Background/Objectives: Azathioprine (AZA) is widely used for maintaining remission in inflammatory bowel disease (IBD), but the implications of its withdrawal remain unclear. This study evaluates relapse rates after AZA discontinuation in adult IBD patients in remission and identifies predictors of relapse. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251016594). Databases were searched from inception to 4 January 2025, including RCTs and cohort studies involving adult IBD patients who discontinued AZA in clinical remission. The main outcome assessed was relapse incidence, with additional outcomes covering time until relapse, predictors of relapse, and management following relapse. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed. Results: Twenty-two studies comprising 3057 patients were included. The pooled relapse rate after AZA withdrawal was 32.5% (95% CI: 28.2–37.2%; I² = 94.2%). UC patients exhibited higher relapse rates (41.3%) than CD patients (24.7%, p = 0.003). Shorter AZA duration, elevated CRP, and absence of mucosal healing were associated with increased relapse risk. Meta-regression identified AZA duration as a significant predictor (β = −0.18, p = 0.009). Post-relapse management often involved AZA reintroduction or escalation to biologics, with low surgery rates. The GRADE assessment revealed that the certainty of evidence for the majority of primary outcomes was classified as low to very low. Conclusions: While this meta-analysis suggests that relapse after AZA withdrawal occurs frequently in IBD patients, the low to very low certainty of evidence limits definitive recommendations. The significant heterogeneity indicates that relapse risk varies across different patient populations and different settings.

Trauma-induced coagulopathy (TIC) at admission to the emergency department is associated with severe bleeding, massive transfusion, increased morbidity, and mortality. There are significant regional variations in the accessibility and acceptance of point-of-care technology, such as viscoelastic hemostatic testing (VET), for coagulation monitoring and bleeding management in the Arabian Gulf council countries (GCC). Notable regional differences among these countries are mainly due to variation in the awareness of the benefits of VET-guided bleeding management using rotational thromboelastometry (ROTEM) or thromboelastography (TEG), compared with a transfusion ratio-based approach using shock packs, rather than for economic reasons. This review highlights the superiority of VET-guided bleeding management in severe trauma over conventional coagulation tests (CCTs) for early TIC detection and the importance of monitoring hemostatic disorders, whether hypocoagulability or hypercoagulability. VET consistently outperforms traditional coagulation tests in detecting early coagulation abnormalities and predicting massive transfusion and mortality in major trauma. Besides hyperfibrinolysis, fibrinogen deficiency often represents the first issue in TIC. Recent meta-analyses consistently demonstrated a reduction in mortality by implementing VET-guided bleeding management algorithms in severe trauma. Several studies demonstrated that VETs are valuable tools for massive transfusion and mortality prediction in bleeding patients with severe trauma. There is a notable variation in VET adoption and practice across trauma settings in the Arab Gulf. GCC-specific primary evidence is limited, with the Qatar cohort representing the largest directly identified regional study.

Context: Nicotine has been investigated in prior studies for its analgesic effects and its impact on postoperative nausea and vomiting (PONV), yet results have been inconsistent. Objectives: This systematic review and narrative synthesis evaluates the effects of perioperative nicotine administration on postoperative pain control and PONV in patients undergoing general anesthesia. Methods: A systematic literature review was conducted, and findings were summarized narratively. Comprehensive searches were performed in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar for studies published between 2004 and 2023, using a PICO-based approach. The PICO criteria included: Patients undergoing general anesthesia, perioperative nicotine as the intervention, placebo or no nicotine as the comparator, and pain scores as the primary outcome. The Mendeley application was utilized to eliminate duplicate data. Title, abstract, and full-text screenings were independently conducted by all authors using the online review platform Rayyan. Final data were individually extracted into Excel spreadsheets. The risk of bias in the included studies was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Eleven studies encompassing 753 participants (384 receiving nicotine, 369 controls) were included. Of these, 514 were female and 239 were male, all having undergone different surgical procedures and receiving nicotine via various methods and dosage forms. The majority of participants were nonsmokers. Primary outcomes across the studies predominantly involved postoperative pain scores, while secondary outcomes included the incidence of PONV, antiemetic requirements, and opioid consumption. No additional analyses were performed due to heterogeneity among the included studies. Conclusions: Although perioperative nicotine administration demonstrated reductions in postoperative pain, nausea, vomiting, and opioid consumption in some studies, the effect of nicotine on PONV was inconsistent. Variability in patient populations, dosage forms, and dosages complicates the formulation of definitive clinical recommendations. Overall, perioperative nicotine shows promise for improving postoperative pain management, but its impact on PONV requires careful consideration. Nicotine administration has been investigated as an analgesic adjunct and as a strategy for preventing PONV. This systematic review aimed to determine the effect of perioperative nicotine administration on postoperative pain and PONV.