Background/Objectives: Bariatric surgery improves weight and metabolic health in individuals with severe obesity; however, challenges like gut dysbiosis and nutrient deficiencies persist postoperatively. Probiotic supplementation may enhance recovery by modulating gut microbiota. This updated meta-analysis aimed to assess the effects of probiotics/synbiotics on metabolic, anthropometric, and nutritional outcomes after bariatric surgery. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, SCOPUS, Web of Science, and CENTRAL through December 2024. Studies comparing probiotics/synbiotics (which contain both probiotics and prebiotics) versus a placebo in adults post-bariatric surgery were included. Meta-analyses were conducted, with subgroup analyses by surgery type, the timing of the intervention, and probiotic formulation (PROSPERO ID: CRD420251019199). Results: Thirteen RCTs involving 809 patients were included in the analysis. Probiotic use significantly reduced BMI (MD = 0.67, 95% CI: 0.33 to 1.00), HbA1c (MD = −0.19%, 95% CI: −0.36 to −0.01), triglycerides (MD = −16.56 mg/dL), and AST levels (MD = −3.68 U/L), while increasing ALP (MD = 8.12 U/L) and vitamin D (MD = 13.68 pg/mL). Ferritin levels were significantly lower (MD = −18.89 µg/L) in the probiotic group. A subgroup analysis showed enhanced benefits in patients undergoing mini-gastric bypass, with perioperative or synbiotic interventions specifically improving triglycerides, total cholesterol, and HbA1c. Conclusions: Probiotics may offer modest but significant improvements in BMI, glycemic control, lipid profile, liver enzymes, and vitamin D levels after bariatric surgery. These findings support the potential role of probiotics/synbiotics as an adjunct therapy, though further large-scale trials are warranted to confirm long-term benefits.

Respiratory syncytial virus (RSV) is recognized as the leading cause of lower respiratory tract infections (LRTI) and a major contributor to newborn hospitalizations. Recent clinical trials have demonstrated the effectiveness of nirsevimab in preventing RSV infections among infants. This meta-analysis evaluated the efficacy and safety of nirsevimab in healthy infants born at varying gestational ages during their first RSV season. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched electronic databases—PubMed, SCOPUS, Cochrane Library, and Web of Science—to identify relevant studies published up to March 2025. We included three studies with 11,001 participants. Nirsevimab was significantly associated with decreased hospitalization for LRTI due to RSV (risk ratio [RR]: 0.21; 95% confidence interval [CI] 0.13, 0.33; P = 0.00001), hospitalization for respiratory illness due to any cause (RR: 0.46; 95% CI 0.36, 0.59; P = 0.00001), and medically attended RSV-associated LRTI (RR: 0.25; 95% CI 0.18, 0.36; P = 0.00001) compared to placebo. Comparable results were found in composite safety outcomes and adverse events; however, nirsevimab significantly reduced the incidence of bronchiolitis (RR: 0.70; 95% CI 0.56, 0.88; P = 0.002). Nirsevimab shows promise in preventing RSV infections and hospitalizations, warranting further study on its practicality and cost-effectiveness.

Introduction: Concerns about diabetic ketoacidosis (DKA) and euglycemic ketoacidosis (eKA) are balanced against possible organ‐protective benefits in the debated perioperative management of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors. This meta‐analysis compared the perioperative clinical and laboratory outcomes associated with perioperative exposure to SGLT2i. Methods: Through July 31, 2025, we searched PubMed, Web of Science, Scopus, and CENTRAL for observational studies and randomised controlled trials comparing the outcomes of preoperative use of SGLT2 inhibitors with non‐use in patients undergoing cardiac or non‐cardiac surgery. We pooled data using a random‐effects model and investigated heterogeneity using leave‐one‐out sensitivity analyses. PROSPERO‐ID: CRD420251155809. Results: There were 10 studies comprising 246,242 patients. Due to considerable heterogeneity, the primary pooled analysis revealed no significant association between SGLT2 inhibitor use and either eKA (OR 4.86; p = 0.11) or DKA (OR 2.21; p = 0.11). However, a significant increase in the risk of eKA (OR 1.11; p < 0.001) and DKA (OR 5.33; p < 0.001) was observed using leave‐one‐out sensitivity analysis to identify outliers. On the other hand, the usage of SGLT2 inhibitors was associated with a statistically significant decrease in both mortality (OR 0.73; p = 0.006) and acute renal injury (OR 0.68; p < 0.0001). The SGLT2 inhibitor group had significantly lower perioperative pH, base excess, and blood glucose levels. Conclusion: The use of perioperative SGLT2 inhibitors poses a clinical paradox between significant renoprotection and survival advantages and a latent risk of ketoacidosis concealed by considerable heterogeneity. While metabolic monitoring is essential, current surgeries requiring more prolonged withholding may need to weigh metabolic risk against the drug's significant benefit in reducing acute kidney injury and mortality.

High blood pressure (BP) is common in acute stroke and a predictor of poor outcomes. Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. We aimed to assess whether patients with presumed acute stroke benefit from pre-hospital BP lowering. We conducted a comprehensive systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches until June 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). CRD42024560200. Our analysis included five RCTs encompassing 3,933 patients. There was no difference between early BP control and usual care regarding National Institutes of Health Stroke Scale (NIHSS) after 24 hours (MD: 0.65 with 95% CI [0.01, 1.29], P = 0.05), excellent neurological recovery (Modified Rankin Score (mRS) 0-1) (RR: 1.00 with 95% CI [0.91, 1.11], P= 0.98), functional independence (mRS 0-2) (RR: 1.04 with 95% CI [0.96, 1.13], P= 0.30), and independent Ambulation (mRS 0-3) (RR: 1.01 with 95% CI [0.95, 1.06], P= 0.84). Also, there was no difference between both groups in poor neurological recovery (mRS 4-6) (RR: 0.98 with 95% CI [0.91, 1.07], P= 0.68), all-cause mortality (RR: 1.02 with 95% CI [0.90, 1.15], P= 0.79), and any serious adverse events (RR: 1.04 with 95% CI [0.95, 1.15], P= 0.40). However, early BP control significantly increased the incidence of hypotension (RR: 2.24 with 95% CI [1.14, 4.38], P= 0.02) and headache (RR: 1.51 with 95% CI [1.01, 2.26], P= 0.04). In patients with presumed hyperacute stroke and elevated blood pressure, the rapid initiation of blood pressure reduction in the ambulance very early after symptom onset had no significant benefit regarding functional outcomes in patients with undifferentiated stroke but with an increased incidence of hypotension and headaches.