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BackgroundLabor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone.ObjectiveThis study aims to compare the effectiveness and safety of intravaginal misoprostol versus dinoprostone for inducing labor, examining their impact on various maternal and neonatal outcomes.MethodsA systematic review and meta-analysis were conducted using four databases—PubMed, Google Scholar, EBSCO, and the Cochrane Library—from January 2000 to April 2023. We included randomized controlled trials (RCTs) involving singleton pregnancies at term (37–42 weeks) with unfavorable cervices, where intravaginal misoprostol was compared to dinoprostone. Key outcomes evaluated for effectiveness included vaginal delivery within 24 h, overall vaginal delivery rate, and need for oxytocin augmentation. Safety outcomes assessed were tachysystole, uterine hyperstimulation, abnormal cardiotocography, NICU admissions, cesarean delivery, and APGAR scores. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager (RevMan) version 5.4.1.ResultsEight RCTs with a total of 1,801 participants (937 in the misoprostol group and 864 in the dinoprostone group) met the inclusion criteria. Misoprostol required a significantly less oxytocin augmentation than dinoprostone [RR = 0.83; 95% CI (0.71, 0.97), p = 0.02]. Other outcomes, including rates of cesarean delivery, uterine tachysystole, hyperstimulation, and NICU admissions, showed no significant differences between the two groups, indicating comparable safety and efficacy profiles.ConclusionThis meta-analysis demonstrates that intravaginal misoprostol is an effective and safe alternative to dinoprostone for labor induction at term. Misoprostol achieved comparable efficacy and safety outcomes while requiring less oxytocin augmentation, supporting its potential as a practical induction agent in clinical settings.

BackgroundLaparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors.MethodsThis retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group.ResultsAmong 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups.ConclusionReduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.

Abstract Background Osteoprotegerin (OPG) is a secretory glycoprotein known for its involvement in bone metabolism and immune regulation. Research has extended OPG's significance in cardiovascular diseases (CVDs). Elevated OPG levels have been associated with increased cardiovascular risks, prompting interest in its role as a potential biomarker. Main Body This study summarizes several studies that investigated the relationship between OPG levels and the incidence of CVD. The studies indicate that higher plasma levels of OPG are associated with an increased incidence of all‐cause death, cardiovascular death, and heart failure, even after adjusting for clinical confounders. Moreover, the findings suggest that OPG has the potential to serve as a predictive biomarker for adverse cardiovascular events in the patient population studied. The findings suggest that OPG could aid in risk stratification, allowing clinicians to identify high‐risk patients who might benefit from intensified preventive measures or tailored therapeutic interventions. Therefore, early identification of individuals at risk for adverse cardiovascular events could lead to improved patient outcomes and reduced disease burden. Conclusions OPG's role in bone health and immune regulation has expanded to potential use as a biomarker for adverse cardiovascular events in stable coronary artery disease (CAD) patients. Despite limitations, its association with cardiovascular risks highlights its importance in risk assessment and personalized interventions.

Respected Sir, Violence is the utilization of actual power that either result in or has high possibilitys of causing injury, death, psychological mischief, or hardship. The World Health Organization estimates that physical violence affects 8–38 percent of healthcare employees at some time in their professional lives(1). An innumerable large number of health personals are verbally abused. Intolerance and hostility toward doctors are global phenomena. In1996, the Forty-Ninth World Health Assembly proclaimed violence as a significant public health issue(2). Violence is becoming more common in many professions, but it is known to be particularly prevalent in the medical area. Doctors have been the target of violence for a long time, as observed worldwide, and it is nothing new in Pakistan. In fact, because of the already common political violence and a fragile law enforcement system, countries like Pakistan are at a greater risk of violence. Exposure to violence in the medical fraternity consequences in accelerated tiers of anxiety, stress, insomnia, and depression which has a direct impact on the quality of treatment delivered to patients and can even end in a patient's death. A cross-sectional study was carried out within the emergency departments of nine predominant tertiary hospitals in Pakistan, which revealed a significant problem, with nearly 77 per cent of physicians dealing with verbal or bodily abuse from patients and their attendants(3). According to the Pakistan Medical Association (PMA), An independent organization that addresses the problems of healthcare providers, 54 doctors were killed in Karachi between 2010 and 2014 for various reasons. Most incidents were reported in 2014, when approximately 17 doctors were killed(4). This is the only figure that is reported; many more go unreported. There are complicated motives in the back of the violence toward Health Care Personnel (HCP); as a result, medical disputes and, at times, violence have increased. However, the primary motives are poor medical service quality and communication between HCPs and patients. Inadequate security and funds can also lead to violence. Awareness campaigns to improve HCPs' communication skills, better health care facilities, patient satisfaction, and attendants should be kept in the loop at every medical step, and security should be maintained in hospitals to protect the staff are among the preventative measures that can significantly reduce incidents of violence against HCPs.

This study aimed to investigate the role of the political discourse of King Abdullah II bin Al-Hussein in fostering humanitarian and ethical values among University of Jordan students from the perspective of faculty members. The researcher employed a descriptive-analytical quantitative method. To achieve the study's objectives, the researcher developed a scale measuring the role of King Abdullah II bin Al-Hussein's political discourse in nurturing humanitarian and ethical values among University of Jordan students, as perceived by faculty members. This scale comprised 44 items distributed across five domains: personal values, social values, national values, humanitarian values, and cognitive values. The study sample consisted of 60 faculty members selected purposively for the academic year 2023/2024. The results of the study indicated that the role of King Abdullah II bin Al-Hussein's political discourse in fostering humanitarian and ethical values among University of Jordan students, as perceived by faculty members, was high, with all domains showing high scores. The study recommended the establishment of a course focusing on King Abdullah II bin Al-Hussein's political discourse in universities and colleges to instill humanitarian and ethical values among students. [ABSTRACT FROM AUTHOR]

Background/objective: Methotrexate (MTX) is widely used in various medical specialties. However, hepatotoxicity is an ongoing concern and this is thought to be directly associated with cumulative dose. We sought to synthesise the published literature to evaluate the association between methotrexate hepatotoxicity and cumulative dose. Methods: A systematic review of Medline (PubMed) EMBASE, CINAHL and The Cochrane Library was performed. Full texts of articles were examined, and excluded articles were recorded with reasons for exclusion. A meta‐analysis of correlation coefficients was performed using Fisher's z‐transformation and a random effects model. Cochran's Q‐test and the I2 statistic were calculated to assess heterogeneity. Results: A total of 35 studies met inclusion criteria. Measures of hepatotoxicity were highly varied and included liver biopsy, elastography, FibroTest, biochemical tests and scoring systems (Fib‐4, APRI, AST:ALT). Some studies analysed for the association with MTX cumulative dose using more than one modality. Overall, 38 analyses found no significant association between MTX cumulative dose and hepatoxicity vs eight that identified a significant association. The pooled correlation coefficient from five studies which utilised elastography was 0.18 (95% CI, −0.09 to 0.42), with significant heterogeneity between studies (P < 0.0001), I2 = 92%). Conclusions: Our synthesis of a large volume of studies in this review found no significant association between MTX cumulative dose and hepatotoxicity, both in terms of vote counting and with regard to the meta‐analysis of correlation coefficients from studies that utilised elastography. This challenges the long‐held belief that liver injury is a direct result of drug accumulation. [ABSTRACT FROM AUTHOR]