis that can be exploited to increase the pool of effective anti-stroke and neuroprotective agents through de novo drug development and drug repurposing.

Background: The advent of the hepatitis B vaccine has achieved tremendous success in eradicating and reducing the burden of hepatitis B infection, which is the main culprit for hepatocellular carcinoma—one of the most fatal malignancies globally. Response to the vaccine is achieved in about 90–95% of healthy individuals and up to only 50% in immunocompromised patients. This review aimed to provide an overview of hepatitis B vaccine non-response, the mechanisms involved, B cell amnesia, and strategies to overcome it. Methods: Databases, including Google Scholar, PubMed, Scopus, Cochrane, and ClinicalTrials.org, were used to search and retrieve articles using keywords on hepatitis B vaccine non-response and B cell amnesia. The PRISMA guideline was followed in identifying studies, screening, selection, and reporting of findings. Results: A total of 133 studies on hepatitis B vaccine non-response, mechanisms, and prevention/management strategies were included in the review after screening and final selection. Factors responsible for hepatitis B vaccine non-response were found to include genetic, immunological factors, and B cell amnesia in healthy individuals. The genetic factors were sex, HLA haplotypes, and genetic polymorphisms in immune response markers (cytokines). Non-response was common in conditions of immunodeficiency, such as renal failure, haemodialysis, celiac disease, inflammatory bowel disease, hepatitis C co-infection, and latent hepatitis B infection. Others included diabetes mellitus and HIV infection. The mechanisms involved were impaired immune response by suppression of response (T helper cells) or induced suppression of response (through regulatory B and T cells). Discussion: A comprehensive and careful understanding of the patient factors and the nature of the vaccine contributes to developing effective preventive measures. These include revaccination or booster dose, vaccine administration through the intradermal route, and the use of adjuvants in the vaccine.

Hepatitis B virus (HBV) infection remains a critical global health issue, particularly in high‐burden regions with substantial global morbidity and mortality. Despite the efficacy of the hepatitis B vaccine in inducing immunity, a subset of vaccinated individuals fails to achieve adequate immunity. This study investigated the factors influencing immunological response to the hepatitis B vaccine among Nigerian adults. A cohort study was conducted at Usmanu Danfodiyo University Teaching Hospital, Sokoto, involving 307 participants aged 19–60 who had not previously received the hepatitis B vaccine. Data were collected using structured questionnaires assessing demographic characteristics, medical history, and lifestyle factors. Participants received GeneVac‐B, a recombinant hepatitis B vaccine, and 0‐, 1‐, and 2‐month schedule anti‐HB levels were measured post‐vaccination using a commercial enzyme‐linked immunosorbent assay (ELISA) kit (AccuDiag ELISA, Diagnostic Automation/Cortez Diagnostics, Inc., USA) to classify vaccine response. The association between demographic and lifestyle factors and vaccine response was analyzed using IBM SPSS Statistics (Version 25). Of the 307 participants, 209 received the first vaccine dose, and 192 completed all three doses. Anti‐HB quantification revealed that 94.3% of the participants achieved protective immunity (≥ 10 IU/L), while 5.7% were classified as nonresponders (< 10 IU/L). Statistical analysis indicated significant differences in the immune response based on gender ( p = 0.031), with females exhibiting higher mean anti‐HB levels than males. Negative correlations were observed between age and vaccine response ( ρ = −0.296, p < 0.01) and between body mass index (BMI) and response, although the latter was not statistically significant ( ρ = −0.131, p = 0.071). Prior tuberculosis, malaria, measles, smoking, and alcohol use showed no significant impact on the immune response, although recurrent malaria, measles, and smoking were associated with slightly lower mean antibody levels. The study indicates gender and age significantly influence hepatitis B vaccine response, with females and younger individuals demonstrating stronger immunity.

Introduction: The management of type 2 diabetes with metformin as the first‐line therapy has long been established. However, combination therapy of metformin and other oral antidiabetics became necessary to achieve optimal glycemic targets. Recently, the rising cost of these combinations poses a challenge for the healthcare system and patients, particularly in low‐ and middle‐income settings, highlighting the need to balance clinical benefits with economic considerations to ensure access to treatment while maintaining sustainability in patient care. This review aims to compare the efficacy, safety, and cost‐effectiveness of DPP‐4 inhibitors with metformin/metformin with other combinations and metformin alone. Methods: A literature search was performed through databases including PubMed, Scopus, Cochrane, clinicaltrials.gov, and Google Scholar using specific keywords on “type 2 diabetes mellitus management,” “metformin,” “DPP‐4 inhibitors,” “safety,” and “efficacy.” The retrieved studies were screened and selected according to eligibility criteria, followed by data extraction and critical appraisal. The extracted data were synthesized and reported according to the PRISMA guidelines. Results: Thirty‐five eligible studies were included in the review. From the studies, oral antidiabetic options apart from DPP‐4 inhibitors commonly combined with metformin, either as free or fixed‐dose combinations, include SGLT‐2 inhibitors, sulfonylureas, GLP‐1 receptor agonists, insulin, and thiazolidinediones (TZDs). The efficacy of this drug combination is comparable to that of metformin monotherapy, which is more cost‐effective, especially at the beginning of treatment. Where metformin monotherapy fails, the efficacy of an add‐on therapy as a second line depends on the specific target and individual patient differences, and even triple therapy may be recommended for some individuals. The cost‐effectiveness of each combination depended on the cost‐effectiveness model used in the assessment and the nature of the healthcare setting. Discussion: DPP‐4 inhibitors/metformin demonstrate significant HbA1c reduction, but their low cost‐effectiveness hinders patient adherence compared to metformin monotherapy, free drugs, or other combinations. For that, initiating therapy with cost‐effective metformin alone is recommended. Manufacturer‐funded trials highlight a potential bias, necessitating independent research validations.

Background: C–X–C motif chemokine ligand 13 (CXCL13) is a critical chemokine for lymphoid organization and immune cell migration during hepatitis B virus (HBV) infection. This systematic review assessed the function of CXCL13 in HBV immunoregulation, pathogenesis, genetic susceptibility, and treatment outcome. Methods: We systematically searched five databases, including PubMed, Scopus, Web of Science, and Google Scholar, to identify studies reporting on CXCL13 expression, genetic variants, and clinical outcomes in the context of HBV infection. Thirteen qualified studies were identified and assessed using standard quality appraisal instruments. Results: Data consistently supported the role of CXCL13 in recruiting CXCR5 T and B cells, conditioning germinal center–like reaction(s) as well as antiviral immune responses. Elevated serum CXCL13 levels correlated with better virological response, higher HBsAg clearance, and more favorable response to PegIFNα and nucleos(t)ide analogs. On the other hand, downregulation of CXCL13 was associated with immune tolerance, resistance failure, and disease persistence. Genetically, these polymorphic sites, such as rs355687 and rs76084459, have been associated with vaccine response, the possibility of transplacental transmission, and outcomes of antiviral therapy. Conclusion: CXCL13 is a key immunomodulatory factor in HBV infection and represents an excellent candidate predictive biomarker for treatment response and disease course. Prospective multicenter studies and laboratory research are needed to confirm its usefulness in clinical trials and to investigate therapeutic strategies targeting CXCL13.

Objective: Depression is a major neuropsychiatric disorder with a substantial global burden. Existing pharmacotherapies are limited by delayed onset of action, incomplete response, and adverse effects, necessitating the exploration of alternative therapeutic agents, particularly from medicinal plants. Triplochiton scleroxylon was selected based on its ethnomedicinal use and reported richness in bioactive phytochemicals with potential neuropharmacological activity. This study evaluated the antidepressant-like activity, phytochemical composition, and acute toxicity profile of the ethanol leaf extract of T. scleroxylon in murine models.Methods: Fresh leaves of T. scleroxylon were extracted by ethanol maceration, yielding 14.4% crude extract. Preliminary phytochemical screening was conducted using standard qualitative methods. Acute toxicity was assessed using Lorke’s method. Antidepressant-like activity was evaluated in mice (n=4 per group) using the Tail Suspension Test (TST) and Forced Swim Test (FST). Animals received oral doses of 22.5, 45, and 90 mg/kg extract, with imipramine (10 mg/kg) as the reference drug. Results: Phytochemical analysis revealed the presence of flavonoids, alkaloids, tannins, saponins, and steroids. No mortality was observed at 10 and 100 mg/kg in the acute toxicity study, while mortality occurred at 1000 mg/kg. In both TST and FST models, the extract significantly reduced immobility time at 45 and 90 mg/kg in a dose-dependent manner (p