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Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent, and smoking is associated with greater disease severity. We investigated whether documented smoking cessation attempts among adults with MASLD were associated with liver-related outcomes, cardiovascular outcomes, and all-cause mortality. We performed a retrospective cohort study using the TriNetX Research Network. Adults (≥ 18years) with MASLD and documented smoking history were included. A smoking cessation attempt was defined by cessation counseling and/or cessation pharmacotherapy; comparators had no documented cessation attempt. Patients with depressive disorders and competing liver etiologies were excluded. Cohorts were matched 1:1 using propensity scores, and outcomes were analyzed using Cox proportional hazards models. Sensitivity analyses were performed at fixed follow-up horizons of 6months, 1year, and 2years. Among 418,784 eligible patients, 85,639 had a documented cessation attempt and 333,145 did not; after matching, 83,315 patients remained in each cohort. In the matched cohort, cessation attempt was associated with lower hazards of cirrhosis progression (1.7% vs. 2.1%; HR 0.87, 95% CI 0.81-0.93), hepatocellular carcinoma (0.2% vs. 0.3%; HR 0.58, 95% CI 0.48-0.70), portal hypertension (0.8% vs. 1.1%; HR 0.77, 95% CI 0.70-0.86), and MASH progression (2.2% vs. 2.9%; HR 0.76, 95% CI 0.71-0.81). The cessation attempt was also associated with higher hazards of MACE (13.6% vs. 11.4%; HR 1.24, 95% CI 1.20-1.28), peripheral artery disease (4.1% vs. 3.2%; HR 1.33, 95% CI 1.26-1.40), and all-cause mortality (8.5% vs. 7.3%; HR 1.23, 95% CI 1.18-1.27). Fixed-horizon analyses showed similar patterns over time. In adults with MASLD and smoking history, documented smoking cessation attempts were associated with lower hazards of several liver outcomes but higher cardiovascular event rates and mortality, findings likely influenced by residual confounding and clinical risk clustering in patients receiving cessation interventions.

Severe hypertriglyceridemia (HTG) can interfere with laboratory assays. HTG‐induced pancreatitis usually presents with hypocalcemia, but the effect of severe HTG, with no associated pancreatitis, on calcium levels is not well described. We present a 25‐year‐old male with severe HTG and diabetes who presented with generalized weakness, nausea, and vomiting. His labs revealed a severely elevated triglyceride level, as well as a critically low total calcium of 2.8 mg/dL, but only mildly reduced ionized calcium (1.10 mmol/L), with no evidence of laboratory or imaging findings of pancreatitis. Hypocalcemia signs were positive on physical examination. Treatment for HTG led to rapid normalization of total calcium levels, while intravenous calcium gluconate normalized ionized calcium and resulted in symptom resolution. This case shows that severe HTG can cause significant total pseudohypocalcemia alongside mild true ionized hypocalcemia, highlighting the importance of monitoring ionized calcium in this setting. Key Clinical Message In severe hypertriglyceridemia, very low total calcium may reflect pseudohypocalcemia from assay interference, even without pancreatitis. Ionized calcium may be mildly reduced yet symptomatic. Relying on total calcium alone can cause misdiagnosis; ionized calcium should be measured in lipemic samples to guide appropriate management.

Autoimmune hepatitis (AIH) following COVID‐19 vaccination is a rare adverse event. We present the case of a 55‐year‐old male with a history of ulcerative colitis (UC) who developed AIH 3 weeks after receiving his second dose of the Pfizer–BioNTech mRNA vaccine. He presented with jaundice and significantly elevated liver enzymes. A liver biopsy confirmed the diagnosis of AIH. The patient was successfully treated with corticosteroids and azathioprine, leading to complete clinical and biochemical remission. This case highlights the potential for vaccine‐induced autoimmune phenomena, particularly in individuals with preexisting autoimmune conditions, and underscores the importance of prompt diagnosis and treatment. Key Clinical Message This case describes a patient with ulcerative colitis who developed acute autoimmune hepatitis (AIH) 3 weeks after a COVID‐19 booster. While a causal link cannot be definitively proven, the temporal association highlights the importance of considering AIH in the differential diagnosis of postvaccination liver injury. Prompt diagnosis and treatment with standard immunosuppressive therapy led to complete remission.

Background. Establishing prompt vascular access facilitates resuscitation for out-of-hospital cardiac arrest (OHCA). While intraosseous access may decrease the time to vascular access, the impact on clinical outcomes in OHCA is unclear. Therefore, we aim to compare the effect of intraosseous (IO) versus intravenous (IV) vascular access on clinical outcomes after OHCA resuscitation. Methods. A systematic review and meta-analysis were performed to synthesize evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until January 2025. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes using the risk ratio (RR) and continuous outcomes using the mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42024627354. Results. Four RCTs and 9475 patients were included. There was no difference between both groups regarding the prehospital return of spontaneous circulation (ROSC) (RR: 0.97, 95% CI [0.91, 1.03], p = 0.33), maintained ROSC (RR: 0.94, 95% CI [0.87, 1.01], p = 0.09), survival to discharge (RR: 1.03 with 95% CI [0.88, 1.21], p = 0.71), 30-day survival (RR: 0.98, 95% CI [0.82, 1.17], p = 0.79), or favorable neurological recovery (RR: 1.07, 95% CI [0.90, 1.29], p = 0.44). However, IO access significantly increased first-attempt access (RR: 1.24, 95% CI [1.19, 1.29], p < 0.001), decreased time to vascular access (MD: −0.24 min with 95% CI [−0.48, −0.01], p = 0.04), and decreased time to drug administration (MD: −0.38, 95% CI [−0.66, −0.10], p = 0.01). Conclusions. IO and IV vascular accesses showed similar clinical outcomes in OHCA patients, with no difference in ROSC, survival, or neurological recovery. Still, IO access showed a better procedural outcome with increased first-attempt success rates, faster access, and faster drug administration.

Background and Aim The role of Resmetirom in non‐alcoholic steatohepatitis (NASH) represents a promising therapeutic approach in addressing the growing global burden of liver disease. With NASH emerging as a leading cause of liver‐related morbidity and mortality worldwide, there is an urgent need for effective treatments. Resmetirom, a selective thyroid hormone receptor‐β agonist, offers potential benefits in improving liver histology and metabolic parameters in patients with NASH. This review examines the current evidence surrounding Resmetirom's role in NASH management. Methods A systematic review and meta‐analysis was done by searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE (including MEDLINE InProcess) (OvidSP), Web of Science, Embase (OvidSP), and Scopus databases. ROB2 Cochrane tool was used for assessing risk of bias in randomized controlled trials (RCTs). In the analysis, we used RevMan Cochrane software. Results The study showed that patients who were treated with Resmetirom had significantly lower low‐density lipoprotein‐cholesterol (LDL‐C) levels (mean difference [MD] −10.45; 95% confidence interval [CI] −15.86 to −5.83; P < 0.001) and alanine aminotransferase (ALT) levels (MD −7.18; 95% CI −12.67 to −1.68; P = 0.01) as compared with those in the placebo group. The risk of adverse events including diarrhea [risk ratio (RR) 1.81; 95% CI 1.40 to 2.35; P < 0.001] and nausea (RR 1.72; 95% CI 1.31 to 2.27; P < 0.001) was significantly increased for the Resmetirom group as compared with the placebo group. Conclusion Resmetirom presents a promising therapeutic option for NASH, offering potential benefits in reducing liver fat content and improving histological outcomes. The encouraging results from clinical trials suggest that Resmetirom may address an unmet need in NASH management, providing hope for patients with this progressive liver disease. Further research and long‐term studies are warranted to validate its efficacy and safety profile in larger patient populations. Resmetirom presents a promising therapeutic option for non‐alcoholic steatohepatitis (NASH), offering potential benefits in reducing liver fat content and improving histological outcomes.

Background: Pre-diabetes, characterized by elevated glycemic indices, poses a high risk of diabetes development, and is increasingly linked to non-specific low back pain. While mechanisms remain incompletely understood, metabolic, inflammatory, and neurological factors are implicated. Dietary interventions, including low-glycemic and anti-inflammatory diets, alongside weight management, may improve outcomes in this population. Objectives: In this non-randomized controlled trial, we aim to evaluate the influence of decreasing HbA1c levels on reducing chronic non-specific low back pain in pre-diabetic, non-obese individuals, as well as emphasizing the importance of such a study in supporting the literature. Methods: A non-randomized controlled single-blind clinical trial was conducted among 82 participants with chronic non-specific low back pain and pre-diabetes at an outpatient clinic in Baghdad from the 30th of January to the 22nd of September. The intervention methods aimed at reducing HbA1c levels to assess the reduction impact on alleviating chronic non-specific low back pain included dietary adjustments, sleep optimization, and correction of vitamins and minerals deficiencies. The follow-up process was conducted individually for each participant, with a monthly assessment over a period of six months. Results: At 12 weeks a significant decrease in chronic non-specific low back pain severity was observed in patients with lower HbA1C levels yielding a P-value of .021. Similarly, at 24 weeks there was a decline in the number of patients who reported chronic non-specific low back pain, and the association to lower HbA1C levels was significant with a p-value of .005. Conclusion: This study suggests the presence of a statistically significant association between reduction of HbA1C levels and ensuing improvement in chronic non-specific low back pain symptoms in non-obese prediabetic patients. Plain language summary The Effects of HbA1c Reduction on Alleviating Nonspecific Back Pain Pre-diabetes is a condition where blood sugar levels are higher than normal but not high enough to be classified as diabetes. People with pre-diabetes are at risk of developing diabetes and other health problems, including low back pain, a type of low back pain without a clear cause. Researchers believe this link might be due to problems with metabolism, inflammation, or nerve function. Changes in diet, especially focusing on lowering blood sugar levels and reducing inflammation, along with managing weight, may help people with pre-diabetes who have low back pain without a clear cause feel better. In this study, 82 people with both pre-diabetes and low back pain without a clear cause that lasted for more than 3 months took part in a clinical trial at a clinic in Baghdad. The trial lasted from January to September and was designed to see if lowering blood sugar (measured by HbA1c levels) would reduce low back pain. The participants received personalized care, which included making changes to their diet, improving their sleep, and correcting any vitamin or mineral deficiencies they had. They were followed closely for six months, with monthly check-ups. The results showed that after 12 weeks, many people who managed to lower their blood sugar levels experienced less severe low back pain. The improvement was even more noticeable after 24 weeks, as fewer people reported ongoing low back pain, and this improvement was strongly linked to lower blood sugar levels. In conclusion, the study found that reducing blood sugar levels in people with pre-diabetes who are not obese can significantly improve symptoms of low back pain. This suggests that managing blood sugar could be an important way to relieve low back pain without a clear cause.