Background: Depression is prevalent among patients with end-stage renal disease (ESRD) undergoing dialysis, with significant implications for their quality of life and treatment compliance. Traditional treatments for depression, including various therapies and pharmacological interventions, have limitations due to their adverse effects. Sertraline, a selective serotonin re-uptake inhibitor (SSRI), offers a promising alternative, but its efficacy and safety in this population require thorough evaluation. Objective: This meta-analysis aims to assess the effectiveness and adverse effects of sertraline in treating depressive episodes in dialysis patients compared to placebo. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted a comprehensive search of databases, including PubMed, Cochrane Library, and Science Direct, up to 20 June 2024. The authors included randomized controlled trials (RCTs) that compared sertraline with placebo in dialysis patients with depression. Two researchers independently performed data extraction and risk of bias assessment. Statistical analysis was conducted using ReviewManager 5.4.1, employing a random effects model. Results: Four RCTs involving 468 participants were included. Sertraline significantly reduced depressive symptoms, as measured by the Quick Inventory of Depressive Symptomatology (QIDS) and Beck Depression Inventory-II (BDI-II) scores, at 6 and 12 weeks compared to placebo. Improvements in kidney disease-specific quality of life (KDQOL-36) scores were also noted. However, sertraline was associated with a higher risk of adverse events compared to placebo. Conclusions: Sertraline effectively reduces depressive symptoms and improves the quality of life in dialysis patients with ESRD. Despite the increased risk of adverse events, the overall benefits make sertraline a viable treatment option for this population. Larger, more comprehensive studies are needed to confirm these findings and optimize sertraline use in clinical practice.

Background: Despite advances in coronary artery disease (CAD) treatment, challenges persist, particularly in complex lesions. While percutaneous coronary intervention (PCI) is widely used, its outcomes can be affected by complications like restenosis. Optical coherence tomography (OCT), offering higher-resolution imaging than angiography, shows promise in guiding PCI. However, meta-analytical comparisons between OCT-guided and angiography-guided PCI remain limited. Methods: Databases, including PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov, were queried through May 2025 to identify randomized controlled trials (RCTs) comparing OCT-guided PCI with angiography-guided PCI. Data were pooled using risk ratios (RRs) and mean difference (MD) with 95% confidence intervals (CIs) in a random-effects model. Results: Five RCTs involving 5737 patients (OCT: 2738 and angiography: 2999) were included. On pooled analysis, OCT-guided PCI was associated with a notable reduction in major adverse cardiovascular event (MACE) (RR: 0.71, p = 0.0001), cardiac mortality (RR: 0.43, p = 0.003), target lesion revascularization (TLR) (RR: 0.53, p = 0.007), and stroke (RR: 0.17, p = 0.02), compared to angiography-guided PCI. No significant differences were noted for all-cause mortality and myocardial infarction. Conclusions: In patients with complex coronary lesions, OCT-guided PCI reduces the risk of MACE, cardiac mortality, TLR, and stroke, compared to angiography-guided PCI only. This study supports incorporating advanced imaging techniques like OCT to improve clinical outcomes, especially in complex PCIs.

Introduction and importance: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by substantial damage to oligodendrocytes. It clinically presents as movement impairment, cognitive disability, language aphasia, dysarthria, and visual impairments. It was first identified in 1958. It is commonly associated with either Hodgkin’s lymphoma or chronic lymphocytic leukemia. Case presentation: A 40-year-old male Asian farmer presented with altered behavior, fever, and weakness on the right side of his body after suffering a widespread tonic-clonic seizure. His medical background included a tonsillectomy, treatment for pulmonary tuberculosis, and hepatitis C (negative polymerase chain reaction). On admission, he had asymmetric plantar responses, pallor, brisk deep tendon reflexes, an oral thrush, and decreased strength and tone in the muscles on his right side. The findings of the laboratory tests revealed elevated pH, red blood cells, lymphocytes, and protein in the cerebrospinal fluid, as well as an elevated erythrocyte sedimentation rate, abnormal liver function tests, and no bacterial growth. Magnetic resonance imaging (MRI) showed bilateral parietal, temporal, and frontal lobe high signal lesions (T2W, FLAIR sequences), with more severe lesions in the left lobe and no contrast enhancement, consistent with the imaging features of PML. According to the spinal tap, the patient was JC virus-positive. HIV testing indicated a significant viral load, and electroencephalogram recorded seizures. Clinical discussion: JC virus reactivation causes PML, a serious brain condition in patients with weak immune systems. HIV and immunosuppressive drugs are thought to be the potential risk factors behind the reactivation of the JC virus and the appearance of PML. Symptoms like seizures and fever are not usually associated with PML, but the presence of these symptoms hints toward the complexity of the diagnosis of this case. Doctors should focus on treating the root cause of the weakened immune system to help patients. PML was identified by combining the results of an MRI scan with the patient’s HIV status and the results of a spinal tap. The patient’s health deteriorated even after receiving corticosteroids, acyclovir, nutritional supplements, and palliative therapy. As time passed, he developed neurological complications, respiratory failure, and ultimately death. Conclusion: This case highlights the more aggressive and unique course of PML in HIV patients, it underscores the importance of assessment of the neurological symptoms in high-risk individuals. As PML carries high mortality risk it necessitates prompt diagnosis and treatment with antiretroviral drugs to slow the disease progression.