Aesthetic rehabilitation in implant prosthodontics is an integral component of contemporary dental practice, with treatment success determined not only by implant survival but also by restoration of natural function, appearance, and patient satisfaction. Predictable aesthetic outcomes require a prosthodontically driven approach involving comprehensive diagnosis, accurate three-dimensional implant positioning, and preservation of peri-implant hard and soft tissues. Factors such as smile line, periodontal phenotype, bone morphology, implant position, emergence profile, and restorative material selection influence the final aesthetic outcome. Thorough preoperative assessment facilitates identification of risk factors and individualized treatment planning. Digital technologies, including cone-beam computed tomography (CBCT), digital smile design, intraoral scanning, computer-aided design and manufacturing (CAD/CAM), and computer-guided implant surgery, have improved diagnostic accuracy, treatment planning, restorative precision, and interdisciplinary communication. The Pink Esthetic Score (PES) and White Esthetic Score (WES) provide standardized methods for evaluating peri-implant soft-tissue and prosthetic aesthetics. Soft-tissue augmentation, customized healing abutments, and immediate provisionalization may further enhance peri-implant tissue management and aesthetic outcomes in appropriately selected cases. However, complications such as mucosal recession, papillary deficiency, inadequate soft-tissue volume, and unfavourable emergence profiles remain challenging. Predictable aesthetic rehabilitation therefore requires an interdisciplinary, evidence-based approach integrating biological principles, prosthodontic concepts, and contemporary digital technologies to achieve functionally sound, biologically stable, and aesthetically harmonious implant-supported restorations.
Background: Drug-eluting balloon (DEB) angioplasty has emerged as an effective alternative to stent-based coronary revascularization, offering comparable efficacy without the long-term complications associated with permanent metallic implants. Sirolimus-based drug-coated balloon platforms offer distinct mechanistic advantages through inhibition of the mammalian target of rapamycin (mTOR) pathway, enabling selective suppression of smooth muscle cell proliferation while preserving endothelial integrity. Herein, we report the clinical outcomes of a prospective cohort of 59 patients treated with sirolimus-DEB angioplasty. Methods: We prospectively enrolled 59 consecutive patients undergoing sirolimus-Drug eluting balloon angioplasty for coronary artery disease at a single center over a two-year period (2023-2025). Primary endpoints were technical and procedural success. Secondary endpoints included major adverse cardiovascular events (MACE), restenosis, and target lesion revascularization (TLR) at 6-12 months of follow-up. Results: The mean age of the cohort was 59.1±10.7 years; 40 (67.8%) were male and 19 (32.2%) were female, with male predominance. Clinical presentations included acute coronary syndromes in 29 (49.2%) and chronic coronary disease in 30 (50.8%). Sirolimus DEB was deployed in 56 of 59 cases (94.9%). Technical and procedural success was achieved in 59 of 59 cases (100%), with all procedures achieving Thrombolysis in myocardial infarction 3 flow and residual stenosis <30%. In-hospital MACE occurred in 1 of 59 patients (1.7%), attributable to refractory cardiogenic shock in the setting of anterior myocardial infarction with severe left ventricular dysfunction; no procedure-related mortality or major bleeding was recorded. At 6-12-month follow-up, available in 56 of 59 patients (94.9%), 53 of 56 (94.6%) were symptom-free with zero TLR and zero late MACE. Conclusion: Sirolimus-eluting balloon angioplasty demonstrates excellent safety and efficacy in this single-center prospective cohort. The 59/59 (100%) technical success rate, 58/59 (98.3%) uneventful procedural course, and 1/59 (1.7%) MACE rate compare favorably with published benchmarks and support the continued adoption of sirolimus-based drug-coated balloon technology for percutaneous coronary revascularization in appropriately selected patients.
Background: Femoral head osteonecrosis (FHO) is a debilitating condition leading to progressive hip joint destruction. Epidemiological data in Bangladesh are limited. This study aimed to describe the demographic profile, etiology, sex distribution, affected side, and residence patterns among patients with FHO. Methods: A cross-sectional study was conducted on 122 patients diagnosed with FHO. Data were collected on age, sex, occupation, residence, etiology, and affected side. Descriptive statistics were used for frequency and percentage distributions. Associations between categorical variables, including sex and residence with etiology, were analyzed using Fisher’s exact test. Results: The study population comprised 72 males (59%) and 50 females (41%). The most affected age group was 18–29 years (42.6%). Rural patients accounted for 65.6% of the cohort. Idiopathic FHO was the predominant etiology (41%), followed by steroid-induced cases (27.9%) and trauma (13.1%). Ankylosing spondylitis, alcohol intake, sequelae of Perthes disease, and thalassemia were less common. Right hip involvement occurred in 44.3% of patients, left in 18%, and bilateral in 37.7%. Sex distribution showed idiopathic FHO was more frequent in males (41.7%), while steroid-induced cases were higher in females (44%), with a statistically significant association (p < 0.001). Residence did not show a significant association with etiology (p = 0.288). Conclusions: Idiopathic and steroid-induced osteonecrosis are the leading causes of FHO in Bangladesh, with males more frequently affected and a high proportion of rural cases. The findings highlight the need for targeted awareness, early diagnosis, and management strategies, particularly in young adults and rural populations.
Background: Chemical denture cleansers may cause irritation, discoloration, and allergic reactions in denture wearers. Herbal agents with antimicrobial properties are being explored as safer alternatives to prevent denture-associated infections such as oral candidiasis. This study aimed to develop and evaluate a natural denture cleanser using Acacia concinna (Shikakai) and Rosa spp. (rose petals). Methods: Dried plant materials were extracted using the Soxhlet extraction method and subjected to qualitative phytochemical screening. Antimicrobial activity against Candida species was assessed in vitro. The extracts were formulated into effervescent tablets for immersion-type denture cleansing. The tablets were evaluated for weight variation, hardness, friability, pH, disintegration time, and in vitro dissolution. Cleaning efficiency and anticandidal activity were also studied. Results: Phytochemical screening confirmed the presence of flavonoids, saponins, tannins, and glycosides, with Shikakai extract showing a richer phytochemical profile. Antimicrobial studies demonstrated stronger antifungal activity of Shikakai against Candida species compared to rose petal extract. The formulated tablets met acceptable quality control parameters. In vitro dissolution studies showed about 20% release within one hour and nearly 90% release within six hours. Shikakai-based formulations exhibited superior cleaning efficiency and anticandidal activity. Conclusions: Shikakai-based herbal denture cleanser tablets showed effective antifungal activity, satisfactory tablet properties, and good cleaning performance, indicating their potential as a natural alternative to synthetic denture cleansers. Further clinical studies are needed to confirm long-term safety and user acceptability.
Background: Accurate dosimetry in low-density media is essential for stereotactic body radiation therapy (SBRT) of lung tumors, particularly with small radiation fields and flattening filter-free (FFF) photon beams. This study experimentally evaluated ionization chamber stem effects under low-density conditions. Methods: This experimental dosimetric study was conducted from March 2025 to June 2025 at the Department of Radiation Oncology, Sutter Gould Medical Foundation, Modesto, CA, USA. A PTW TN30013 Farmer-type ionization chamber was evaluated for 6 MV, 6 MV FFF, 10 MV and 10 MV FFF photon beams in a low-density Styrofoam phantom (0.04–0.05 g/cm³) and in-air conditions for field sizes ranging from 2×2 cm² to 20×20 cm² and depths from 1.5 to 20 cm. Results: Within the phantom, ionization readings for FFF beams were 5–20% lower than those for flattened beams at shallow depths due to reduced scatter. In-air measurements for FFF beams were up to 30% higher than flattened beams for small field sizes. Stem effects remained below 0.6% across all tested conditions. Collimator rotation dependence was negligible (<0.05%, p>0.05). Significant interactions between beam type, setup and depth were observed (p<0.001). Conclusions: The PTW TN30013 chamber demonstrated stable and reliable performance in low-density media relevant to lung SBRT. Stem-related perturbations were clinically negligible, although beam-specific correction factors remain important for FFF small-field dosimetry.
Background: Prolonged orthodontic treatment is associated with increased risk of enamel demineralization, root resorption, periodontal complications and reduced patient compliance. Leukocyte platelet-rich fibrin (L-PRF), an autologous platelet concentrate rich in growth factors and cytokines, has been proposed as a biological adjunct to accelerate orthodontic tooth movement. To evaluate the effectiveness of L-PRF in enhancing orthodontic canine retraction. Methods: A split-mouth clinico-experimental study was conducted on nine patients aged 15–25 years requiring bilateral maxillary first premolar extractions. The right side received L-PRF placement in the extraction socket and served as the experimental side, while the left side acted as the control. Canine retraction was performed using nickel-titanium closed-coil springs delivering 150 g force. Tooth movement was assessed using three-dimensional digital models at baseline (T0), one month (T1), two months (T2) and three months (T3). Data were analyzed using paired t-test, repeated measures ANOVA and Bonferroni post-hoc analysis. Results: Greater canine movement was observed on the L-PRF side throughout the study period. Statistically significant acceleration was noted during the initial phase of retraction, whereas differences during later intervals were not significant. Both groups demonstrated significant time-related variations in tooth movement. Conclusions: L-PRF enhanced orthodontic tooth movement primarily during the early stages of canine retraction. It may serve as a safe, minimally invasive and biologically effective adjunct for accelerating orthodontic treatment and potentially reducing overall treatment duration.
Physiological evacuation (Istifrāgh-e-tabī) is an essential physiological process described in Unani medicine through which the body naturally eliminates Fuḍlāt (metabolic waste products) generated during digestion and metabolism. Proper physiological evacuation is considered crucial for maintaining humoral equilibrium, preserving Ḥarārat Gharīzī (innate heat), and preventing disease. This narrative review examined Unani literature alongside contemporary biomedical evidence retrieved from PubMed, Scopus, ScienceDirect, Web of Science, Google Scholar, and the AYUSH Research Portal. The literature was critically analyzed to explore the formation of Fuḍlāt, the concept of Huḍūm Arba‘a, and the physiological pathways of waste elimination, including gastrointestinal, renal, respiratory, cutaneous, and secretory routes. Classical Unani descriptions of Barāz (feces), Bawl (urine), Ḥayḍ (menstruation), ‘Araq (sweat), Laban (breast milk), Tanaffus (respiration), Lu‘āb (saliva), and Ānsū (tears) were found to correspond conceptually with modern physiological mechanisms responsible for removing carbon dioxide, urea, uric acid, creatinine, bile pigments, excess electrolytes, and inflammatory metabolites. Effective physiological evacuation supports metabolic homeostasis, immune regulation, acid–base balance, thermoregulation, and tissue health, whereas impaired clearance contributes to oxidative stress, inflammation, and metabolic dysfunction. The review demonstrates a strong conceptual similarity between Unani principles and modern biomedical understanding of physiological waste elimination, highlighting the potential relevance of Istifrāgh-e-Ṭabī in preventive and integrative healthcare.
Diabetes mellitus is a chronic metabolic disease characterized by insulin resistance and pancreatic β-cell dysfunction persistent hyperglycemia, contributing to severe complications including cardiovascular, renal, hepatic, and neurological disorders. Worldwide incidence of diabetes has risen significantly, with over 537 million individuals affected in 2021, and projections indicate 783 million by 2045, imposing a significant public health and economic burden. Polyherbalism leverages synergistic interactions between multiple medicinal plants, enhancing therapeutic efficacy while minimizing toxicity. Commonly studied antidiabetic plants include Momordica charantia, Gymnema sylvestre, Trigonella foenum-graecum, Syzygium cumini, and Ocimum sanctum, which demonstrate hypoglycemic, antioxidant, and antihyperlipidemic activities by pathway like β-cell regeneration, decreased of glucose assimilation, and modulation of oxidative stress. This review highlights the potential of polyherbal formulations as safe, economically viable, and multi-targeted interventions for sustainable glycemic control, emphasizing the need for rigorous pharmacological, clinical, and formulation research to integrate traditional remedies into modern diabetes management.
Background: Benign paroxysmal positional vertigo (BPPV) accounts for approximately 20% of all cases of vertigo. Despite successful repositioning maneuvers, a significant proportion of patients experience residual dizziness, characterized by a persistent sensation of imbalance without true vertigo. The Epley maneuver remains the standard treatment for BPPV; however, adjunctive therapy with betahistine has been shown to facilitate vestibular compensation, thereby reducing residual dizziness and the risk of recurrent vertigo. This study aimed to assess expert opinions on the role of betahistine 48 mg/day for 3 months in preventing vertigo recurrence and reducing residual dizziness in patients with BPPV in real-world clinical practice. Methods: Total 43 neurologists from diverse regions across India treating BPPV participated in the survey. A literature review based on the Medline database search was used to prepare a structured questionnaire about BPPV management, treatment practices, recurrence, and residual dizziness. Results: Among the surveyed experts, 37% reported vertigo recurrence in 10-25% of patients following repositioning maneuvers. A majority (56%) indicated routine prescribing of betahistine at 48 mg/day. Furthermore, 67% opined that improved vestibular compensation and enhanced vestibular blood supply contributed to reduced recurrence, while 68% acknowledged the dose-dependent efficacy of betahistine. Notably, 35% reported a 75-90% reduction in residual dizziness with betahistine 48 mg/day administered for 3 months. Conclusions: Residual dizziness and recurrence remain common after successful repositioning maneuvers in BPPV. Expert opinion from real‑world practice supports adjunctive treatment with betahistine 48 mg/day for at least 3 months to facilitate vestibular compensation and significantly reduce residual dizziness and recurrence, with a favorable safety profile.
Background: Epidemiological data from Western populations show a higher prevalence of depression in elderly women, attributed to biological and psychosocial factors. However, this pattern is challenged by sociocultural contexts that shape gender roles and aging experiences. The geriatric gender gap in depression within Indian clinical populations remains inadequately characterized. This study investigated gender-based differences in the prevalence and correlates of depressive symptoms in geriatric outpatients in Northern India. Methods: A hospital-based, cross-sectional study was conducted over six months in the Medicine Outpatient Department of a tertiary-care hospital. A total of 100 consecutive patients (60 men, 40 women) aged ≥60 years were enrolled. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Between-group comparisons and gender-stratified correlation analyses were performed. Results: The prevalence of clinically significant depressive symptoms (GDS-15 ≥5) was significantly higher in men (68.3%) compared to women (40.0%) (p=0.004). The mean GDS-15 score was also significantly elevated in men (5.4±2.3) relative to women (4.1±2.3) (p=0.004). Among men, depression scores correlated positively with coronary artery disease (r=0.32, p=0.01); no significant clinical correlates were identified in women. Conclusions: This study reveals a significant reversal of the typical gender disparity in geriatric depression within a North Indian clinical sample. The findings suggest that culturally constructed masculine roles, compounded by age-related stressors like retirement, may predispose elderly men to higher depression risk. This underscores the need for gender-sensitive mental health screening tailored to aging populations in India.
Liver cirrhosis represents a significant and growing cause of morbidity and mortality in Bangladesh, reflecting the increasing burden of chronic liver diseases in low- and middle-income countries. This systematic review aims to evaluate the current etiological patterns of cirrhosis in Bangladesh, summarize its major complications and clinical outcomes, and identify critical gaps in prevention and management. A comprehensive literature search was conducted across MEDLINE/PubMed, Scopus, Web of Science, Google Scholar, and BanglaJOL from database inception to August 29, 2025. Eligible studies included observational studies, clinical trials, and national reports involving Bangladeshi populations with chronic liver disease or cirrhosis. Study selection, data extraction, and quality assessment followed PRISMA 2020 guidelines. Due to substantial methodological heterogeneity, findings were synthesized narratively. Of 1,847 identified records, 62 studies met eligibility criteria. Most were single-center hospital-based cross-sectional studies from tertiary centers in Dhaka. Hepatitis B virus (HBV) remains the predominant etiology, accounting for 30-60% of cirrhosis cases, while hepatitis C virus (HCV) contributes 5-20%. Recent meta-analyses indicate a pooled HBV prevalence of 4.0% (95% CI: 3.0-5.1%) in the general population. Non-alcoholic fatty liver disease (NAFLD/MASLD) has emerged as a rapidly increasing cause, with community prevalence of 25-35% among adults, rising to over 50% in individuals with metabolic risk factors. Major health system challenges include inadequate HBV/HCV screening, limited access to endoscopy and liver transplantation, insufficient hepatocellular carcinoma (HCC) surveillance, and absence of structured NAFLD/MASLD management pathways. Bangladesh is experiencing an epidemiological transition from viral to metabolic causes of cirrhosis, necessitating strengthened viral hepatitis control, expanded metabolic disease prevention, improved specialist services, and establishment of standardized national surveillance programs.
Background: The study aimed to compare the efficacy of glucosamine, chondroitin sulfate and a fixed dose combination (FDC) of glucosamine and chondroitin sulfate in patients with osteoarthritis (OA) of the knee. Methods: This was an open-label prospective comparative cohort study conducted from November 2023 to April 2024. Subjects were recruited consecutively from the orthopaedics outpatient department of GCMCH, Chidambaram, and assigned to one of three treatment groups based on the treating physician's prescription. Study tools including a patient data collection form and Western Ontario McMaster Universities Arthritis Index (WOMAC) questionnaires were used to measure outcomes at baseline and at monthly intervals over 4 months. Results: After 4 months, the fixed dose combination group showed a statistically significant reduction in WOMAC pain score compared to glucosamine and chondroitin sulfate monotherapy groups (p=0.009). No significant differences were observed among the groups for stiffness (p=0.234) or physical function (p=0.439). The fixed dose combination consistently produced the greatest numerical improvement across all WOMAC domains. Conclusions: The fixed dose combination of glucosamine 750 mg and chondroitin sulfate 600 mg is slightly more effective than either agent used alone, demonstrating greater relief of pain in patients with osteoarthritis of the knee.
Background: Objectives were to study socio-demographic factors associated with animal bites, assess wound severity, and estimate work/school days lost. Methods: A descriptive cross-sectional study was conducted at the anti-rabies clinic, Sub-District Hospital, Karad, among 400 new animal bite patients. Data were analyzed using descriptive statistics and Chi-square tests. Results: Majority were males (66.3%), aged 18-45 years (41.8%). Severe Class III bites predominated (72.5%), mainly from street dogs (82%). Lower limbs were most affected (61%). Soap-and-water wound washing was reported by 38.5%. Anti-rabies serum was administered to 42.3% of patients. Students (58.6%) and skilled workers (29.3%) reported highest absenteeism (1-3 days). Daily wage loss was noted in 37.3%. Conclusions: Animal bites, predominantly by stray dogs, cause significant morbidity and indirect economic burden through lost wages and school days. Strengthened rabies prophylaxis and community awareness are essential.
Background: Nutritional deficiencies are common in pregnant women in developing countries and contribute to poor pregnancy outcomes. This longitudinal study assessed trimester‑specific trends in nutritional and iron‑related biomarkers in Calabar, Nigeria. Methods: Seventy‑two pregnant women (18-41 years) were enrolled in the first trimester and followed to the third trimester at the University of Calabar Teaching Hospital. Fifty age‑ and parity‑matched non‑pregnant women served as controls. Blood samples were collected at 10, 24 and 36 weeks of gestation. Total protein, albumin, iron, unsaturated iron‑binding capacity (UIBC), ferritin, folate, vitamin B12 and soluble transferrin receptors (sTfR) were analysed; total iron‑binding capacity (TIBC) and transferrin saturation (TS) were calculated. Results: Albumin, folate and vitamin B12 were significantly lower in pregnant women by the second trimester compared to non‑pregnant controls. Within the pregnant cohort, albumin (39.6±7.7 to 24.3±2.7 g/L, p=0.001), ferritin (65.7±54.8 to 30.3±20.4 ng/mL, p=0.01) and total protein (74.4±12.4 to 60.5±4.1 g/L, p=0.01) declined progressively. Folate dipped in the second trimester (14.8±8.2 ng/mL) before rising in the third. Serum iron and TS% increased significantly in the third trimester. Over 90% of participants had abnormal total protein or albumin levels by the third trimester. Conclusions: Key nutritional biomarkers decline significantly in the second and third trimesters, supporting enhanced targeted nutritional monitoring and interventions in later pregnancy.
Background: Pregnancy-related acute kidney injury (PRAKI) remains a significant contributor to maternal morbidity and mortality in developing countries, despite a global decline in incidence. Data from Indian tertiary care centers continue to demonstrate a predominance of preventable obstetric and infectious causes. Methods: This combined prospective and retrospective observational study included pregnant women aged 18-42 years diagnosed with PRAKI at Goa Medical College. Patients with pre- existing kidney disease were excluded. Demographic variables, obstetric profile, etiologies, severity of AKI (KDIGO criteria), need for renal replacement therapy, and renal outcomes were analyzed. Results: Seventy-two women were included, with a mean age of 30.6±5.5 years. Most patients presented in the third trimester (88.9%). Sepsis was the most common etiology (41.6%), followed by preeclampsia (22.2%) and postpartum hemorrhage (12.5%). Severe AKI predominated with 59.7% classified as KDIGO stage 3. Complete renal recovery occurred in 55.6% of patients, partial recovery in 26.4%, while 8.3% became dialysis-dependent. Overall mortality was 9.7%. Progression to chronic kidney disease (CKD) was observed in 35% of patients during follow-up. Conclusions: PRAKI continues to cause substantial renal morbidity and mortality. Sepsis and hypertensive disorders of pregnancy remain the leading etiologies. Early diagnosis, timely intervention, and long-term renal follow-up are crucial to improving outcomes.
Background: Chronic liver disease (CLD) relentlessly progresses to fibrosis and cirrhosis unless the causative agent is eliminated. Cirrhosis leads to hepatic dysfunction and additionally has an effect on several systems. Liver is vital to thyroid hormone metabolism and also in the synthesis of thyroid binding globulin. Low free T3 syndrome is described in liver cirrhosis. Aim was to investigate the thyroid function of patients with CLD in relation to the severity of the disease. Methods: This is a prospective observational, single centre, hospital-based case-control study, comparing thyroid function in 112 decompensated CLD subjects and 112 matched healthy controls. Results: In the present study majority of participants are between the ages of 31 to 50 years. TSH level was found to be elevated in hepatic encephalopathy (HE) patients with a higher West Haven grade compared to lower grades of encephalopathy. Reduced levels of FT3 and FT4 were found in higher grades of HE. MELD score and Child Pugh score severity correlation with FT3 has shown a reduced FT3 and was directly proportional to the severity of CLD. Conclusions: Patients with CLD showed abnormalities in thyroid hormone concentrations and these abnormalities were related to advanced Child Pugh score and MELD score. Serum T3 level has been found to be low in significant number of cirrhotic patients.
Severe Plasmodium falciparum malaria is associated with life-threatening complications due to widespread microvascular dysfunction and multiorgan involvement. While cerebral malaria, acute kidney injury, and acute lung injury are recognized complications, rare manifestations such as peripheral gangrene and subarachnoid hemorrhage are seldom reported. We report the case of a 60-year-old female from rural India who presented with high-grade fever, chills, and respiratory distress. Laboratory evaluation confirmed P. falciparum malaria with severe parasitemia. Her clinical course was complicated by acute lung injury, generalized seizures, subarachnoid hemorrhage, acute kidney injury, coagulopathy, and evolving peripheral gangrene. She required intensive care support, intravenous artesunate, ventilatory assistance, anticonvulsants, and transfusions. Despite developing dry gangrene necessitating partial amputation of fingers, the patient improved with aggressive management and was discharged in stable condition. This case highlights the potential for P. falciparum malaria to cause rare and severe complications, including asymmetrical peripheral gangrene and subarachnoid hemorrhage. Early recognition of atypical manifestations, multidisciplinary care, and timely intervention are crucial for improving survival and reducing morbidity in severe malaria.
Background: Sentinel lymph node biopsy (SLNB) can reduce the morbidity of axillary lymph node dissection (ALND) in clinically node-negative breast cancer, but dual-tracer SLNB requires nuclear medicine infrastructure that is unavailable in many Indian hospitals. We evaluated 1% methylene blue dye (MBD) as a single tracer for SLNB in a resource-constrained setting. Methods: In this prospective observational study, 30 women with clinically node-negative, early-stage breast cancer (T1-T2, N0, M0) underwent periareolar injection of 3 ml of 1% MBD during modified radical mastectomy. Sentinel lymph node(s) were identified and harvested separately during axillary dissection, followed by complete axillary lymph node dissection in all patients during our unit’s learning phase for histopathological validation. Results: A sentinel node was identified in 29 of 30 patients (96.67%). Among these 29 patients, sensitivity was 88.89%, specificity 95.00%, positive predictive value 88.89%, negative predictive value 95.00%, and overall accuracy 93.10%. The false-negative rate was 11.11%. No anaphylaxis, skin necrosis, allergic reaction, or wound complication occurred. Three patients (10.0%) developed transient skin tattooing that resolved spontaneously. Conclusions: MBD-only SLNB achieved a high identification rate and diagnostic accuracy during the learning phase, with no major adverse events. It may provide a pragmatic, low-cost alternative for axillary staging where radioisotope-based SLNB is unavailable. Larger multicentre studies are required before ALND can be safely omitted after a negative MBD-only SLNB.
Background: Obesity is a well-established cardiovascular risk factor and is strongly associated with metabolic dysregulation, systemic inflammation, and accelerated atherosclerosis. However, its influence on clinical presentation, laboratory parameters, and coronary angiographic characteristics in patients with ST-elevation myocardial infarction (STEMI) remains controversial. Methods: The study included 75 patients with STEMI who were admitted to the Grodno Regional Cardiological Center (Belarus) for treatment from July to October 2025. Patients were divided into two groups according to body mass index (BMI): group 1 (obese, BMI≥30 kg/m2; n=37) and group 2 (non-obese, BMI≤29.9 kg/m2; n=38). All patients underwent clinical, laboratory, and instrumental studies. Statistical analysis was performed using STATISTICA 12.0. Results: Obese patients had a significantly higher prevalence of diabetes mellitus compared with non-obese patients (35.13% versus 7.89%, p=0.04). They also demonstrated a distinct metabolic profile characterized by higher triglycerides (p=0.001) and lower HDL cholesterol concentrations (p=0.037). No significant differences were observed in cardiac biomarkers, or renal function parameters. Angiographically, involvement of the left anterior descending artery (p=0.025) and left circumflex artery (p=0.03) was more frequent in obese patients. The rate of percutaneous coronary intervention and the number of implanted stents were comparable between groups. Conclusions: Obesity in STEMI patients is associated with a higher burden of metabolic disturbances and more frequent multi-vessel coronary involvement, particularly affecting the left coronary system. These findings highlight the complex interaction between adiposity, metabolic dysregulation, and atherosclerotic severity in acute coronary syndromes.
Acute copper sulfate poisoning usually causes severe toxicity only after large ingestions. We report a man in his early 50s with psoriasis vulgaris receiving methotrexate who developed severe intravascular hemolysis, methemoglobinemia, acute hepatotoxicity, and acute kidney injury after ingesting only 1 g of copper sulfate. Serial peripheral blood smears, biochemical parameters, and clinical progression confirmed delayed multi-organ toxicity. He recovered following aggressive supportive care, forced alkaline diuresis, and withdrawal of methotrexate, without requiring dialysis. This case suggests that psoriasis-associated copper dysregulation and methotrexate-induced oxidative stress may lower the threshold for severe copper sulfate toxicity.
