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Background Statins or 3‑hydroxy‑3‑methyl‑glutarylcoenzyme A (HMG‑CoA) reductase inhibitors are medications that act by reducing the cholesterol content of liver cells Moreover, statins have been found to improve endothelial function and reduce vascular wall inflammation. A growing body of research suggests that statins are associated with less risk of migraine, and they can be used to treat symptoms. However, the evidence has been inconclusive, so we aim to investigate the nature and strength of the effect of statins on the prevention and prophylaxis of migraines. Methods We conducted a comprehensive systematic search across multiple electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, from inception until October 2024, to include studies on the association between statins use and migraine. The outcomes of interest involved the association of the HMG-CoA reductase gene with the risk of migraine, as well as the association and efficacy of statins in migraine patients. Results Thirteen studies were included in our systematic review. Mendelian Randomization (MR) studies revealed that expression of HMGCR was associated with an increased risk of migraine with odds ratio (OR) ranging from 1.38 to 1.55 ( P  < 0.001). Three observational studies investigating the relationship between statins and migraine risk demonstrated a protective effect, with odds ratios ranging from 0.73 to 0.94 ( P  < 0.001). The findings suggest a significant reduction in overall migraine risk, particularly for migraines with aura and in patients with higher vitamin D levels. Meta-analysis of randomized controlled trials (RCTs) showed that statins significantly reduced monthly migraine frequency (MD= -3.16, 95%CI= [-5.79, -0.53]; p  = 0.02, I2 = 79%; P  = 0.03). RCTs supported the efficacy of statins in reducing migraine frequency, days, and intensity compared to placebo. Conclusions Statins, already well-established for cardiovascular benefits, emerge as a promising dual-purpose therapy for many neurological disorders. The association between the HMGCR gene and increased migraine risk, coupled with the possible efficacy of statins in reducing migraine frequency, may open new avenues for migraine prophylaxis. However, the variability in study design hinders definitive conclusions, so larger studies with longer follow-ups are required to ascertain both findings.

Introduction : Dabigatran is a direct oral anticoagulant associated with a high incidence of gastrointestinal bleeding, which presents a significant clinical concern. Genetic polymorphisms in the enzymes responsible for drug absorption (ABCB1) and activation (CES1) may influence dabigatran’s pharmacokinetics, potentially altering drug concentration and therapeutic response. The current systematic review and meta-analysis aim to identify genetic variants correlated with dabigatran exposure and evaluate their importance. Methods We systematically searched PubMed, Web of Science, Scopus, Cochrane Library, and Embase to identify studies on dabigatran pharmacogenomics. The review included observational and clinical studies that met eligibility criteria. RevMan 5.4 was used to conduct the meta-analysis. Quality assessment was done using ROB 2.0 and NOS tools. Results Out of 1336 records retrieved, 1008 were screened, resulting in 16 studies included in the systematic review and 9 in the meta-analysis. Data from 3834 participants (61.8% males) were reviewed. For the ABCB1 polymorphism rs4148738 , both CT and TT genotypes decreased C trough compared to CC genotype (MD = − 9.82, 95% CI [− 17.65, − 1.99], P  = 0.01) and (MD= − 7.69, 95% CI [− 15.54, 0.16], P  = 0.05), respectively. While CES1 rs8192935 GG increased C max compared to AA (MD = 22.66, 95% CI [5.04, 40.27], P  = 0.01). For CES1 rs2244613 AA , both C max and C trough exhibited higher levels compared to GG (MD = 13.58, 95% CI [− 0.08,27.25], P  = 0.05) and (MD = 13.41, 95% CI [8.05,18.77], P  < 0.01), respectively. Also, compared to GG the heterozygote type GA increased the C max (MD = 32.02, 95%CI [16.54,47.5], P  < 0.01). Bleeding risk did not significantly differ across ABCB1 rs1045642 , ABCB1 rs4148738 and CES1 rs8192935 polymorphisms. Only CES1 rs2244613 T allele showed significant effect on bleeding (OR = 2.43, P  = 0.002). Stroke incidence did not differ across ABCB1 rs4148738 , CES1 rs2244613 , and CES1 rs8192935 genotypes. Conclusion ABCB1 rs4148738 T allele reduced dabigatran trough levels, while CES1 rs8192935 GG increased peak levels. CES1 rs2244613 TT raised both peak and trough levels, and its T allele was linked to higher bleeding risk. No consistent associations were found for other variants. These findings highlight CES1 rs2244613 as a key contributor to variability in dabigatran response, warranting further large-scale studies to confirm its role in personalized anticoagulation therapy.

Background Dementia is a growing public health concern, affecting over 55 million people worldwide, with Alzheimer’s disease (AD) being the most prevalent cause. Cholinesterase inhibitors (ChEIs) and memantine remain the mainstay pharmacological treatment for AD and other dementias, despite their modest benefits and potential adverse effects. The safety profiles of these medications, particularly at different doses and formulations, remain inadequately explored, necessitating a comprehensive evaluation. Methods This systematic review and network meta-analysis (NMA) will assess the safety of ChEIs (donepezil, galantamine, rivastigmine) and memantine in dementia treatment. We will include randomized controlled trials (RCTs) with ≥ 3 months of follow-up, evaluating adverse events (AEs), serious adverse events (SAEs), and treatment discontinuation rates. A comprehensive literature search will be conducted in PubMed, Scopus, Web of Science, and Cochrane Library, with additional searches in Google Scholar and reference lists of included studies. Data extraction will follow a standardized approach, and study quality will be assessed using the Cochrane risk-of-bias tool-2. A Frequentist or Bayesian NMA framework will be used to compare safety profiles, with heterogeneity assessed using the I 2 test. Discussion By addressing gaps in prior NMAs, this study aims to provide an in-depth evaluation of safety outcomes associated with different ChEI and memantine doses and formulations across various dementia types. The findings will support clinicians in making informed treatment decisions and guide future research and policy development for dementia management. Systematic review registration PROSPERO (CRD42025642902).

Background Nivolumab and ipilimumab combination immunotherapy has become a standard treatment option for certain cancers. However, the benefits of combination therapy compared to nivolumab monotherapy in lung cancer patients are not entirely clear. We aimed to evaluate whether nivolumab plus ipilimumab improves clinical outcomes in lung cancer patients compared to nivolumab monotherapy. Methods A literature search was performed on PubMed, Web of Science, and Scopus from inception until November 2024 to identify relevant randomized controlled trials. The Cochrane risk of bias tool was used to assess the risk of bias, the hazard ratio (HR) was calculated for survival, risk ratios (RRs) were calculated for response rate and safety outcomes, and a random effects model meta-analysis was performed to estimate the safety and efficacy of the treatments. Results Seven trials comprising 2134 patients were included. Compared with patients receiving nivolumab monotherapy, non-small cell lung cancer patients who received combination therapy had better progression-free survival (HR = 0.82, 95% CI 0.71; 0.93, P  < 0.01, low certainty), and there were no significant differences in overall survival (HR = 0.95, 95% CI 0.86; 1.0, P  = 0.31, moderate certainty), or objective response rate (RR = 1.36, 95% CI 0.91; 2.02, P  = 0.14 very low certainty). The combination group had a significantly greater risk of grade 3–4 adverse events (RR = 2.77, 95% CI 1.38; 5.56, P  < 0.01, low certainty). Conclusion Although combination treatment significantly improved progression-free survival in NSCLC patients, it was also associated with a greater risk of adverse events and treatment-related mortality than nivolumab monotherapy. The current evidence is insufficient for choosing combination treatment over nivolumab monotherapy.

Acute coronary syndrome (ACS) poses a significant global health burden despite advancements in its management. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily used in type 2 diabetes mellitus (T2DM), have gained recent consideration as potential agents for ACS management due to their cardiovascular benefits beyond glycemic control. This study aimed to assess the effects of empagliflozin on left cardiac parameters in ACS patients. PubMed, Cochrane, Scopus, and Web of Science were searched thoroughly to identify relevant randomized controlled trials (RCTs). Four RCTs involving 701 patients were included. Compared to placebo, empagliflozin significantly reduced left ventricular end-systolic volume index (mean difference (MD): -2.38, 95% CI: -3.95 to -0.80, p = 0.0032), left ventricular mass index (MD: -2.76, 95% CI: -4.95 to -0.56, p = 0.0137), and left ventricular filling pressure (MD: -0.59, 95% CI: -1.07 to -0.10, p = 0.0189). However, empagliflozin treatment did not yield a statistically significant change in left ventricular ejection fraction (MD: 1.21, 95% CI: -0.05 to 2.48, p = 0.0603) nor a significant change in left ventricular end-diastolic volume (MD: -4.49, 95% CI: -14.24 to 5.26, p = 0.37), left ventricular end-systolic volume (MD: -5.19, 95% CI: -10.77 to 0.39, p = 0.0682), and left ventricular end-diastolic volume index (MD: -2.20, 95% CI: -4.59 to 0.19, p = 0.0718). Empagliflozin provides favorable effects on left cardiac structural parameters in ACS patients. This suggests a potential role for SGLT2 inhibitors as adjunctive therapy in ACS management, warranting further investigation into their mechanisms and long-term clinical outcomes.

Sudan's healthcare system has been severely disrupted by the ongoing humanitarian crisis, limiting access to essential services and medications. Understanding health-seeking behaviors during such disruptions is critical to informing culturally appropriate public health responses, particularly regarding traditional medicine use. This study aimed to assessPatterns of Herbal Medicine Utilization for Hypertension During the Sudanese Crisis of 2025. This cross-sectional study was conducted from February to June 2025 among adults with physician-diagnosed hypertension who were prescribed antihypertensive medication at diagnosis. Data were collected using a structured validated questionnaire administered face-to-face using Kobo Toolbox. Convenience sampling yielded 749 valid responses. Data were analyzed using SPSS v27, with statistical significance set at p < 0.05. The mean age was(56.8 ± 11.9) years; (54.1%) were female, (29.8%) were displaced and (50.5%) reported difficulty accessing antihypertensive medications. Herbal medicine use was reported by (91.2%); 65.2% used herbs before and during the crisis, and (19.8%) initiated use after the crisis began. Concurrent use of herb-drug use was reported by (71.7%), while adverse effects were uncommon(5.7%), and mostly mild. Lower income and rural residence were significantly associated with herbal use (p < 0.05). Herbal medicine use was wide spread among hypertensive Sudanese adults during the crisis, largely driven by affordability, accessibility challenges, and cultural familiarity. Given the high rate of concurrent use, public health messaging and clinician training on herb-drug safety should be prioritized.