Sharif Medical and Dental College

Meningiomas are the most common primary intracranial tumors, often treated surgically. However, complete resection is frequently limited by proximity to critical structures, necessitating adjuvant or definitive radiotherapy. Proton therapy offers dosimetric advantages over photon-based radiotherapy, particularly in sparing adjacent normal tissues. This study aims to systematically evaluate the effectiveness and safety of proton therapy for intracranial meningiomas across tumor grades and clinical scenarios. A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines using PubMed, EMBASE, Scopus, Web of Science, and Cochrane from inception to November 10, 2025. Studies were eligible if they reported clinical outcomes of proton therapy in ≥ 10 adult meningioma patients. Data extraction and risk-of-bias assessment were performed independently by two reviewers. Pooled complication rates and survival outcomes were calculated using random-effects models. Nineteen studies involving 1,431 patients were included. WHO Grade I tumors comprised 70.6

Obesity is becoming increasingly common around the world and is often co-occurring with chronic diseases that could complicate surgical treatment. Partial Nephrectomy is a complex surgical procedure and obesity may influence surgical complexity, postoperative recovery and resource use. Previous studies have produced mixed results, and many are limited by small sample sizes or single-center data. This study assesses how obesity affects in-hospital perioperative outcomes by analyzing data from a large national dataset. We performed a retrospective analysis of the National Inpatient Sample from 2018 to 2020, including adult patients with non-metastatic RCC who underwent open, laparoscopic, or robot assisted partial nephrectomy. Outcomes included in-hospital mortality, complications, discharge disposition, length of stay, and total hospital charges. Survey-weighted methods and multivariable regression models were employed to adjust for measured demographic, clinical, and hospital-level factors. Among 40,300 weighted hospitalizations, 10,270 patients were obese, younger and had higher comorbidity burdens. Surgical approaches were similar across groups, with robotic partial nephrectomy most frequent. Unadjusted analyses showed higher postoperative complication rates in obese patients. However, after adjusted analysis, obesity was not independently linked to in-hospital mortality, major complications, non-home discharge, length of stay, or hospital costs. Robotic surgery was associated with lowest adjusted odds of complications, mortality, and shorter hospitalization. The comorbidity index proved a reliable predictor for mortality, complications, length of stay, and total charges. Obesity alone was not an independent predictor of adverse in-hospital perioperative outcomes following partial nephrectomy. It is of utmost importance to manage the underlying conditions, as the comorbidity index remains the strongest determinant of worse outcomes and higher hospital costs. The robotic partial nephrectomy was associated with lowest adjusted odds of complications and shorter hospitalization within contemporary practice patterns.

Background Subclinical microbial dysbiosis and chronic low-grade infections have recently emerged as important contributors to systemic inflammation, autonomic nervous system dysfunction, and cardiovascular disease progression. A disruption in the balance of gut microbes can affect inflammation, metabolism and blood vessel function, especially in urban dwellers who are more likely to have sedentary lifestyles and poor diets. Objective To assess the relationship between subclinical microbial dysbiosis, chronic low-level infections and systemic inflammation, autonomic dysfunction and cardiovascular risk in adults in a community-based population in the urban area. Methods This community-based cross-sectional study was conducted from June 2024 to September 2025 at the Department of Public Health, Health Services Academy, Islamabad, Pakistan, in collaboration with Abwa Medical College, Faisalabad, Punjab, Pakistan. A total of 130 participants aged 25–70 years were enrolled through non-probability consecutive sampling. Demographic and anthropometric data, inflammatory markers, parameters of the autonomic nervous system and cardiovascular risk markers were measured. The presence of microbial dysbiosis in stool samples was analyzed. ECG recordings were used to assess HRV. Data were analyzed with SPSS version 26.0 and difference at p<0.05 was considered significant. Results Subclinical microbial dysbiosis was identified in 76 (58.5%) participants. Individuals with dysbiosis demonstrated significantly elevated hs-CRP (5.9±1.8 vs 2.7±1.1 mg/L), IL-6 (11.8±3.4 vs 6.1±2.2 pg/mL), and TNF-α levels (18.9±4.3 vs 10.2±2.9 pg/mL) compared with controls (p<0.001). Dysbiosis was significantly related to decreased HRV and increased resting HR. Participants with microbial imbalance had significantly higher Framingham cardiovascular risk scores and CIT (p<0.001). Conclusion Systemic inflammation, autonomic dysfunction and cardiovascular risk are all significantly linked to subclinical microbial dysbiosis and chronic low-grade infections in adults living in urban areas.

BACKGROUND:Obstructive sleep apnea (OSA) and hypertension (HTN) frequently coexist and are associated with increased cardiovascular morbidity and mortality in the United States. RESEARCH DESIGN AND METHODS:Mortality data from 1999-2023 were obtained from the CDC WONDER Multiple Causes of Death database. Deaths were identified when ICD-10 codes for OSA (G47.3) and HTN (I10-I15) were listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) were calculated and stratified by demographic and geographic factors. Temporal trends were evaluated using Joinpoint regression, and mortality was forecasted using Poisson regression model. RESULTS:A total of 107,514 deaths were associated with OSA and HTN between 1999 and 2023. AAMRs increased from 0.4 in 1999 to 12.4 in 2023, with higher rates observed among males, adults aged ≥75 years, NH-White individuals, rural populations, and residents of the Midwest. Among states, West Virginia had the highest AAMR. Forecasting models project continued increases in overall mortality, with AAMRs reaching 55.38 by 2035. CONCLUSIONS:Mortality associated with OSA and HTN has increased substantially over the past two decades, disproportionately affecting older adults, males, and rural populations. Forecasted trends highlight the need for targeted prevention, early diagnosis, and improved access to effective therapies.