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.

Arterial thrombosis emerges from the interplay between plaque disruption, platelet activation, and coagulation pathway amplification on a background of heterogeneous ischemic and bleeding risk. Optimal antithrombotic therapy therefore varies across clinical settings, from acute coronary syndromes (ACS) to chronic coronary syndromes (CCS), ischemic stroke, peripheral artery disease (PAD), and atrial fibrillation (AF) associated with atherosclerotic disease. Contemporary European and North American guidelines endorse an increasingly individualized approach, moving away from rigid “one-size-fits-all” dual antiplatelet therapy (DAPT) duration and intensity and incorporating dual pathway inhibition with low-dose rivaroxaban plus aspirin in selected high-risk CCS and PAD patients. In ischemic stroke, short-course DAPT is confined to minor events and transient ischemic attacks, whereas long-term monotherapy remains standard, and the coexistence of AF typically shifts the balance toward oral anticoagulation. Across all scenarios, antithrombotic benefit must be weighed against bleeding, especially in elderly, frail, or comorbid patients. Evidence gaps remain substantial, particularly in patients with overlapping vascular territories, AF plus atherosclerotic disease, and after ischemic stroke of complex or mixed mechanisms. This narrative review summarizes current evidence and guideline-based strategies in major atherosclerotic settings, proposes a unifying conceptual framework, and highlights key uncertainties and research directions for truly personalized antithrombotic care.

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.

Respiratory Syncytial Virus (RSV) causes over 50,000 hospitalizations annually among children under five years of age, leading to long-term consequences, such as asthma. Monoclonal antibodies (mAb) have been recommended for prevention, but their limitations have prompted the search for alternative preventive measures. The recent Food and Drug Administration (FDA) approval of a maternal RSV vaccine with 80% efficacy in protecting infants up to 90 days post-birth marks a significant advancement. Our narrative review investigates the differences in RSV immunization in pregnant mothers versus infants and children, with the goal of identifying factors that influence parental decisions. This study provides insights for optimising preventive strategies, and the results highlight the importance of maternal vaccination in combating RSV in children.