Background: Reduction mammaplasty is a common plastic surgery procedure that provides functional and aesthetic benefits. However, postoperative changes in nipple-areola complex (NAC) sensitivity remain a concern, as sensory outcomes vary among different breast reduction techniques. This meta-analysis aimed to systematically evaluate and compare nipple sensitivity preservation, reoperation rates, and complication rates among different breast reduction techniques. Methods: This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed, Google Scholar, UpToDate, EMBASE, Cochrane Library, and the Egyptian Knowledge Bank were searched for studies published from 2014 to 2025. Eligible studies assessed postoperative nipple sensitivity after breast reduction with at least 6 months of follow-up. Data on study characteristics, surgical techniques, nipple sensitivity, complications, success rates, and reoperation rates were extracted. Results: Twenty studies were included in the final analysis. The included studies varied in design, sample size, follow-up duration, surgical technique, and methods of nipple sensitivity assessment. The pooled mean BMI was 28.84 kg/m². Nipple sensitivity preservation rates were generally high across the studied techniques. The superomedial pedicle showed the most consistent pooled estimate for nipple sensitivity preservation, while PALM demonstrated favorable complication and reoperation profiles in the available studies. The overall pooled success rate was 83.7%, and the pooled complication rate was 15.6%. Substantial heterogeneity was observed across several outcomes. Conclusion: Breast reduction surgery remains an effective procedure with generally high success rates and low reoperation rates. However, postoperative nipple sensitivity and complication rates vary according to surgical technique, patient characteristics, and assessment methods.
Background: Colistin-resistant Klebsiella pneumoniae (K. pneumoniae) has become an increasingly important high-priority pathogen. Nevertheless, reliable assessment of colistin susceptibility remains technically difficult. Although broth microdilution (BMD) is regarded as the reference method, its laborious procedure limits its routine application among clinical laboratories. This research aimed to assess the diagnostic utility of colistin broth disk elution (CBDE) and modified colistin broth disk elution (mCBDE) as feasible alternatives to BMD for determining colistin susceptibility for K. pneumoniae isolates. Methods: A hospital-based cross-sectional study was performed among intensive care unit patients with different hospital-acquired infections. Following isolation and PCR identification, K. pneumoniae isolates were tested for antibiotic susceptibility using the disk diffusion method. Colistin susceptibility was tested utilizing the BMD method in parallel to both CBDE and mCBDE. The performance of both methods was evaluated and compared to the BMD as the reference standard. Results: Colistin resistance frequency was 10.9% (12/110) by BMD. Compared with BMD, the CBDE performed excellently, reporting a colistin resistance frequency of 10% and achieving essential agreement (EA) and categorical agreement (CA) of 99.1% and 100% specificity, 91.7% sensitivity, 99.1% accuracy, and 8.3% very major error (VME). The mCBDE showed moderate performance, recording 5.5% colistin resistance with 99.0% specificity, 41.7% sensitivity, and 58.3% VME. Conclusion: The CBDE could be an appropriate alternative for BMD in the detection of colistin resistance in routine microbiological work. Further studies are warranted to evaluate the performance of mCBDE.
Background: Peripheral nerve injury remains difficult to manage, as regeneration is slow and recovery is often incomplete. Nanofat grafting has emerged as a promising regenerative approach due to its anti-inflammatory, anti-fibrotic, and tissue-repair potential. This study aimed to evaluate the effect of immediate autologous nanofat grafting on sciatic nerve repair in male albino rats. Methods: This prospective experimental animal study included 16 adult male albino rats weighing 200–250g. Bilateral sciatic nerve transection and immediate repair were performed. The left nerve served as the control and underwent epineural microsuture repair only, while the right nerve received the same repair followed by perineural autologous nanofat injection. After four anesthesia-related deaths, 12 rats completed the study. Functional recovery was assessed weekly by SFI for 5 weeks, followed by histopathological, histochemical, immunohistochemical, and morphometric evaluation. Results: The control side showed moderate nerve injury with inflammation, edema, fibrosis, nerve fiber disorganization, vacuolation, and degeneration. In contrast, the nanofat-treated side showed better nerve architecture, organized axons, regenerative changes, and reduced inflammatory and fibrotic reactions. SFI showed no significant difference at week 1 (p=0.478), but significantly improved in the experimental group from week 2 to week 5 (p < 0.001). Morphometric analysis revealed reduced fibrosis thickness, fibroblast percentage, and TNF-α expression, with increased myelin percentage and axonal count in the nanofat-treated group. Nerve thickness was higher but not statistically significant (p=0.1023). Conclusion: Immediate perineural autologous nanofat grafting improved functional recovery and histological regeneration after sciatic nerve repair in male albino rats.
Background: In many low-resource settings, women with breast cancer face major financial barriers to care. The cost burden of diagnosis and treatment—often described as financial toxicity—can influence whether patients start, continue, or complete therapy. Despite its importance, evidence on its scale and clinical impact in such settings remains limited. Objective: To estimate how common financial toxicity is among breast cancer patients and to explore factors linked to it, as well as its early effects on treatment and outcomes. Methods: This retrospective cross-sectional study included 104 women with histologically confirmed breast cancer treated at a tertiary facility. Information on clinical characteristics and treatment was retrieved from hospital records, while financial experiences and payment patterns were obtained through structured interviews. Financial toxicity was defined using both economic burden and patient-reported financial difficulty. Statistical analyses were performed to identify associated factors and outcome patterns. Results: Financial toxicity was present in 63 patients (60.6%), and 45 (43.3%) experienced catastrophic health spending. It was more frequent among women with limited income, no insurance coverage, advanced disease, and those receiving combined treatment approaches. Patients affected by financial strain were more likely to delay treatment, interrupt therapy, and show early signs of disease progression. Conclusion: Financial hardship is widespread and is associated with disruptions in the delivery of optimal breast cancer care. Expanding financial support systems may help improve treatment completion and early outcomes in resource-constrained settings.
Background: Anemia remains frequent among patients on maintenance hemodialysis despite the use of iron and erythropoietin therapy. Insulin like growth factor 1 (IGF-1) may support erythropoiesis, but its relation to anemia in dialysis patients needs further clarification. This research aimed to assess serum IGF-1 level in maintenance hemodialysis patients and evaluate its link with anemia and hemoglobin status. Methods: This cross sectional study included 84 patients with end stage renal disease on regular hemodialysis. Cases were categorized into Group A, non-anemic patients, and Group B, anemic patients. Clinical data, dialysis related variables, iron therapy, hematological indices, biochemical profile, iron parameters, Serum IGF-1 was measured by Enzyme-Linked Immunosorbent Assay. Results: Hemoglobin was significantly lower in anemic patients (9.32 ± 0.98 vs 11.81 ± 0.64 g/dL, p = 0.001). Serum IGF-1 was also lower among anemic cases (182.08 ± 59.54 vs 222.97 ± 58.96 ng/mL, p = 0.002), triglycerides were higher (200.0 vs 180.0 mg/dL, p = 0.023). IGF-1 correlated positively with hemoglobin (r = 0.285, p = 0.008), albumin (r = 0.327, p = 0.002), TSAT (r = 0.219, p = 0.046), and iPTH (r = 0.417, p = 0.001). At a cutoff of 195.77 ng/mL, IGF-1 showed AUC 0.676, sensitivity 64.3%, and specificity 59.5%. IGF-1 ≥195.77 ng/mL remained associated with lower anemia odds after adjustment. Conclusion: Lower serum IGF-1 was significantly correlated with anemia among maintenance hemodialysis patients. IGF-1 may serve as a useful marker of hematological status, reflecting erythropoietic activity as well as nutritional, metabolic, and mineral related factors.
Background: The optimal revascularization strategy for significant unprotected distal left main coronary artery disease remains debated, particularly when lesion significance is determined by coronary physiology. This study compared 6-month clinical outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) among patients with iFR-confirmed significant distal left main disease and low-to-intermediate SYNTAX scores. Methods: This prospective observational comparative cohort study included 96 patients with stable angina and 40% to 70% angiographic distal left main stenosis confirmed as hemodynamically significant using instantaneous wave-free ratio (iFR ≤0.89). The same physiological eligibility threshold was applied to both groups. After eligibility was established, patients underwent PCI (n=48) or CABG (n=48) through nonrandom routine clinical decision-making based on coronary anatomy, clinical profile, treating-team judgment. Results: At 6 months, rates of non-fatal MI (0% vs 14.58%; P=0.012) MACEs (8.33% vs 27.08%; P=0.030) were significantly lower after PCI. The unadjusted absolute difference in MACE was 18.75 percentage points. All-cause death TLR did not differ significantly. Kaplan–Meier analysis showed lower cumulative MACE occurrence after PCI (log-rank P=0.014). In an exploratory multivariable Cox model, CABG treatment a greater number of diseased vessels were associated with MACE; the inverse association with dyslipidemia should not be interpreted as biologically protective. Conclusion: Among patients with iFR-confirmed significant unprotected distal left main disease and low-to-intermediate SYNTAX scores, PCI was associated with lower 6-month MACE rates than CABG. Because treatment allocation was nonrandom and median iFR differed between groups, these findings are associative require confirmation in larger randomized studies with longer follow-up.
Background: β-Thalassemia major (β-TM) is one of the most frequent monogenic inherited hemoglobin disorders worldwide, characterized by absent or severely reduced β-globin chain production, resulting in an imbalanced α/β chain ratio, ineffective erythropoiesis, and chronic hemolytic anemia. To evaluate immune-inflammatory interactions with β-TM pathogenesis following splenectomy by quantifying complement regulatory protein expression (CD55, CD59, CD35) on erythrocytes, and to determine their diagnostic utility in distinguishing splenectomized from non-splenectomized patients and from healthy controls. Methods: A case-control study conducted at Zagazig University Hospitals enrolling 57 participants in three age- and sex-matched groups of 19 each: β-TM patients with prior splenectomy, β-TM patients without splenectomy, and healthy controls. Flow cytometric assessment of CD55, CD59 (on granulocytes), and CD35 and CD59 (on erythrocytes) was performed. Hematological, hepatic, and biochemical parameters were compared, and ROC curve analysis was used to determine diagnostic performance. Results: Splenectomized patients had significantly reduced transfusion requirements post-operatively. Post-splenectomy hematological changes included marked leukocytosis and thrombocytosis. A graded reduction in CD55, CD59, and CD35 was observed from controls to non-splenectomized patients to splenectomized patients. Reduced complement regulatory proteins correlated inversely with inflammatory markers and ferritin. For discriminating splenectomized from non-splenectomized patients, CD35 showed the highest diagnostic accuracy. For discriminating all β-TM patients from controls, CD59 showed the best performance. Conclusion: Splenectomy worsens complement dysregulation in β-TM, evidenced by significantly lower erythrocyte complement regulatory protein expression. CD35 is the most accurate single marker for identifying the post-splenectomy state, while CD59 best distinguishes β-TM patients from healthy individuals.
Background: The ideal time for laparoscopic cholecystectomy (LC), whether it be early (during index hospitalization) or delayed (4-6 weeks post-resolution), is still debatable with relation to patient outcomes, despite the fact that cholecystectomy is the ultimate therapy of acute biliary pancreatitis (ABP). This research aimed to evaluate the clinical outcomes of early vs delayed LC for the treatment of mild to moderate ABP. Methods: A prospective cohort study included 100 patients with choledocholithiasis and biliary pancreatitis: 80 underwent ELC and 20 LLC. Mortality and morbidity were primary outcomes, while LoS, biochemical markers, operative time, and conversion to open surgery were secondary outcomes. ANCOVA adjusted for age, and subgroup analyses compared ELC vs LLC by Atlanta severity (mild, moderate, severe). Results: At discharge, clinical improvement was higher with ELC (91.3% vs. 65.0%), with a shorter LoS (7 vs. 11 days, p < 0.001) and lower morbidity (18.8% vs. 85.0%, p < 0.001). LLC was associated with higher rates of conversion to open surgery and intraoperative complications. ELC was beneficial across all severity levels. In mild cases, it reduced LoS (6.5 vs. 9.0 days) and morbidity (15.9% vs. 60.0%). In moderate cases, it shortened operative time (38 vs. 75 min) and reduced conversion rates (12.5% vs. 38.5%). Severe cases had comparable outcomes. After age adjustment using ANCOVA, differences in LoS, morbidity, and operative time remained significant (P < 0.001). Conclusion: ELC is superior to delayed intervention in mild to moderate ABP, supporting its adoption when clinically possible.
Background: Hepatic encephalopathy (HE) is a serious complication of pediatric liver failure. Zinc plays an important role in ammonia metabolism, but its association with HE in children remains unclear. the aim of this study was to evaluate serum zinc levels in pediatric liver failure and their relationship with HE. Methods: This study included 100 children with chronic liver disease (CLD) or acute liver failure (ALF) and a matched control group. Clinical assessment, liver function tests, serum ammonia, serum zinc, and disease-severity scores were evaluated. The predictive value of zinc for HE was assessed using ROC analysis. Results: Serum zinc levels differed significantly among controls, CLD, and ALF patients (p<0.001), with the lowest levels observed in CLD, particularly in those with HE. In CLD, lower zinc levels were associated with greater disease severity and worse liver function parameters. However, zinc levels did not differ significantly according to HE status within disease groups. ROC analysis showed limited predictive value for HE, and multivariable analysis identified Child–Pugh score and serum ammonia, but not serum zinc, as independent predictors of HE. Conclusion: Zinc deficiency was mainly associated with chronic liver disease rather than acute liver failure. Although lower zinc levels correlated with disease severity in CLD, serum zinc was not an independent predictor of HE and may be more useful as a marker of chronic liver disease severity than as a diagnostic marker for hepatic encephalopathy.
