Background:The triangular fibrocartilage complex (TFCC) is a key fibrocartilaginous and ligamentous structure located on the ulnar side of the wrist. It plays a crucial role in separating the ulnocarpal joint from the distal radioulnar joint (DRUJ) and is essential for stabilizing the DRUJ. In addition to maintaining joint stability, the TFCC also functions as a shock absorber, distributing axial loads transmitted through the ulnar aspect of the wrist. Objective:To evaluate the diagnostic utility of high resolution ultrasound and strain elastography in detecting TFCC injuries, focusing primarily on the articular disc, in comparison to MRI using sensitive sequences. Patients and Methods:This study is cross sectional study conducted at the US Radiology Unit; Radiology Department, Ain Shams University Hospitals (ASUH), and the magnetic resonance imaging (MRI) Radiology Unit; Radiology Department, ASUH on 26 patients included in this study. Patients who came to the orthopaedic hand clinic presented with ulnar side wrist pain. Results:The results of the study demonstrated a strong correlation between strain elastography (SE) and MRI in the detection of TFCC injuries. Quantitative Sonoelastography (SEL) measurements showed consistent patterns of altered tissue stiffness in patients with confirmed TFCC pathology on MRI, suggesting that SEL can reliably reflect the biomechanical changes associated with TFCC damage. Statistical analysis revealed a significant positive correlation between SEL findings and MRI-detected abnormalities, supporting the potential of SEL as a complementary diagnostic modality. Conclusion:These findings indicate that SEL may represent a promising adjunctive imaging modality for the early assessment of TFCC injuries, particularly in settings where MRI availability is limited. So incorporating SEL in the diagnostic workflow could help stratify patients, identifying those who may benefit from more advanced imaging modalities such as magnetic resonance arthrography (MRA) or diagnostic arthroscopy for further evaluation and confirmation. This approach may enhance diagnostic accuracy while minimizing unnecessary invasive procedures.
Abstract:The medico-legal assessment of sports injuries in professional athletes continues to rely on tools designed for an entirely different context. Permanent impairment tables measure the reduction in overall individual function, but not the loss of competitive performance, the reduction in expected athletic lifespan, or the impact on contracts and earnings. In this Editorial we argue that closing this gap does not require new, ad hoc composite indices, but a more rigorous and systematic integration of approaches already validated in the sports medicine and rehabilitation literature: objective quantification of the return-to-sport (RTS) deficit, obtained by comparing validated sport-specific functional and performance outcome measures recorded before and after injury; structured documentation of the rehabilitation pathway, including objective RTS criteria, time-to-RTS, and the psychological readiness to compete; and an evidence-based estimate of the economic and contractual impact, grounded in objective performance-analytics data rather than presumptive percentages. The integration of these indices with clinical-orthopaedic assessment may allow a more accurate definition of "functional-professional" damage in athletes, with significant implications for insurance, legal, and medico-legal practice. The aim is to promote a new multidisciplinary assessment model capable of bridging the traditional distinction between biological damage and economic loss, providing a more realistic and equitable measure of the consequences of sports trauma on athletes' careers.
Objective:To describe the origin, morphology, and branching patterns of the prostatic artery in Vietnamese men with symptomatic benign prostatic hyperplasia and to identify anatomical features relevant to planning and safety of prostatic artery embolization (PAE). Methods:This prospective study enrolled 120 patients who underwent pelvic digital subtraction angiography before planned PAE at Bach Mai Hospital, Hanoi, Vietnam between September 2022 and December 2024. For each hemipelvis, the number and origin of prostatic arteries were classified using the Yamaki and Moreira de Assis systems. Arterial diameter, length, tortuosity, atherosclerotic changes, and anastomotic connections with adjacent pelvic vessels were documented. Side-to-side differences were analyzed using paired tests, and correlations between arterial measurements and clinical variables were assessed. Results:A total of 240 hemipelves were evaluated. Yamaki type A was the predominant internal iliac artery branching pattern (77.9%). The most common prostatic artery origin was Moreira de Assis type I (46.7%), followed by types IV and III. A single prostatic artery was identified in 91.3% of hemipelves. Mean arterial diameter and length were 1.90 ± 0.43 mm and 180.53 ± 68.60 mm. Tortuosity was present in 70.4% of arteries, atherosclerosis in 38.3%, and anastomoses in 49.2%. No significant side-to-side differences were found in arterial diameter or tortuosity, whereas atherosclerosis differed (p = 0.040). Prostate volume showed a weak positive correlation with arterial diameter (r = 0.27; p < 0.05). Conclusions:Variability in prostatic artery anatomy highlights the importance of detailed vascular assessment for safe PAE.
Objectives:To evaluate the clinical outcomes of our index needle revision with subconjunctival 5-fluorouracil (5-FU) injection for failed non-penetrating deep sclerectomy (NPDS) in Vietnamese patients. Methods:This prospective study included eyes with failed NPDS that underwent 5-FU-augmented needle revision between 2023 and 2025. Complete and qualified success rates were evaluated at 6 and 12 months postoperatively. Factors potentially associated with procedure success were analyzed. Results:A total of 41 eyes of 33 patients with failed NPDS underwent first needle revision augmented with 5-fluorouracil. The mean patient age was 46.09 ± 16.7 years. Mean pre-needling intraocular pressure (IOP) was 27.66 ± 6.84 mmHg, which was reduced to 14.05 ± 3.22 mmHg, 14.56 ± 5.35 mmHg, and 14.10 ± 3.72 mmHg at 3, 6, and 12 months, respectively (p < 0.001). Best-corrected visual acuity showed a minimal change from 0.67 ± 0.76 preoperatively to 0.65 ± 0.77 at 12 months. Complete and qualified success rates were 78.1% at 6 months, and 68.3% and 70.7%, respectively, at 12 months. Postoperative complications included subconjunctival hemorrhage in 33 eyes (80.5%), hyphema in 4 eyes (9.8%), shallow or flat anterior chamber in 10 eyes (24.4%), corneal epithelial toxicity in 6 eyes (14.6%), iris incarceration in 2 eyes (4.8 %), and hypotony in 4 eyes (9.8%), all occurring in eyes with prior mitomycin C exposure. No cases of endophthalmitis were observed. No significant associations were found between surgical success and patient age, history of previous needle revision, or prior laser goniopuncture, or the interval between the first needle revision and surgery. Conclusion:First-time needle revision augmented with 5-fluorouracil demonstrated satisfactory effectiveness in restoring bleb function in failed NPDS, with an acceptable and predictable safety profile. Most complications were self-limited. Particular caution is recommended when revising thin, avascular blebs, which may be more susceptible to postoperative hypotony.
Background:Temporomandibular joint (TMJ) internal derangement is a common cause of orofacial pain and functional limitation. Clinical symptoms such as joint pain, clicking sounds, and limited mouth opening are frequently used in the initial assessment of temporomandibular disorders (TMD). However, the diagnostic accuracy of these clinical signs in predicting disc displacement remains uncertain. Magnetic resonance imaging (MRI) is considered the gold standard for evaluating TMJ disc position and morphology. This study aimed to assess the diagnostic value of common clinical symptoms for detecting TMJ disc displacement using MRI as the reference standard. Methods:A cross-sectional study was conducted between August 2023 and August 2024. A total of 178 patients, contributing 267 temporomandibular joints, were included. Clinical symptoms including joint pain, joint clicking, and limited mouth opening were recorded during standardized clinical examination. All participants underwent MRI evaluation of the temporomandibular joints. Disc displacement identified on MRI served as the reference standard. Because both joints of a patient could be included, observations were clustered within patients; diagnostic performance (sensitivity, specificity, PPV, NPV, accuracy, likelihood ratios, and diagnostic odds ratios with 95% confidence intervals) and multivariable generalized estimating equation models accounted for this clustering. Results:Disc displacement was present in 206 of 265 analyzed joints (77.7%). Joint pain showed the highest sensitivity (92.7%, 95% CI 88.3-95.5) but low specificity (33.9%), together with the most useful negative likelihood ratio (0.21) and the strongest discrimination (diagnostic odds ratio 6.53, 95% CI 3.08-13.86). Limited mouth opening had the highest specificity (69.5%), whereas joint clicking did not discriminate displaced from normally positioned discs (diagnostic odds ratio 1.34, 95% CI 0.74-2.42). In multivariable analysis, joint pain (adjusted odds ratio 4.06, 95% CI 1.83-9.03) and younger age were the only independent clinical predictors of disc displacement; joint effusion and condylar abnormality were additionally associated when MRI findings were included. Conclusion:Clinical symptoms provide useful preliminary information in the evaluation of TMJ disorders. However, clinical examination alone has limited diagnostic accuracy for identifying disc displacement. MRI remains the most reliable imaging modality for confirming TMJ internal derangement and should be considered when clinical findings are inconclusive.
Background:Reduced Total Antioxidant Status (TAS) and elevated Malondialdehyde (MDA) reflect redox imbalance in coronary artery disease (CAD). Their inverse relationship may help assess cardiovascular risk and disease progression. Objectives:To evaluate the association between serum TAS, MDA and the severity of coronary artery damage in CAD patients at Thai Nguyen National Hospital. Results:Serum TAS showed no significant differences by number of stenotic vessels or lesion sites (p > 0.05). TAS was slightly higher in single-vessel disease (1.15 ± 0.38 mmol/L) than in two-vessel (1.08 ± 0.19) and ≥3-vessel groups (1.09 ± 0.18), without statistical significance (p = 0.721). A significant difference was observed only in the right coronary artery (RCA), where TAS peaked in moderate stenosis and decreased in severe stenosis (p = 0.039). In contrast, MDA increased significantly with disease extent: 255.25 ± 48.43 nmol/mL (1-vessel), 281.30 ± 62.56 (2-vessel), and 317.06 ± 54.53 (≥3-vessel) (p = 0.001). MDA also rose markedly with SYNTAX score (low: 239.98 ± 40.96; medium: 271.49 ± 46.53; high: 392.62 ± 90.85 nmol/mL; p < 0.001). ROC analysis showed good diagnostic performance (AUC up to 0.895). TAS did not differ across SYNTAX groups (p = 0.857). Conclusions:TAS is not associated with CAD severity, whereas MDA strongly correlates with disease extent and complexity. MDA may serve as a useful biomarker for oxidative stress and risk stratification in CAD.
Background:Wrist pain is a prevalent and diagnostically complex issue, often stemming from subtle injuries to the triangular fibrocartilage complex (TFCC). Due to the small size and intricate structure of the wrist ligaments, conventional MRI may not reliably detect all TFCC tears, especially peripheral or partial injuries. Direct magnetic resonance arthrography (MRA) has emerged as a superior imaging modality by improving contrast resolution and visualizing joint integrity more precisely. Objective:To evaluate the diagnostic value of direct MR arthrography using combined radiocarpal (RC) and distal radioulnar (DRU) joint contrast injection compared to conventional MRI in detecting and characterizing TFCC injuries. Methods:A prospective cross-sectional study was conducted on 73 patients (aged 20-43) presenting with chronic wrist pain at Ain Shams University and Misr Radiology Center from January 2023 to December 2024. All patients underwent conventional MRI, followed by direct MRA using combined RC and DRU contrast injection. Arthroscopy was performed as the gold standard. Results:Conventional MRI identified TFCC tears in 30.14% of patients, while direct MRA detected them in 61.64%. When validated against arthroscopy, conventional MRI yielded a sensitivity of 45.65%, specificity of 96.30%, and overall accuracy of 64.4%, with a Kappa value of 0.354 (fair agreement). Conversely, direct MRA demonstrated a markedly higher sensitivity (95.65%), specificity (96.30%), PPV (97.78%), NPV (92.86%), and overall accuracy of 95.9%, with a Kappa value of 0.913 (excellent agreement). Peripheral TFCC tears (Palmer 1b) were the most prevalent subtype (30.14%). Additional pathologies such as scapholunate ligament injuries (48.65%) and ECU tenosynovitis (18.92%) were frequently detected. Conclusions:Direct MRA using combined compartment injection is highly accurate and superior to conventional MRI in diagnosing TFCC injuries. It should be considered an essential imaging tool for evaluating chronic wrist pain and planning surgical intervention.
Background:Acute myeloid leukemia (AML) is a hematologic malignancy associated with significant coagulation abnormalities and endothelial dysfunction. Von Willebrand factor (VWF) and its regulatory protease, a disintegrin and metalloproteinase with thrombospondin type 1 motif member 13 (ADAMTS13), play essential roles in maintaining vascular homeostasis. Disruption of this balance may contribute to thrombotic complications in AML. Methods:This case-control study included 40 newly diagnosed, untreated AML patients and 40 age- and sex-matched healthy controls recruited from Al-Azhar University Hospitals, Cairo, Egypt. Plasma VWF antigen levels and ADAMTS13 activity were measured using enzyme-linked immunosorbent assay (ELISA). Statistical comparisons between groups were performed using appropriate parametric tests, and correlation analysis was conducted to assess the association between both biomarkers. Results:AML patients showed significantly higher plasma VWF antigen levels compared with controls (274.44 ± 139.72% vs. 111.40 ± 31.77%, P < 0.001). In contrast, ADAMTS13 activity was significantly lower in AML patients than in controls (46.70 ± 29.37% vs. 99.01 ± 27.09%, P < 0.001). An inverse correlation was observed between VWF antigen and ADAMTS13 activity (r = -0.28), although this did not reach statistical significance (P = 0.08). Conclusions:Newly diagnosed AML patients demonstrate significant imbalance in the VWF-ADAMTS13 axis, characterized by elevated VWF levels and reduced ADAMTS13 activity. These findings support the presence of early endothelial dysfunction and hemostatic disturbance prior to treatment initiation. Further large-scale prospective studies are needed to determine the prognostic and clinical significance of these biomarkers.
Background:Gliomas are the most common malignant primary brain tumors, and Temozolomide (TMZ) remains a key component of their management. Despite its efficacy, TMZ is associated with adverse drug reactions (ADRs) that may affect quality of life and treatment compliance. This study evaluated the pattern and frequency of ADRs in South Indian glioma patients receiving TMZ, examined demographic associations, and reviewed management strategies. Methods:A retrospective observational study was conducted at KMC Hospital, Mangalore, India, over the past three years. Thirty-eight patients with histologically confirmed glioma who received oral TMZ were included. Data on demographics, tumor characteristics, treatment schedules, hematological and non-hematological ADRs, management approaches, and outcomes were extracted from medical records and analyzed using SPSS. Results:The study population was predominantly male (68.4%), with a median age of 45.5 years. Grade 3 and Grade 4 gliomas accounted for 31.6% and 34.2% of cases, respectively. A total of 38 ADRs were documented. The most frequent ADRs were leukocytopenia (9.3%) and itching (9.3%). Management strategies included treatment deferral, dose reduction, antihistamines, nonsteroidal anti-inflammatory drugs, and blood transfusions. Most ADRs resolved without hospitalization. Skin-related reactions typically subsided within 4-14 days, whereas hematological toxicities such as neutropenia required longer recovery periods (22-75 days). The mortality rate was low (5.3%), suggesting effective ADR management. Conclusion:TMZ-related ADRs in glioma patients are diverse, underscoring the need for vigilant monitoring of both hematological and non-hematological toxicities. Individualized management and careful tracking of recovery times can improve treatment tolerance and patient quality of life.
Background:Artificial intelligence chatbots, particularly ChatGPT, have emerged as increasingly popular sources of health information for the general public. However, concerns persist regarding the accuracy, safety, and appropriateness of AI-generated medical advice, especially for life-threatening conditions such as myocardial infarction. Objectives:This study aimed to evaluate the accuracy, completeness, and safety of ChatGPT-generated responses and information to public questions about heart attacks, assess user perceptions and trust, and compare AI-generated content with expert-validated sources. Methods:A cross-sectional study was conducted between January and March 2026. A total of 73 commonly asked heart attack-related questions were submitted to ChatGPT (GPT-4), and responses were independently evaluated by two expert reviewers and one external reviewer using standardized rubric assessing accuracy, completeness, clarity, safety, and tone. Inter-rater reliability was assessed using intraclass correlation coefficients. In parallel, a survey of 352 participants evaluated user perceptions, trust, and behavioral use of ChatGPT for medical information. Statistical analyses included descriptive statistics, group comparisons, correlation analyses, and multivariable regression models to identify predictors of trust and satisfaction. Results:Expert reviewers assigned high ratings for accuracy (mean: 4.62 ± 0.62 and 4.48 ± 0.63) and safety (mean: 4.78 ± 0.51 and 4.05 ± 0.50), with substantial inter-rater agreement (ICC = 0.788). In contrast, the external reviewer documented considerably lower completeness ratings (2.59 ± 0.57), revealing deficiencies in information coverage. Remarkably, 40.6% of respondents indicated they had followed ChatGPT's medical recommendations without seeking professional consultation, while 17.6% reported depending on the chatbot during urgent medical situations. Levels of user trust and satisfaction were moderate, showing significant correlations with perceived accuracy, usage frequency, and healthcare-related educational background. Conclusions:Expert assessments confirmed that ChatGPT generally provides accurate and safe cardiovascular health information; nevertheless, considerable inter-reviewer variability-especially the markedly lower completeness scores from the external evaluator-reveals significant gaps in content depth. These results indicate that ChatGPT functions more appropriately as an adjunctive educational resource rather than a replacement for professional medical consultatio n, emphasizing the necessity for enhanced safety mechanisms, clearer user instructions, and standardized content protocols when addressing high-stakes health topics. ChatGPT should be considered an adjunctive resource rather than a substitute for urgent professional medical assessment in suspected heart attack cases.
Background:Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and is closely linked to metabolic disturbances such as insulin resistance and dyslipidemia. Thyroid hormones play a critical role in regulating hepatic lipid metabolism and energy homeostasis; however, their relationship with MAFLD in diabetic populations remains incompletely defined. Methods:In this case-control study, 150 patients with T2DM were enrolled, including 75 patients with MAFLD and 75 without MAFLD. Hepatic steatosis was confirmed using transient elastography with controlled attenuation parameter (CAP). Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were measured using chemiluminescent immunoassays. Clinical, anthropometric, and biochemical parameters were assessed. Multivariate logistic regression analysis was performed to identify independent predictors of MAFLD. Results:Patients with MAFLD had significantly lower FT3 levels and higher TSH levels compared with diabetic controls without MAFLD (p = 0.016 and p < 0.001, respectively), while FT4 levels were comparable between groups. MAFLD was also associated with an adverse metabolic profile, including elevated triglycerides, total cholesterol, and low-density lipoprotein cholesterol, along with reduced high-density lipoprotein cholesterol (all p < 0.001). Liver enzymes were significantly higher in the MAFLD group. In multivariate analysis, elevated TSH (OR = 3.62, 95% CI: 1.21-10.84, p = 0.021) and triglycerides (OR = 1.43, 95% CI: 1.14-1.80, p = 0.002) were independently associated with MAFLD, whereas FT3 was not independently associated after adjustment. Conclusions:Elevated TSH levels are independently associated with MAFLD in patients with T2DM, suggesting a link between thyroid function and hepatic steatosis beyond traditional metabolic risk factors. These findings highlight the potential role of thyroid function, particularly TSH, in the metabolic risk stratification of patients with diabetes and warrant further investigation into thyroid-liver interactions.
Abstract:The COVID-19 pandemic placed unprecedented pressure on healthcare systems and exposed healthcare workers (HCWs) to biological hazards, organizational pressures, and psychological strain. Evidence generated during the emergency shows that HCW protection cannot rely on isolated measures, but requires an integrated framework combining epidemiological surveillance, contact tracing, infection prevention and control, vaccination, occupational health, and workforce support. Contact tracing helped identify occupational exposures and clarify how duration, proximity, and inadequate use of personal protective equipment jointly shaped infection risk. Subsequent studies of reinfection showed that susceptibility reflected the interaction of viral circulation, individual immunity, and vaccination status. Vaccination reduced the clinical impact of SARS-CoV-2 and supported service continuity, although uptake depended on trust, communication, and management of adverse event concerns. The pandemic also highlighted substantial economic consequences and a high burden of psychological distress and burnout among HCWs. Building on this evidence, future preparedness should translate these lessons into permanent, adaptable infrastructure rather than temporary emergency arrangements, integrating interoperable, AI-assisted surveillance capable of combining occupational, diagnostic, vaccination, and genomic data to detect emerging risks early, while ensuring robust data governance and human oversight. Equally central is the need to address long-term workforce vulnerabilities, including Long COVID, attrition, and burnout, through early identification, rehabilitation, flexible return-to-work models, and sustained psychosocial support. Achieving this requires structured multidisciplinary collaboration among occupational medicine, infection control, epidemiology, mental health, and digital health specialists, moving from fragmented infection-control protocols to an integrated, proactive, and learning-oriented preparedness strategy. Protecting HCWs is therefore not only an occupational safety priority but a foundational prerequisite for safe, equitable, and sustainable healthcare delivery during future infectious threats.
Objective:Enterocutaneous fistulas are not rare complications in abdominal surgical centers, they cause many serious complications and increase mortality. Non-surgical treatments require a synchronized combination of many contents, aim at such goals as: medical stabilization, infection control, nutritional support and waiting for primary closure of fistula. Surgery is indicated when the fistula does not natually close after 2-6 months. In this case, enterocutaneous fistula responded well to non-surgical treatments after more than 7 months. Report a clinical case of complicated enterocutaneous fistula. Methods:A 30-year-old male patient with complicated enterocutaneous fistula developed following four emergency sugeries due to pancreaticoduodenal trauma, with many serious complications, has been successfully treated by non-surgical treatments for more than 7 months prior to jejunostomy closure. Outcome:Complicated enteric fistula after pancreaticoduodenal trauma surgeries could be successful with intensive, patient and synchronous non-surgical treatments of many methods. Infection control and adequate nutritional support played a key role, fistuloclysis and chyme reinfusion brought many benefits. Conclusion:Complicated enterocutaneous fistula could be successfully managed with intensive non-sugical treatments of many methods over a long period of time.
Objective:This study aimed to describe the diagnostic value of coronary computed tomography angiography (CCTA) compared with invasive coronary angiography (ICA) in patients with coronary artery disease. Methods:A cross-sectional descriptive study was conducted using retrospective data. Non-probability sampling was applied, including all eligible patients who met the inclusion criteria during the study period from January 2022 to December 2024 at Hai Phong International General Hospital. Study Equipment: A 128-slice CT scanner (Revolution CT, GE Healthcare, USA) and a digital subtraction angiography (DSA) system for invasive coronary angiography (Philips, Netherlands) were utilized. Results:A total of 52 patients were included, with a mean age of 71.65 ± 9.5 years. For the diagnosis of >70% stenosis of the right coronary artery (RCA), CCTA demonstrated a sensitivity of 91.3% and a specificity of 24.1% (p = 0.379). For >70% stenosis of the left anterior descending artery (LAD), CCTA showed a sensitivity of 80% and a specificity of 63.6% (p = 0.001). For >70% stenosis of the left circumflex artery (LCx), CCTA yielded a sensitivity of 20.0% and a specificity of 89.1% (p = 0.005). Conclusion:CCTA is a non-invasive technique with shorter acquisition time and lower cost compared to invasive coronary angiography. Advances in CT technology have progressively improved diagnostic performance, thereby supporting more accurate and appropriate therapeutic decision-making.
Abstract:The aim of this study was to evaluate the effectiveness of Transfer of Energy Capacitive and Resistive (TECAR) therapy in combination with massage therapy for the treatment of chronic low back pain. Particular attention was given to assessing the impact of this innovative approach - based on the principle of capacitive and resistive electrical transfer - on tissue regeneration, inflammation reduction, pain relief, as well as the stimulation of blood circulation and metabolic processes. The study involved 35 patients aged 30 to 80 years who had suffered from chronic low back pain for more than 12 weeks. The visual analogue scale for pain and the Roland-Morris Disability Questionnaire were used to assess the outcomes. A comparison between traditional rehabilitation using massage therapy alone and a combination of Tecar therapy and massage therapy revealed that the innovative approach produced significantly better results compared to conventional treatment methods. Patients undergoing rehabilitation with Tecar therapy reported a reduction in pain severity from "severe" to "moderate" and a decrease in disability levels, as measured by the Roland-Morris questionnaire. Tecar therapy is an innovative physiotherapy method that utilises a high-frequency electromagnetic field to activate natural processes of tissue repair, alleviate pain, and reduce inflammation. The method is based on the stimulation of energy exchange between the electrodes of the device, which directly affects the patient's tissues. This study confirms that Tecar therapy, in combination with massage therapy, is an effective method for the rehabilitation of patients with chronic low back pain, enabling rapid functional recovery and pain reduction.
Background:Mesial temporal lobe epilepsy (MTLE), commonly associated with mesial temporal sclerosis (MTS), is a major cause of drug-resistant epilepsy in children. Conventional magnetic resonance imaging (MRI) may fail to detect subtle hippocampal abnormalities, particularly in MRI-negative epilepsy. Quantitative MRI volumetric assessment has emerged as a promising method for identifying structural changes not evident on routine imaging. Objective:To evaluate the clinical value of MRI volumetric assessment of the hippocampus and its subfields for the early diagnosis of MTLE in children with epilepsy. Methods:This case-control study was conducted at the MRI Unit, Ain Shams University Hospitals, Cairo, Egypt, between January 2024 and July 2025. A total of 100 children (50 with epilepsy and 50 age- and sex-matched healthy controls) underwent high-resolution brain MRI with three-dimensional T1-weighted imaging. Hippocampal and hippocampal subfield volumes were automatically quantified using VolBrain software. Group comparisons were performed using SPSS version 27, with statistical significance set at p < 0.05. Results:The epilepsy and control groups were comparable in age and sex. Children with epilepsy had significantly lower total hippocampal volume (4.10 ± 0.66 vs. 4.42 ± 0.87 cm³; p = 0.045) and left hippocampal volume (2.03 ± 0.34 vs. 2.20 ± 0.41 cm³; p = 0.034). The SR-SL-SM subfield demonstrated the greatest volumetric reduction (0.75 ± 0.16 vs. 0.84 ± 0.17 cm³; p = 0.006), while the subiculum was also significantly smaller in the epilepsy group (0.48 ± 0.09 vs. 0.52 ± 0.11 cm³; p = 0.044). Among 38 children with normal conventional MRI findings, quantitative volumetric analysis identified hippocampal abnormalities in 34 cases, corresponding to a detection rate of approximately 89% for MRI-negative epilepsy. Conclusion:MRI volumetric assessment is a valuable adjunct to conventional MRI for detecting subtle hippocampal and hippocampal subfield volume loss in children with epilepsy, including those with normal conventional MRI findings. Quantitative volumetric analysis may improve the detection of structural abnormalities associated with MTLE and supports its use as a complementary imaging tool in the diagnostic evaluation of pediatric epilepsy.
Abstract:Delivery riders have become a defining workforce of contemporary urban economies, yet existing occupational health frameworks remain poorly adapted to the realities of platform-mediated work. This editorial proposes a shift from static, factor-based models of risk toward a dynamic and cumulative perspective, and provides a comparative classification of regulatory approaches worldwide, highlighting how jurisdictions are addressing, or failing to address, the occupational risks of platform work. Riders operate at the intersection of three interacting domains: algorithmic management, environmental exposure, and climate-related stressors. Rather than acting as independent risk factors, these processes mutually reinforce one another, shaping exposure and behaviour in real time. Platform-driven time pressures influence riding practices within hazardous urban environments, while extreme weather and air pollution further affect psychophysiological performance. Within this framework, algorithmic management should be understood not merely as a mode of work organization but as a structural determinant of occupational health. By regulating task allocation, temporal constraints, and incentive structures, digital systems actively generate and redistribute risk. Occupational hazards are therefore not simply encountered by riders but dynamically produced through the interaction between technological control, environmental conditions, and urban infrastructures.
Background:Stalking, only recently criminalized in some countries, involves persistent harassment with severe psychological effects. Research explores prevalence, typologies, personality profiles, gender differences and the need for prevention and treatment strategies. Methods:A systematic search was conducted on Medline/Pubmed and Scopus in mixed clinical-forensic populations. The analysis included 2378 patients with stalking behavior, 14% of whom were female. Results: According to PRISMA (2021) guidelines, 12 papers were included in the systematic review from an initial sample of 200. A higher prevalence of PDs, particularly within Cluster B (i.e., antisocial, narcissistic, borderline, PD) was observed among stalkers. Moreover, PDs appear to be associated with recurrent stalking behavior, whereas findings remain inconsistent regarding their role in the development of violent behaviors. Conclusions:PD diagnosis appears to be a risk factor associated with stalking behavior. A more precise research focus on the evaluation of the individual's psychological profile is warranted in order to prevent recidivism and plan tailored interventions.
Background:Cauda equina syndrome (CES) is a rare but severe neurological emergency requiring urgent surgical decompression. In elderly patients with diabetes mellitus, overlapping neuropathic features may obscure classical CES presentation, leading to delayed diagnosis and worse outcomes. Objectives:To evaluate diagnostic challenges, surgical management, perioperative complications, and recovery outcomes in elderly diabetic patients with CES. Methods:A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL was conducted for studies published between January 2015 and April 2026. Two independent reviewers performed study selection, data extraction, and risk of bias assessment. Random-effects meta-analyses were conducted, and heterogeneity was assessed using the I² statistic. Results:Twenty-eight studies, published between 2016 and 2025 across 14 countries, comprised 1,427 elderly patients with diabetes mellitus and confirmed CES were analyzed. The pooled mean diagnostic delay was 4.8 days (95% CI: 3.9-5.7). Saddle anaesthesia was absent at presentation in 38.7% of patients. Surgical decompression within 48 hours significantly improved bladder recovery (OR: 2.74; 95% CI: 1.89-3.97; I²=38%). Each 1% increase in preoperative HbA1c was associated with a 4.3% reduction in neurological recovery (p=0.003). The pooled complication rate was 34.7% (95% CI: 29.1-40.3%), and 30-day mortality was 2.2%. Conclusions:Elderly diabetic patients with CES experience delayed diagnosis and increased perioperative risk. Early surgical decompression within 48 hours and optimal glycaemic control are key determinants of improved outcomes. Tailored diagnostic pathways for this population are warranted.
Background:Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder causing impaired mucociliary clearance, recurrent respiratory infections, and progressive bronchiectasis. Hepatocyte Growth Factor (HGF) plays a role in lung repair and inflammation, but its relationship with clinical and radiological severity in pediatric PCD remains unclear. Objective:To evaluate serum and bronchoalveolar lavage (BAL) hepatocyte growth factor (HGF) levels in children with genetically confirmed primary ciliary dyskinesia (PCD) compared with healthy controls, and to investigate their associations with clinical, functional, and radiological measures of disease severity. Methods:This case-control study was conducted from July 2023 to June 2024 at Ain Shams University Pediatric Tertiary Hospital. Thirty children aged 1-18 years with genetically confirmed (PCD) were included and compared with 30 age- and sex-matched healthy controls. All patient group underwent clinical, functional, and radiological evaluation. Spirometry Pulmonary function was assessed while radiological severity was evaluated by the modified Bhalla score. Nutritional status was assessed by body mass index (BMI) Z-scores, and airway colonization was documented. Serum and bronchoalveolar lavage (BAL) HGF levels were measured in all participants. The relationship between HGF levels and disease severity was evaluated using both univariate and multivariate linear regression analyses. A p-value < 0.05 was considered statistically significant. Results:In multivariable analysis, the modified Bhalla score was identified as an independent predictor of both BAL and serum HGF levels (P = 0.004 and P = 0.010, respectively), while BAL cell count independently predicted BAL HGF (P = 0.048). Serum HGF showed a significant negative correlation with FVC (r = -0.446, P = 0.029) and FEV₁ (r = -0.418, P = 0.042). BAL HGF was negatively correlated with FVC (r = -0.479, P = 0.018). Conclusions:HGF levels in both serum and BAL fluid are significantly associated with disease severity in children with primary ciliary dyskinesia.
