Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques. We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention. Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients' baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88-9.29; I² = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30-0.59; I² = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39-0.05; I² = 41%; I² = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02-0.94; I² = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in "bias due to deviations from intended interventions" (8,9). Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group. According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in Supplementary Table 1.

Early Warning Score systems (EWSs) based on bedside physiological parameters are widely implemented in high-income countries, yet their performance and utility in low- and middle-income countries (LMICs) remain uncertain, particularly in emergency and acute care settings, due to limited evidence and health system constraints. We systematically reviewed the effectiveness of EWSs for predicting in-hospital mortality and adverse events among adult general-ward patients in LMICs. This systematic review followed PRISMA 2020 and PRISMA-S guidance and was prospectively registered in PROSPERO (CRD420251029273). We searched PubMed, Scopus, LILACS and African Journals Online (AJOL) from inception to May 2025, with no language restrictions. We included studies enrolling adult general-ward patients in LMICs, and excluded studies conducted solely in intensive care units, emergency departments, paediatric or obstetric populations. Data were narratively synthesised, and risk of bias was assessed using PROBAST. Twenty-eight observational studies comprising a total of 36,638 participants — primarily from sub-Saharan Africa and South Asia — met inclusion criteria. The Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) were most frequently assessed and generally demonstrated moderate-to-good discrimination for in-hospital mortality, with substantial heterogeneity by setting. The Universal Vital Assessment (UVA) showed promising discrimination relative to MEWS and qSOFA in some resource-limited contexts, however its dependence on HIV testing and laboratory support limits comparability with purely bedside scores. Only a minority of studies examined unplanned ICU admission, cardiac arrest or rapid-response activation. Limitations included substantial heterogeneity in methodology, outcomes, cut-off values and follow-up periods, which limited comparability, as well as the absence of studies originating from Central and South America. Evidence in LMIC wards is largely observational and frequently based on statistical simulations with small samples; it should not be interpreted as proof of clinical effectiveness. Before widespread adoption, rigorous local validation and recalibration, along with multicentre, pragmatic implementation studies, are needed to define thresholds, workflows and escalation pathways appropriate to LMIC health-system capacity.

Several clinical trials have demonstrated the non-inferiority of transcatheter aortic valve replacement compared with surgical aortic valve replacement in patients with severe aortic stenosis and low to intermediate surgical risk. However, mid-term results are still contentious. We performed this meta-analysis to compare the safety and efficacy of transcatheter vs. surgical aortic valve replacement in the mid-term in patients with aortic stenosis at low to moderate surgical risk. We searched Embase, PubMed®, and Cochrane databases for randomized clinical trials that compared transcatheter with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis with a follow-up of at least four years. Outcomes of interest were all-cause mortality and disabling stroke. We included six randomized clinical trials encompassing 6,444 patients with severe aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic valve replacement. There was no difference in all-cause mortality (risk ratio [RR] 1.08; 95% confidence interval [CI] 0.94 - 1.25; P = 0.30) and disabling stroke (RR 0.95; 95% CI 0.75 - 1.21; P = 0.67) between groups. In the subgroup analysis, five-year mortality (RR 1.28; 95% CI 1.10 - 1.49) was higher in the transcatheter group. The new pacemaker implantation (RR 2.22; 95% CI 1.42 - 3.45) rate was higher in the transcatheter group. However, the new atrial fibrillation (RR 0.40; 95% CI 0.31 - 0.52) rate was higher in the surgical group. Mid-term mortality and disabling stroke rates in patients with severe aortic stenosis treated with either transcatheter or surgical aortic valve replacement were similar.

Background/Objectives: Neuropathic and chronic centralized pain disorders remain difficult to treat because they involve central sensitization, maladaptive neuroplasticity, neuroimmune activation, affective amplification, and large-scale network dysfunction. Psilocybin, a serotonergic psychedelic acting primarily through 5-HT2A receptor agonism, has emerged as a candidate modulator of chronic pain states; however, clinical evidence remains preliminary. This review synthesizes preclinical, clinical, and mechanistic literature on psilocybin in chronic neuropathic and centralized pain, emphasizing biological plausibility, translational gaps, and future trial design. Methods: PubMed/MEDLINE, Google Scholar, bioRxiv, medRxiv, and targeted journal searches were reviewed through February 2026 and supplemented by reference screening. Thirty-seven peer-reviewed evidence sources were retained for mechanistic synthesis, and ClinicalTrials.gov records were reviewed separately to contextualize the registered clinical-trial landscape. Evidence was synthesized narratively because heterogeneity in study design, pain models, interventions, outcomes, and follow-up precluded meta-analysis. Results: Several preclinical studies reported psilocybin-associated reductions in allodynia, hypersensitivity, formalin-induced nociception, or pain-related affective behaviors in selected rodent models, with some effects linked to 5-HT2A signaling. However, findings were not uniform, and one rigorous null study found no immediate or persistent analgesic effect across multiple models. Human evidence remains limited and is primarily derived from one small open-label fibromyalgia pilot trial, case reports or case series, and survey studies, and has been summarized in recent systematic and narrative reviews. Collectively, these data remain insufficient to establish clinical efficacy. Four putative mechanistic domains were identified: descending serotonergic modulation, 5-HT2A- and TrkB/BDNF-related neuroplasticity, neuroimmune/microglial modulation, and affective-salience/default mode network reorganization. Conclusions: Psilocybin should not currently be regarded as an established analgesic. Available evidence supports a biologically plausible but clinically unproven model requiring phenotype-specific randomized trials with active controls, biomarkers, and long-term follow-up.