Knee osteoarthritis (OA) is a degenerative joint disease involving progressive cartilage loss, subchondral bone remodelling, and inflammation. This systematic review and meta-analysis aimed to assess the efficacy and safety of metformin in reducing knee pain and adverse events among overweight and obese adults with symptomatic knee OA. We systematically searched PubMed, Scopus, and CENTRAL from inception to August 2025. Eligible randomised controlled trials (RCTs) compared oral metformin with placebo or standard care in adults with BMI ≥ 25 kg/m2 and symptomatic knee OA. Primary outcomes were pain reduction (standardised mean difference) and gastrointestinal (GI) adverse events (risk ratio). Risk of bias was assessed using the Cochrane ROB 2 tool, publication bias using the Doi plot and LFK index, and evidence certainty using the GRADE-pro approach. Seven studies (n = 1237) were included: six RCTs and one observational study. Meta-analysis included only RCTs. Metformin significantly reduced knee pain compared with controls (SMD: − 0.42; 95
BACKGROUND:Colonic diverticulosis (CD) is a prevalent condition marked by small pouches (diverticula) in the colon wall, particularly in those over 50. Many studies have investigated various risk factors, but the relationship between smoking, alcohol consumption, and CD remains to be decided. This meta-analysis analyses the association between these lifestyle factors and the risk of CD and its complications. METHODS:A comprehensive literature search was conducted using PubMed, Embase, and Google Scholar to find relevant studies. Inclusion criteria were based on predefined eligibility standards, focusing on observational studies reporting smoking, alcohol consumption, and CD. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at P < .05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS:Sixty-two studies encompassing 5,66,903 patients were included finally, where the mean age was 73.8 years, and 44.53% were female. Smoking increased the risk of CD (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.24-1.48), diverticulitis (OR: 1.59, 95% CI: 1.01-2.51), and diverticular bleeding (OR: 1.51, 95% CI: 1.13-2.02). Ex-smokers also showed a higher risk of CD compared to nonsmokers (OR: 1.31, 95% CI: 1.08-1.59). Alcohol consumption was associated with an increased risk of CD (OR: 1.41, 95% CI: 1.09-1.82). However, no association was found between alcohol consumption and diverticular bleeding (OR: 1.15, 95% CI: 0.77-1.71) or diverticulitis (OR: 1.36, 95% CI: 0.98-1.88). No publication bias was clear in the analysis. CONCLUSION:This meta-analysis suggests an association between smoking, alcohol consumption, and increased risk of CD. Smoking is associated with an increased risk of CD and diverticular bleeding. The relationship between alcohol consumption and diverticular disease requires further investigation. Future research should explore the mechanisms by which these factors influence the development of CD to understand and inform public health recommendations.
Abstract Background: Retractions of the Pars Tensa of the Tympanic membrane are an unwanted consequence of sharp variations in middle-ear pressure related to the functionality of the Eustachian Tube. Such retractions can cause conductive hearing loss because of either fixation of the ossicular chain or necrosis. This study aims to compare the advantages and disadvantages of Tragal Cartilage and Temporalis Fascia as graft materials in the management of Pars Tensa Retractions with focus on hearing thresholds. Methods: A prospective comparative study was conducted on 60 patients with unilateral Pars Tensa retractions and conductive hearing loss. Patients were randomized into two groups: Group A underwent tympanoplasty using Tragal Cartilage, while Group B received Temporalis Fascia graft, all under General Anaesthesia. Pre-operative and post-operative hearing outcomes were assessed using Pure Tone Audiometry and Impedance Audiometry. Results: One month postoperatively, Group B had a better Air Conduction Threshold ( P =0.04) and Air-Bone Gap ( P =0.03). However, at six months, Group A demonstrated superior hearing outcomes ( P =0.01) and lower failure rates (10% vs. 30%, P =0.02). Tympanograms also favored Group A, with 86.7% achieving Type A compared to 63.3% in Group B (p<0.01). Conclusion: Although the management of chronic recurrent Pars Tensa retractions is fairly simple, the patients should always be promised only a guarded result. It can be seen from the results of our study that although both graft materials have good long term results, Cartilage seems to perform better in bridging the ABG and having lesser recurrence rates.
Adverse drug reactions (ADRs) are frequently under-recognized in patients with gastrointestinal disorders. Differences may exist between patient-reported experiences and formal pharmacovigilance records. Therefore, it is of interest to evaluate self-reported ADRs among 265 adults receiving treatment for gastrointestinal conditions and compared findings with regional pharmacovigilance data from the same period. A structured and pretested survey collected demographic, clinical and ADR-related information. Overall, 51.7% reported at least one ADR, most commonly abdominal discomfort (27.2%), nausea (21.9%) and headache (17.4%). Awareness of formal ADR reporting systems was low, with only 38.5% having heard of such systems and 25.7% knowing how to report. Concordance between patient reports and pharmacovigilance data was high for gastrointestinal and central nervous system reactions but lower for severe and dermatological reactions. Female gender, higher education and polypharmacy were significantly associated with increased ADR reporting (p < 0.05). Thus, gaps in awareness of ADR reporting support integration of patient-reported outcomes into pharmacovigilance systems.
Introduction The upper segment to lower segment (US:LS) ratio is a key anthropometric measure for assessing body proportions in children, which provides insight into disorders with disproportionate growth. However, body proportions are governed by ethnic, genetic, nutritional, and environmental factors. This study aimed to establish US:LS ratio reference values in live-born neonates from rural Telangana, India; compare US:LS ratios across sex, gestational age categories, birth weight categories, and intrauterine growth status; and assess whether Western normative values apply to this population. Methods A cross-sectional study was conducted between January and December 2021, at MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India, and 998 neonates were enrolled. Crown-heel length was measured with an infantometer, and the lower segment from pubic symphysis to heel with the help of an inch tape, and the upper segment was derived by subtraction. Neonates were classified by sex, gestational age (preterm, term, post-term), birth weight categories, and intrauterine growth status, and their US:LS ratio was compared. Descriptive statistics included mean and standard deviation for continuous variables and percentages for categorical variables. Independent t-tests were used to compare means between two groups. One-way ANOVA with post-hoc Tukey's honestly significant difference (HSD) was used for comparing more than two groups. A p-value of <0.05 was considered statistically significant. Results The study included 998 neonates, of whom 530 (53.1%) were males, and 468 (46.9%) were females. The mean gestational age ± SD was 38.16 ± 1.29 weeks. The overall mean US:LS ratio was 1.511 ± 0.13. Male neonates exhibited a significantly higher ratio than females (1.519 ± 0.14 vs. 1.502 ± 0.13; p = 0.048). Preterm neonates had a significantly higher mean ratio compared to term infants (1.56 ± 0.15 vs. 1.510 ± 0.13; p = 0.0031). Among gestational age groups, only the comparison between < 32 weeks and 37-39 weeks reached significance (p = 0.0083). Conclusion The mean US:LS ratio of neonates is lower than the typical values available in the literature. There is a gender difference observed with male neonates having a greater US:LS ratio. The mean US:LS ratio differs between preterm and term neonates. There is a need for further large-scale multicentric population-level studies on the US:LS ratio among Indian children. Clinicians should consider population-specific reference values when evaluating neonates for suspected skeletal dysplasia or disproportionate growth.
