Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide. Patients commonly present with advanced/unresectable HCC where several treatment options are not effective. In this review, the authors discuss the indications and usage of lenvatinib, a multikinase inhibitor, as first-line therapy for advanced/unresectable HCC, its mode of action, efficacy, drug reactions, response to treatment and adverse effects. Since its approval in 2007, sorafenib has been used as first-line therapy for unresectable HCC. In 2018, a phase III multinational REFLECT trial on subjects with unresectable HCC (Child-Pugh class A) demonstrated that lenvatinib was non-inferior compared to sorafenib for overall survival, with a controllable toxicity profile, leading to its approval. In addition, our review discusses studies that compare the safety and efficacy profile of lenvatinib especially in patients who have a decline in their liver function to Child-Pugh class B. A current real world analysis of lenvatinib approval for unresectable HCC worldwide is reported.

Acute esophageal necrosis (AEN), also termed "black esophagus," is a unique and uncommon occurrence observed in severely sick patients. Other terminologies include acute necrotizing esophagitis and Gurvits syndrome. This condition is described as a darkened distal third of the esophagus observed on endoscopy and presents as an upper gastrointestinal (GI) bleed, difficulty swallowing, abdominal pain, fever, syncope, nausea, and vomiting. The etiology of AEN has been linked to several possibilities, such as excessive gastric acid reflux, hypoperfusion, and ischemia due to impaired vascular supply and hemodynamic instability. Risk factors include increased age, sex (male), heart disease, hemodynamic insufficiency, alcohol use, gastric outlet obstruction, diabetic ketoacidosis (DKA), malnutrition, renal disease, and trauma which also have the propensity to complicate disease course. An esophageal biopsy is not warranted. Treatment of AEN is comprised of supportive management with intravenous fluids, proton pump inhibitors (PPI), sucralfate, parenteral nutrition, and antacids. Management of preexisting comorbidities associated with AEN is crucial to prevent exacerbation of the disease course that could result in a poor prognosis and increased mortality rates. This literature review article comprises epidemiology, etiology, pathogenesis, diagnosis, and management of AEN.

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Background: Partially reversible airflow restriction is a symptom typical of COPD, a kind of obstructive lung disease. Chronic obstructive pulmonary disease distinct pathological and clinical phenotypes: emphysema and chronic bronchitis (COPD). Both elements are quite individualistic. Whether or not to regularly examine COPD patients for the possibility of GERD and treat it effectively might be aided by the discovery of an increased prevalence of Gastroesophageal reflux disease (GERD) in this patient population. Objective: As GERD is associated with a worse prognosis in COPD patients, it is important to understand the prevalence of this condition among those who suffer from the disease. Methodology: From January 2021 to January 2022, researchers at a major hospital in Peshawar analyzed data from many similar hospitals. A total of 108 participants participated in this trial. Comprehensive histories and physical examinations were performed on patients (aged 20 to 75). Then, spirometry and the Q-questionnaire were administered to individuals who had satisfied the inclusion and exclusion criteria. All patients had their spirometry readings taken by the same CPSP-certified technicianpatients' FEV1 measurements following a bronchodilator treatment were assessed by the same CPSP-fellow consultant of pulmonology using the GOLD criteria, giving each patient a grade (from "01" to "04"). The prevalence of GERD was calculated as a percentage of all COPD cases in patients who completed the Q-questionnaire. Results: There was a 12.580 standard variation in the individuals' ages, with a mean of 58.76. Most patients were women (60%), while men made up just 40% of the Total. The prevalence of GERD among those with COPD was 52 percent. Conclusion: This study's findings led us to conclude that patients with COPD had a frequency of gastroesophageal reflux disease (GERD), which was 52%. Keywords: Acid Reflux In The Stomach; COPD, Multicenter

The rapid spread of COVID-19 worldwide resulted in critical illness and mortality. Supportive measures have been the center stage for therapy. One crucial question since the onset of the deadly SARS-CoV-2 pandemic was the development of a vaccine. Developed by Moderna, the mRNA1273 vaccine, Elasomeran contains a lipid nanoparticle (LNP) that encapsulates a nucleoside-modified messenger RNA (modRNA), which encodes the spike (S) protein of the SARS-CoV-2 virus. This vaccine is administered as a dual dose regimen 28 days apart (1 month). Seven days following Pfizer's BNT162b2 vaccine, mRNA1273 received FDA-Emergency Use Authorization (EUA) on December 18, 2020, making it the second candidate. During the randomized, placebo-controlled, observer-blinded, phase 3 clinical trials, the mRNA1273 vaccine demonstrated 94.1% efficacy. Clinical trials in children aged 5–12 and adolescents also received FDA-EUA. The Moderna vaccine is also the second vaccine following Pfizer's BNT162b2 vaccine to receive full FDA approval on January 31, 2020, for use in individuals aged 18 and above for COVID-19 prevention. Real-world outcomes have been profoundly positive, reflecting its effectiveness in reducing hospitalization rates, infections, and mortality. This review article encompasses Moderna's vaccine journey, summarizing the mRNA1273 vaccine's preclinical studies, phase 1, phase 2, phase 3 clinical trials, dosages, immune response, adverse effects, FDA-EUA, FDA approval, and real-world outcomes discussing the overall effectiveness of the vaccine in healthy individuals, individuals with pre-existing underlying medical conditions, single-dose effects, delayed second dose, SARS-CoV-2 variants, and mix and match vaccines.