Background. Aducanumab, a new monoclonal antibody that targets β-amyloid aggregates, has been granted conditional approval by the U.S. FDA for treatment of mild Alzheimers disease (AD). The approval of this drug without a confirmed significant clinical impact has resulted in several debates. Objective. In this narrative review, aducanumab approval-related controversy, the drugs pharmacokinetics and pharmacodynamic characteristics, evidence from the efficacy and safety trials of aducanumab, implications of the drug approval, and the future directions in the management of patients with AD are summarized. Methods. Using relevant keywords, Google Scholar, Web of Science, and MEDLINE databases and manufacturers website were searched. Results. Infusion of aducanumab at a higher dose resulted in a modest slowing of cognitive decline among patients with mild cognitive impairment or early-onset AD dementia. The drug however can cause amyloid-related imaging abnormalities. Due to modest impact on cognition, the use of this drug by patients with AD will most likely be limited. The manufacturer is required to run an extended phase IIIb trial to verify the benefit of this drug. Access to therapy requires a careful selection of patients and periodic monitoring to ensure the optimal use of the drug. Conclusion. Despite the limitations, aducanumab is the first disease-modifying therapy approved for the treatment of AD. Aducanumab addresses a part of the pathogenesis of AD; therefore, drugs that can act on multiple targets are needed. In addition, the search for preventive strategies, validated plasma-based assays, and newer drugs for AD, which are effective, safe, convenient, and affordable, is vital.

Upper airway surgery for obstructive sleep apnea (OSA) offers an alternative to CPAP, but its impact on weight changes is poorly studied. To systematically review published literature on the relationship between surgical intervention for OSA and changes in body mass index (BMI). A literature search was conducted from 2013-2024 in five databases. Full-text English articles which examined BMI changes in adults with OSA pre- and post-surgery were included. The quality of each study was assessed independently by two researchers using the Newcastle-Ottawa Scale. This study was reported according to the PRISMA-ScR. Eleven studies, involving 406 patients from six countries were included. Most patients were males (88.4%) with a mean age of 40 years old. The pre-operative BMI were higher [27.8 kg/m² (SD = 2.6)] compared to a BMI of 27.7 kg/m² (SD = 1.3) at 21.0 months post-operation. The pre-operative Epworth Sleepiness Score was 13.28 (SD = 6.36), while the apnea-hypopnea index was 41.2 (SD = 16.88), indicating that most patients were diagnosed with severe OSA. The average oxygen desaturation index was 35.63 (SD = 11.17). The meta-analysis showed no significant BMI changes after surgery (mean difference:-0.29; 95% CI:-0.80 to 0.21; I² = 30%). Findings were consistent with no publication bias found. Upper airway surgery for OSA does not significantly affect BMI. The authors propose closer monitoring of weight changes following upper airway surgery, as weight fluctuations can impact the outcomes of surgery. Unchanged weight post-surgery may be attributed to suboptimal OSA treatment.

Deep vein thrombosis (DVT) is the formation of thrombi in the deep venous system, most often in the lower extremities. Although usually not life-threatening, DVT requires timely diagnosis to prevent complications such as pulmonary embolism and post-thrombotic syndrome. The growing demand for image interpretation has generated interest in applying artificial intelligence (AI) to automated DVT detection. This scoping review analyzes the performance of artificial intelligence in diagnosing DVT using computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). We conducted a search across seven databases from inception to May 2025 using terms related to deep vein thrombosis, artificial intelligence, and machine learning. Eligible studies were limited to those evaluating DVT diagnosis using CT, MRI, or ultrasound. Two independent reviewers selected eligible studies, and quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Eleven studies published between 2021 and 2025 met the inclusion criteria. Some of the AI algorithms included RetinaNet, Deep R-Belief Neural Networks, and Sooty Tern Optimization. US-based models were the most studied algorithms, with sensitivities and specificities ranging from 68 to 100% and 70–100%, respectively. The MRI-based model achieved sensitivities, specificities, and accuracies of 95% to 97%. One CT-based model demonstrated a sensitivity of 83%. Studies evaluated across multiple imaging datasets showed high sensitivities, specificities, and precision of 96% or higher. Future research should prioritize multicenter validation and integration of clinical factors. In addition, explainable frameworks capable of integrating multiple imaging datasets must be developed with attention to workflow efficiency and cost-effectiveness to support clinical translation. The results indicate that AI is best situated as a supplementary tool rather than a replacement for expert interpretation in DVT diagnosis.

Background: Over half of the 550 million people with chronic respiratory disease (CRD) live in low- and middle-income countries with limited access to pulmonary rehabilitation (PR) that could improve exercise tolerance and quality of life. The PuRe trial tests effectiveness of Home- and Centre-based PR versus usual care in four centres across India, Bangladesh and Malaysia. This protocol outlines the methods used in the process evaluation of the PuRe trial, focused on understanding the context, implementation and mechanisms of PR. Aim:To understand how PR was delivered in the four centres, how the delivery was influenced by the local and national context and the likely mechanisms of impact of PR on trial outcomes. Methods: We use a mixed-methods design. Quantitative data will be collected from researcher and therapist logs and validated questionnaires; qualitative data from interviews with patients, therapists, healthcare professionals, managers, and policymakers. Approximately 80 patients and 20–32 healthcare/stakeholders will be interviewed, guided by data saturation. Implementation: This is assessed via PR reach, fidelity, dose and adaptation. Sustainability will be explored in stakeholder interviews. Mechanisms: These are assessed by patient engagement with PR, patient and therapist experiences and mediators (smoking, physical activity, breathlessness). Context: This is assessed using the Consolidated Framework for Implementation Research exploring how setting, individuals and implementation processes shape delivery and outcomes. Quantitative and qualitative data will be analysed separately and later combined in a mixed-methods synthesis for the purposes of triangulation and complementarity. Discussion: Alongside the trial evidence on effectiveness, an understanding of when, why and how PR works gained through the process evaluation will be valuable for those implementing similar services in other low-resource settings. Trial registration: ISRCTN 65701828.

Hospital acquired bacteremia is predominantly caused by Staphylococcus aureus. Given its virulence, patients may experience serious complications that can be difficult to diagnose at the time of the infection leading to increased morbidity and mortality. The objective of this study is to evaluate the incidence of hospital-acquired Staphylococcus aureus bacteremia (HA-SAB) and its risk factors associated with mortality among hospitalized patients in Universiti Malaya Medical Centre (UMMC), a tertiary teaching hospital in Malaysia This is a retrospective analysis of patients with HA-SAB admitted to UMMC over three time periods (P) in relation to the COVID-19 pandemic; P1 beginning of the pandemic (July 2020-May 2021), P2 during the peak of pandemic (June 2021-June 2022) and P3 recovery phase (July 2022-March 2023). We included patients ≥18 years old who fulfilled the criteria for HA-SAB. HA-SAB was defined as the first positive blood culture performed ≥48 hours after admission in patients with no evidence of infection at the time of admission. HA-SAB rates per 100 days admission and its risk factors associated with mortality were analyzed. A total of 287 cases of HA-SAB were identified (P1=80, P2=151 and P3=56) and the overall mortality rate was 31%. The HA-SAB rate increased by 42% from 0.19 (P1) to 0.33 (P2) per 100 admission days and decreased to 0.15 per 100 admission days (P3). On multivariate analysis, risk factors associated with mortality among patients with HA-SAB were older age (OR: 1.04, 95% Cl: 1.02-1.06), use of arterial lines (OR: 4.30, 95% Cl:1.57-11.5) and secondary bloodstream infection (BSI) (OR: 0.39, 95% Cl: 0.22 - 0.70). The COVID-19 pandemic was associated with substantial increase in HA-SAB rate. This was likely due to changes in infection control measures in general and line care prevention bundle specifically to cope with the pandemic such as extended use of personal protective equipment (PPE), and non-adherence to the 5-moments of hand hygiene especially changing gloves between patients. Older age, use of arterial lines and secondary BSI were significantly associated with mortality among patients with HA-SAB. All Authors: No reported disclosures