Shalamar Medical and Dental College

Glioblastoma (GBM) remains the most common and lethal primary central nervous system tumor, with a median survival of only 14.6 months under standard care. The tumor’s characteristic "Warburg effect"—a dependency on aerobic glycolysis for energy—creates a metabolic vulnerability. This review evaluates the efficacy and safety of the ketogenic diet (KD) as an adjunctive metabolic therapy aimed at exploiting this glucose dependency. This PRISMA-compliant systematic review updates clinical evidence by synthesizing data from databases from 2000 to September 2025. We searched PubMed, Embase, Cochrane, and Web of science for human studies assessing the ketogenic diet (KD) in glioblastoma and high-grade gliomas. Primary outcomes included overall survival (OS), progression-free survival (PFS), feasibility, and adverse events. Study quality was assessed using Joanna Briggs Institute tools. Prospero registration: CRD420251232650. Forty-one studies were included, ranging from randomized trials to case series and abstracts, utilizing interventions such as the classic 4:1 ketogenic diet, Modified Atkins Diet, and calorie restriction. Adherence was high (> 75

Non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM) are increasingly prevalent, interrelated conditions contributing significantly to morbidity and mortality. Understanding long-term mortality trends is essential to guide public health strategies. This study aimed to evaluate nationwide mortality trends involving NAFLD and DM in the United States from 1999 to 2022 and to assess demographic and geographic disparities. CDC WONDER was used to extract data for adults aged ≥ 25 years. 10th Revision (ICD−10), using the explicit codes with K74.0, K74.6, K75.8, K76.0 and K76.9 for NAFLD and E10-E14 for DM. Age- Adjusted Mortality Rates (AAMRs) per million population were calculated and trends were analyzed by calculating annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint Regression Program (version 5.2.0.0; National Cancer Institute), with statistical significance set at p < 0.05. From 1999 to 2022, a total of 126,431 NAFLD and DM related deaths were recorded with most of the deaths occurring in Medical Facilities (43.52

BACKGROUND:The management of reproductive health in individuals with autoimmune rheumatic diseases (AIRDs) has evolved into a primary clinical priority. Wide variations in clinical practice and drug availability in the Asia-Pacific regions necessitate localized frameworks. These consensus statements, developed by the Asia Pacific League of Associations for Rheumatology (APLAR) Special Interest Group for Women's Health & Reproductive Issues in Rheumatic and Musculoskeletal Diseases, aim to bridge the gaps within the region, foster multidisciplinary collaboration, and address regional knowledge deficits. METHODS:An expert panel comprising 16 members of the 13 APLAR member nation organizations formulated 23 research questions using the PICO framework. A systematic review of English-language literature up to July 2025 was conducted across the MEDLINE, Scopus, Google Scholar, and Cochrane Library databases, supplemented by a manual search of journals from the APLAR regions. Evidence from the APLAR region was appraised using the GRADE system. A modified Delphi online voting process was employed to reach consensus, pre-defined as ≥ 75% agreement. RESULTS:The panel approved four overarching principles and 86 statements, organized into 16 broad categories. These statements cover all three phases of pregnancy in AIRDs, the safety of medications during pregnancy and lactation, contraception, assisted reproductive techniques, fertility preservation, and hormonal replacement therapy, covering both female and male aspects as relevant. CONCLUSION:In a field often lacking high-quality data, these consensus statements from APLAR provide expert opinion-based guidance to support clinical decision-making. It is envisaged that it will assist in educational and training purposes and help shape future research priorities.

Pulmonary embolism (PE) often presents with non-specific symptoms that make the diagnosis challenging, but the identification of right heart strain (RHS) can help determine the disease severity. Therefore, timely identification and diagnosis of RHS in patients with pulmonary embolisms is critical for accurate risk categorization and appropriate management. The review mainly concentrates on acute pulmonary embolism and right‑heart strain assessment, risk stratification, and management using European Society of Cardiology (ESC) 2019 guidelines developed in collaboration with the European Respiratory Society (ERS). Right‑heart strain is diagnosed by imaging signs such as right‑ventricular dilation, interventricular septal flattening, McConnell's sign, TAPSE < 16 mm, or an RV/LV ratio > 1 on CTPA, together with elevated biomarkers (NT‑proBNP, troponin I, and MPV). These biochemical markers are chosen because they rise with right‑ventricular overload or injury. The aim of this study is to identify a literature gap in the diagnosis of RHS in the context of PE. Various biochemical markers and imaging modalities to diagnose RHS with PE are assessed. Despite the available tools, the current diagnostic approaches remain limited due to the absence of standardized measurement techniques and guidelines for right heart strain assessment on CTPA and echocardiography. Standardization of the assessment of right heart structure and function should be established, as this significantly impacts patient management. This study invites the researchers and international collaboration to set guidelines for the diagnosis of right heart strain in the context of pulmonary embolism to improve patient management and outcomes. This will also help to reduce mortality worldwide. A narrative review of existing studies, imaging techniques, and blood test markers was conducted to highlight existing gaps and call for future guidelines. A literature search was conducted using the Google Scholar database for articles published from 2000 to the most recent ones. Keywords included 'pulmonary embolism,' 'right ventricular dysfunction,' 'right heart strain,' 'thromboembolism,' 'deep venous thrombosis,' 'CT pulmonary angiogram,' 'echocardiography,' and 'anticoagulation.' No limitations were placed on the search to maximize inclusion of relevant literature. Duplicates and non-English articles were excluded.

Inflammation and autoimmunity create a complex array of pathological parameters to induce rheumatoid arthritis (RA) that is primarily a disease of the musculoskeletal system. To date, there is no cure for RA. The purpose of the present study was to evaluate the antiarthritic effects of n-Hexane (CHnHE) and methanolic (CHME) extracts of Calliandra haematocephala in Complete Freund’s adjuvant-induced (CFA) arthritis. For this purpose, 30 mg/kg Naproxen and 3 doses of C. haematocephala extracts (250, 500 and 750 mg/kg) were administered to Wistar rats immunised with CFA. To evaluate the antiarthritic effects, the assessment parameters included paw swelling, arthritic index, changes in body and immune organ weights, haematological indices, biochemical markers, oxidative stress markers, radiographic and histopathological evaluation of paws, and mRNA expression analysis. Results of the study revealed significant (p < 0.05) improvement in disease parameters in contrast to the arthritic control group. Both extracts attenuated paw inflammation and restored the whole body and immune organ weights. Haematological and biochemical derangements were significantly improved in the extract treated animals. Serum levelsof antioxidant enzymes were increased, whereas malondialdehyde (MDA) level was decreased in the extract treated animals. Radiographic and histopathological examination of paws revealed that both extracts prevented synovitis, pannus formation and bone erosion. RT-qPCR analysis revealed the downregulation of pro-inflammatory mediators and upregulation of anti-inflammatory cytokines in the extract treated rats. Phytochemical analysis exhibited the presence of phenolic acids, flavonoids, terpenoids, sterols and tannins in both extracts. On the basis of the findings of the present study, it is proposed that CHnHE and CHME possess noticeable antiarthritic activity possibly via modulation of the immune system and antioxidant defense mechanisms.