Background and Objectives: A person’s quality of life and everyday functioning may be significantly restricted by chronic back pain including lumbosacral discogenic pain. The purpose of this study is to evaluate the GDS method’s initial effects on patients with chronic lumbosacral discogenic pain in terms of both pain and quality of life delivered through a smart phone application in a pilot study. Methodology: Between July 2025 and September 2025, a one-group pretest-posttest design was chosen, and a total of fifteen patients (six male and nine female; mean age 45±9.0 years; range, 35 to 65 years) were enrolled in the study. Study was Designed at Superior University, Lahore and conducted at Seyal Medical Center. A free local designed smartphone application was used to deliver the 6-week GDS program. Daily reminders, video instructions, and guided postural exercises were all part of the intervention aligning it with SDG three and four. The SF-36 Quality of Life Survey and the ODI scale for pain were used as outcome measures both before and after the intervention. Data on adherence and user engagement were also gathered. Results: From pre-intervention to post-intervention, all SF-36 short form domains showed a statistically significant increase (p <.05). A small scale change (40%) was seen in the ODI scale after the intervention. Eighty percent of participants completed at least five sessions per week on average. Conclusion: Small percentage of patients with chronic discogenic pain showed improvements in pain intensity, functional disability, and certain quality-of-life domains after completing a six-week digitally delivered GDS program. Platforms for digital physiotherapy need to define more parameters, so it could provide a scalable and affordable addition to conventional care.
Background and Objective: p16, a key regulator of the cell cycle, has been implicated in tumor progression and may aid in the stratification of neuroendocrine neoplasms (NENs). To determine the frequency of p16 expression in NENs and evaluate its association with different tumor types and grades is the prime objective of the study. Methodology: This prospective descriptive observational study was conducted at the Department of Histopathology at Shifa International Hospital, Islamabad, from November 2024 to October 2025. A total of 85 cases of NENs were included. Formalin-fixed paraffin-embedded tissue sections were evaluated using immunohistochemistry for p16 expression. Clinicopathological variables including age, gender, tumor site, tumor subtype, and tumor grade were recorded. Data were analyzed using SPSS v27.0, and associations between variables were assessed using the chi-square test with p-value <0.05 considered statistically significant. Results: The mean age of patients was 55.8±14.66 years. A slight male predominance was observed in 56.5% (48) cases. Well-differentiated neuroendocrine tumors (NETs) comprised 69.4% (59) of cases, whereas neuroendocrine carcinomas (NECs) accounted for 30.6% (26). The liver was the most common site of involvement in 29.4% (25) cases. Diffuse p16 positivity was observed in 24.7% (21) cases, heterogeneous positivity in 32.9% (28), and negative staining in 42.4% (36). Diffuse p16 expression was more frequent in NECs i.e. 65.4% (17) compared with well-differentiated NETs in 6.8% (4) cases. Conclusion: Diffuse p16 expression is significantly associated with neuroendocrine carcinomas and is rarely observed in well-differentiated neuroendocrine tumors. Keywords: Neuroendocrine Tumors; Neuroendocrine Carcinoma; p16 Protein; Immunohistochemistry; Cell Cycle Proteins.
Objectives: This study’s primary objective was to assess the efficacy of systemic opioids with pre-incision bilateral scalp nerve block for supratentorial craniotomy pain via intraoperative hemodynamic variables at different intervals. The secondary objective was to assess the postoperative pain, rescue analgesia requirement, sedation, nausea and vomiting in first 24 hours of surgery. Methodology: This double-blinded randomized controlled trial, conducted at Aga Khan University Hospital, Karachi. The 62 adult patients (ASA I–III), recruited for elective supratentorial craniotomy via randomization into two groups (n=31/group). Group-M received intravenous morphine (0.1 mg/kg) at induction. Group-S received bilateral SNB with lidocaine, ropivacaine, adrenaline, and dexamethasone. The heart rate, systolic, diastolic, and mean arterial pressures were recorded at predefined intraoperative intervals. Postoperatively, both participants received PCIA morphine, and pain was assessed by visual analogue scale (VAS), along with sedation, nausea and vomiting incidences, which were recorded in first 24 hours at various intervals. Results: The demographic and surgical characteristics were insignificant in both groups (p<0.05). The hemodynamic variables such as heart rate was only increased on intense stimulation in both groups, relatively was higher in group-S compared to group-M. However, statistically it was insignificant. The systolic, diastolic, and mean arterial pressures were significantly stable in group-S, compared to Group-M, at various intraoperative intervals (p<0.05). The sedation, nausea and vomiting incidence were equivocal in both groups. The VAS pain score was significantly lower in group-S, compared to group-M, postoperatively from 2 to 24 hours. Conclusion: Pre-incisional scalp nerve block provides better attenuation of intraoperative noxious stimuli via hemodynamic control, and it shows superior postoperative analgesia, without risking the sedation, nausea and vomiting in supratentorial craniotomy surgeries.
Objectives:To determine the microbiological spectrum of multi-drug resistant (MDR) bacterial infections within the first 30 days post-living donor liver transplantation (LDLT) and identify the associated risk factors contributing to their emergence. Methodology:This retrospective cohort study reviewed the medical records of patients who underwent LDLT from January 2020 to December 2024 at the Liver Transplant and Hepatopancreatobiliary Surgery Unit of Dow University Hospital, Karachi. Patients were categorized into MDR and no-MDR groups based on culture-confirmed MDR bacterial infection with clinical features of sepsis. Types of MDR bacterial infections were noted. Baseline, pre-transplant, intraoperative, and post-transplant variables were recorded. Pearson Chi-square test, Mann-Whitney U test, and univariate and multivariate logistic regression analyses were performed for statistical inference. Results:Of 151 LDLT recipients, 75 (49.7%) developed MDR bacterial infections within 30 days. Among these, gram negative MDR organisms were predominated, with carbapenem-resistant Enterobacteriaceae (21.2%) and carbapenem-resistant Acinetobacter baumannii (20.5%) most frequent, followed by vancomycin-resistant Enterococci (13.2%). On univariate analysis, MDR infection was associated with pre-transplant ICU admission, renal dysfunction, prolonged postoperative ICU stay, mechanical ventilation >48 h, hemodialysis and/or sustained low-efficiency dialysis (SLED), postoperative complications, longer invasive device duration, prolonged hospital stay, central line-associated blood stream infection (CLABSI), and intra-abdominal infections. On multivariate analysis, only CLABSI [Wald χ²=17.696 (OR 0.021; 95% CI: 0.003-0.127; p<0.001)] and intra-abdominal infections [Wald χ²=25.567 (OR 0.008; 95% CI: 0.001-0.050; p<0.001)] remained independently associated with MDR infection. Conclusion:Nearly half of LDLT recipients developed MDR infections, predominantly due to gram-negative organisms. CLABSI and intra-abdominal infections emerged as the key predictors of MDR bacterial infections.
Objectives:Dexmedetomidine has been increasingly used as an alternative sedative agent during bronchoscopy, but its comparative efficacy and safety remain unclear. This systematic review and meta-analysis aimed to assess the effectiveness and safety of dexmedetomidine compared with other sedative agents in adult bronchoscopy. Methodology:PubMed, Embase, CENTRAL, and Scopus were searched up to 17 December 2025 for randomised controlled trials (RCTs) comparing dexmedetomidine with other sedatives. Procedural success was assessed descriptively, while procedural duration, satisfaction scores, safety and hemodynamic parameters were analyzed quantitatively in a random-effects model. Results:Seventeen RCTs were included. Qualitative synthesis showed mixed results for the adequacy of sedation between dexmedetomidine and midazolam or propofol. However, studies did note a tendency for better sedation with remimazolam as compared to dexmedetomidine. Compared with midazolam, dexmedetomidine significantly reduced the incidence of hypoxia, but was associated with higher risks of bradycardia and reduced risk of hypotension; no consistent differences were observed in procedure duration or rescue sedation. Compared with propofol, dexmedetomidine was associated with lower rates of hypoxia and hypertension but a higher incidence of bradycardia. Compared with remimazolam, dexmedetomidine was associated with lower patient satisfaction scores and higher rates of hypoxia, whereas other safety outcomes did not show any significant difference. Studies comparing dexmedetomidine with opioids were scarce. Conclusions:Evidence shows dexmedetomidine is an effective sedative for adult bronchoscopy, comparable to midazolam and propofol in sedation levels. It may reduce hypoxia but increases bradycardia. Compared with remimazolam, it seems to offer less favourable sedation with a higher risk of hypoxia. However, data was from a limited number of studies. Registration No.: PROSPERO (CRD420251242030).
Objectives:Conventional pathological examination can diagnose small cell lung cancer (SCLC) relying on the combined use of multiple immunohistochemical markers, and the diagnostic accuracy still does not meet clinical needs. In recent years, insulinoma-associated protein 1 (INSM1) has gradually demonstrated its value in identifying SCLC in surgical and biopsy specimens of lung tissue. Therefore, we aimed to evaluate the diagnostic utility of INSM1 as an immunohistochemical marker in accelerating and simplifying the diagnosis of SCLC. Methodology:PubMed, Embase and Web of Science databases were searched to retrieve literature. A meta-analysis was performed with Stata software (Stata 18.0). A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity. Results:The initial search identified 257 articles. According to the inclusion criteria, 1523 patients from 10 studies were included in this meta-analysis. The pooled sensitivity and specificity of INSM1 immunohistochemistry for the diagnosis of SCLC were 0.93 (95% CI: 0.89 - 0.96) and 0.96 (95% CI: 0.92 - 0.98), respectively. The corresponding positive likelihood ratio (PLR) was 20.84 (95% CI: 11.64 - 37.32), and the negative likelihood ratio (NLR) was 0.07 (95% CI: 0.04 - 0.12). The area under the summary receiver operating characteristic (SROC) curve was 0.98 (95% CI: 0.97 - 0.99). Conclusions:INSM1 is a relatively promising and reliable immunohistochemical biomarker for the diagnosis of SCLC, with high sensitivity and specificity. In the future, INSM1 may be widely applied in the diagnosis of lung malignancies to improve the accuracy of pathological diagnosis for SCLC.
Objective:To identify the association among the gut, brain, and related microbiota, to reach the best-suited personalized management plan for Irritable Bowel Syndrome (IBS). Methodology:A systematic review was conducted by reviewing studies across multiple Databases, i.e., Scopus, MEDLINE, PubMed, Web of Science, ScienceDirect (Elsevier), Cochrane Library, Embase, and Google Scholar. The timeframe of selected publications was from 2007 to 2025. The results were extracted from 49 selected manuscripts using PRISMA guidelines. The review discussed the pertinent link between the brain-gut axis and IBS, in relation to etiology, clinical features, and underlying pathophysiological mechanisms, and an optimal management plan that aligns with the new concept of personalized health care, alongside evidence-based medicine. Results:IBS is a multidimensional ailment concerning gut hypersensitivity, hyper-immunity, imbalanced gut flora, and excessive anxiety or derailed psychology, each presented with a particular feature and associated with related etiology. Conventional therapeutic management benefits from reducing fermentation through a suitable diet plan, antibiotics to regulate gut flora, and neuroregulators that augment signaling pathways between visceral (gut-related) and central (brain) nervous systems. Stress-reducing interventions helped to decline the nociception and symptomatic-anxiety bursts. Upcoming advanced techniques such as Fecal microbiota transplantation (FMT), psychedelic-assisted therapy, traditional Chinese medicine, and the use of neuromodulator devices express possibilities to cure. Conclusion:IBS is a multisystem pathology triggered by gut dysbiosis, hyper-immune responses, visceral hypersensitivity, and stress-axis dysregulation. Thus, it is evident that a multimodal personalized management approach, including dietary, microbiome-targeted, pharmacological, and psychological therapies, is recommended for IBS, based on symptomology and etiology.
Intertrochanteric femoral fractures are common in older adults. Internal fixation remains a mainstay of treatment, as appropriately selected fixation can restore mechanical stability and facilitate early mobilization. This narrative review focuses on commonly used fixation methods for intertrochanteric femoral fractures, including intramedullary devices such as PFNA and InterTan, extramedullary devices such as DHS and LCP, and emerging technology-assisted approaches such as PFBN, 3D-printed navigation templates, and robot-assisted fixation. The review summarizes the technical principles, clinical indications, potential advantages, and limitations of these methods, and discusses current trends toward minimally invasive, precise, and individualized fixation, as well as the potential role of new materials and technology-assisted procedures. The purpose of this review was to provide a clinically oriented reference for selecting appropriate internal fixation strategies according to fracture characteristics, bone quality, patient condition, and the available level of evidence, thereby supporting evidence-informed decision-making in the management of intertrochanteric femoral fractures.
Median arcuate ligament syndrome (MALS) is a rare vascular condition, more commonly observed in females and typically considered a diagnosis of exclusion. Its clinical presentation often mimics chronic mesenteric ischemia, making diagnosis challenging. We report an interestingly rare case of a young male presenting with chronic postprandial abdominal pain, nausea, and significant weight loss. Following an extensive diagnostic workup and exclusion of other potential etiologies, a diagnosis of MALS was established. The patient underwent successful laparoscopic decompression of the celiac artery with division of the median arcuate ligament, resulting in complete symptom resolution.
Objective: To generate comparative evidence on outcomes of hysteroscopic (HS) vs vacuum aspiration (VA) for retained products of conception (RPOC). Methodology: We included all study designs comparing HS with VA for RPOC and available on PubMed, CENTRAL, Scopus, Embase, and Web of Science up to 15th January 2025. Surgical and pregnancy outcomes were analyzed. Results: Four studies were included. Meta-analysis showed that procedure duration was significantly longer with HS as compared to VA. The risk of intra-operative and post-operative complications did not differ between the two groups. The risk of incomplete evacuation of RPOC was significantly lower with HS as compared to VA with no difference in the risk of uterine perforation or hemorrhage ≥500ml. There was a tendency of higher risk of conversion to another procedure with HS as compared to VA. Meta-analysis showed that conception rates and subsequent risk of miscarriage did not significantly differ between the two groups. Conclusions:Limited evidence suggests that HS for RPOC may result in a lower risk of incomplete evacuation but has a longer procedural duration as compared to VA. The risk of complications and pregnancy outcomes do not seem to differ between the two. However, important fertility-related outcomes, including intrauterine adhesions, live birth rates, time to conception, and placental complications, could not be adequately assessed due to limited data. The quality of evidence is low due to scarce literature.
Objectives:Early diagnosis of pediatric sepsis remains challenging due to limitations of conventional biomarkers. The platelet-to-lymphocyte ratio (PLR), derived from routine blood tests, has emerged as a potential diagnostic marker. This study aimed to evaluate the diagnostic accuracy of PLR for pediatric sepsis. Methodology:A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to March 15, 2026. Studies assessing the diagnostic performance of PLR in pediatric sepsis and reporting sufficient data to construct 2×2 contingency tables were included. Pooled sensitivity and specificity were calculated using a random-effects model. Summary receiver operating characteristic (SROC) analysis and Deeks' funnel plot were performed. Results:Fifteen studies with 1,980 patients were included. The pooled sensitivity and specificity of PLR for diagnosing pediatric sepsis were 0.81 (95% CI: 0.73-0.87) and 0.72 (95% CI: 0.60-0.82), respectively. The SROC curve demonstrated an area under the curve of 0.79, indicating moderate diagnostic accuracy. Significant heterogeneity was observed. Subgroup analysis showed better performance in larger studies (≥150 patients) and studies using higher PLR cut-offs (>50). Deeks' funnel plot showed no evidence of publication bias (p = 0.536). Conclusions:Evidence from studies with high-risk of bias indicates that PLR may have moderate diagnostic accuracy for pediatric sepsis and may serve as a simple, cost-effective adjunctive biomarker. Since, most studies were on neonatal population, evidence may not be generalized to older pediatric populations. Further large-scale prospective studies are needed to establish standardized cut-off values and validate its clinical utility.Registration No: PROSPERO (No. CRD420261338676).
Global health governance faces challenges due to differences in philosophy, the complexity and political nature of the governance domain, and the uncertainty of funding sources. As an emerging economy, China will participate in global health governance through “South-South cooperation” and the “Belt and Road” Initiative. The China-Pakistan Economic Corridor (CPEC) serves as the hub and flagship project of the “Belt and Road” Initiative, while the China-Pakistan Health Corridor represents a specialized collaboration and extension of CPEC in the healthcare sector. Focusing on pharmaceuticals, disease prevention and control, and medical technology, it aims to improve the livelihoods of the Pakistani people and jointly advance the deepening of the All-Weather Strategic Partnership. This study is part of the research project entitled “General Project of Philosophy and Social Sciences in Heilongjiang Province “A Study on the Pragmatic Motivation and Mechanism of ‘Sub-Prototypical Category Fuzzy Expressions’ in Modern Chinese” (22YYB250)”and “2022 Heilongjiang Province Postdoctoral Funding Project: Research on the Value of Marxist View of Literature and Art in the New Era(LBH-Z22205)”.
Objective:To explore the impact of nursing risk management on quality of life (QoL), complications and nursing care satisfaction in patients undergoing percutaneous coronary intervention (PCI). Methodology:A retrospective analysis was conducted of 156 patients with coronary heart disease (CHD) who underwent PCI at the Second Hospital of Hebei Medical University from September 2024 to October 2025. Among them, 78 patients receiving nursing risk management were matched 1:1 with the cohort receiving routine nursing care. QoL, length of hospital stay (LOS), incidence of complications, and nursing care satisfaction were compared between the two groups. Results:The QoL score of the observation group was significantly higher than that of the control group (P<0.05). The LOS in the observation group was shorter, and the incidence rates of MACE, abdominal distension, irritability, and insomnia were significantly lower in the observation group than in the control group (P<0.05). The nursing care satisfaction rate of the observation group (91.0%) was significantly higher than that of the control group (78.2%) (P<0.05). Conclusion:Implementing nursing risk management in CHD patients undergoing PCI is associated with improved postoperative QoL, shortened LOS, reduced incidence of postoperative complications, and enhanced nursing care satisfaction.
Objective:To investigate the clinical characteristics and advances in diagnosis and treatment of neonatal Ureaplasma parvum (U. parvum) meningitis. Methodology:Clinical manifestations, diagnosis, treatment, and follow-up data of a neonate with persistent fever, normal blood routine, but persistently abnormal cerebrospinal fluid (CSF) results due to U. parvum meningitis were retrospectively analyzed. A literature review was conducted to identify relevant studies reporting on neonatal U. parvum meningitis published until May 2025. Results:A male infant born at 35+2 weeks of gestation with eight hours of premature rupture of membranes (PROM) was admitted at 17 days of age with persistent fever. The routine blood test was normal, while the CSF suggested purulent meningitis. Empirical treatment was ineffective, and metagenomic next-generation sequencing (mNGS) of CSF confirmed U. parvum meningitis. The infant recovered after three weeks of azithromycin treatment, but a language delay was found at two-year follow-up. The literature review identified 16 previously reported cases of U. parvum meningitis, which were combined with the current case, totaling 17 cases. Main manifestations included fever and convulsions, or initial circulatory and respiratory symptoms. CSF in the included studies showed leukocytosis, decreased glucose, and elevated protein. Diagnosis was mainly based on mNGS, and the predominant treatment consisted of macrolides, sometimes combined with quinolones, for 3-10 weeks. Two patients relapsed after drug withdrawal, and one had elevated liver enzymes. Major neurological complications included lateral ventricular dilatation and hydrocephalus, cerebral hemorrhage, infarction, malacia, and herniation. Most cases had a favorable prognosis, with rare developmental delay. Conclusion:Clinical manifestations of neonatal U. parvum meningitis are nonspecific. Some patients present with normal blood routine but purulent CSF. U. parvum meningitis should be suspected in patients with poor response to empirical antibiotics and confirmed by CSF mNGS. Macrolides are biologically rational and commonly used for neonatal U. parvum meningitis; however, the optimal regimen and duration remain unclear due to limited and heterogeneous case-based evidence.
Background and Objective: Abdominal tuberculosis is a concern in developing countries due to socioeconomic factors, influencing disease severity. This study at Jinnah Postgraduate Medical Centre (JPMC), Karachi, aimed to explore the link between social determinants like socioeconomic status, residence, co-morbidities, addiction patterns, and abdominal tuberculosis severity in patients. Methodology: A descriptive cross-sectional study was conducted at the Department of Gastroenterology, JPMC, Karachi. Study duration was 16 months from September 26, 2024 to January 26, 2026. A total of 503 patients diagnosed with intestinal tuberculosis were included. Data on social determinants such as socioeconomic status, residence, addiction, HIV status, diabetes, and malnutrition were collected. Disease severity was categorized as mild, moderate or severe based on clinical and radiological, endoscopic assessment. Associations between social determinants and abdominal tuberculosis severity were analyzed using Chi-square tests with a significance level of p ≤ 0.05. Results: The sample was nearly evenly split by gender and had a mean age of 47.7 years. Most participants came from urban areas and low to middle socio-economic backgrounds. Notably, 20.3% were HIV-positive, 4.2% had diabetes, and nearly one-third (32.7%) were malnourished. Addictive behaviors were common, with 27.8% chewing tobacco and 15% smoking. The severity of intestinal TB was classified as mild (39.9%), moderate (30.7%), or severe (29.4%), based on predefined criteria. While gender, socio-economic status, residence, and HIV status were not significantly associated with disease severity, diabetes (p = 0.029), malnutrition (p = 0.001), type of addiction (p = 0.001), and geographic location (p = 0.001) showed significant correlations. Conclusion: Abdominal tuberculosis severity is significantly influenced by factors like diabetes, malnutrition, type of addiction, and geographic location but not with socioeconomic status, gender, and residence.
Objective:To evaluate the clinical efficacy and safety of the Fuzheng Jiedu Huayu decoction combined with antibiotics in elderly patients with drug-resistant bacterial pneumonia. Method:A retrospective analysis was conducted on 166 elderly patients with drug-resistant bacterial pneumonia who were admitted to Beijing Hospital of Integrated Traditional Chinese and Western Medicine between January 2022 and June 2025. Patients were assigned to either the control group(n= 83, treated with antibiotics alone) or the observation group(n= 83, treated with antibiotics plus Fuzheng Jiedu Huayu decoction). After 14 days of treatment, the two groups were compared in terms of traditional Chinese medicine(TCM) syndrome scores, serum inflammatory markers chest computed tomography (CT) absorption rate of pulmonary infiltrates, sputum pathogen clearance rate, overall clinical response rate (ORR), and adverse events. Results:After treatment, both groups showed significant reductions in cough, productive cough, dyspnea/wheezing, and fever scores, with the observation group demonstrating significantly lower TCM syndrome scores compared with the control group(P< 0.05, respectively).The observation group achieved significantly higher rates of chest CT absorption of inflammatory infiltrates (81.93% vs. 68.67%), ORR (84.34% vs. 71.08%), and sputum pathogen clearance (81.93% vs. 67.47%) compared with the control group(P< 0.05, respectively). The incidence of adverse events did not differ significantly between groups(P> 0.05). Conclusion:The combination of the Fuzheng Jiedu Huayu decoction with antibiotics may significantly improve clinical symptoms, suppress inflammatory responses, enhance oxygenation, promote resolution of pulmonary inflammation, and increase pathogen clearance and clinical efficacy in elderly patients with drug-resistant bacterial pneumonia.
Objective:To compare the effectiveness of oral lactase enzyme versus lactose-free formula in the management of secondary lactose intolerance in persistent and severe persistent diarrhea. Methods:This randomized controlled trial was conducted at the pediatric unit of Ziauddin University Hospital, Kemari, Karachi, Pakistan, from June, 2023 to July,2024. A total of 50 children were included in this study following the inclusion criteria of both genders aged 6-24 months and presented with persistent or severe persistent diarrhea due to secondary lactose intolerance. In Group-A, five drops of lactase enzyme (200 units lactase/drop)/ounce of milk were added 5-30 minutes before feeding, while in Group-B, lactose-free formula milk/diet was advised. They were monitored from day one through day five and assessed for outcome measures, comprising clinical (on day five) and laboratory assessments (stool pH and reducing substances on day six), success or failure, and duration of hospital stay (less or more than five days). Results:In a total of 50 children, the median age was 11 (9-15.3) months. There were 30 (60.0%) children who presented with vomiting, while 14 (28.0%) had severe dehydration. At day five, lactase enzyme children showed significantly less episodes of diarrhea versus lactose free formula (20.0% vs. 48.0%, p=0.037), while all other complaints were statistically similar (p>0.05). The duration of hospital stay was significantly less among children in lactase enzyme group versus lactose free formula group (p=0.001). Conclusion:The effectiveness of lactase enzyme supplementation was better than lactose-free formula in children with persistent diarrhea due to secondary lactose intolerance.Clinical Trial Registration: NCT06827405 (https://clinicaltrials.gov).
Background and Objective:Individuals with schizophrenia and bipolar disorder experience excess cardiovascular morbidity and premature mortality; however, the specific risk of incident heart failure has not been comprehensively quantified. We conducted a systematic review and meta-analysis to evaluate the risk of heart failure in these populations. Methodology:A search was conducted on PubMed, Embase, Scopus, and Web of Science databases from inception through February 10, 2026, with no language restrictions, for cohort studies that reported adjusted estimates of the risk of incident heart failure in patients with schizophrenia or bipolar disorder. Random-effects meta-analyses were performed to obtain risk ratio (RR). Heterogeneity was assessed using the I² statistic. Results:Seven retrospective cohort studies met the inclusion criteria. Schizophrenia was associated with a significantly increased risk of incident heart failure (RR: 1.50, 95% CI 1.35-1.67; I² = 74.9%). Bipolar disorder was associated with an even greater risk (RR: 1.95, 95% CI 1.31-2.91; I² = 80.1%). Sensitivity analyses confirmed the robustness of pooled estimates. Conclusions:Both schizophrenia and bipolar disorder are independently associated with substantially elevated risks of incident heart failure. High heterogeneity in the meta-analysis warrants caution in interpreting the results.Registration No: PROSPERO (No. CRD420261303975).
Objective:To evaluate the effect of intravenous esketamine administration during anesthesia induction on postoperative sleep quality in female patients undergoing laparoscopic surgery. Methodology:This study was designed as a prospective, double-blind, single-center randomized controlled trial and was conducted at Huzhou Maternity & Child Health Care Hospital between December 5, 2025, and January 31, 2026. One hundred ASA I-II female patients (25-50 years) undergoing elective laparoscopic surgery (Dec 2025-Jan 2026) were randomized to control (Group C, n=50) or esketamine (Group S, n=50). Both groups received propofol 2 mg/kg, cisatracurium 0.15 mg/kg, and sufentanil 0.3 μg/kg for induction; Group-S additionally received esketamine 0.3 mg/kg, while Group-C received normal saline. Anesthesia was maintained with propofol (4-6 mg/kg/h) and remifentanil (0.1-0.2 μg/kg/min) via infusion pumps to maintain the Bispectral Index (BIS) between 40 and 60 and end-tidal carbon dioxide (PETCO2) between 35 and 45 mmHg. Outcomes included Pittsburgh Sleep Quality Index (PSQI) on postoperative days (POD) one, three, seven; intraoperative sufentanil use; 6/24 h VAS pain scores; 24 hours rescue analgesia rate; adverse events; emergence time; and PACU stay. Results:Ninety eight patients (Group C: 49; Group S: 49) completed the study. Group-S had lower PSQI scores on POD one and three (P<0.05), reduced intraoperative sufentanil consumption (P<0.05), lower 6/24 hours VAS scores (P<0.05), and lower 24 hours rescue analgesia rate (P<0.05). No significant differences in emergence time, PACU duration, or adverse event rates were observed (P>0.05), with no severe adverse events. Conclusion:Administration of 0.3 mg/kg esketamine during anesthesia induction reduces opioid consumption, improves early postoperative sleep quality, and decreases sleep disturbance incidence in female laparoscopic patients without increasing adverse event risks.
