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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Research Article: Self-reported practice patterns for cognitive preservation during whole-brain radiotherapy: a multinational cross-sectional survey of radiation oncologists in the Middle East and North Africa

Date Published: 2026-10-13

Abstract:
Whole-brain radiotherapy (WBRT) remains an important treatment for patients with diffuse brain metastases, but radiation-induced cognitive decline is a major concern. Hippocampal-avoidance WBRT (HA-WBRT) and memantine are recommended by international guidelines for eligible patients, yet the extent of their adoption across the Middle East and North Africa (MENA) region remains unclear. A cross-sectional, anonymous questionnaire was distributed to radiation oncologists practising across the MENA region between January and March 2025 by email and professional social media. Because distribution was open, no sampling frame or response denominator could be defined, so the sample is a convenience sample. The instrument assessed self-reported practice patterns, availability and reported utilisation of HA-WBRT and memantine, perceived barriers, and follow-up and cognitive-assessment practices. All proportions are reported at the respondent level. Categorical comparisons used the chi-squared or Fisher’s exact test with exact p values and odds ratios; multivariable logistic regression with cluster-robust standard errors by centre was performed as an exploratory analysis. Reporting follows STROBE and CHERRIES. In total, 124 radiation oncologists from 45 centres across 15 countries responded. HA-WBRT was reported as being routinely offered to eligible patients by 60 respondents (48.4%) and memantine by 34 (27.4%); 28 (22.6%) reported offering both routinely and 58 (46.8%) neither. When asked what proportion of their WBRT patients actually received both interventions, 70 (56.5%) answered never and only 4 (3.2%) more than 50%. Memantine was reported as available in the respondent’s centre by 48 (38.7%), while 66 (53.2%) did not know whether it was approved for brain metastases. The most frequently endorsed barriers were concern about missing intracranial disease (72; 58.1%) for HA-WBRT and lack of experience with the drug (84; 67.7%) for memantine. Formal cognitive testing was infrequent: 90 respondents (72.6%) reported using no cognitive assessment tool. Among the radiation oncologists who responded, self-reported routine use of cognitive-preservation strategies during WBRT was limited, with reported utilisation lower than reported offering. These findings describe the practices reported by a convenience sample and should not be interpreted as establishing the prevalence of underuse across the MENA region.

Introduction:
Whole-brain radiotherapy (WBRT) remains an important treatment for patients with diffuse brain metastases, but radiation-induced cognitive decline is a major concern. Hippocampal-avoidance WBRT (HA-WBRT) and memantine are recommended by international guidelines for eligible patients, yet the extent of their adoption across the Middle East and North Africa (MENA) region remains unclear.

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