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The global burden of non-alcoholic fatty liver disease (NAFLD) necessitates reliable biomarkers for early detection, particularly in high-risk South Asian populations. This cross-sectional study evaluated oxidative stress markers, dietary patterns, and fibrosis indices in 100 biopsy-proven NAFLD patients (50 male, 50 female; age 35–60 years; BMI 25–40 kg/m²) and 50 matched controls from Sargodha, Pakistan. Comprehensive profiling revealed significantly elevated oxidative stress in NAFLD patients, with malondialdehyde (MDA) levels 61.2% higher (214.1 ± 12.3 vs. 132.9 ± 11.2 nmol/gHb, p < 0.001) and glutathione (GSH) 50.5% lower (35.4 ± 2.1 vs. 71.6 ± 1.9 mg/gHb, p < 0.001) than controls. Fibrosis-4 (FIB-4) scores correlated strongly with oxidative markers (r = 0.72, p < 0.01) and Western dietary patterns (r = 0.65, p < 0.05). Hypomagnesemia (1.65 ± 0.06 vs. 2.3 ± 0.07 mg/dL, p < 0.04) and elevated TNF-α (p < 0.01) were prominent metabolic disturbances. Dietary analysis identified three patterns, with meat-based diets associated with the highest oxidative stress index (OSI: 37.3 vs. 17.5 in vegetarians, p < 0.01). These findings propose a cost-effective prognostic panel combining oxidative stress markers (MDA, GSH), fibrosis indices (FIB-4), and dietary assessment for NAFLD management in resource-limited settings. However, larger multicenter studies are needed to validate these associations and explore causal mechanisms
Background: Polycystic ovary syndrome is a leading cause of anovulatory infertility and is frequently associated with insulin resistance, obesity, menstrual dysfunction, and psychosocial burden. Integrated treatment strategies may improve reproductive outcomes by targeting both metabolic and ovulatory mechanisms. Objective: To evaluate the impact of lifestyle modification alone versus combined lifestyle and pharmacological therapy on ovulation, menstrual regularity, pregnancy, BMI, and patient experiences among women with insulin-resistant PCOS. Methods: A prospective mixed-methods observational study was conducted over four months in the Islamabad-Rawalpindi region. Seventy-two women aged 18–35 years with PCOS, insulin resistance, and subfertility were enrolled, and 68 completed follow-up. Quantitative outcomes included ovulation confirmed by mid-luteal progesterone, menstrual regularity, pregnancy confirmed by serum beta-hCG, BMI change, and progesterone levels. Qualitative interviews explored adherence and treatment experiences. Results: Ovulation increased from 18.1% to 57.4%, menstrual regularity from 22.1% to 61.8%, and pregnancy occurred in 20.6% of participants. Combined therapy produced higher ovulation than lifestyle modification alone (68.2% vs 46.7%) and greater BMI reduction (1.6 ± 0.8 vs 0.9 ± 0.6 kg/m²). BMI reduction correlated positively with ovulatory improvement. Conclusion: Combined lifestyle and pharmacological therapy improved short-term reproductive and metabolic outcomes in insulin-resistant PCOS.
Background: Type 1 diabetes requires strict adherence to insulin therapy and self-monitoring; however, psychosocial factors such as perceived stigma may interfere with effective disease management, particularly among young adults. Objective: To evaluate the impact of diabetes-related stigma on treatment adherence and glycemic outcomes among young adults with type 1 diabetes. Methods: A descriptive mixed-methods study was conducted over four months in an urban clinical setting, enrolling 72 participants aged 18–30 years with established type 1 diabetes. Perceived stigma was assessed using the Diabetes Stigma Assessment Scale (DSAS-1), while adherence behaviors were measured through the Summary of Diabetes Self-Care Activities (SDSCA). HbA1c values were obtained from medical records. Quantitative data were analyzed using Pearson correlation and independent t-tests, while qualitative insights were explored through thematic analysis of semi-structured interviews. Results: Participants demonstrated moderate stigma levels (mean DSAS-1 score: 2.9 ± 0.6) and suboptimal adherence to insulin administration (4.1 ± 1.2 days/week) and glucose monitoring (3.5 ± 1.4 days/week). Higher stigma scores were significantly associated with lower adherence to insulin (r = -0.48, p = 0.001) and glucose monitoring (r = -0.52, p < 0.001), as well as higher HbA1c levels (r = 0.44, p = 0.002). Individuals in the high-stigma group exhibited significantly poorer adherence and glycemic control compared to those with lower stigma. Conclusion: Perceived diabetes-related stigma was a significant barrier to treatment adherence and optimal glycemic control. Addressing stigma through patient-centered and psychosocially informed interventions may enhance diabetes management outcomes.
Background: Chronic obstructive pulmonary disease and hypertension are major contributors to cardiopulmonary and vascular morbidity and mortality in the United States. Although mortality trends for each condition have been extensively studied, the long-term national burden associated with their coexistence remains insufficiently characterized. This study examines mortality trends attributed to chronic obstructive pulmonary disease with coexisting hypertension and evaluates demographic and geographic disparities. Methods: Mortality data from 1999 to 2023 were obtained from the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research database. Adults aged 25 years and older with death certificates listing both chronic obstructive pulmonary disease and hypertension as underlying or contributing causes of death were included. Age adjusted mortality rates per 100,000 population were calculated using the 2000 United States standard population and stratified by age, sex, race, state, urbanization level, and census region. Temporal trends were assessed using Joinpoint regression with annual percent change estimates. Results: A total of 1,001,700 deaths were attributed to coexisting chronic obstructive pulmonary disease and hypertension during the study period. National age-adjusted mortality rates increased more than threefold, rising from 6.23 in 1999 to 21.56 in 2023. Mortality rose sharply between 1999 and 2001, followed by sustained increases through 2011 and persistently elevated rates thereafter, with only modest declines observed after 2021. Rates were consistently higher among males than females. The highest mortality burden was observed among non-Hispanic Black and non-Hispanic White populations, residents of nonmetropolitan areas, and individuals living in the South and Midwest. Mississippi and Oklahoma demonstrated the highest state-level mortality rates. Conclusions: Mortality associated with coexisting chronic obstructive pulmonary disease and hypertension has increased substantially over the past two decades, with pronounced racial and geographic disparities. These findings highlight the importance of integrated vascular and pulmonary risk management, improved hypertension control, and region-specific public health strategies to reduce mortality among populations with high-risk cardiopulmonary comorbidity.
Background:This systematic review and meta-analysis study was undertaken to compare the efficacy and safety of remimazolam versus propofol for sedation in elderly patients (≥60 years old) undergoing gastrointestinal endoscopy. Methods:The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov were used to perform a thorough literature search from their inception to December 2025. A random-effects meta-analysis was performed using RevMan. The Mantel-Haenszel method was used to pool risk ratios (RRs) along with 95% confidence intervals (95% CIs) for dichotomous outcomes. The inverse variance method was used to pool mean differences (MDs) with 95% CI. Results:This meta-analysis included 11 RCTs consisting of 2456 participants. Remimazolam significantly reduced the risk of overall adverse events (RR: 0.60, 95% CI: 0.42-0.86), injection site pain (RR: 0.20, 95% CI: 0.12-0.34), hypotension (RR: 0.46, 95% CI: 0.35-0.59), bradycardia (RR: 0.52, 95% CI: 0.34-0.77), need for vasopressors (RR: 0.39, 95% CI: 0.23-0.67), hypoxemia (RR: 0.42, 95% CI: 0.29-0.59), and respiratory depression (RR: 0.42, 95% CI: 0.29-0.62) compared with propofol. There were no statistically significant differences between remimazolam and propofol in sedation success, procedure success, procedure time, onset time, time to full alertness, time to discharge, patient satisfaction, endoscopist satisfaction, postoperative nausea and vomiting, or prolonged sedation. Conclusion:Our analysis suggests that remimazolam is safer compared to propofol for sedation in endoscopic procedures.
