To determine whether IL-6, IL-8, TNF-α, and BDNF concentrations are associated with pain severity in women with endometriosis aged 19 to 44, and their potential as non-invasive pain assessment tools. Hedges’ g was calculated for individual comparisons and Fisher-transformed correlations were pooled (random-effects model). BDNF was significantly elevated (g = 0.71, 95
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for obesity and type 2 diabetes mellitus (T2DM), resulting in a growing number of patients presenting for elective non-bariatric surgery while receiving these agents. Concerns regarding delayed gastric emptying and perioperative aspiration risk have led to inconsistent guidance on whether GLP-1 RAs should be continued or withheld before surgery, and the broader effect of perioperative exposure on postoperative outcomes remains poorly characterised. We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, prospectively registered with the International Prospective Register of Systematic Reviews. MEDLINE, Embase, the Cochrane Library, Scopus, and Web of Science were searched from January 2015 to October 2025. Observational studies enrolling adults with obesity undergoing elective non-bariatric procedures under general or regional anaesthesia were included if they reported postoperative outcomes according to any classification of perioperative GLP-1 RA exposure (e.g., continuation versus discontinuation, recent versus non-recent use, or use versus non-use). Primary outcomes were pulmonary aspiration and delayed gastric emptying or increased residual gastric contents. Secondary outcomes included postoperative nausea and vomiting, perioperative metabolic events, and broader surgical outcomes. Additional postoperative outcomes identified during data extraction were also captured descriptively. Risk of bias was assessed using the ROBINS-I tool. Due to substantial heterogeneity, a narrative synthesis was undertaken. Seven observational cohort studies were included (one prospective, six retrospective; sample sizes 426 to 275,970). None employed a randomised or fully parallel comparison of continuation versus discontinuation; most compared GLP-1 RA users with non-users, one was a single-arm continuation cohort, and two incorporated within-user discontinuation-timing analyses. Aspiration events were rare across all studies, with no consistent increase in risk associated with GLP-1 RA use or continuation. Several endoscopy-based cohorts reported higher rates of residual gastric contents or delayed gastric emptying among users, but this did not translate into a measurable increase in clinically evident aspiration. In orthopaedic and spine surgery cohorts, GLP-1 RA use was associated with significantly higher rates of nonunion, pseudarthrosis, and dysphagia, a discordant cellulitis signal, and, in one cohort, significantly lower mortality and cardiac arrest; these outcomes were not prespecified and should be interpreted as exploratory. Overall certainty of evidence was low to very low. Aspiration events were rare across predominantly observational comparisons of GLP-1 RA users and non-users, with no consistent increase in clinically significant aspiration observed with continuation or use. This evidence is indirect, of low to very low certainty, and precludes reliable inference regarding the safety of routine continuation. Exploratory orthopaedic and spine surgery findings suggest the perioperative risk–benefit profile of GLP-1 RAs may vary by surgical context and warrant confirmation in future studies. These findings do not support a firm recommendation for or against routine discontinuation before elective non-bariatric surgery; management should instead be individualised according to symptom burden, procedural risk, and surgical context.
Drug-induced liver injury (DILI) is a rare but potentially serious adverse effect associated with systemic therapies, particularly in elderly oncology patients. Enzalutamide, a second-generation androgen receptor signaling inhibitor (ARSI), is generally well tolerated. However, associated hepatotoxicities are rare and need to be documented further. We report a 71-year-old male with no prior comorbidities who presented with lower urinary tract symptoms, acute kidney injury, and bilateral lower limb edema. Investigations revealed a serum PSA of 154 ng/ml and creatinine of 5.1 mg/dl. Imaging showed bilateral hydroureteronephrosis, gross prostatomegaly, and pelvic lymphadenopathy. TRUS-guided biopsy confirmed prostate adenocarcinoma (Gleason score 9, Grade Group 5). The patient was diagnosed with hormone-sensitive metastatic prostate carcinoma and was initiated on Leuprolide, Denosumab, and Enzalutamide. At month four of treatment, he developed progressive jaundice and deranged liver function tests. Infectious, autoimmune, and liver metastatic causes were excluded. MRI revealed mild hepatomegaly, periportal edema, and ascites without focal lesions. Liver biopsy demonstrated interface hepatitis, portal inflammation, fibrosis, and features consistent with DILI. The RUCAM and Naranjo scores were 8 each, suggesting a probable adverse drug reaction. Enzalutamide was discontinued, and hepatoprotective therapy with N-acetylcysteine, ursodeoxycholic acid, and steroids was initiated, leading to clinical and biochemical recovery. Transitioning to Abiraterone provided an effective and safe alternative for continued oncologic control. This case highlights a rare but significant hepatotoxic reaction to Enzalutamide in an elderly patient. While mild hepatic abnormalities have been previously reported, severe liver injury is seldom documented. This underscores the importance of vigilant monitoring of liver function during ARSI therapy. Early recognition and intervention are crucial in minimizing morbidity. This report contributes to the growing recognition of rare hepatic adverse events associated with newer hormonal agents in prostate cancer management.
Socioeconomic status (SES) has been proposed as a determining factor in asthma severity and management, independent of its role as a confounder. This scoping review aims to systematically map the existing literature on the relationship between parental education, income, occupation, insurance status, and residential environment, and various aspects of asthma, including diagnostic delay, severity, treatment adherence, and environmental exposure. Following the Arksey and O’Malley framework and the PRISMA-ScR reporting guideline, a comprehensive search was conducted across Scopus, web of Science, Google Scholar and PubMed. The search encompassed studies published between 2013 and 2025, focusing on the interaction between SES and childhood asthma (aged 0–18 years). Eighteen studies met the predefined eligibility criteria and were subsequently analysed based on exposure, outcome, population characteristics, and study design. Analysis of the 17 studies identified a consistent association between lower SES and increased asthma severity, frequent exacerbations, and higher rates of emergency and intensive care unit (ICU) admissions. Furthermore, a “diagnostic paradox” was observed in several studies, where children from lower SES reported fewer subjective symptoms despite showing poorer outcomes and experiencing longer delays in formal diagnosis. Conversely, higher parental income and education were consistently linked to improved asthma control and treatment adherence. Nevertheless, there was substantial variability in the concerning casual pathways and outcome definitions across the studies. The synthesized results suggests that socioeconomic disadvantage is linked with a cumulative burden that could hinder early diagnosis and treatment adherence in childhood asthma. Given the scoping nature of this review, these association should be viewed as a indicative of a significant research and policy gap than definitive proof of causal mechanisms. In future, longitudinal and mechanistic studies is essential before specific clinical or policy interventions can be confidently recommended.
Health-related physical fitness assessment is fundamental to clinical practice and public health. While in-person assessment remains the gold standard, accessibility barriers among young adults — including time constraints and limited facility access — necessitate alternative modalities. Telehealth has emerged as a promising platform for remote fitness assessment; however, evidence validating its reliability in healthy young adults remains limited. To investigate the reliability of health-related physical fitness assessments administered via telehealth compared to conventional in-person assessment among young adults. This observational study compared the reliability of the teleassessment to in-person assessment of health-related physical fitness in healthy young adults using a within-subject, counterbalanced crossover design. 19 participants (18–22 years) completed three assessment sessions, one in-person assessment and a 2-session series of teleassessment, 1 week apart. Order and practice effects were minimized by randomly assigning participants to one of two sequences of assessment. Anthropometric measurements were body height, body weight and body mass index (BMI). Assessment of health-related physical fitness was evaluated with the use of one minute push-up test (Upper body muscular endurance), sit and reach test (Flexibility) and prone plank test (core muscular endurance). The intraclass correlation coefficient (ICC) with 95
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine–metabolic disorder characterized by reproductive, metabolic, hormonal, and inflammatory abnormalities associated with significant long-term health consequences. Conventional therapies primarily provide symptomatic management, with variable efficacy across different PCOS phenotypes. Drug repurposing has gained increasing attention as a therapeutic strategy to identify alternative applications of existing pharmacological agents with established safety profiles to target multiple pathogenic pathways implicated in PCOS. This review examines current evidence regarding repurposed therapies targeting metabolic dysfunction, hormonal imbalance, reproductive impairment, and chronic inflammation, with emphasis on mechanistic rationale, clinical outcomes, and translational challenges. Evidence from preclinical studies, clinical trials, systematic reviews, and meta-analyses was evaluated to distinguish mechanistic findings from clinically validated outcomes. In addition, multi-target therapeutic combinations, integration of nutraceutical and lifestyle-based interventions, and the application of artificial intelligence and omics technologies are discussed as potential approaches for improving therapeutic stratification and translational applicability. Although several therapies demonstrate beneficial metabolic and endocrine effects, interpretation of current findings remains limited by heterogeneous study design, small sample sizes, inconsistent outcome reporting, and insufficient long-term clinical data. Drug repurposing may provide an alternative framework for expanding therapeutic options in PCOS management and supporting more individualized therapeutic strategies. Further large-scale randomized clinical studies and standardized translational frameworks are required before widespread clinical implementation can be achieved.
Healthcare-associated bloodstream infection in intensive care unit (ICU-BSI) have high morbidity and mortality rate. This study aims to investigate epidemiology as well as temporal patterns of bacterial pathogens causing ICU-BSI during ICU hospitalization in a tertiary care hospital in Croatia. A retrospective study performed from January 2018 to December 2022, using laboratory data and medical records. ICU-BSI defined as detecting bacteria in blood cultures taken on day three or later of the ICU admission. During a five-year period, among 228 microorganisms isolated, Gram-negative bacteria predominated with the Gram-negative versus Gram-positive ratio of 58.8
Aspirin and acetaminophen are widely used analgesics that have individually demonstrated anticancer potential; however, their combined effects on breast cancer cells and the underlying apoptotic mechanisms remain insufficiently characterized. Cell viability was assessed by MTT assay. Forty-eight-hour IC₅₀ values were used as dose anchors, and combination experiments were performed for 24 h using 0.5 × IC₅₀ of each drug (4.95 mM aspirin and 6.4 mM acetaminophen). Apoptosis-associated cell populations were evaluated by Annexin V-FITC/PI flow cytometry, and Bax and Bcl-2 mRNA expression was assessed by quantitative real-time PCR. Drug interaction at the tested dose pair was explored using the Bliss independence model. At 24 h, mean cell viability was 97.37 ± 7.36
Reviews highlighting the clinical and radiological mimicry between tuberculosis and invasive mycosis are frequent in the literature. In addition, there’s been some emphasis on the occurrence of invasive fungal diseases in previously treated tuberculosis patients. In contrast, data on concurrent tuberculosis and invasive fungal disease are sparse in the literature. This knowledge gap may drive a poor cognizance of such cases, hence the need for this review. We conducted a scoping review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to identify cases of tuberculosis coexisting with invasive fungal disease reported worldwide. One hundred and fifteen cases were reported from Asia (n = 61, 53.0
Pregnancy is associated with physiological, hormonal, and biomechanical adaptations that frequently predispose women to musculoskeletal discomfort. Low back pain and pelvic girdle pain are among the most commonly reported conditions and often worsen as pregnancy progresses. Although myofascial trigger points (MTrPs) are a well-recognized source of musculoskeletal pain in the general population, their role in pregnancy-related musculoskeletal disorders remains inadequately understood. This scoping review aimed to map, synthesize, and thematically summarize the available literature on MTrPs in pregnancy-related musculoskeletal disorders, with emphasis on their reported prevalence, underlying mechanisms, clinical presentation, assessment approaches, management strategies, and current evidence gaps. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Electronic searches of PubMed, Google Scholar, and ResearchGate were performed for studies published between January 2014 and December 2024 using predefined keywords and Boolean operators. Reference lists of eligible articles were also manually screened. Studies published in English that involved pregnant or postpartum women and addressed MTrPs and/or pregnancy-related musculoskeletal disorders were included. Following two-stage screening, data were extracted and synthesized using a descriptive thematic approach. Of 320 records identified, nine studies met the eligibility criteria. The included evidence comprised a heterogeneous mix of original research articles, review articles, and clinical guidance documents. Findings were synthesized into themes encompassing the prevalence of musculoskeletal pain, proposed mechanisms underlying MTrP development, distribution of MTrPs, associations with pain and function, assessment approaches, management strategies, and research gaps. Overall, pregnancy-specific primary evidence was limited, with most studies providing descriptive or exploratory findings. The available evidence suggests that MTrPs may be associated with pregnancy-related musculoskeletal pain; however, direct pregnancy-specific evidence remains limited and heterogeneous. This review highlights important knowledge gaps and underscores the need for well-designed pregnancy-specific primary studies using standardized assessment methods to strengthen the evidence base and inform physiotherapy practice.
Oxidative stress is increasingly implicated in epilepsy, yet the short-term temporal behavior of circulating oxidative damage and antioxidant biomarkers following seizures remains insufficiently characterized. This prospective study investigated early postictal changes in oxidative stress and antioxidant defense in 40 patients with epilepsy compared with 40 healthy controls. Serum malondialdehyde (MDA), protein carbonyl (PCO), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) were assessed using spectrophotometric methods, with patient samples collected at 1 and 2 h after seizure onset. MDA increased markedly from 354.3 ± 9.20 nmol/mL in controls to 2271 ± 58.99 nmol/mL at 1 h and 14,558 ± 378.1 nmol/mL at 2 h (p < 0.05). PCO also increased progressively from 0.203 ± 0.019 to 0.504 ± 0.032 and 0.615 ± 0.030 nmol/mg, respectively (p < 0.05). Conversely, SOD decreased from 2.518 ± 0.027 U/mL in controls to 2.208 ± 0.062 U/mL at 1 h and 1.886 ± 0.022 U/mL at 2 h, while GSH declined from 0.0564 ± 0.0027 to 0.0148 ± 0.0048 and 0.0018 ± 0.0012 µmol/L, respectively (p < 0.05). CAT activity showed no statistically significant difference among the study conditions. These findings demonstrate a distinct early postictal pattern characterized by increasing oxidative damage in circulation and concurrent depletion of selected antioxidant defenses. However, because these serum biomarkers reflect systemic redox status, they should not be interpreted as direct evidence of neuronal oxidative injury. Longitudinal studies incorporating interictal baselines and brain-specific measures are needed to determine the clinical significance of these temporal changes.
This study aimed to investigate patients with chronic renal insufficiency and co-morbidities undergoing dialysis for genomic damage measured using comet assay and to determine prognostic factors which may be useful for interventional strategies as a part of CKD support, care and management. The patients had significantly elevated genetic damage compared to controls. Significance within sub-groups revealed maximal DNA damage in patients with diabetes and/or hypertension as co-morbidities. On MDR analysis, the best model comprised per cent tail DNA, damage index and mean DNA migration length and showed independent interaction as prognostic markers. On PCA, clusters of factors were identified in disease- progression/prognosis as principal component one comprised DI, mean DNA migration length, per cent tail DNA, urea, creatinine and hemoglobin levels, time-on-medication, time on-dialysis and medication status. These determinants in CKD patients on dialysis can be regarded as prognostic markers of clinical significance in the local scenario where extracorporeal dialysis (hemodialysis) using the diffusive technique is the only option available to most patients. Given the correlation of DNA damage and mortality risk in CKD patients reported in literature, the significantly increased DNA damage observed across patient sub-groups may be considered prognostic through periodic bio-monitoring and longitudinal inferences in further studies. Hemodialysis is an important and often the only renal replacement therapy available in this region to most patients with ESRD. Disease progression can further be compromised by co-morbidity (ies) as well as by the dialysis process, and therefore for optimal management, prognostic markers need to be identified at the primary level. DNA damage was aggravated in all patients of this study and was maximal in the sub-groups with diabetes and/or hypertension as co-morbidities. DNA damage, time-on-dialysis, time-on-medication besides traditional clinical factors emerged as prognostic markers. Though further investigation on larger sample size is warranted, nonetheless appropriate interventions through patient centeredness should lead to improved quality of life in patients with ESRD.
Child malnutrition remains a major public health concern in India, particularly in socioeconomically disadvantaged regions where inequalities in diet quality and nutritional outcomes persist. In West Bengal, the National Family Health Survey (NFHS-5) reported that 32.2
Optic nerve sheath diameter (ONSD) ultrasonography (US) has not been adequately investigated in meningitis, despite being a safe, noninvasive proxy for intracranial pressure (ICP). To compare the diagnostic accuracy of ONSD ultrasonography with lumbar puncture opening pressure (LPOP) in identifying elevated ICP in patients with central nervous system (CNS) infections and to examine their correlation Cross-sectional study. Fifty participants were enrolled in the study. Patients included 35 intensive care units (ICU) residents with acute meningitis or meningoencephalitis, and 15 healthy controls. Ultrasound of the ONSD was performed in all subjects, whereas LPOP was performed only in patients to measure CSF opening pressure and obtain samples for CSF analysis. We observed a significant positive correlation between ONSD and LPOP. An ONSD at a cut-off ≥ 5.875 mm discriminated meningitis from normal individuals precisely. It achieved 100
Stroke outcome disparities between African settings and high-income regions are conventionally explained as the sum of discrete deficits. This narrative review proposes care-pathway fragmentation as a unifying conceptual framework that reorganizes these deficits around a single mechanism. Drawing on the Levesque conceptual framework of healthcare access and a structured narrative search of the African stroke, health systems, and health economics literature, we map fragmentation onto five pathway nodes. These are community recognition and decision to seek care, prehospital transport, acute hospital management, inpatient-to-rehabilitation transition, and long-term secondary prevention and reintegration. Each node has been documented separately in the literature without being connected analytically. We synthesize country-level case-fatality data, prehospital delay statistics, stroke-unit availability surveys, catastrophic health expenditure meta-analyses, and longitudinal survivorship cohorts into a node-by-node evidence map, and contrast this with explicit pathway-integration efforts within Africa and a middle-income comparator. We argue that isolated, node-specific interventions, for example, building a stroke unit without addressing prehospital delay or post-discharge linkage, have limited population-level impact precisely because fragmentation, not any single deficit, is the operative lesion. We close with implications for research design, registry development, and health-systems financing reform, while emphasizing the need for geographically diverse evidence before the framework is generalized across Africa. The available evidence is geographically concentrated, with substantial representation from sub-Saharan and predominantly Anglophone settings, and should therefore not be interpreted as uniformly representative of all African health systems. These include insufficient emergency transport, scarce stroke units, limited imaging, and underdeveloped rehabilitation services.
Chronic venous disease (CVD) is a common vascular disorder characterized by venous hypertension resulting from valvular incompetence or venous obstruction. Progressive disease leads to structural skin and subcutaneous tissue changes that may not be fully appreciated on clinical examination alone. High-resolution ultrasonography offers a non-invasive method for evaluating these structural alterations. To assess cutaneous and subcutaneous changes detected by high-resolution ultrasonography in patients with CVD and to determine their association with the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. This prospective cross-sectional study included 100 patients with CVD who underwent clinical evaluation and duplex Doppler ultrasonography. Clinical severity was graded using the CEAP classification. High-resolution ultrasonography (6–15 MHz) was performed to assess dermal edema, skin and subcutaneous tissue thickness, dermo-hypodermal junction integrity, inflammatory changes, and anechoic lacunae. Associations between ultrasonographic findings and CEAP clinical class were analyzed using the chi-square test. The mean age of the study population was 47.56 ± 9.92 years, and CEAP class C2 was the most frequent presentation (43
This study aimed to evaluate the effects of education- and counseling-based interventions on sexual function among women of reproductive age with sexual dysfunction through a systematic review and meta-analysis. This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was performed between May and October 2025 using PubMed, Web of Science, EBSCOhost, and Google Scholar databases. Study selection was conducted according to the PICOS framework, and randomized controlled trials evaluating education-, counseling-, psychoeducation-, or theory/model-based interventions designed to improve female sexual function among women of reproductive age were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. Data were analyzed using Comprehensive Meta-Analysis (CMA) Version 2 software, and effect sizes were calculated as standardized mean differences (SMDs). A total of 2,464 records were identified through database searching. After removing 62 duplicate records, 2,402 records underwent title and abstract screening. Following screening, 17 full-text articles were assessed for eligibility, and 12 studies were excluded for not fulfilling the predefined eligibility criteria. Ultimately, five randomized controlled trials involving 392 participants (195 intervention, 197 control) conducted in Iran and Türkiye were included in the meta-analysis. The Female Sexual Function Index (FSFI) was the most frequently used assessment tool, although other validated instruments, such as the Arizona Sexual Experiences Scale (ASEX), were also used across studies. Education- and counseling-based interventions may contribute to improvements in women’s sexual function. However, substantial heterogeneity, possible publication bias, and methodological differences across studies require cautious interpretation of the findings. Further randomized controlled trials involving larger and more homogeneous samples, standardized intervention protocols, consistent outcome measures, and longer follow-up periods are needed to strengthen the current evidence base.
Elderly patients with multiple comorbidities present significant anesthetic challenges during hip fracture surgery. In patients with limited cardiopulmonary reserve, both general and neuraxial anesthesia may be associated with substantial perioperative risk. This report describes the use of a combined regional anesthesia approach as an alternative strategy to achieve surgical anesthesia in a high-risk geriatric patient. An 82-year-old woman with severe cardiopulmonary comorbidities, including active pneumonia, reduced ejection fraction, pulmonary hypertension, dementia, and a potentially difficult airway, was scheduled for femoral neck fracture surgery. Following individualized multidisciplinary assessment of the patient’s respiratory, airway, and hemodynamic risks, an ultrasound-guided peripheral regional anesthetic strategy was selected. A combination of ultrasound-guided pericapsular nerve group (PENG), transmuscular quadratus lumborum (QLB III), and lateral femoral cutaneous nerve (LFCN) blocks was performed in the intensive care unit. Dexmedetomidine was continued without a loading dose, providing cooperative light sedation with a Richmond Agitation–Sedation Scale score between − 1 and 0. Surgery was performed in the lateral decubitus position and completed uneventfully. Hemodynamic stability and adequate oxygenation were maintained throughout the procedure, with no requirement for additional sedative or analgesic agents. Postoperative Faces Pain Scale scores were 0 at rest and 1 during movement, increasing to 4 at 12 h, when intravenous tramadol was administered. No anesthetic- or surgery-related complications were observed. The patient was transferred to the ward on postoperative day two. This case suggests that a carefully selected combination of regional anesthesia techniques may provide surgical anesthesia in selected high-risk geriatric patients when patient-specific considerations make general or neuraxial anesthesia less desirable. This individualized approach requires appropriate expertise, careful patient selection, and a clearly defined rescue plan.
Guillian-Barre Syndrome is the most common cause of acute ascending flaccid paralysis worldwide. In 2004, the estimated annual economic cost of GBS in the US was 1.7 billion US dollars (USD). In the Philippines, the cost of GBS has yet to be investigated. This study aimed to estimate the cost of managing Guillain-Barré Syndrome among Filipino patients seen at a tertiary public hospital in Metro Manila and to determine the factors possibly associated with the estimated cost of GBS. A retrospective cross-sectional study was conducted at the Philippine General Hospital, including adult patients admitted with GBS from January 2017 to December 2024. Medical records were reviewed for predetermined variables. Costs were estimated per patient using a bottom-up approach based on final hospital bills, covering ICU fees, professional fees, medications, diagnostics, machine rentals, and miscellaneous expenses. Statistical analyses included unpaired t-test, rank-sum test, Chi-square, and Fisher’s exact tests. A total of seventy-six (N = 76) patients were included in the study. The cost of admission of GBS averaged at PHP 301,574.20 (USD 5,277), with a median cost of PHP 275,231.30 (USD 4,811). Adjusted for inflation to the year 2025, the average cost of admission for GBS at current rates is estimated at PHP 326,655.09 ± 321,784.95 (USD 5,710). The type of intervention, year of admission, type of admission, and tracheostomy significantly predict 68
