BACKGROUND:Sarcopenia is common among cancer patients and is associated with adverse clinical outcomes. The strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire is a simple screening tool for evaluating sarcopenia; however, no validated Hindi version is currently available for use in Indian oncology practice. AIM:To translate and culturally adapt the SARC-F questionnaire into Hindi and assess its reliability and content validity. METHODS:This single-center cross-sectional study was conducted at a tertiary cancer center in India. The questionnaire was translated using forward-backward translation following World Health Organization and International Society for Pharmacoeconomics and Outcomes Research guidelines. Pilot testing assessed clarity and cultural relevance. Adult Hindi-speaking cancer patients completed the finalized questionnaire. Reliability and content validity were evaluated using Cronbach's alpha and content validity indices, and descriptive statistics with Pearson correlation analyses were performed. RESULTS:A total of 100 patients were included (mean age 50.9 ± 12.6 years; 63% female). The Hindi SARC-F demonstrated acceptable internal consistency (Cronbach's α = 0.70). Content validity was excellent, with a scale-level content validity index of 0.92 and item-level indices ranging from 0.80 to 1.00. The median SARC-F score was 1 (interquartile range 0-3). No statistically significant correlations were observed between SARC-F scores and age, performance status, or body composition parameters (all P > 0.05). CONCLUSION:The Hindi SARC-F is linguistically valid, culturally appropriate, and suitable for functional sarcopenia screening in Hindi-speaking cancer patients.
Fragility fractures represent a significant global health burden, with osteoporosis affecting over 500 million individuals and contributing to nearly 9 million fractures annually. Conventional diagnosis relies on dual-energy X-ray absorptiometry (DEXA) to measure bone mineral density (BMD), yet BMD alone explains only part of fracture risk. Many fractures occur in patients without osteoporosis by DEXA criteria, underscoring the limitations of bone quantity-based assessment. Advances in imaging and biomarker research highlight the importance of bone quality, microarchitecture, and marrow composition in fracture prediction. Quantitative magnetic resonance imaging (MRI) techniques - including T1ρ, T2 mapping, proton density fat fraction, and diffusion-weighted imaging - offer non-invasive insights into collagen integrity, proteoglycan content, water distribution, and marrow adiposity. These parameters correlate with trabecular deterioration and cortical porosity, enhancing risk stratification beyond BMD. Similarly, Vertebral Bone Quality (VBQ) scoring, derived from routine T1-weighted MRI, provides a practical surrogate for bone quality by quantifying vertebral marrow signal intensity relative to cerebrospinal fluid. Modified VBQ improves accuracy by minimising posterior vertebral artefacts, demonstrating stronger correlation with DEXA T scores and trabecular microarchitecture. Studies show VBQ predicts vertebral fragility fractures independently of BMD, with sensitivity exceeding 90% and discriminatory ability comparable to the fracture risk assessment tool and trabecular bone score. Integration of quantitative MRI and VBQ/modified VBQ into predictive models, supported by artificial intelligence, enables opportunistic, radiation-free screening and more precise fracture risk assessment. Together, these advanced imaging biomarkers represent a paradigm shift toward comprehensive evaluation of bone strength, bridging the gap between bone quantity and quality for improved prevention and management of fragility fractures.
Pancreatic nerves exhibit significant anatomical and functional disparities across species, with profound implications for metabolism and clinical practices like pancreatic transplantation and disease treatment. In humans, pancreatic nerves feature a complex distribution of sympathetic and parasympathetic fibers, forming intricate plexuses that closely interact with surrounding organs, playing a crucial role in regulating both endocrine (e.g., insulin and glucagon release) and exocrine secretions to maintain metabolic balance. Rodents, such as rats and mice-common experimental models-have relatively simpler pancreatic nerve architectures; for instance, mice show more concentrated nerve fibers around islets, while rats display greater variability in nerve density across pancreatic regions, which influences their responses to metabolic stimuli and makes them valuable but not fully analogous to human models. Canines and felines, often used in translational studies, possess pancreatic nerve systems that share some similarities with humans, such as comparable nerve plexus organization, yet differ in fiber type proportions, affecting their susceptibility to metabolic abnormalities like pancreatitis-related glucose dysregulation. These species-specific differences in pancreatic nerves directly impact metabolic processes: In humans, impaired nerve function is linked to metabolic disorders like diabetes and obesity, whereas in animal models, variations in neural control of hormone release and pancreatic homeostasis lead to differences in disease progression and response to interventions. Understanding these discrepancies is vital: It not only helps interpret findings from animal studies when translating to human therapies but also guides pancreatic transplantation by highlighting the need for species-specific considerations in nerve reconstruction to restore metabolic function, and identifies potential therapeutic targets tailored to the unique neural-metabolic interactions of each species.
BACKGROUND:Indoor climbing has grown substantially in popularity; however, clinically assessed data on climbing-related nail and skin conditions remain limited. Tight, performance-oriented climbing shoes and repetitive training exposure may contribute to mechanical stress affecting the toes and forefoot, but evidence derived from direct clinical examination is scarce. AIM:To characterize the frequency, typology, and anatomical distribution of nail and skin lesions in a clinic-based sample of indoor climbers, and to assess associations with footwear compression and training exposure. METHODS:A retrospective cross-sectional analysis was conducted from data on 156 indoor climbers attending a single outpatient podiatric clinic. Lesions were classified by type, anatomical location, laterality, and affected digit. Demographic, anthropometric, footwear-related (shoe size discrepancy), and training-related variables were also recorded. Associations between lesion burden and continuous variables were assessed using Spearman's rank correlation and non-parametric tests, with statistical significance set at P < 0.05. RESULTS:Patients showed a mean of 6.6 lesions per individual (range 0-21), most exhibiting multiple nail and skin lesions. Hyperkeratosis accounted for approximately two-thirds of recorded lesions and was mostly localized to the first toe and periungual regions. Traumatic nail disorders, including Beau's lines, longitudinal ridges, onycholysis, and subungual hematomas, were predominantly hallux-related. Shoe size discrepancy showed a weak but statistically significant positive correlation with total lesion burden (ρ = 0.195, P = 0.015), as did weekly training frequency (ρ = 0.180, P = 0.025). No significant associations were observed for age, sex, body mass index, or session duration. CONCLUSION:In the selected population of the study, footwear compression and training frequency showed weak but statistically significant associations with lesion burden, while demographic variables showed no significant correlation. Although causal inference is not possible from this cross-sectional design, findings highlight the potential clinical relevance of modifiable sport-specific factors and warrant longitudinal investigation.
BACKGROUND:Glucagon-like peptide receptors-1 agonists (GLP-1 agonists) have revolutionized the treatment of obesity and diabetes due to their potent effects on weight and glycemic control, and cardiorenal protection. However, emerging reports and post-marketing surveillance have raised concerns regarding erectile dysfunction (ED) or impotence in a subset of male patients. AIM:To assess the association between GLP-1 agonists, ED, total (TT) and free testosterone (FT), sex hormone binding globulins (SHBG), luteinizing hormone (LH), and follicular stimulating hormone (FSH). METHODS:We systematically searched PubMed, Google Scholar, and Web of Science in November and December 2026 for articles examining the association between GLP-1 agonists and ED, with no publication date restriction. However, only articles published in the English language were eligible. The terms used were GLP-1 agonists, ED, semaglutide, liraglutide, ozympic, tirzepatide, dulaglutide, and Impotence. RESULTS:One hundred seventy-two articles were found; after removing duplicates, 63 remained, of which 12 full texts were screened, and 7 studies were included in the final meta-analysis. Seven studies involving 237 males were included. GLP-1 agonist therapy improved ED score with a significant statistical difference, MD = 2.73, 95% confidence interval (CI): 1.64-3.83. A significant increase was found regarding TT, SHBG, and FSH, MD 73.04, 95%CI: 16.91-129.17, MD 7.00, 95%CI: 1.71-12.30, and MD 0.46, 95%CI: 0.01-0.91 respectively. CONCLUSION:No significant differences were evident regarding the FT, and LH. GLP-1 agonists significantly improved ED, TT, SHBG, and FSH in males, no effects were observed on FT, and LH; larger randomized trials are needed.
BACKGROUND:Electroconvulsive therapy (ECT) is also an ideal treatment alternative when dealing with treatment-resistant depression, together with other severe mental conditions. Localization of seizures and cognitive effects of anesthetic agents is significantly influenced by the anesthetic used, but an optimal anesthetic method/regime remains debatable. AIM:To identify comparative consequences of propofol, etomidate, and ketamine regarding the length of seizures and post-ECT cognition. METHODS:The current study involved a methodical search of the literature, based on PRISMA guidelines, to identify randomized controlled trials (RCTs) and observational research studies that evaluate the difference between anesthetics used during ECT. The articles analyzed pertained to seizure durations, cognitive performance, hemodynamic factors, and recovery. The quality evaluation was done on the applicable tools of RCT and observational research. Interpretation of the statistical data, based on IBM SPSS, was conducted with the assistance of qualitative synthesis. RESULTS:There were 24 articles taken into account, 11 RCTs and 13 observational studies identified. Several studies have revealed that etomidate is more effective in reducing seizure duration than propofol in various patient groups. Ketamine also recorded increased efficacy in antidepressant but inconsistent activity in the length of seizures. Propofol was linked with shorter recovery times, although the reduction of seizures was constant and shorter each time. The reviews revealed a significant disparity in cognitive outcomes among the agents, with etomidate exhibiting better cognitive profiles than propofol in several trials. CONCLUSION:The available evidence in the existing literature suggests that etomidate may be beneficial in terms of seizure duration and could yield satisfactory cognitive outcomes. Ketamine shows signs of greater treatment efficacy, but its application must be carefully evaluated in regard to dosage plans. The effectiveness of seizure control can be influenced by this predictive anesthesia that accompanies the rapid recovery of activities following propofol administration. The choice of anesthetic agent should be individualized, based on the nature of the patient and the motive behind the treatment, as well as institutional policy. Large-scale RCT is needed to provide evidence-based recommendations that may be taken decisively.
The study by Chen et al recently published in World Journal of Methodology provides a significant advancement in the field of diabetic wound healing by demonstrating that low-energy fractional carbon dioxide laser preconditioning (40 mJ/cm², 300 Hz, 5% density) significantly enhances the angiogenic potential of adipose-derived mesenchymal stem cell-derived exosomes. This single-exposure, 10 mm × 10 mm Micro-DeepFX protocol raised the culture temperature to 42.7 °C and increased exosomal sphingosine-1-phosphate (S1P) content by about 1.8-fold (enzyme-linked immunosorbent assay: 2.4 ng/109 vs 1.3 ng/109 particles, P < 0.01). Through carefully controlled photothermal stimulation, the authors enriched exosomal S1P) content, thereby activating the S1PR1/AKT/HIF-1α signalling axis in endothelial cells. This mechanistic cascade resulted in improved proliferation, migration, and tube formation, ultimately accelerating wound closure in diabetic mouse models. The work under discussion highlights a clinically feasible, non-chemical strategy for augmenting exosome bioactivity and offers strong translational potential. However, the heterogeneity of donors, the limited mechanistic depth of exosomal lipid remodelling, and the need for validation in larger and more clinically representative models warrant further investigation.
BACKGROUND:Functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) exhibit substantial symptom overlap (40%-50%), and up to one-third of patients diagnosed with FD demonstrate pathologic acid exposure on objective testing. While GERD is a well-established risk factor for Barrett's esophagus (BE), the association between FD diagnosis and BE risk remains unexplored. Understanding this relationship is critical because FD is typically diagnosed symptomatically without routine objective reflux testing in clinical practice, potentially masking undiagnosed GERD or identifying shared pathophysiologic mechanisms. We hypothesized that patients diagnosed with FD demonstrate an elevated risk for BE and Barrett's-associated dysplasia compared to matched controls. AIM:To investigate the association between FD diagnosis and the risk of BE and dysplasia. METHODS:This retrospective cohort study utilized the TriNetX Global Collaborative Network database. Patients diagnosed with FD (International Classification of Diseases, 10th Revision code K30) between January 2006 and December 2022 were identified, and propensity-score matched 1:1 with controls based on demographics, comorbidities, and GERD diagnosis. The primary outcomes were the development of BE and Barrett's-associated dysplasia. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HR) with 95% confidence intervals (CI). A sensitivity analysis was conducted to include patients with documented esophagoduodenoscopy during the study period. RESULTS:After PSM, 384267 patients were included in each cohort. Patients with FD demonstrated significantly higher risk for BE (HR: 1.900, 95%CI: 1.813-1.991), Barrett's associated dysplasia (HR: 3.568, 95%CI: 3.064-4.155), and esophageal cancer (HR: 1.649, 95%CI: 1.450-1.875). Sensitivity analysis confirmed the increased risk of BE and dysplasia but not esophageal cancer. CONCLUSION:Patients diagnosed with FD demonstrate substantially elevated risk for BE and dysplasia. This association, whether reflecting undiagnosed GERD, shared pathophysiology, or both, identifies FD patients as a higher-risk population warranting consideration of objective reflux testing and selective endoscopic evaluation in appropriate clinical contexts.
BACKGROUND:Periodontitis consists of a chronic inflammatory disease of the periodontal tissue. In addition to inflammation, oxidation is also involved in periodontitis. Glutathione peroxidase (GPx) is an antioxidant enzyme. There are 8 forms of GPx (GPx 1-8) and GPx-1 is the most abundant. The comparison of salivary GPx-1 levels in patients with periodontitis and periodontally healthy subjects has been explored in small sample size studies (the largest including 101 subjects) and the results are contradictory. AIM:To compare salivary GPx-1 concentrations in subjects with and without periodontitis in a study with a larger sample size. In addition, novel aims were exploring the possible association of salivary GPx-1 concentrations with periodontitis by a regression analysis and determining the capability of salivary GPx-1 concentrations to predict the diagnosis of periodontitis by a receiver operating characteristic (ROC) analysis. METHODS:Observational and prospective study including subjects with and without periodontitis. Salivary samples were taken to determine GPx-1 concentrations. A multivariate logistic regression analysis was performed to determine whether salivary GPx-1 levels were independently associated with periodontitis. A ROC analysis was carried out to determine the capability for the diagnosis of periodontitis by salivary GPx-1 concentrations. RESULTS:We found lower salivary GPx-1 concentrations in 57 subjects with periodontitis than in 86 without periodontitis. We found that salivary GPx-1 concentrations showed an area under the curve for periodontitis diagnosis of 76% (95%CI: 68%-83%; P < 0.001) in ROC analysis, and that salivary GPx-1 levels < 1214 pg/mL showed an independent association with periodontitis (odds ratio: 6.25; 95%CI: 2.844-13.717; P < 0.001) in regression analysis. CONCLUSION:To our knowledge, our series has the largest sample size on salivary GPx-1 concentrations in periodontitis. Novel findings of our study were that salivary GPx-1 levels were able to diagnose periodontitis and were independently associated with periodontitis. However, our preliminary study has some limitations as there were significant differences in age between subjects with and without periodontitis, other antioxidant enzymes or total antioxidant capacity were not assessed, other biological samples were not analyzed, and GPx-1 genetic variations were not studied. Nevertheless, we think that the results of our study could encourage further research on the role of salivary biomarkers concentrations (as GPx-1) in the management of periodontitis.
BACKGROUND:Atrial fibrillation (AF) is a prevalent arrhythmia associated with increased stroke risk, morbidity, and healthcare burden. Oral anticoagulation (OAC) is essential for stroke prevention, but adherence is often suboptimal. Smartphone-based mobile health (mHealth) applications offer potential to enhance adherence, quality of life (QoL), and reduce healthcare utilization. AIM:To systematically review randomized controlled trials (RCTs) evaluating the impact of smartphone-based mHealth interventions on OAC adherence, health-related QoL, and healthcare utilization in adults with AF. METHODS:Following PRISMA guidelines and a PROSPERO-registered protocol (CRD420251169904), databases (PubMed, Scopus, Web of Science, EMBASE, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov) were searched from January 1, 2000, to July 30, 2025. Eligible studies were RCTs of mHealth apps for AF management in adults (≥ 18 years). Two reviewers screened records, extracted data, and assessed risk of bias using Cochrane risk of bias 2. Narrative synthesis was used due to heterogeneity. RESULTS:Of 968 records, 16 RCTs (n = 209-3324 participants) were included, primarily from China, United States, Taiwan, and South Korea. Integrated interventions (e.g., mAFA-II aligning with AF better care pathway) improved OAC adherence (e.g., higher self-reported scores, P < 0.05; increased OAC persistence, P < 0.001), enhanced QoL (e.g., EQ-5D improvements, P < 0.001), and reduced healthcare utilization (e.g., rehospitalizations hazard ratio = 0.32, P < 0.001) without increasing bleeding risks. Simpler apps showed inconsistent benefits. Heterogeneity in designs, adherence measures, and follow-up (3 months to 2 years) limited generalizability. Risk of bias was high in 10 studies due to open-label designs and post-hoc analyses. CONCLUSION:mHealth apps, especially comprehensive ones, can improve OAC adherence, QoL, and reduce utilization in AF patients. Future research should focus on long-term efficacy, cost-effectiveness, and equitable implementation for diverse populations.
Gastrointestinal tumor-associated osteoporosis (GTO) is defined as secondary osteoporosis in patients with gastrointestinal tumors caused by tumorderived factors, chemotherapy, surgery, or malabsorption; it is an underrecognized but clinically significant complication that adversely affects skeletal health, treatment adherence, quality of life, and longterm prognosis. Its pathogenesis is multifactorial and involves a metabolic imbalance in the tumor microenvironment, antitumor therapy-related bone toxicity, and nutrient malabsorption caused by gastrointestinal dysfunction. These factors collectively increase the risk of skeletal-related events and worsen clinical outcomes. The aim of this review is to systematically evaluate the methodological quality, clinical validity, and translational evidence of cutting-edge technologies in GTO precision management and to clarify key methodological gaps and standardized directions for future research. In recent years, emerging technologies such as artificial intelligence (AI), nanotargeted drug delivery systems, and multiomics approaches have provided new opportunities for the precision management of GTO. This review summarizes their current applications in AI-assisted early screening and risk prediction, nanoenabled targeted bone protection, and multiomics-based mechanistic exploration of the tumor-bone-gut axis. It also discusses major barriers to clinical translation, including limited AI generalizability, nanomedicine safety and manufacturing challenges, difficulties in multidimensional data integration and standardization, imperfect multidisciplinary collaboration, and ethical concerns. Overall, these technologies are expected to drive the transition of GTO management from empirical practice to precision medicine and ultimately improve long-term patient outcomes.
BACKGROUND:Persistent microbial contamination of duodenoscopes remains a critical vector for healthcare-associated infections involving multidrug-resistant organisms. Despite adherence to standard high-level disinfection (HLD) protocols, contamination rates remain alarming. To mitigate this risk, the United States Food and Drug Administration has recommended transitioning to duodenoscopes with disposable components. AIM:To investigate the efficacy of disposable distal cap compared to standard duodenoscope reprocessing with HLD in reducing microbial contamination. METHODS:Following Preferred Reporting Items for Systematic Reviews and Meta-analysis and Cochrane guidelines, we conducted a systematic search of MEDLINE, EMBASE, Google Scholar, and grey literature for randomized controlled trials comparing disposable distal cap vs standard duodenoscopes. The primary outcome was the rate of microbial contamination, defined as an adenosine triphosphate level > 40 relative light unit. Risk ratio was pooled using a random-effects model, and the quality of evidence was assessed using the Grading Recommendations Assessment, Development, and Evaluation methodology. RESULTS:Four randomized controlled trials met the inclusion criteria, encompassing 1092 duodenoscopes (543 disposable distal cap, 549 standard). The use of disposable cap demonstrated a significant and substantial reduction in post-HLD contamination rates. The pooled analysis showed a risk ratio of 0.32 (95% confidence interval: 0.16-0.67; P = 0.003), representing a 68% reduction in contamination risk. No statistical heterogeneity was detected (I 2 = 0%). The overall quality of evidence for this outcome was rated as high. CONCLUSION:Disposable distal cap significantly decreases microbial contamination rates compared to standard duodenoscope reprocessing protocols. This technology represents a robust and effective strategy to enhance the safety of duodenoscope reprocessing.
Some genes, such as HLA class I and class II genes, play important roles in the pathogenesis of vitiligo and its associated autoimmune diseases. Attempts to identify these genes have involved several approaches, including analysis of HLA expression patterns, genetic association studies, and genome-wide association studies. These strategies employ a variety of laboratory techniques, each with distinct advantages and limitations. This review provides a comprehensive overview of current strategies for identifying HLA genes linked to vitiligo susceptibility, with a critical comparison of study designs and methodological approaches. Enhancing these methods is essential to improve accuracy and reliability, ultimately facilitating the development of therapeutic targets and clinically relevant diagnostic biomarkers for patients with vitiligo.
Artificial intelligence in ophthalmology encounters a continual challenge: Systems proficient in picture classification seldom yield quantifiable enhancements in patient outcomes. The primary concern is the disparity between pixel-level performance metrics and their clinical significance. Primary obstacles encompass data bias, domain shift, and label noise, exacerbated by the lack of prospective, randomized deployment trials. The frequent disregard for patient-centered objectives, cost-effectiveness, and equity evaluations is significant. Rectifying these deficiencies necessitates stringent external validation, established decision criteria, and ongoing surveillance within actual clinical practices. Transparent reporting criteria and the deliberate incorporation of human-factors engineering are essential. Only by bridging this gap can algorithmic accuracy be converted into significant diagnostic precision for glaucoma, diabetic retinopathy, and macular conditions (specifically diabetic macular edema and age-related macular degeneration). This paper aims to assess the limits of using high-performing artificial intelligence systems in ocular image processing, which seldom lead to enhanced patient outcomes, and to delineate the scientific, clinical, and practical techniques required to close this gap.
Constipation is a common multifactorial gastrointestinal disorder with a significant impact on quality of life, healthcare utilization, and economic burden. It encompasses a spectrum of symptoms, including infrequent bowel movements (fewer than three per week), lumpy or hard stools (Bristol Stool Form Scale 1 or 2), straining, difficult stool passage, a sense of incomplete evacuation, etc. When no organic cause is identifiable, the condition is labeled as functional constipation. Pharmacological management of constipation has been extensively explored, with several new therapies added to the armamentarium in the last decade. However, its management remains challenging due to heterogeneous etiologies, varied diagnostic approaches, and the broad spectrum of therapeutic options. This narrative review summarizes contemporary strategies for the management of constipation, encompassing lifestyle and dietary modifications, pharmacological therapies, behavioral interventions, and surgical options for refractory cases. Traditional laxatives continue to form the mainstay of treatment, but newer agents such as prosecretory drugs, serotonergic agonists, and bile acid modulators have expanded therapeutic possibilities, offering targeted mechanisms and improved tolerability. Non-pharmacological approaches, including biofeedback for pelvic floor dysfunction and neuromodulation techniques, provide effective alternatives in selected patients. Despite these advances, substantial methodological variability exists in clinical trials, including differences in diagnostic criteria, endpoints, and follow-up durations, limiting the generalizability of findings. A more standardized framework for defining outcomes and assessing long-term efficacy is needed to strengthen evidence-based practice. Ultimately, the management of constipation requires an individualized approach that integrates symptom severity, underlying pathophysiology, patient preference, and availability of resources. Newer research is focused on tailoring treatment to special groups of patients with refractory constipation, surgical modalities for patients with neurogenic bowel, and microbiome modulation using artificial intelligence.
Eyelid ptosis after cosmetic use of Botulinum toxin A, though uncommon, can impair function and patient satisfaction. We aimed to develop a methodological framework that standardizes prevention and management via a derivation-based risk index, explicit safety rules, and an evidence-graded, onset-anchored treatment algorithm. We conducted a structured scoping approach to map existing evidence and anatomical insights, then used consensus-style item generation to derive a practical risk index and codify ten safety rules. Treatments were organized into an onset-anchored algorithm with indicative effect windows and contraindications. The framework introduces a Levator Diffusion Risk Index combining anatomical, technical, and patient factors; a codified ten-rule injection protocol specifying distances, depths, dilution, and needle orientation; and a graded management algorithm for symptomatic ptosis. A standardized, reproducible methodology - risk stratification, measurable technique rules, and a graded treatment pathway - can reduce complication rates and harmonize reporting and care.
BACKGROUND:Dopaminergic neurons are lost in Parkinson's disease (PD), a degenerative neurological condition. While the effects of PD on motor functions are well understood, its impact on respiratory function is less clear. In PD patients with suspicious pulmonary symptoms, the presence and degree of impairment in lung function often cannot be optimally assessed through pulmonary function tests (PFTs) due to the patients' neurological symptoms. AIM:To examine the relationship between diaphragmatic thickness as determined by ultrasonography (US) and conventional PFTs in PD patients. Additionally, we evaluated the potential use of diaphragmatic thickness as an alternative measure for assessing respiratory function in PD patients who are unable to perform PFTs. METHODS:A total of 43 PD patients who presented to the clinics between June 15, 2021, and June 30, 2022, were included. Patients with coronavirus disease 2019 infection history, conditions affecting diaphragmatic motility, recent thoracic or abdominal surgery, or imaging showing restrictive masses were excluded. Demographic data, disease duration, Hoehn-Yahr stage, and medication use were recorded. PFTs were used to evaluate forced vital capacity, forced expiratory volume in the first second, and other parameters, while US was used to measure diaphragmatic thickness. Breathlessness was assessed using the modified medical research council dyspnea scale. RESULTS:Significant correlations were found between peak expiratory flow (PEF) and diaphragm fraction (P = 0.019), as well as between PEF percentage and diaphragmatic thickness during expiration (P = 0.023). In early-stage PD, diaphragmatic thickness during inspiration correlated with oxygen saturation (P = 0.048). In advanced-stage PD, PEF and PEF% were significantly correlated with diaphragm thickness during expiration [r = 0.405, P = 0.049 (for PEF); r = 0.463, P = 0.023 (for PEF%)] and diaphragm fraction [r = -0.476, P = 0.019 (for PEF); r = -0.617, P = 0.001 (for PEF%)]. CONCLUSION:Present study assessed the relationship between PFTs and diaphragmatic thickness in PD patients. Diaphragmatic thickness measured by US was found to correlate with certain PFT parameters, suggesting it could be used as an alternative measure for assessing respiratory function in Parkinson's patients who have difficulty performing PFTs.
BACKGROUND:Propofol is widely used for induction in glioma surgery for its neuroprotective effects and favorable recovery profile. However, its dose-dependent hypotension is a major limitation in procedures requiring stable cerebral perfusion. AIM:To compare the efficacy of propofol vs propofol-phenylephrine (PPE) combination in maintaining hemodynamic stability in patients undergoing glioma surgery. METHODS:Ninety American Society of Anesthesiologists I-II patients scheduled for elective glioma surgery were randomized to receive either propofol (group P) or a PPE admixture (group PPE). Induction was performed with slow titration of the study drug until loss of verbal response and Bispectral index < 60, followed by a continuous infusion (50 μg/kg/minute) until skin closure. Hemodynamic parameters [mean arterial pressure (MAP), systolic blood pressure, diastolic blood pressure, and heart rate] were recorded at baseline, during induction, immediately after intubation, and at predefined intraoperative time points. The incidence of hypotension, vasopressor and esmolol use, and brain relaxation scores were compared. RESULTS:Group PPE demonstrated significantly better preservation of MAP, systolic blood pressure, diastolic blood pressure, and heart rate throughout the peri-induction and intraoperative periods (P < 0.05). The mean maximum MAP reduction during induction was greater in group P compared with group PPE (19.7 mmHg vs 12.5 mmHg; P < 0.01). Hypotensive episodes were significantly more frequent in group P than in group PPE (84.4% vs 6.7%; P < 0.001). Rescue phenylephrine requirements were markedly lower in group PPE (P < 0.001). Esmolol use and brain relaxation scores were comparable between groups. CONCLUSION:Adding phenylephrine to propofol for induction and maintenance provides superior hemodynamic stability without compromising brain relaxation in glioma surgery.
Obesity has reached epidemic proportions globally, with projections indicating that by 2050, nearly 3.8 billion adults will be overweight or obese. Despite the critical need for effective interventions, current obesity treatments ranging from lifestyle changes to bariatric surgery are often limited in efficacy or suitability. Pharmacotherapy is increasingly utilized for individuals with significant obesity or related comorbidities. However, some anti-obesity medications have been linked to ocular complications such as non-arteritic anterior ischemic optic neuropathy and diabetic retinopathy progression. This review analyzes currently approved anti-obesity medications, emphasizing their potential ocular adverse effects and the underlying mechanisms by which these occur. A comprehensive literature search identified the historical evolution, classification, and spectrum of ocular effects associated with these agents. The findings underscore the importance of evaluating both the risks and benefits of anti-obesity pharmacotherapy and highlight the need for vigilant clinical assessment of ocular health in patients undergoing such treatments.
Approximately one-quarter of United States medical students train at osteopathic medical schools, which confer the Doctor of Osteopathic Medicine (DO) degree upon graduation. That number has risen exponentially over the past several years, with the American Association of Colleges of Osteopathic Medicine reporting a 65.7% increase in total enrollment since 2013. This increase is at least partly due to the opening of more DO-granting medical schools. However, despite the growing number of osteopathic physicians entering the United States workforce, the degree remains under recognized by patients, nurses, and ancillary staff within hospital systems across the country. Surprisingly, a portion of DO physicians themselves contribute to this under recognition through degree misrepresentation with the Doctor of Medicine label. These physicians have also been historically marginalized from certain competitive specialties and leadership positions, which play a role in under recognition. We suggest proper degree identification and the promotion of more DOs into leadership roles to ultimately improve awareness. Some perceptual challenges and specific barriers to career advancement persist, particularly in competitive specialties, and the continued under recognition despite more osteopathic physicians than ever in the workforce may further perpetuate biases that limit opportunities for prominent leadership roles.
