St. George's University School of Medicine

Introduction:Menstrual disorders-including premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea-are highly prevalent among women of reproductive age and are associated with impaired academic performance, psychological distress, and reduced social functioning. Nursing students are particularly vulnerable due to the combined demands of intensive academic schedules and clinical training, yet prevalence estimates and institutional responses remain inconsistent. Methods:A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251109363). PubMed, Scopus, Web of Science, CINAHL Ultimate, and APA PsycINFO were searched for studies published between 2016 and 2025. Eligible studies reported prevalence or impact of PMS, PMDD, or dysmenorrhea exclusively in nursing students. The Joanna Briggs Institute checklist for prevalence studies was used for quality appraisal. Random-effects meta-analysis was applied to calculate pooled prevalence estimates, and thematic synthesis was used to evaluate academic, social, and psychosocial impacts, coping strategies, and interventions. Results:Twenty studies involving 5,131 nursing students were included. The pooled prevalence was 62% for PMS, 21% for PMDD (including severe PMS), and 72% for dysmenorrhea, with substantial heterogeneity (I 2 > 80%). Reported impacts included absenteeism, reduced concentration, diminished clinical performance, and impaired quality of life. Coping strategies were largely self-directed, including analgesics, rest, and dietary modifications, while few students accessed formal healthcare or institutional support. Only a limited number of studies evaluated structured interventions such as exercise, yoga, or nutritional supplementation. Conclusion:Menstrual disorders are highly prevalent among nursing students and carry significant academic, social, and psychological consequences. Nursing education programs should integrate routine screening, structured wellness initiatives, and evidence-based interventions to improve student wellbeing, reduce academic disruption, and strengthen workforce preparedness. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD420251109363, PROSPERO CRD420251109363.

PURPOSE:Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, non-pharmacologic therapy with efficacy in treating chronic pain. This study evaluated the analgesic effectiveness of TENS in individuals with chronic neuropathic/nociplastic ocular pain (NOP) and explored predictors of response. DESIGN:Prospective, randomized, controlled pilot study PARTICIPANTS: Thirty-seven individuals (mean age 58 ± 12 years, 51% female) with moderate to severe chronic NOP. METHODS:Participants were randomized (2:1) to a 20-minute high-frequency TENS (hfTENS, 60 Hz) or low-frequency TENS (lfTENS, 3 Hz) intervention, delivered at the forehead three times/week, for six months. Study visits occurred at baseline, three, and six months, during which data from ocular symptom questionnaires, quantitative sensory testing (QST), and ocular examinations were collected. MAIN OUTCOME MEASURES:The primary outcome was change in ratings of pain intensity (0-10 numerical rating scale [NRS]). Secondary outcomes included changes in other measures of NOP symptom severity, QST metrics assessing evoked somatosensory sensitivity, and ocular signs (eg, corneal staining). RESULTS:Both hfTENS and lfTENS significantly reduced eye pain intensity acutely (within 24-hours of initial treatment), and hfTENS produced long-lasting improvements in the NPSI-Eye subscores of pressing pain (2.50 [5.50] to 1.50 [2.50], p = .03) and paroxysmal pain (1.50 [3.50] to 0.00 [1.50], P = .02) at three months, though without corresponding changes in NRS scores of generalized ocular pain intensity. No changes were noted at six months, and neither intervention impacted ocular exam findings at any time point. Significant baseline predictors of long-term TENS response included lower NPSI-Eye scores and lower sensitivity to noxious heat stimuli. CONCLUSIONS:Both hfTENS and lfTENS effectively reduced NOP short-term, with hfTENS also demonstrating sustained analgesia for neuropathic-like symptoms at three months. Baseline NOP severity and cutaneous sensitivity were predictive of treatment response and suggest reduced disruption of central pain modulatory mechanisms is efficacious for susceptibility to hfTENS analgesia. Together, the results from this pilot study highlight the potential of TENS as a neuromodulatory treatment for NOP, warranting future studies to guide patient selection and optimization of therapeutic benefit. CLINICAL TRIAL REGISTRATION:Pilot Study of TENS for Ocular pain; NCT05531643.

Post-COVID syndrome (PCS), or long COVID, refers to a cluster of enduring symptoms that extend beyond the acute phase of the initial SARS-CoV-2 infection. Acute infection predominantly impacts the respiratory tract, but there is growing evidence for the multisystem involvement, such as cardiovascular, metabolic, and neurological, to be responsible for the prolonged presentation in PCS. Underlying cardiometabolic vulnerability may contribute to a high degree of susceptibility in patients with comorbidities like hypertension (HTN) and diabetes mellitus (DM). This narrative review summarizes current literature regarding PCS in patients with HTN and/or DM, focusing on proposed pathophysiological mechanisms, clinical manifestations, and reported long-term outcomes. In these populations, PCS has been linked across studies to processes including endothelial dysfunction, chronic low-grade inflammation, autonomic imbalance, and potential dysregulation of the renin-angiotensin-aldosterone system (RAAS). Persistent cardiovascular, metabolic, and neurocognitive symptoms are reported, but the magnitude and patterns of risk vary across studies, while comparative findings across HTN and DM remain heterogeneous. Symptoms reported frequently include fatigue, cognitive impairment ("brain fog"), and psychological distress, supporting the multisystem complexity of PCS. Although, previous work has indicated that cardiometabolic comorbidities could interact and moderate PCS severity and persistence, there is an important shortfall of both causality and prognosis, as well as the management of PCS. Longitudinal studies are needed for future research regarding risk stratification, disease course, and targeted interventions in individuals with PCS with comorbid high blood pressure and diabetes.

Introduction: Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis characterized by inflammation of medium-sized arteries. CNS involvement occurs in as many as 14.8% of cases and is a poor prognostic indicator. Neurologic involvement is characterized by peripheral neuropathy, ischemic stroke, extracranial or intracranial aneurysm formation, hemorrhage, seizures or headache. Laboratory markers are nonspecific; tissue biopsy remains the gold diagnostic standard. CNS PAN is diagnosed with systemic disease, a compatible clinical presentation and supportive neurovascular imaging. Angiographic findings include small- and medium-sized arterial aneurysms, luminal irregularities or occlusions. Despite PAN representing a unique, rare, dangerous and treatable etiology of aneurysm formation, current literature is limited to case reports, and no prior studies have characterized the clinical features or outcomes of aneurysms in PAN. Methods: We performed a systematic literature review to characterize intracranial aneurysms in PAN. Searches of PubMed, Ovid and Google Scholar were performed using key terms and Boolean operators. Studies were screened against inclusion/exclusion criteria and data was extracted. Results: Thirty articles (n=30 patients) met inclusion criteria. Mean age was 31 years and 60.5% were male. 63% first presented a ruptured aneurysm. Complications included aneurysmal subarachnoid hemorrhage (40%), intracerebral hemorrhage (10%), intraventricular hemorrhage and cavernous sinus syndrome. Presentations included cranial neuropathies, monocular vision loss, gait disturbance, hemiparesis, hemisensory loss, ptosis, limb ataxia, loss of consciousness, headache or seizures. In 48%, PAN diagnosis followed aneurysm identification. Aneurysms were located in the anterior circulation (53%), posterior (40%), or both (17%); 67% had > 2 aneurysms. 10% either underwent clipping or endovascular embolization while 80% did not undergo an intervention. 97% received steroids and 60% also received immunosuppressants. Mean follow-up was 30 months; 15% died during this period. 49% recovered without recurrence. 15% experienced progressive or relapsing symptoms. Conclusion: To our knowledge, this study is the first to describe the clinical features, treatment and outcomes of intracranial aneurysms in PAN. Although rare and treatable, aneurysms pose significant morbidity and mortality in PAN. We aim to inform practitioners about the spectrum of neurovascular disease in PAN.

PURPOSE:Type 2 diabetes mellitus (T2DM) is a common comorbidity among patients with heart failure (HF). This study aims to describe how T2DM relates to HF hospitalization patterns across demographic groups and HF subtypes. METHODS:We conducted a population-based retrospective cohort study using 19 years of clinical data from Cerner Health Facts®, a nationwide electronic health record (EHR) database. Adult patients hospitalized with HF were identified using ICD-9/ICD-10 diagnosis codes and HF-related medications and were stratified by T2DM status. Measures included HF-related hospitalization count, length of first HF hospitalization, and age at first HF hospitalization. Comparisons were examined across HF subtypes (historically termed systolic, diastolic, other). Additionally, sensitivity analyses were conducted using alternative inclusion criteria to assess the robustness of the findings. RESULTS:We identified 137,785 HF patients from the EHR database, among whom 29.5% had T2DM. Overall HF hospitalization was more common in men than in women; however, diastolic HF was more prevalent among women and presented at older ages whereas systolic HF was more prevalent among men. Compared with patients without T2DM, patients with T2DM experienced higher HF hospitalization count (mean: 2.81 vs. 2.42, p < 0.001), and both longer stay (mean: 7.03 vs. 6.85 days, p < 0.001) and earlier age (mean: 68.9 vs. 70.4 years, p < 0.001) of initial HF hospitalization. Across HF subtypes, T2DM was more prevalent among patients with diastolic HF (31.4% diastolic vs. 29.5% systolic vs. 28.7% other), and patients with T2DM were younger at first HF hospitalization than those without T2DM, with the largest difference observed for diastolic HF (mean: 70.4 vs. 73.1 years, p < 0.001). CONCLUSIONS:In this large nationwide EHR cohort, T2DM was associated with more intensive HF hospitalization patterns and was more prevalent in the diastolic HF subtype. These findings highlight the relevance of diabetes status and HF subtype, in addition to demographic factors, in shaping HF-related healthcare utilization.