Introduction and importance: Small-bowel obstruction (SBO) is a common surgical emergency, most often caused by postoperative adhesions. However, it may also occur in patients without prior abdominal surgery, commonly referred to as the “virgin abdomen.” In such cases, the causes include congenital bands, inflammation, neoplasms, or rare intra-abdominal entities such as peritoneal loose bodies, which are typically discovered incidentally during imaging or surgery. Case presentation: A 42-year-old man presented with a 3-day history of progressive crampy abdominal pain, bilious vomiting, abdominal distension, and obstipation, with no prior abdominal surgery. Radiography showed dilated small-bowel loops with multiple air–fluid levels, consistent with obstruction. An emergency laparotomy revealed adhesive bands causing SBO. A freely mobile 5 × 4 × 4 cm peritoneal mass was also removed, and histopathology confirmed a giant peritoneal loose body with central fat necrosis, fibrosis, and calcification. Clinical discussion: Peritoneal loose bodies are uncommon and usually asymptomatic, most often arising from torsion and infarction of epiploic appendages that subsequently detach and undergo progressive fibrosis and calcification. Giant peritoneal loose bodies are particularly rare and may mimic intra-abdominal tumors or occasionally produce symptoms due to mass effect. Their diagnosis is frequently established intraoperatively, and surgical removal allows definitive histopathological confirmation. Conclusion: This case highlights an adhesive SBO in a surgically naïve patient, with the incidental discovery of a giant peritoneal loose body. It emphasizes that adhesions may occur without prior surgery and underscores the importance of careful intraoperative exploration to ensure an accurate diagnosis, appropriate surgical management, and definitive histopathological confirmation.
Background: Subdural empyema (SDE) is an uncommon, potentially life-threatening intracranial infection that can present with meningitis-like features, causing a diagnostic challenge. Streptococcus constellatus , a member of the Streptococcus anginosus group, is an unusual cause of central nervous system infections in adolescents, but is well known for its propensity to form abscesses. Case presentation: We report a previously healthy 14-year-old female who presented with acute severe headache, neck stiffness, photophobia, and vomiting following an upper respiratory illness with foul-smelling nasal discharge. Laboratory testing showed marked systemic inflammation (C-reactive protein >320 mg/L) and neutrophilia. Head CT demonstrated a right-sided 6-mm subdural collection with midline shift; magnetic resonance imaging confirmed a SDE with leptomeningeal enhancement and restricted diffusion. She underwent endoscopic sinus surgery and bilateral craniotomy for evacuation of the empyema with intracranial pressure monitoring; intraoperative cultures from the purulent collection grew S. constellatus . Management included targeted intravenous antibiotics and early neurorehabilitation. The patient exhibited steady improvement, as evidenced by clinical and laboratory findings. Conclusion: This case highlights that SDE can mimic meningitis in adolescents and underscores the importance of suspecting SDE in the presence of focal neurological deficits in addition to meningeal signs. Early neuroimaging, prompt combined surgical source control (including sinus drainage), and culture-directed antimicrobial therapy are essential for favorable outcomes. Clinicians should consider S. constellatus as a possible pathogen in sinus-associated intracranial empyema.
Background and importance: Subdural hematomas (SDH) may occur spontaneously in patients with intracranial hypotension or in those taking anticoagulants such as warfarin. Bilateral cases are rare and often indicate warfarin-induced vascular fragility. Case presentation: A 68-year-old male with a mechanical aortic valve on chronic warfarin therapy presented with dizziness and nausea and was initially diagnosed with a small left parietal subarachnoid hemorrhage, with imaging showing no vascular anomaly; it remained stable, and he was discharged. Forty days later, he was readmitted with dizziness and confusion, and imaging revealed bilateral acute SDH. Warfarin was discontinued and low-molecular-weight heparin was initiated, but rapid hemorrhage progression necessitated bilateral burr-hole evacuation, followed by reoperation for a recurrent right parietal hematoma. Anticoagulation was carefully adjusted due to the competing risks of valve thrombosis and rebleeding. Postoperatively, he developed transient hemiparesis that resolved, and subsequent ventricular dilatation was managed with lumbar puncture. Clinical discussion: Warfarin, widely used for cardiovascular disease, increases the risk of bleeding complications, including subdural hematoma, especially in patients with mechanical heart valves. Patients and clinicians are confronted with both clinical and surgical challenges. Conclusion: Subdural hematoma remains a challenging condition to manage. Timely surgical intervention might be necessary and life-saving, even while on warfarin therapy. Once the hemorrhage is controlled, anticoagulation can be safely resumed.
Background: Schizophrenia is associated with an elevated cardiovascular disease burden and mortality. However, outcomes for patients with schizophrenia undergoing coronary artery bypass grafting (CABG) remain poorly characterized. We investigated perioperative outcomes, resource utilization, and discharge disposition in this vulnerable population. Methods: Using the National Inpatient Sample (2017–2020), we identified 773 925 adult CABG admissions, including 2250 patients with schizophrenia and 771 675 without. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospital charges, post-operative complications, and discharge disposition. Multivariable logistic and linear regression models were adjusted for demographics, comorbidities, and hospital characteristics. Results: Patients with schizophrenia were younger (59.6 vs 66.3 years, P < 0.001), had a higher comorbidity burden (Charlson index 3.1 vs 2.7, P < 0.001), and a greater prevalence of diabetes (58.0% vs 51.1%, P < 0.0001), tobacco use (41.6% vs 18.4%, P < 0.001), and prior myocardial infarction (21.6% vs 17.5%, P < 0.001). After adjustment, schizophrenia was associated with increased odds of in-hospital mortality of borderline statistical significance (adjusted OR 1.30, 95% CI 1.001–1.69, P = 0.049), prolonged hospitalization (1.74 additional days, 95% CI 1.40–2.04, P < 0.0001), and discharge to skilled nursing facilities (adjusted OR 1.74, 95% CI 1.33–2.27, P < 0.0001). Post-operative infection, stroke, and bleeding rates were similar between groups. Conclusions: Schizophrenia was associated with increased odds of in-hospital mortality of borderline statistical significance (adjusted OR 1.30, 95% CI 1.001–1.69, P = 0.049), prolonged hospitalization, and a greater need for post-acute skilled nursing care following CABG. These findings highlight the need for integrated perioperative psychiatric care, optimized perioperative protocols, and structured discharge planning to improve outcomes and ensure equitable care for patients with serious mental illness undergoing cardiac surgery.
Introduction: Distal radius fractures can delay return to sport, particularly when early weight-bearing is restricted. Although volar locking plate (VLP) fixation is widely used, it may provide insufficient stability in fractures involving a small volar lunate facet fragment. Dorsal spanning plate fixation offers rigid stability and may facilitate early functional recovery, but its application in athletes remains underreported. Presentation of Case: A 28-year-old professional KEIRIN cyclist sustained a comminuted intra-articular distal radius fracture (AO type C2) with a small volar lunate facet fragment. Given the need for early return to training and concerns regarding stability with VLP fixation alone, dorsal spanning plate fixation was performed. Bicycle training with weight-bearing on the injured limb was initiated at 3 weeks postoperatively. Radiographic union was achieved at 3 months, followed by plate removal. The patient returned to full competitive racing at 6 months. At 12 months, he demonstrated excellent outcomes, with near-normal wrist range of motion, an 89% grip-strength recovery, no pain, and a Q-DASH score of 0. Discussion: Spanning plate fixation provides rigid stability and enables early weight-bearing, which is particularly advantageous for high-demand athletes. In this case, early rehabilitation allowed for the maintenance of sport-specific conditioning and facilitated a timely return to competition. Conclusion: Dorsal spanning plate fixation may be a valuable option for selected athletes with complex distal radius fractures requiring an early return to sport.
Introduction and importance: Alcohol withdrawal (AW) results from abrupt cessation or reduction in chronic alcohol use, leading to central nervous system hyperexcitability and autonomic overactivity. AW poses significant cardiovascular stress, predisposing to myocardial ischemia via various mechanisms. Case presentation: A 46-year-old male with chronic heavy alcohol use and no known major cardiovascular risk factors presented with restlessness. On admission, he exhibited features of moderate alcohol withdrawal, including tremors, agitation, and disorientation. He was managed supportively in the intensive care unit with a titrated diazepam infusion, resulting in gradual improvement in withdrawal symptoms. On the 10th day, a routine ECG demonstrated an acute inferior wall ST-elevation myocardial infarction (STEMI), and the qualitative troponin I test was positive, despite the absence of ischemic symptoms. Clinical discussion: The underlying mechanism of myocardial infarction could not be definitively established because coronary angiography was declined. Although recent alcohol withdrawal may have contributed through persistent physiological stress, coronary artery vasospasm, myocardial oxygen supply-demand mismatch, platelet hyperactivity, or other mechanisms remain possible. The patient was fully oriented at the time of infarction, supporting the diagnosis of a silent myocardial infarction. Conclusion: This case report adds to the scarce literature on acute coronary events during hospitalization for severe alcohol withdrawal and emphasizes that the patient’s silent STEMI may have arisen from multiple underlying mechanisms. It highlights the importance of maintaining a high index of suspicion for silent myocardial infarction in hospitalized patients recovering from alcohol withdrawal.
Monocarboxylate transporter 1 (MCT1) deficiency is an ultra-rare autosomal recessive metabolic disorder caused by pathogenic variants in the SLC16A1 gene, which encodes a proton-linked transporter of lactate, pyruvate, and ketone bodies. Few cases have been genetically confirmed worldwide, and diagnosis is often delayed due to nonspecific clinical features and the absence of characteristic metabolic markers. We report the case of a 5-year-old Egyptian boy with recurrent episodes of ketoacidosis and neurological symptoms, who was confirmed by whole-exome sequencing to have homozygous SLC16A1 pathogenic variants. Clinical data, biochemical findings, treatment course, and follow-up were documented in accordance with CARE guidelines. To contextualize this case, we conducted a systematic review of the literature following PRISMA 2020 guidelines, identifying genetically confirmed cases of MCT1 deficiency and summarizing clinical, genetic, and therapeutic insights. The patient presented with high anion gap metabolic acidosis (pH 6.8, bicarbonate 5.2 mmol/L) and normal glucose, lactate, and ammonia levels, consistent with impaired monocarboxylate transport. He developed severe rebound hypokalemia (serum potassium 1.7 mmol/L) during bicarbonate therapy, necessitating intensive correction. He recovered with supportive management, including careful fluid and electrolyte replacement. Our systematic review identified seven eligible studies, encompassing eight patients across six countries. Age of onset ranged from 2 months to 6 years, with clinical presentations including recurrent vomiting, lethargy, seizures, and metabolic crises. While outcomes varied, early recognition and supportive management were associated with more favorable neurodevelopmental trajectories. This study highlights the diagnostic and therapeutic challenges of MCT1 deficiency. The case illustrates not only the typical metabolic phenotype but also treatment-related complications such as hypokalemia. Findings from the systematic review emphasize the importance of genetic testing for early recognition, multidisciplinary management, and the need for greater clinical awareness of this emerging metabolic disorder. Expanding patient registries and investigating genotype–phenotype correlations are essential to improve outcomes in affected individuals.
Introduction: Breast tuberculosis (BTB) is a highly unusual form of extrapulmonary tuberculosis, accounting for less than 1% of all breast tumors worldwide. The disease poses a serious diagnostic problem because of its clinical and radiological resemblance to breast cancer. Bilateral involvement is highly uncommon and has been reported in only 3% of BTB cases. We report an unusual case of bilateral primary BTB mimicking carcinoma in a perimenopausal woman from Pakistan. Case presentation: A 42-year-old perimenopausal housewife presented with bilateral breast lumps with asymmetrical progression for 10 months. On the right side, there was an inflammatory and painful lump measuring 6 × 5 cm with skin thickening (peau d’orange) and retraction of the nipple. On the left side, there was a painless, mobile lump measuring 3 × 4 cm. Bilateral suspicious parenchymal densities were observed on mammography, with right BI-RADS 5 and left BI-RADS 4A findings. All microbiological investigations, including acid-fast bacilli, Gram staining, and cultures, were negative. Biopsies of the bilateral masses confirmed, histopathologically, benign mammary parenchyma with prominent central necrotizing granulomatous inflammation, and a diagnosis of tuberculous mastitis was made. Unfortunately, advanced molecular testing (GeneXpert MTB/RIF) could not be performed because of financial considerations. She received ATT for 6 months and required surgical debridement during the sixth week of her treatment due to paradoxical abscess and sinus formation. Healing was complete without recurrence for up to 1.5 years. Conclusion: BTB is an important pitfall that may mimic advanced breast carcinoma and idiopathic granulomatous mastitis. In countries where tuberculosis is endemic, a strong index of suspicion for BTB is essential when encountering atypical or bilateral breast masses. Histopathology is indispensable for confirming the diagnosis and avoiding inappropriate oncological management, especially in areas where advanced diagnostics for TB are not available.
Introduction: Mast cell leukemia (MCL) is the rarest and most aggressive variant of systemic mastocytosis (approximately 1% of cases), with a median survival of under 2 years. Diagnosis requires ≥20% atypical mast cells in the marrow aspirate, and the disease frequently overlaps with myeloid neoplasms. Case presentation: An 86-year-old man with paranasal sinus diffuse large B-cell lymphoma in remission since 2017 after R-CHOP and methotrexate, and prostate adenocarcinoma treated in 2019, presented with acute pancytopenia, presumed to represent lymphoma relapse. Serum tryptase exceeded 11 999 ng/mL; the aspirate showed 20% pleomorphic mast cells (CD117+, weak CD25, CD2−), confirming aleukemic MCL. Formal CMML criteria could not be confirmed due to the unavailability of monocyte differential data; however, the findings raised suspicion for an associated myeloid neoplasm, with SM with an associated hematological neoplasm remaining an alternative classification. Karyotyping was normal; next-generation sequencing revealed pathogenic variants in TP53, RB1, DAXX, ASXL1, TET2, and SRSF2, and a rare extracellular-domain KIT p.D419del. He declined inpatient midostaurin, deteriorated rapidly, and died 2 weeks later. Clinical discussion: This case illustrates a therapy-related MCL (plausible but unconfirmed given the non-leukemogenic profile of methotrexate and the focal nature of prostate stereotactic body radiation therapy) with a suspected associated myeloid neoplasm and complex pathogenic mutations. The KIT p.D419del extracellular domain variant is a rare non-D816V mutation; the canonical D816V was not detected on NGS, though the presence of a low-variant allele fraction D816V cannot be fully excluded due to assay sensitivity. Despite midostaurin, the disease remained aggressive. Conclusion: Persistent unexplained cytopenias warrant heightened suspicion of MCL, and comprehensive genomic profiling clarifies diagnosis, distinguishes overlapping myeloid disease, and informs prognosis in this aggressive, refractory neoplasm.
Introduction and significance: Bee stings are common but can cause severe systemic reactions, including anaphylaxis, cardiovascular instability, and, rarely, neurological complications such as watershed cerebral infarctions, as well as death. Stroke following bee envenomation is uncommon and may result from multiple pathological mechanisms. Case presentation: A 65-year-old male presented to the emergency department 30 minutes after sustaining more than 60 bee stings. He exhibited hypotension (BP 90/50 mmHg), hypoxia (SpO₂ 88%), generalized swelling, and respiratory distress. Initial management included intramuscular epinephrine, corticosteroids, antihistamines, nebulized bronchodilators, intravenous fluids, and tetanus prophylaxis. After stabilization, he developed acute left upper-limb weakness (power 2/5). Neuroimaging revealed multifocal acute infarcts in the ACA–MCA and MCA–PCA watershed regions, with hemorrhagic transformation. He was initially started on dual antiplatelet therapy and low-molecular-weight heparin, with the antithrombotic regimen later de-escalated to aspirin alone due to hemorrhagic conversion. Early physiotherapy and rehabilitation were initiated, resulting in gradual recovery, with near-complete restoration of left upper-limb function at six months. Discussion: Stroke after bee envenomation can arise from multiple mechanisms, including severe hypotension causing watershed infarcts, venom-induced vasospasm, inflammatory and pro-coagulant effects promoting thrombosis, and transient arrhythmias leading to cardioembolic events. Hemorrhagic transformation, as seen in this patient, adds complexity to antithrombotic management. Early recognition, hemodynamic stabilization, neurological monitoring, and timely rehabilitation are essential to optimize outcomes and prevent long-term deficits. Conclusion: Massive bee stings can precipitate life-threatening allergic reactions and rare cerebrovascular events. Clinicians should maintain vigilance for neurological complications, ensure early intervention, and implement structured rehabilitation to improve functional recovery.
Background: Trauma-related psychological distress may manifest through culturally shaped patterns of emotional expression that are not fully captured by conventional psychiatric frameworks. Silence, beyond the absence of speech, may represent a socially and culturally mediated response to unexpressed emotional experiences. This case report introduces silence-embedded distress (SED) as a culturally mediated form of psychological suffering characterized by preserved emotional awareness alongside sustained silence regarding distressing experiences. Case presentation: A 25-year-old woman participating in a community-based psychosocial support program in Rwanda experienced acute emotional distress during an “empty chair” therapeutic exercise, characterized by intense crying, withdrawal, and temporary difficulty expressing underlying emotions. Following stabilization within a trauma-informed and culturally sensitive environment, she disclosed a previously unspoken distressing experience related to a past abortion, which had remained concealed due to fear of stigma, social judgment, and perceived threats to dignity and belonging. She demonstrated preserved insight and judgment, without clinical features suggestive of major depressive disorder, PTSD, complex PTSD, dissociation, alexithymia, or generalized anxiety disorder. Discussion: This case illustrates a form of psychological suffering maintained not only by the original distressing experience but also by sociocultural constraints surrounding disclosure. SED differs from emotional suppression, repression, and avoidance by emphasizing conscious emotional awareness combined with culturally mediated silence. Recognizing nonverbal and relational expressions of distress may enhance culturally responsive community-based mental health practice. Conclusion: SED represents a preliminary clinical construct that may contribute to understanding culturally embedded psychological suffering. Further research is required to examine its prevalence, cross-cultural applicability, and relationship with established trauma-related conditions. Trauma-informed and culturally sensitive interventions may provide safe spaces that facilitate emotional expression and recovery.
Introduction and importance: Blunt abdominal trauma is a major cause of morbidity and mortality across all age groups. Among solid organs, the spleen and liver are most frequently injured, followed by the kidneys. Diaphragmatic injuries are rare and typically result from high-impact trauma, often occurring alongside other intra-abdominal injuries. Case presentation: We present the case of a 21-year-old male who sustained multiple injuries following a fall from a height of ten meters. Upon arrival, he was pale, tachycardic, and irritable, with an oxygen saturation of 80% and a blood pressure of 100/50 mmHg. Resuscitation was initiated immediately. Focused Assessment with Sonography for Trauma revealed intra-abdominal free fluid. After initial stabilization, a whole-body computed tomography scan demonstrated a grade IV–V splenic injury, hemothorax, and an ectopic left kidney located above the spleen. Emergency laparotomy revealed complete avulsion of the left kidney, splenic rupture, a diaphragmatic tear, and a serosal injury at the splenic flexure. Surgical intervention included splenectomy, left nephrectomy, and primary repair of the diaphragm. Clinical discussion: Diaphragmatic injuries are reported in only 1% of blunt trauma cases, most often on the left side. They are frequently missed due to non-specific symptoms and associated organ injuries. Early recognition and surgical repair are essential to prevent complications. Hemodynamically unstable patients with high-grade solid-organ injuries require immediate operative management. Conclusion: Simultaneous avulsion of the spleen and kidney with diaphragmatic rupture is extremely rare. Prompt diagnosis and surgical intervention are vital for favorable outcomes in such complex trauma cases.
Background: Alcoholic liver cirrhosis (ALC) remains a leading cause of liver-related mortality in the United States (U.S.); however, national data on place of death and sociodemographic patterns are limited. This study aimed to evaluate 25-year national trends in ALC-related mortality and place of death and to examine demographic and geographic predictors shaping end-of-life outcomes. Methods: Using CDC WONDER death certificate data and the National Center for Health Statistics individual-level mortality files, we analyzed deaths among adults aged ≥25 years (1999–2023). Place of death was categorized as hospital, home, hospice, or nursing home/long-term care; emergency/outpatient deaths were examined separately. Results: From 1999 to 2023, 302 815 ALC-related deaths occurred. Inpatient deaths fell from 65.2 to 48.6%, while home deaths rose from 20.7 to 30.2%. Hospice/nursing facility deaths increased to 23.7% in 2015, then declined to 18.3% in 2023; emergency/outpatient deaths decreased from 4.1 to 2.8%. Ages 50–64 accounted for most deaths, and younger adults had the highest inpatient proportion. In multivariable models, sex, race/ethnicity, and urbanization were significant: men, racial/ethnic minorities, and metropolitan residents were more likely to die in inpatient or emergency settings. Conclusion: ALC-related deaths shifted from inpatient facilities toward home and the combined hospice/long-term care facility category, while sociodemographic differences in place of death suggest uneven end-of-life care pathways and support efforts to improve equitable palliative and supportive care planning.
Despite advances in reproductive medicine, a widely acceptable male contraceptive method is still lacking, leaving the burden of birth control largely on women. As a result, female-centric methods continue to dominate global contraceptive trends, as male options are limited to condoms and vasectomy, both of which are constrained by issues related to reliability, reversibility, or social acceptability. Adoption of novel methods in this regard remains low as well due to social perceptions, myths surrounding masculinity, and concerns regarding side effects. This study was conducted as a narrative literature review to synthesize current scientific, translational, social, and ethical perspectives related to the development of male contraceptive methods. In this narrative review, we have provided a historical record of developments in the field of male contraception, from traditional methods such as condoms and vasectomy to novel hormonal and non-hormonal methods, highlighting major clinical trials along with various scientific, social, economic, ethical, and cultural barriers that impede both the development and acceptance of these novel approaches. In addition, the review explores the role of unequal gender expectations and cultural norms that discourage male participation, and the broad impact of this on reproductive health. Lastly, we discuss how pairing scientific advancements with societal norms and preferences could be pivotal in promoting shared responsibility, equity, and sustainability in reproductive health.
Background: Spinal anesthesia (SA) often causes shivering, which can lead to harmful physiological effects. Recent research suggests that intravenous paracetamol may help prevent this complication, but evidence is limited in low-resource settings such as Ethiopia. Objective: This study aimed to evaluate the effectiveness of prophylactic intravenous (IV) paracetamol in preventing post-SA shivering in mothers undergoing cesarean section. Methods: A prospective cohort study was conducted at a tertiary specialized hospital from January to April 2025. One hundred ASA Physical Status II parturients scheduled for cesarean delivery under SA were enrolled. Participants were divided into paracetamol (exposed) and non-paracetamol (unexposed) groups using systematic random sampling. Shivering incidence and severity, axillary temperature, mean arterial pressure, and intraoperative adverse effects were monitored at various intervals. Data were analyzed using SPSS version 27. Chi-square and Fisher’s exact tests were used for categorical data, and the Shapiro–Wilk test assessed normality. Independent-samples t-tests and Mann–Whitney U tests were used to compare group differences. Results: Shivering occurred in 30% of the paracetamol group versus 54% in the control group ( P = 0.015). Shivering severity also differed significantly ( P = 0.035). Conclusion: Prophylactic IV paracetamol significantly reduces the incidence and severity of shivering after SA in cesarean deliveries. These findings support its use and encourage further comparative studies with other agents.
Background:Outcomes after total joint arthroplasty are influenced by various biopsychosocial factors, among which preoperative psychological status and personality traits play a crucial role. Given that personality traits - such as extroversion, psychoticism, anxiety, and neuroticism - represent a wider, enduring framework compared to transient mental states like depression and stress, their impact on surgical outcomes is significant. This systematic review aims to evaluate the influence of personality traits on clinical outcomes after total joint arthroplasty. Methods:PubMed, Web of Science, Scopus, and Embase were explored from initiation until May 2025. The inclusion terms were "personality traits," "total knee arthroplasty," and "total hip arthroplasty," along with related MeSH terms, with no boundaries for language. Backward reference citation searches were also conducted. Results:Finally, a total of 15 studies were included. Anxiety is one of the most substantial factors impacting the consequences of total joint arthroplasty. Although there is unsatisfactory evidence supporting pain reduction in extroverted individuals, extroversion has been associated with improved quality of life and postoperative functional outcomes. Additionally, neuroticism has a negative correlation with quality of life and is linked to increased pain levels. Pessimism is associated with greater pain, reduced knee function improvement, and increased activity limitations. Based on quality-of-life questionnaires, extroversion and melancholic traits were associated with higher scores. However, neuroticism showed a negative correlation with Short Form (SF)-36 scores. Conclusions:Pain was the most significant assessed outcome. A positive association was observed between pain and traits such as extroversion, neuroticism, pessimism, anxiety, depression, and persistence. Concerning quality of life, features like extroversion and melancholic temperament were associated with higher quality of life, whereas neuroticism had a negative correlation with SF-36. Based on these findings, considering personality and psychological factors can contribute to improving surgical outcomes, and preoperative counseling is recommended.
Introduction:Respiratory failure is a serious condition caused by impaired gas exchange, leading to hypoxemia or hypercapnia. Nasal high-flow therapy (NHFT) has emerged as an alternative to standard oxygen therapy (SOT). This meta-analysis evaluates the efficacy and safety of NHFT versus SOT by incorporating newly published trials to guide current clinical practice. Methods:This systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials (RCTs) comparing NHFT with SOT in acute respiratory failure were included. Primary outcomes were mortality and hospital stay. Data were pooled using a random-effects model in RevMan 5.4, and the certainty of evidence was assessed using GRADE. Results:Sixteen RCTs (n = 5805) were included. NHFT showed no significant difference in 28-day mortality [risk ratio (RR) = 1.00; 95% confidence interval (CI): 0.85-1.17] or 90-day mortality (RR = 0.87; 95% CI: 0.58-1.29), length of hospital stay, length of ICU stay, or need for intubation. Oxygen saturation improved with NHFT after sensitivity analysis. Certainty of evidence ranged from moderate to very low using GRADE assessment, with heterogeneity addressed by removing outlier studies. Conclusion:NHFT shows comparable safety and efficacy to SOT in acute hypoxemic respiratory failure, with no significant differences in mortality, length of hospital stay, or intubation rates. Oxygen saturation improved with NHFT, reflecting its physiological advantages. Variability in study design limits generalizability. These findings support the individualized use of NHFT. Future research should explore patient-specific benefits, standardize protocols, and assess long-term outcomes.
