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Outcomes of Surgical versus Transcatheter Aortic Valve Replacement: A Clinical Review
Full text linkIntroduction: Surgical aortic valve replacement (SAVR) has been the predominant
treatment for aortic stenosis (AS) for decades. However, transcatheter aortic valve replacement (TAVR) is becoming increasingly popular. Originally, TAVRs were only performed on patients who were deemed high-risk for surgery and would have died without the valve replacement. The purpose of this paper is to determine if TAVR or SAVR has better health outcomes for all patients no matter their surgical risk.
Methods: A search via PubMed database was done using the key words “aortic stenosis”, “surgical aortic valve replacement”, “transcatheter aortic valve replacement”, and “mortality.” Additional search filters were applied for randomized control trials, systematic reviews, and meta- analyses. Dates were restricted to the last 5 years, and restrictions were added for English language and free full text only. This yielded 67 results and 5 were selected.
Results: Of the five reviewed articles, all were meta-analyses and one systematic review. There was a total of 52122 patients. Primary endpoints across all articles were that there is no significant difference between TAVR and SAVR in the outcomes studied.
Discussion: This review of studies provided supportive evidence that both TAVR and SAVR are valid treatment options or AS. TAVR had better short-term outcomes while SAVR had better long-term outcomes
Comparing Autografts and Bioengineered Skin Equivalents in the Management of Severe Burns
Full text linkINTRODUCTION: Severe burns are associated with high morbidity, mortality, and treatment costs, often requiring surgical intervention to restore the skin barrier and prevent complications like infection and hypothermia. Autologous skin grafting is the current gold standard for burn wound closure but may not be feasible in cases of large TBSA injuries with limited donor sites. Bioengineered skin equivalents, including acellular dermal substitutes and cell-based therapies, offer potential benefits in wound healing and scar quality while reducing donor site morbidity. This review evaluates the effectiveness of autografts compared to bioengineered skin equivalents in severe burn management, with a focus on healing time, graft adherence, infection rates, and treatment success.
METHODS: A PubMed search was conducted using key terms like “burns”, “autografting”, “bioengineered skin”. MeSH terms and Boolean operators were added to the search strategy as well as filters for publications from 2020-2025, RCTs, systematic reviews, meta-analyses, available in full-text, and published in the English language. Four studies met inclusion criteria based on study design, patient population, burn characteristics, graft type, and clinical outcomes.
RESULTS: Across the included studies, graft adherence and infection rates were comparable between bioengineered skin equivalents and autografts. In one meta-analysis, full-thickness burn wounds treated with Matriderm plus STSG had delayed re-epithelialization by 4-7 days compared to STSG (mean difference -7.30%, p=0.02). However, acellular dermal matrices significantly improved scar quality at six months (mean difference -1.95 on Vancouver Scar Scale, p\u3c 0.01). Cell-based therapies using cultured keratinocytes and fibroblasts accelerated epithelialization and demonstrated \u3c 95% wound closure rates comparable to STSG, while requiring smaller donor sites and reducing pain (p\u3c 0.0001). In other studies, autologous-engineered substitutes showed reduced donor skin requirements and lower mortality (6.25%) compared to standard autografts (96.5% integration but higher morbidity).
DISCUSSION: Evidence included in this review suggests that bioengineered skin equivalents can achieve comparable graft adherence and infection rates compared to autografts, with possible advantages in scar quality, preserved donor sites, and functional and cosmetic outcomes. They may be most beneficial in cases of large TBSA injuries, limited donor site availability, or when prioritizing aesthetic results. However, limitations in study design, risk of bias among studies, and lack of consistent methodology weaken the evidence needed to definitively conclude that bioengineered skin substitutes are an equal or superior alternative to autografting
Efficacy of Zuranolone Use for Postpartum Depression
Full text linkIntroduction: Postpartum depression is a major form of depression that occurs anytime within the first year after a woman gives birth. It is characterized by low moods, increased feelings of sadness and anxiety, and a decreased interest in one’s baby. It is commonly treated with the use of selective serotonin reuptake inhibitors (SSRIs), which present with negative side effects and have a long duration of onset. The purpose of this study is to evaluate the efficacy of zuranolone, a fast-acting neuroactive steroid and GABA-A receptor modulator, on its ability to reduce symptoms of postpartum depression.
Methods: The PubMed database was searched for clinical trials to assess the efficacy of zuranolone in women with postpartum depression. The keywords “Postpartum Depression” and “zuranolone” were used with specifiers that resulted in 15 articles. After all articles were further reviewed, 4 articles were selected for clinical review based on the similarities of subjects with postpartum depression and treatment groups that used oral zuranolone versus placebo.
Results: All studies concluded that the data from randomized controlled trials and meta-analyses supported the efficacy of zuranolone in reducing depressive symptoms in postpartum women. All data were statistically significant, with P values less than 0.05 and a 95% Confidence Interval.
Discussion: This review has proven the use of zuranolone to be efficacious for treating postpartum depression in women. While this medication has been confirmed safe, women experiencing postpartum depression should always seek attention from a medical professional for treatment. Further research is needed, utilizing larger sample sizes and more prolonged treatment durations to provide a more comprehensive revie
“ECMO Anticoagulation: Should We Consider Bivalirudin Over Heparin?”
Full text linkIntroduction: Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to prevent thrombotic events within the circuit. The use of unfractionated heparin has been the traditional anticoagulant of choice. Bivalirudin, a direct thrombin inhibitor, offers an alternative that has theoretical and observed benefits. The purpose of this clinical review is to evaluate whether bivalirudin provides superior safety and efficacy compared to UFH in ECMO patients.
Methods: PubMed was searched with a specific search strategy using key terms “Extracorporeal membrane oxygenation” AND “indirect anticoagulants” AND “deep vein thrombosis”. Operators and filters narrowed the results to four relevant, quality articles for review.
Results: In four studies, bivalirudin showed a statistically significant reduction in major bleeding events and ECMO circuit thrombosis compared to UFH. Three studies showed evidence of decrease in-hospital mortality. In one study, heparin and bivalirudin had comparable overall in-hospital mortality rates. Patients treated with bivalirudin had an improved time-in-therapeutic range for APTT, lower transfusion rates, and reduced incidence of HIT.
Discussion: The articles reviewed suggest that bivalirudin may offer clinical advantages over UFH in ECMO anticoagulation. Bivalirudin studies suggest more predictable pharmacokinetics, lower rates of bleeding, and fewer cases of circuit thrombosis. Existing evidence is limited by the use of retrospective studies and inconsistencies in the management of ECMO. Further research is needed to determine whether bivalirudin should replace UFH as standard anticoagulation in ECMO
Comparison of Vagal Maneuvers and Antiarrhythmics on Adult Patients Presenting with Supraventricular Tachycardias (SVT)
Full text linkINTRODUCTION: SVT is a well-known and potentially life-threatening arrhythmia, with vagal maneuvers and/or antiarrhythmic drugs often attempted for first-line conversion. The purpose of this clinical review is to analyze the relative effectiveness and success rates of these specific maneuvers and medications.
METHODS: The following PubMed database search was performed:“((vagal maneuver*) OR (valsalva)) AND (pharmacologic) ((medication) OR (medical therapy) OR (adenosine) OR (beta blocker*) OR (calcium channel blocker*) OR (anti-arrhythmic*) OR (anti arrhythmic*) OR (antiarrhythmic)) AND ((SVT) OR (supraventricular tachycardia))”. Filters were then applied and article titles/abstracts reviewed, resulting in a final selection of five articles for review.
RESULTS:. The most effective vagal maneuver found across two studies was modified valsava, with one meta-analysis resulting \u3e40% SVT conversion . Adenosine consistently performed with a higher success rate (~90%) compared to vagal maneuvers (20-40%) in termination of stable SVT, however the latter were still recommended to be attempted first due to their noninvasive and convenient nature. Novel intranasal agents like etrapamil have recently shown efficacy in initial RCT’s for acute termination of SVT, and have the potential for further study.
DISCUSSION: Modified valsalva consistently showed the most favorable results, however only 2-3 attempts should be made prior to deferring to administration of adenosine, with multiple administrations and increased dosing preferred prior to second-line alternatives. Unstable SVT requires synchronized cardioversion
Monotherapy versus Combination Levothyroxine and Liothyronine in the Treatment of Hypothyroidism
Full text linkIntroduction: Primary hypothyroidism is a common condition where the thyroid gland cannot produce free thyroxine (T4), leading to low serum levels of it. For this reason, it is often treated directly with monotherapy synthetic T4 or as a combined synthetic T4/T3. The purpose of this clinical review is to analyze the effectiveness of T4 monotherapy versus T4/T3 combination therapy in normalizing TSH values and improving symptoms in adults with hypothyroidism.
Methods: A specific search strategy in PubMed was used to conduct the research, incorporating key terms such as “hypothyroidism,” “levothyroxine,” “liothyronine,” and “TSH.” Four quality articles were left for final review after filters and operators dwindled them down from a list of 58 articles.
Results: One article was a randomized controlled trial (RCT) directly comparing LT4/LT3 and LT4 monotherapy. Another article was a systematic review of studies comparing these treatment regimens, while two articles were systematic reviews and meta-analyses comparing the same therapies as well.
Discussion: The articles had a general conclusion that there was no benefit in LT4/LT3 combined therapy versus monotherapy. However, these generalizations do not discuss the findings that combined therapy aided in some specific symptom alleviation, along with being the patient’s preferred treatment. Therefore, further research is needed
Modern Approaches to Mental Health: App-Based CBT versus Traditional Psychotherapy
Full text linkBackground: Digital mental health tools are becoming widely used as flexible alternatives to in-person therapy. A key question is how effective they are compared to traditional therapy for people with depression and anxiety.
Objective: To compare how effective digital interventions, like app-based CBT or telehealth, are compared to in-person psychotherapy in reducing symptoms of depression and anxiety in adults.
Methods: A structured PubMed search was conducted using specific search terms, limited to English-language randomized controlled trials, systematic reviews, and meta-analyses published between 2020 and 2025. After screening 116 articles, four high-quality studies were selected for review.
Results: Of the four studies reviewed, one was a meta-analysis and 3 were randomized controlled trials. Response and remission rates were similar, and the patient groups were comparable. There were no major differences in treatment success, dropout rates, or how well patients stuck with the therapy.
Discussion: Digital mental health interventions, such as online CBT programs and video-based therapy, can be effective alternatives to traditional therapy for adults with depression and anxiety. More research is still needed to look at long-term outcomes, access issues, and how to best match patients to the right kind of treatment
Epinephrine in Cardiac Arrest: Is It Enough?
Full text linkIntroduction: Epinephrine has long been the clinical mainstay of pharmacologic treatment for cardiac arrest management. It provides both α- and β-adrenergic receptor activation. However, at higher dosages, it may lead to sympathetic overload, oxidative stress, and cardiac myocyte apoptosis. The purpose of this paper is to evaluate the rates of ROSC (return of spontaneous circulation) with in-hospital cardiac arrest between epinephrine monotherapy and VSE (vasopressin, steroid, and epinephrine).
Methods: A search via PubMed database using the keywords “Cardiac arrest” AND “VSE” AND “Vasopressor monotherapy” with additional specifiers resulted in 30 articles. 26 articles were removed due to study type and characteristics. What remained were four studies consisting of a randomized controlled trial and three meta-analyses.
Results: In four articles reviewed, there was an overall increase in rates of ROSC in patients receiving VSE compared to those receiving epinephrine monotherapy as a placebo (P \u3c 0.034). One study demonstrated that vasopressin and epinephrine together did not increase rates of ROSC. But with the addition of glucocorticoids ROSC improved. Patients in all studies received baseline cardiopulmonary resuscitation in accordance with current guidelines.
Conclusion: VSE therapy in limited studies has been proven efficacious for improving rates of ROSC in adult patients suffering from cardiac arrest when compared to sole administration of epinephrine as the vasopressor of choice. However, this treatment modality will need to obtain a larger sample size before results can be validated
Efficacy of Metformin Compared to Insulin in the Management of Gestational Diabetes
Full text linkIntro: Gestational diabetes (GDM) is a condition in which pregnant women are unable to use insulin effectively, leading to increased levels of glucose in the body. Although insulin has traditionally been a first-line pharmacologic treatment for GDM, metformin is increasingly being explored as an alternative. The purpose of this clinical review is to analyze whether metformin could be a safe and effective oral antihyperglycemic option compared to insulin in the treatment of GDM.
Methods: PubMed was searched with a specific search strategy using the key terms “insulin,” “metformin,” “gestational diabetes,” and “blood glucose.” Operator and filters narrowed results to 19 relevant articles, and 4 quality articles were selected for review.
Results: Four studies evaluated the effect on HbA1c and glycemic control in pregnant women taking either metformin or insulin. Three of the studies also evaluated the outcomes of weight gain and preeclampsia in pregnant women taking metformin or insulin. All the studies evaluated neonatal outcomes. Three of the articles reviewed were meta-analyses or systematic reviews, and one was a randomized controlled trial.
Discussion: Overall, evidence shows that metformin was proven effective and safe in the short term for the treatment of gestational diabetes patients. Further investigation is needed to determine the long-term metabolic effects of metformin in children whose mothers were treated with metformin for GDM
Pharmacological Management of a Spinal Cord Injury: A Review
Full text linkIntroduction
A spinal cord injury results from damage to the cord itself. People who experience such an injury often live with pain for the rest of their lives. This review aims to compare the effectiveness of gabapentin versus tramadol in managing post-spinal cord injury pain.
Methods
A search using the key terms “spinal cord injury,” “gabapentin,” and “tramadol” was conducted on PubMed. Five relevant results were identified after applying operators and filters to narrow down the articles. Of those five articles, four were reviewed in this analysis.
Results
All four articles directly compare gabapentin to a test substance. Three of the articles compare tramadol to a test substance. One article does not analyze tramadol, but it does conclude on how tramadol should be used to treat post-spinal cord injury (SCI) pain.
Conclusions
Overall, gabapentin was found to be a more effective treatment option than tramadol for post-spinal cord injury pain—more research comparing these medications and other treatments is needed before any recommendations can be made