Background: Anti-CD38 monoclonal antibodies (mAbs) have significantly changed the multiple myeloma treatment landscape. This meta-analysis compared the efficacy and safety of anti-CD38 mAb-based therapy versus standard therapy in newly diagnosed multiple myeloma (NDMM) patients. Methods: We performed a comprehensive literature search on PubMed, the Cochrane Database, and ClinicalTrials.gov. The primary outcomes were progression-free survival (PFS) and minimal residual disease (MRD) status. Dichotomous outcomes were pooled using risk ratio (RR) along with the 95% confidence interval (CI) in RevMan 5.4. Subgroup analysis and meta-regression analysis were performed. The RoB 2.0 tool was used to assess the risk of bias. Results: Our meta-analysis included 11 randomized controlled trials. There were 5270 patients; 3040 TEs and 2230 TIEs. Anti-CD38 mAbs significantly improved MRD negativity (RR 1.94, 95% CI: 1.59–2.37; p < 0.00001) and PFS (RR 0.51, 95% CI: 0.45–0.58; p < 0.00001). Subgroup analyses revealed better outcomes for both the TE (MRD: RR 1.52, 95% CI: 1.37–1.68; PFS: RR 0.43, 95% CI: 0.34–0.54) and TIE (MRD: RR 3.49, 95% CI: 2.65–4.61; PFS: RR 0.55, 95% CI: 0.47–0.64) populations. Meta-regression revealed that Eastern Cooperative Oncology Group (ECOG) score 0 significantly influenced MRD status (β = −0.015, p < 0.05), whereas ECOG scores 1 and 2 lacked statistical significance. Subgroup analysis revealed that PFS was significantly different between standard (RR 0.47) and high (RR 0.81) cytogenetic risk groups. Conclusion: In NDMM patients, anti-CD38 mAb-based therapy significantly improved MRD status, and PFS compared with standard therapy alone, in both TE and TIE patients, suggesting a favorable benefit–risk profile.

Transcatheter aortic valve replacement (TAVR) is widely used to treat severe aortic stenosis; however, periprocedural stroke remains a significant concern. This systematic review and meta‐analysis evaluate whether the use of cerebral embolic protection devices (CEPDs) during TAVR reduces the risk of stroke and other complications. To conduct a network meta‐analysis of relevant trials to assess the efficacy of CEPDs currently used in TAVR. PubMed, Embase, and Scopus were systematically searched through April 2025 to identify studies comparing TAVR performed with and without CEPDs. Primary outcomes included stroke, all‐cause mortality, major bleeding, and major vascular complications. Data were analyzed using RevMan (Version 5.4.1). A random‐effects model was used for all analyses, applying the Mantel−Haenszel method for dichotomous outcomes, reported as risk ratios with 95% confidence intervals. Funnel plots were used to assess publication bias. Twenty‐four studies (9 randomized controlled trials and 15 observational studies), including a total of 437,487 patients (59,274 with CEPD and 384,213 without), were included in the analysis. The mean patient age was 80 years, and 46.4% were female. Compared to patients undergoing TAVR without protection, those receiving CEPDs had significantly lower risks of stroke (RR = 0.70; 95% CI: 0.60–0.82; p < 0.0001), all‐cause mortality (RR = 0.69; 95% CI: 0.50–0.93; p  = 0.02), disabling stroke (RR = 0.44; 95% CI: 0.26–0.75; p = 0.003), acute kidney injury (RR = 0.84; 95% CI: 0.79–0.89; p < 0.00001), and 30‐day readmission (RR = 0.75; 95% CI: 0.60–0.95; p = 0.02). A reduction in major bleeding was also observed (RR = 0.83; 95% CI: 0.59–1.17), although this did not reach statistical significance ( p = 0.29). No significant differences were found between groups in terms of major vascular complications, transient ischemic attack (TIA), new pacemaker implantation, or delirium. The use of CEPDs during TAVR is associated with reduced risks of stroke, disabling stroke, acute kidney injury, and 30‐day readmission. However, discrepancies between randomized and observational studies warrant cautious interpretation. Further research is needed to clarify the benefits and evaluate the cost‐effectiveness of CEPD implementation in routine clinical practice.

Background: Endovascular thrombectomy (EVT) improves functional outcomes at 90 days in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, its long-term efficacy and safety beyond 90 days remain unclear. Objective: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EVT plus best medical treatment (BMT) versus BMT alone beyond 90 days in patients with AIS and LVO. Methods: PubMed, Embase, and Cochrane Central databases were searched to identify randomized controlled trials (RCTs) comparing EVT plus BMT versus BMT alone in AIS patients with LVO. Primary outcomes included functional independence (mRS ≤2), independent ambulation (mRS ≤3), death or dependency (mRS 4–6), and all-cause mortality beyond 90 days. We applied a random-effects model and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) using the Cochrane RoB2 tool for assessing risk of bias in randomized trials. Results: Seven RCTs with 2358 patients (56% males) were included. The mean age of the patients was 69.5 years and mean follow-up duration was 1.2 years. The results showed that EVT combined with BMT improved functional independence (mRS ≤2) (RR 2.08, CI: 1.55–2.80; P < 0.00001), independent ambulation (mRS ≤3) (RR 1.71, CI: 1.36–2.15; P < 0.00001), and quality of life (SMD 0.36; CI: 0.19–0.54; P < 0.00001) beyond 90 days compared to BMT alone. Moreover, the EVT plus BMT group also had a significantly reduced death or dependency (mRS 4–6) (RR 0.78, CI: 0.73–0.84; P < 0.00001) and all-cause mortality (RR 0.83, CI: 0.76–0.90; P < 0.0001) beyond 90 days than the BMT group. All RCTs were rated as having a low risk of bias. Conclusion: EVT combined with BMT significantly improves long-term functional outcomes and quality of life and reduces mortality in AIS patients with LVO compared to BMT alone.

Background & objective: It’s no secret that medical students have access to a plethora of medical literature, which can make it challenging to determine the right sources and how to cover them effectively using various study habits and strategies. Our objective was to determine the association of study habits (time and location), study duration, study strategies, and study sources with academic performance. Methods: It was a cross-sectional study conducted in six Medical Colleges in Peshawar, Pakistan between 13th April 2023 to 13th Jun 2023. Total 138 students were selected for the study. A well-structured questionnaire was used for data collection. Participants were from both genders and in both public and private sector medical colleges. First-year students and students from medical colleges outside of Peshawar were excluded from the study. SPSS (Version 20.0) was used for data analysis. Results: The study revealed that daily study hours (during normal days), residence status, library study, morning study timings, active recall, MCQS solving, and watching online videos made a significant association with academic performance (P < 0.05). Pearson’s correlation showed a positive and statistically significant association between daily study hours (during normal days), study strategies, and academic performance (p < 0.05). The multiple regression model explained 30.5% of the variance in academic performance. Conclusion: This study established a noteworthy link between academic performance and various factors, including daily study hours, strategies, and specific study sources. Notably, morning study sessions, active recall, MCQs-based strategies, and online video resources showed significant associations with enhanced academic performance. doi: https://doi.org/10.12669/pjms.40.11.9502 How to cite this: Osama M, Saeed A, Raza ul Haq M, Baseer MA. Academic excellence: A comprehensive investigation of medical students′ study habits, strategies, and sources in medical colleges of Peshawar, Pakistan. Pak J Med Sci. 2024;40(11):2594-2599. doi: https://doi.org/10.12669/pjms.40.11.9502 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Portal vein thrombosis (PVT) contributes substantially to morbidity and mortality in cirrhotic patients. A clear insight into the anticoagulation therapy benefits in these patients could improve clinical decision‐making. This meta‐analysis aimed to assess the efficacy and safety of Anticoagulants in cirrhotic patients with PVT.Methods: PubMed, Cochrane Library, and ScienceDirect were searched from inception to September 2024. The Risk Ratios (RR) with 95% Confidence Interval (CI) were pooled for dichotomous outcomes under the random effects model using Review Manager 5.4.1. The primary endpoint of interest is PVT recanalization. Quality assessment was done through the Newcastle Ottawa Scale and the Cochrane RoB2.0 tool. Leave‐one‐out sensitivity analysis was done to investigate the cause of heterogeneity. Publication bias was assessed through funnel plots.Results: Twenty‐three studies (including 19 cohorts and 4 Randomized trials), pooling 81,599 patients, were included in the analysis. Anticoagulants significantly increased the PVT recanalization (RR = 2.00; 95% CI: [1.59, 2.52]; p < 0.00001; I² = 13%), PVT improvement (RR = 1.98; 95% CI: [1.70, 2.29], p < 0.00001; I² = 0%) while decreasing the PVT stability (RR = 0.78; 95% CI: [0.62,0.99], p = 0.04; I² = 19%) and PVT progression (RR = 0.42; 95% CI: [0.29, 0.60], p < 0.00001; I² = 27%). Other outcomes including mortality (RR = 0.53; 95% CI: [0.27, 1.03]; p = 0.06; I² = 94%), total bleeding (RR = 1.02; 95% CI: [0.76, 1.37], p = 0.89; I² = 31%), esophageal variceal bleeding (RR = 0.74; 95% CI: [0.54, 1.01], p = 0.06; I² = 56%), Gastrointestinal bleeding (RR = 1.07; 95% CI: [0.78, 1.48]; p = 0.66, I² = 13%) and Intracranial hemorrhage (RR = 1.19; 95% CI: [0.89, 1.58], p = 0.24, I² = 0%) were comparable between the 2 arms.Conclusion: Anticoagulants significantly increased PVT recanalization and PVT improvement while decreasing PVT stability and PVT progression in cirrhotic patients. Other outcomes were comparable between the two groups.