Background and Aims: Cardiac surgeries often lead to postoperative complications, which affect recovery and increase morbidity and mortality. This systematic review aims to assess L-carnitine’s effect on preventing postoperative complications across various cardiac surgeries, addressing gaps in current literature on its potential therapeutic benefits. Methods: We systematically searched Web of Science, Cochrane, Embase, PubMed, and Scopus databases until March 2025. Statistical analysis was performed using R version 4.3.2. Effect sizes were measured with relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, while heterogeneity was evaluated using the I² statistic. Results: Thirteen randomised controlled trials(RCTs) with 786 patients were included. L-carnitine significantly increased the cardiac index (CI) (MD: 0.14; 95% CI: 0.07, 0.20; P < 0.01) and left ventricular stroke work index (LVSWI) (MD: 0.42; 95% CI: 0.06, 0.78; P = 0.02). In addition, L-carnitine significantly improved the left ventricular ejection fraction (LVEF) (MD: 7.88; 95% CI: 6.67, 9.09; P < 0.01), with a significant reduction in postoperative atrial fibrillation (POAF) (RR: 0.53; 95% CI: 0.30, 0.95; P = 0.03). In contrast, there was no significant reduction in in-hospital mortality (RR: 0.51; 95% CI: 0.10, 2.63; P = 1.00) and stroke incidence (RR: 0.85; 95% CI: 0.12, 5.76; P = 0.82). Conclusion: Preoperative administration of L-carnitine demonstrates meaningful short-term benefits in enhancing CI, LVSWI, and LVEF while reducing the incidence of POAF following cardiac surgery. These findings suggest a potential role for L-carnitine supplementation in optimising perioperative cardiac care, enhancing recovery, and reducing complications following cardiac surgery. However, the existing studies are limited in scope, making it challenging to draw robust conclusions.

Background: Resistant hypertension represents a significant clinical challenge, often driven by dysregulated aldosterone production. Aldosterone synthase inhibitors (ASIs) are a novel therapeutic class designed to directly suppress aldosterone biosynthesis. This study aimed to synthesize evidence regarding the comparative efficacy, optimal dosing, and dose–response relationships of three ASIs—baxdrostat, lorundrostat, and osilodrostat—for the treatment of resistant hypertension. Methods: A systematic review and network meta-analysis (NMA) were conducted following PRISMA 2020 guidelines. We searched PubMed, Web of Science, and CENTRAL for randomized controlled trials (RCTs) published up to 31 October 2025. The primary outcome was the mean change in systolic blood pressure (SBP) compared to placebo. We utilized a frequentist random-effects model, characterized dose–response relationships via meta-regression, and ranked treatments using the Surface Under the Cumulative Ranking Curve (SUCRA). Results: The analysis included 8 RCTs comprising 3253 participants. Baxdrostat 2 mg once daily demonstrated the greatest antihypertensive efficacy with a mean SBP reduction of −13.8 mmHg (95% CI: −17.5 to −10.1) versus placebo, followed by Lorundrostat 100 mg (−12.5 mmHg) and Baxdrostat 1 mg (−11.5 mmHg). SUCRA analysis identified Baxdrostat as the highest-ranked treatment (83.0%), followed by Lorundrostat (67.8%) and Osilodrostat (55.5%). Dose–response meta-regression revealed strong linear correlations for Baxdrostat (R² = 0.91), Osilodrostat (R² = 0.81), and Lorundrostat (R² = 0.80). Conclusions: ASIs, particularly Baxdrostat and Lorundrostat, offer robust blood pressure reductions in patients with resistant hypertension. The strong linear dose–response relationships suggest these agents have a favorable therapeutic window for titration. While effective, clinical implementation requires careful monitoring for adverse events.

Purpose: To compare the efficacy and safety of the Paul Glaucoma Implant (PGI) with those of the two established glaucoma drainage devices, the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI). Methods: PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, ScienceDirect and Google Scholar were searched. Eligible studies were randomised or comparative observational studies reporting outcomes in patients who received the PGI alongside a concurrent AGV or BGI comparator. The primary outcomes were intraocular pressure (IOP) reduction, surgical success rate, and reduction in glaucoma medications. A Bayesian network meta-analysis was performed, with treatment ranking summarized by surface under the cumulative ranking curve (SUCRA). Quality assessment and evidence certainty was performed using the Cochrane Risk of Bias tool and GRADE framework respectively. Results: Five comparative studies (238 patients) were included. Relative to the AGV, the PGI was associated with a mean difference in IOP at 12 months of -3.344 (95% CrI − 7.743 to 1.058) mmHg, and relative to the BGI of 4.387 (95% CrI − 0.288 to 9.074) mmHg. Corresponding differences in medication number at 12 months were]− 0.186 (95% CrI − 0.858 to 0.545) and 0.444 (95% CrI − 0.358 to 1.272). Credible intervals crossed the null for 29 of the 30 primary contrasts. Ranking probabilities favoured the AGV for IOP reduction from 3 to 12 months (SUCRA 0.885 to 0.976) and the PGI for early medication reduction (SUCRA 0.769 at 1 month), but these rankings were derived from imprecise estimates. Safety estimates were based on small numbers of events and several were unstable. Certainty of evidence was low to very low for most comparisons. Conclusion: Within the limits of a small and predominantly non-randomised evidence base, the PGI achieved intraocular pressure and medication reduction broadly comparable to those of the AGV and BGI over the first postoperative year, with a distinct complication profile. The rankings reported here are hypothesis-generating and should not by themselves determine device selection. Adequately large randomised comparisons with follow-up beyond one year are required.

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