The use of Edaravone, given orally, for the treatment of amyotrophic lateral sclerosis (ALS) was officially approved by the Federal Drug Association (FDA) in 2017. ALS is a rare and progressive degenerative disease that worsens over time. It attacks and destroys the nerve cells that control voluntary muscles, thus leading to weakness, eventual paralysis, and, ultimately death. Edaravone was given initially intravenously, but recent evidence shows better results with oral suspension. This narrative review is aimed to investigate the benefit of Edaravone for the management of ALS, compare it to Riluzole, discuss its mechanism of action, route of use, and side effects, and ultimately discuss future implications of this pharmacotherapy.

Background: Traditionally, X-rays have remained the standard modality for bone fracture diagnosis. However, other diagnostic modalities most notably ultrasound have emerged as a simple, radiation-safe, effective imaging tool to diagnose bone fractures. Despite the advantages, there is a prevalent scarcity of literature recognizing its significance in bone trauma management. This review investigates the effectiveness of ultrasound in the diagnosis of various bone fractures when compared to conventional radiography such as X-rays. Methodology: Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science (WOS) were reviewed for observational studies and review articles from the years 2017–2022 utilizing MESH terminology in a broad term search strategy. The search returned a total of 248 articles. After removal of duplicates, abstract, and full-text screening this systematic review ultimately utilized data from 31 articles. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology and were conducted during August 2022. In accordance with the guidelines for assessing the quality of included systematic reviews, we used the AMSTAR 2020, Supplemental Digital Content 2, http://links.lww.com/MS9/A241 (A Measurement Tool to Assess Systematic Reviews) tool to evaluate the methodological quality of the included studies. A data extraction form based on the Cochrane Consumers and Communication Review group’s extraction template for quality assessment and evidence synthesis was used for data extraction. The information extracted included details such as author information, database, journal details, type of study, etc. Studies included will be classified into long bones, short bones, pneumatic bones, irregular bones, ankle and knee, stress fractures, hip fractures, POCUS, and others. All included studies considered bias and ethical criteria and provided valuable evidence to answer the research question. Results: The search returned a total of 248 articles, with 192 articles remaining after the removal of duplicates. Primary screening of the title and abstract articles from the database search and additional sources identified 68 relevant articles for full-text screening. This systematic review ultimately used data from 33 articles of the remaining articles we included all of them because they had more than 70% certainty, using the STROBE tool for observational articles, narrative reviews with the ENTREQ guide, and systematic reviews and meta-analyses with the PRISMA guide; however, two articles were excluded at the eligibility stage because of risk of bias. Conclusion: This systematic review provides insightful evidence on safety and effectiveness of ultrasound in diagnosing fractures when compared to the conventional imaging modalities such as X-rays. This shall promote further large-scale, multi-centre research that can eventually guide clinic practice in diagnosing and managing various bone fractures.

Background: Lung cancer (LC) and pneumonia remain leading causes of mortality in the United States, with particularly severe impacts on vulnerable populations. While LC continues to be the deadliest cancer, pneumonia poses a critical threat to immunocompromised individuals, especially those with LC. This study examines 24-year trends in LC and pneumonia-related deaths, analyzing disparities across demographic groups and geographic regions to inform targeted public health strategies. Methods: We analyzed mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (1999-2023), calculating age-adjusted mortality rates (AAMRs) per 100 000 population. The study population included adults aged 25 + with LC and pneumonia listed as underlying or contributing causes of death. Joinpoint regression identified significant trends in mortality rates, stratified by sex, race/ethnicity, urbanization level, and US census region. Results: The analysis revealed a 51% decline in LC and pneumonia-related mortality over 24 years, with AAMRs dropping from 53.1 to 25.9 deaths per 100 000. The most dramatic improvement occurred between 2006 and 2009, when mortality rates fell by nearly 10% annually – likely reflecting advances in targeted cancer therapies, expanded screening programs, and stronger vaccination efforts. Despite overall progress, significant disparities persisted. Men died at twice the rate of women throughout the study period, with 2023 AAMRs of 32.6 for males versus 20.1 for females. Racial gaps remained troubling, as Black Americans consistently faced the highest mortality rates (65.7 in 1999 vs 30.7 in 2023), while Asian/Pacific Islanders saw an unexpected 10% mortality increase post-2021. Geographically, rural areas had 31% higher death rates than urban centers, and Southern states carried the heaviest burden across all regions. Conclusions: While national mortality trends show encouraging declines – particularly after 2006 – persistent disparities by sex, race, and geography highlight unmet public health needs. The findings call for tailored interventions addressing higher-risk groups, including enhanced screening in rural areas, culturally competent care for racial/ethnic minorities, and continued smoking cessation support. Sustained progress will require equitable access to emerging treatments and preventive services across all communities.

Background The global incidence and prevalence of chronic kidney disease (CKD) is skyrocketing. In Asia, the prevalence of CKD varies from 10%-18%. However, as Asia is largely populated by developing countries with nascent health care systems, there is a dearth of research and data. It is estimated that a large number of cases go unreported. As a result, the exact disease burden remains unclear. The knowledge about risk factors and their proportionate role in CKD is indispensable in regards to patient management and care. Objective The early recognition of the most important risk factors for end-stage renal disease (ESRD) is key to early diagnosis, successful treatment, and general heightened awareness regarding CKD. In developing countries, the provision of medical services, in general, and nephrological services, in particular, is wholly inadequate. The insufficiency of solid and regularly updated data compounds the problem. This research study aims to partake in catering to that need. Methodology A structured questionnaire was used to obtain quantitative and categorical data from 119 ESRD patients in the nephrology ward, Allied Hospital, Faisalabad through non-probability sampling. Socio-demographic profile of the patients and information regarding the presence or absence of risk factors were collected. The resulting dataset was analyzed using R version 3.6.3 (R Foundation for Statistical Computing, Vienna, Austria) for data visualization and descriptive analysis. Results The most common age group for ESRD presentation was 46-60 years (52.1%). Among the 119 ESRD patients, the most frequent risk factor was hypertension with 85.7% of the patients presenting with the condition, followed by diabetes mellitus (DM) in 54.6%, renal calculi in 28.6%, glomerulonephritis (GN) in 31.1%, Family history of CKD in 24.4%, and polycystic kidney disease (PKD) in 5% of the patients. Gender-wise distribution of the patients shows that the proportion of patients with hypertension, renal calculi, and family history of CKD varied very little among the two groups. Conclusion In conclusion, our study has reinforced the existing body of knowledge and brought some fresh evidence regarding the prevalence of risk factors in ESRD to light. Hypertension and DM, together, represent the vast majority of cases with ESRD. However, hypertension far outpaces DM as the leading risk factor. Nephrolithiasis was also present in a considerable minority, with a figure much higher than previously reported. Finally, a relatively younger age group (45-60 years) formed the majority of the ESRD patients which is a concerning development. It points to early progression of CKD to ESRD. Long-term adequate control of these risk factors limits disease progression.

Background: Pneumonia is the most common respiratory tract infection among patients with diabetes, affecting individuals across all age groups and sexes. Objective: This study aims to examine demographic trends in mortality among patients diagnosed with both diabetes mellitus (DM) and pneumonia. Methods: Deidentified death certificate data for DM- and pneumonia-related deaths in adults aged 25 years and older from 1999 to 2022 were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. The Joinpoint Regression Program was used to evaluate annual percentage changes (APCs) in mortality trends, with statistical significance set at P<.05. This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting. Results: Between 1999 and 2022, a total of 425,777 deaths were recorded from DM and pneumonia. The overall AAMR declined significantly (P=.001) from 98.73 in 1999 to 49.17 in 2016 (APC –4.68), and then surged to 97.66 by 2022 (APC 23.55). Men consistently experienced higher mortality than women throughout the study period. Male AAMR rose from 62.61 in 2016 to 127.05 in 2022 (APC 24.88), while female AAMR increased from 41.05 in 2017 to 75.25 in 2022 (APC 27.60). Race-based analysis demonstrated that American Indian or Alaska Native populations had the highest mortality rates among racial groups. Non-Hispanic White individuals exhibited a significant decline in AAMR (P=.002) from 89.76 in 1999 to 44.19 in 2017 (APC −4.58), followed by an increase to 83.11 by 2022 (APC 25.25). Adults aged 65 years or older bore the highest mortality burden, with rates declining steadily to 206.9 in 2017 (APC –5.15) before rising sharply to 371.3 in 2022 (APC 20.01). Nonmetropolitan areas consistently exhibited higher mortality than metropolitan areas, with particularly steep increases after 2018 (APC 64.42). Type-specific mortality revealed that type 1 DM AAMRs declined from 9.2 in 1999 to 1.4 in 2015 (APC –11.94) before rising again. By contrast, type 2 DM AAMRs surged drastically after 2017, peaking at 62.2 in 2020 (APC 58.74) before partially declining to 41.6 by 2022. Conclusions: DM is associated with an increased risk of mortality following pneumonia, particularly among men, older adults, and American Indian populations. Strengthening health care interventions and policies is essential to curb the rising mortality trend in these at-risk groups.

Paroxysmal nocturnal hemoglobinuria can rarely present as cerebral ischemia and stroke due to arterial thrombosis. However, it should be considered in a young patient with bone marrow failure features, systemic thromboses, and hemolysis. The variants of paroxysmal nocturnal hemoglobinuria pose a diagnostic challenge and hence are important to recognize. We report a case of a 28-years-old female with Herlyn Werner Wunderlich Syndrome who presented with an ischemic cerebrovascular accident, pancytopenia, hemoglobinuria, and widespread abdominal thromboses suggestive of paroxysmal nocturnal hemoglobinuria. The patient was managed symptomatically and referred toa hematologist.