Post-stroke seizures present a global challenge, yet its frequency and factors associated with its incidence are poorly documented, particularly in the Middle East. Thus, this study aims to investigate post-stroke seizure frequency and stroke-associated factors among ischemic stroke patients in Saudi Arabia, addressing demographic, clinical, and comorbid aspects to improve prognosis, diagnosis, prevention, and management. A multicenter, cohort observational study included eligible ischemic stroke patients who were categorized into those who developed seizures after injury and those who did not. Additionally, the study assessed the association between post-stroke seizure and 12-month mortality, 12-month stroke recurrence, and the occurrence of hemorrhagic transformation (HT) within 30 days. The study involved 1235 ischemic stroke patients, in which 13.5% developed post-stroke seizures. Patients with post-stroke seizures had more extended hospital stays, higher intensive care unit (ICU) admission rates, and a higher prevalence of comorbidities. Factors independently associated with post-stroke seizures included previous stroke history (OR = 1.93; 1.35–2.75), ICU admission (OR = 1.7; 1.15–2.5), and depression (OR = 2.1; 1.38–3.30). Logistic regression revealed associations between post-stroke seizures and HT (OR = 2.61; 1.70-4.00), stroke recurrence (OR = 2.30; 1.58–3.36), and mortality (OR = 1.89; 1.33–2.68). However, after adjusting for covariates, post-stroke seizures were significantly associated with stroke recurrence only (aOR = 1.7; 1.11–2.63). Our study identifies notable associations and risk factors for post-stroke seizures in ischemic stroke patients. This underscores the importance of adopting a comprehensive approach to stroke care to enhance the prediction, prevention, and management of post-stroke seizures. Further research is warranted to validate these findings, enhance the understanding of post-stroke seizure mechanisms, and guide management strategies.

Chronic rhinosinusitis (CR) is a persistent inflammation of the nasal mucosa and paranasal sinuses. Endoscopic sinus surgery (ESS) is a procedure that improves sinus drainage and ventilation. Despite advancements in ESS, additional corrective procedures post-ESS are often needed. Clinical trials have explored the efficacy of platelet-rich plasma (PRP) as adjunctive therapy after ESS. This study aims to provide evidence supporting the efficacy of PRP post-ESS for CS patients. Independent authors searched three electronic databases (Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL)) and assessed the methodological quality of included studies using the Cochrane risk of bias 2 tool (RoB 2). Only randomized controlled trials (RCTs) were included. We pooled standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) using a random-effects model. Five RCTs met our inclusion criteria. Among 260 patients, 133 were allocated to PRP and 127 to the control group. PRP was associated with significantly lower postoperative nasal endoscopy scores (-1.74 (95% CI: -2.96, -0.52), P = 0.005) and Lund-Kennedy scores (-3.05 (95% CI: -4.97, -1.13), P = 0.002). PRP also significantly lowered Sinonasal Outcome Test-22 (SNOT-22) scores at one and three months follow-up (-8.25 (95% CI: -11.26, -5.24), P < 0.00001, and -2.75 (95% CI: -5.38, -0.12), P = 0.04, respectively). Subgroup analysis based on the location of administration showed borderline significance in the middle meatus group (-2.70 (95% CI: -5.35, -0.04), P = 0.05). This meta-analysis supports using PRP following ESS for CS patients. Despite promising results, further RCTs are needed to confirm long-term efficacy.

Objective: Drug-induced liver injury (DILI) is a significant global health concern, and herbal medicines are increasingly being used to treat herb-induced liver injury (HILI). Withania somnifera ( Ashwagandha ), which is widely used for its health benefits, has been associated with emerging cases of liver toxicity. This systematic review synthesizes the literature regarding the clinical presentation, diagnostic findings, treatment strategies, and outcomes of Ashwagandha -induced liver injury. Methods: A systematic search of PubMed, Medline, Google Scholar, ScienceDirect, and Web of Science was conducted following PRISMA guidelines. Case reports and series documenting Ashwagandha -associated liver injury were included. The extracted data included patient demographics, symptoms, liver function tests, imaging findings, treatment interventions, and outcomes. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of the included reports. Results: The analysis was performed on 19 studies involving 26 patients. The mean age was 37.8 ± 15.1 years, with 53.9% of patients being male. The most reported symptoms were jaundice (88.5%) and pruritus (72.9%). Liver injury manifests as hepatocellular, cholestatic, or mixed patterns, with elevated bilirubin, AST, and ALT levels. Most cases demonstrate probable or possible causality on the basis of RUCAM scores (Roussel Uclaf Causality Assessment Method). Discontinuation of Ashwagandha led to recovery in most cases, although severe cases required intensive care or liver transplantation. Conclusion: Despite its apparent safety, Ashwagandha can cause liver damage and injury. These findings underscore the importance of vigilant clinical assessment, early recognition, and prompt discontinuation of the supplement in suspected cases.