Background: Cholangitis is a serious bile duct infection caused by obstruction that permits bacterial growth and may progress to sepsis. Management includes antibiotics and biliary drainage, but selection is challenged by antibiotic resistance and differing pathogen patterns between benign and malignant obstruction. This systematic review aimed to compare the prevalence and distribution of pathogens identified in bile, blood, and biliary stent cultures between benign and malignant biliary obstruction in patients with cholangitis. Methods: A systematic search of PubMed, Scopus, and ScienceDirect (January 1, 2014-October 17, 2024) identified cohort, case-control, and cross-sectional studies comparing microbial profiles in benign versus malignant cholangitis. Non-English articles, case reports, randomized trials, and reviews were excluded. Results: Eight studies involving 3,575 patients were included. Culture positivity was generally higher in benign obstruction (bile 55.7% vs. 44.3%; blood 19.6% vs. 14.2%). Escherichia coli was most frequently isolated, followed by Enterococcus spp., Klebsiella pneumoniae, and Pseudomonas aeruginosa. Malignant cases more often yielded Candida spp. and viridans-group streptococci from stents. Conclusion: Distinct pathogen patterns may inform empirical therapy, though further research is needed.
Purpose: This systematic review synthesizes evidence on the mechanistic pathways through which phthalates act as obesogenic endocrine-disrupting chemicals. It focuses on molecular and cellular processes, including peroxisome proliferator-activated receptor gamma (PPARγ) activation, adipogenesis, adipokine dysregulation, oxidative stress, endocrine disruption, mitochondrial dysfunction, and epigenetic reprogramming, and integrates evidence from in-vitro, in-vivo, and human epidemiological studies published between 2018 and 2025. Method: The review was conducted in accordance with PRISMA 2020. Searches were performed in PubMed, Scopus, Web of Science, and ScienceDirect using predefined keywords related to phthalates, obesity, adipogenesis, lipid metabolism, endocrine disruption, and epigenetics. After duplicate removal, title and abstract screening, and full-text eligibility assessment, 34 studies were included: 10 cellular or animal mechanistic studies, 14 mechanistic or epigenetic reviews, and 10 human epidemiological studies or meta-analyses with mechanistic discussion. Findings: Across multiple models, phthalates, particularly di(2-ethylhexyl) phthalate and its metabolites, were associated with activation of PPARγ and other adipogenic transcription factors, enhanced adipocyte differentiation, disrupted adipokine balance, oxidative stress, adipose tissue inflammation, and endocrine dysregulation. Mechanistic and epigenetic reviews further suggest that phthalate exposure may induce DNA methylation changes, histone modification, and transgenerational effects, especially during critical developmental windows. Human cohort studies and meta-analyses generally support positive associations between phthalate exposure and adiposity, central obesity, and metabolic syndrome features, although heterogeneity, non-linear relationships, and sex-specific patterns remain evident. Implications: The evidence supports a multi-pathway mechanistic model in which phthalates contribute to obesity through adipogenesis, inflammatory and mitochondrial dysfunction, hormonal disruption, and epigenetic programming. These findings provide a useful framework for regulatory risk assessment, public health prevention, and future mechanistic research on phthalate substitutes and mixed chemical exposures.
Self-medication and polypharmacy are major global challenges, with significant impacts on the safety of drug therapy and the rational use of medicines. The increasing access to over-the-counter (OTC) medicines and the prevalence of chronic diseases contribute to the concomitant use of multiple therapies, often without adequate medical supervision. The study aims to systematically assess the prevalence, determinants, and clinical consequences of self-medication and polypharmacy, with a focus on their impact on medication safety. A systematic literature review was conducted using major international databases (PubMed, Scopus, Web of Science, ScienceDirect, Springer, and Wiley) for the period 2020-2025. Studies were selected based on pre-established inclusion criteria, with the analysis focusing on the prevalence, risk factors, and adverse effects associated with self-medication and polypharmacy. The results highlight a high global prevalence of self-medication, ranging from approximately 53% to 74%, with higher values in Asia and Europe. Polypharmacy is prevalent among the elderly population and patients with multiple comorbidities. Both phenomena are associated with an increased risk of adverse drug reactions, drug interactions, inappropriate treatment use, and decreased therapeutic efficacy. The main determining factors include limited access to health services, socioeconomic constraints, previous experiences with medicines, and the wide availability of OTC products. Self-medication and polypharmacy significantly affect the safety of drug therapy and represent major public health problems. Strengthening regulations, patient education, and interdisciplinary collaboration are essential to reduce risks and optimize the use of medicines.
Background: Adhesive small bowel obstruction (ASBO) results from postoperative adhesions, causing prolonged hospital stays and surgeries. Objective: To evaluate the effectiveness of ASBO prevention: surgical, adhesion prevention strategies, and conservative methods. Methods: A meta-analysis evaluating interventions to prevent ASBO post-surgery used data from Web of Science, Scopus, Cochrane Library, ProQuest, PubMed, and Google Scholar (2020-2025). RevMan 5.4 and R Studio were used, including 25 relevant studies. Results: Results highlighted differences in reoperation rates (1.4-20.7%), hospital stay lengths (4-23 days), and follow-up durations (≥ 2 years for 55% of studies). Surgical methods (odds ratio [OR] = 12.01) and the use of adhesion barriers (OR = 0.21) mitigated the risk of adhesive intestinal obstruction (AIO). Conservative management (OR = 4.58) was also effective. Conclusions: Surgical methods, the use of barriers to adhesions, and other less invasive interventions help in the prevention of AIO, as well as in the recovery processes.
Introduction and objectives: Urethral stricture (US) management is complex and requires evaluation. The emergence of reconstructive approach is a revolutionary change. Thus, a reconstructive urologist may alter the quality of US management for further improvements. Materials and methods: We retrospectively reviewed the medical records of US patients underwent surgery from January 2013 to December 2022 divided into two groups before and after reconstructive urologist presence in our center to analyze the significance of reconstructive approach. Results: Out of 360 patients, 171 in group A and 189 in group B. The most common etiology is trauma, mostly located in posterior. DVIU was the most performed procedure in group A, while in group B was urethroplasty. We identified significance (p < 0.05) between the two groups regarding the clinical outcomes. Conclusion: In our experience, there are shifting in management of US from endoscopic to urethral reconstruction that improved the clinical outcomes in our center.
Social determinants of health (SDoH), including economic stability, education, healthcare access, neighborhood environment, and community context, play a critical role in shaping health outcomes. Telehealth, defined as the use of digital and telecommunications technologies to deliver healthcare remotely, presents both opportunities and risks for equity. It can reduce barriers such as transportation costs and distance, yet it may also deepen disparities among populations with limited digital access or literacy. This review highlights lessons from selected global and U.S. telehealth programs to examine how SDoH influence adoption and outcomes. Key challenges include digital literacy gaps, privacy concerns, cultural preferences for in-person care, provider training deficits, infrastructure limitations, and reimbursement inconsistencies. Potential solutions include policy reforms, broadband expansion, digital literacy initiatives, and community-centered approaches. By framing telehealth through an SDoH lens, this review contributes to the literature by clarifying strategies that can advance more equitable and sustainable implementation.
Effective management of chronic medical conditions relies heavily on medication access and adherence, both of which are significantly impacted by the social determinants of health (SDOH). This narrative review examines how the five pillars of SDOH impact medication access and adherence among individuals with chronic conditions such as hypertension, diabetes, and HIV/AIDS, primarily in the USA. Financial barriers, including high out-of-pocket costs and restrictive insurance policies, directly impact treatment continuity, exacerbate health disparities, and contribute to the health care burden. Social support networks, confidence in providers, and community-level engagement play pivotal roles in promoting adherence, while geographic and infrastructure limitations, such as pharmacy deserts and hospital closures, further restrict access. This narrative review also explores how systemic reforms, including cost transparency, multidisciplinary care models, and technology-driven solutions such as telemedicine and health applications, can improve patient engagement and autonomy. Addressing SDOH through targeted policy, education, and infrastructure initiatives is essential for equitable health outcomes. By identifying barriers to medication access within a public health context, this review highlights actionable strategies to reduce disparities and strengthen chronic disease management across communities, particularly in underserved populations.
Introduction: Cervical discomfort, or neck pain, is a significant global health issue and a leading cause of disability. This systematic review and meta-analysis evaluate the effectiveness of non-surgical interventions, including physiotherapy, exercise, manual therapy, and muscle energy techniques, in reducing pain and improving function. Methods: A comprehensive search of PubMed, the Cochrane Library, and Scopus up to September 2024 identified 17 randomized controlled trials (RCTs) involving 3,286 participants. Studies comparing these interventions to placebo or other treatments were included. Exclusions applied to cases involving cancer, infections, fractures, radiculopathy, prior cervical surgery, or high-risk bias studies. Results: All interventions significantly reduced pain and improved function. Manual therapy was superior to physical therapy for pain relief (SMD -0.30), while exercise outperformed usual care for pain (SMD -0.68) and function (SMD -0.49). NSAIDs showed moderate pain relief (SMD -0.31). Conclusion: Non-surgical interventions effectively treat cervical pain, but further research is necessary to optimize strategies.
Background: Postmenopausal obesity is a major health concern associated with impaired clinical parameters and reduced quality of life. Objective: To evaluate the effects of a structured weight-loss program on clinical parameters and health-related quality of life in obese postmenopausal women. Materials and methods: Two hundred postmenopausal women (50-58 years) with body mass index (BMI) between 30 and 35 kg/m2 were randomly assigned to two groups. Group A followed a calorie-restricted diet combined with moderate-intensity aerobic treadmill training for three months, while group B received no intervention. BMI, hand grip strength, six-minute walktest(6MWT), and shortform-36(SF-36)scores were assessed before and after the intervention. Results: Group A showed significant reductions in BMI and significant improvements in grip strength, 6MWT distance, and SF-36 subscale scores (p < 0.05), with significant differences compared to group B. Conclusion: Combined dietary restriction and aerobic exercisesignificantly improve clinical outcomes and quality of life in obese postmenopausal women.
Recent global epidemics have called attention to how vulnerable communities are to outbreaks, particularly those involving novel diseases. Due to underlying social and health disparities, the Indigenous Orang Asli Community are more susceptible to severe impact from outbreaks. However, preparedness levels in this community remain low, and there is a lack of culturally tailored programs that effectively engage them. The objective of this study is to develop and test the usability of Wabak X, a serious card game designed to educate Orang Asli in Selangor, Malaysia, on household outbreak preparedness. Wabak X was developed and evaluated through five stages: predevelopment and storyboarding, alpha 1, alpha 2, beta and final build. Findings demonstrated that Wabak X was well-accepted by the community, with majority reporting high perceived knowledge and confidence in applying what they learned. Wabak X exhibits considerable potential as an evidence-based, culturally appropriate tool to enhance outbreak preparedness in Orang Asli households.
Background: Nowadays, global aging is phenomenal and drawing attention towards novel health perspectives. Geriatric syndromes have a crucial, but under-studied influence on critical care outcomes. This study aimed to assess the impact of potentially inappropriate medication (PIM) and pressure ulcer (PU) on hospital outcomes among geriatric patients with critical illnesses. Methods: A prospective cohort study included 203 geriatric patients with critical illnesses at Ain Shams University geriatrics hospital. The 3(rd) version of the screening tool of older persons' prescriptions criteria and the 4(th )edition of international PU guidelines were implemented to define PIM and PU, respectively. A thorough clinical assessment was carried out. Comorbidity, demographic, and laboratory profiles were gathered upon admission. The age-adjusted Charlson comorbidity index measured multimorbidity. Patients were observed for mortality as the sequel hospital outcome. Statistical analyses were executed. Results: Mean age was 75.00 +/- 7.42 years. The most prevalent PU were of the second stage (40.4%) and sacrococcygeal site (26.7%). While the most frequent PIM were anticholinergics (51.30%) and opioids (27.60%). In-hospital mortality rate was 74.9%. Factors independently associated with mortality included serum albumin (odds ratio [OR] = .251, p =0.001, 95% confidence interval [CI] = 0.111-0.565) and the number of PIM (OR = 1.302, p = 0.037, 95% CI = 1.016-1.667). Use of > 1.5 PIM predicted mortality with 63.4% sensitivity and 51.7% specificity with an area under the receiver operating characteristic curve of 0.640, p = 0.005. Conclusion: The study underscores the deleterious impact of PIM and PU as pervasive age-related conditions during critical illness. The number of PIM and serum albumin are independently associated with hospital mortality. However, the involvement of a restricted number of participants from a selected geriatrics hospital in Egypt limits the generalization of the findings and warrants further longitudinal research and external validation. Pertinent medication reconciliation and periodic skin evaluation should be routinely integrated within a holistic solicitation towards geriatric patients with critical illnesses.
Introduction: Physical literacy (PL) is crucial for promoting lifelong physical activity, yet there is a lack of validated instruments to measure perceived PL among urban adolescents in Indonesia. This study aimed to adapt and validate the perceived physical literacy questionnaire (PPLQ) for Indonesian adolescents, creating the PPLQ Indonesian version (PPLQ-Id). Methods: The study involved a comprehensive process of translating, culturally adapting, and validating the PPLQ for the Indonesian context. A sample of 519 adolescents aged 12-18 from various educational institutions in Semarang, Indonesia, participated in the study. The psychometric properties of PPLQ-Id were assessed through exploratory factor analysis (EFA), confirmatory factor analysis using structural equation modelling (SEM), construct validity testing and reliability analysis. Result: EFA revealed a two-factor structure explaining 53.101% of the total variance. SEM confirmed the six-domain structure of PL with acceptable model fit (RMSEA = 0.043, CFI = 0.904, SRMR = 0.050). The physical activity behavior (PAB) domain showed the highest loading (139.472) on the PL construct. Construct validity analysis indicated strong correlations between physical competence and motivation (MOT) (rs = 0.503, p < 0.01) and between MOT and understanding (UND) (rs = 0.505, p < 0.01). The instrument showed no significant differences across gender or education levels. Reliability analysis yielded a Cronbach’s alpha of 0.613 after adjustments. Conclusion: The PPLQ-Id demonstrates potential as a valid and reliable instrument for measuring perceived PL among Indonesian adolescents. However, some domains, particularly knowledge and PAB, require further refinement. This study provides a foundation for UND and promoting PL in the Indonesian urban context, with implications for public health strategies to increase physical activity among adolescents.
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder with significant metabolic components, particularly insulin resistance (IR). Irisin and betatrophin have been proposed as novel metabolic regulators. Methods: Patient selection was performed retrospectively, while the study was designed prospectively. Sixty women (20 PCOS, 20 PCOS+IR, 20 controls) were included. Plasma irisin and betatrophin levels were measured using ELISA. Clinical, biochemical, and hormonal parameters were analyzed, and correlations with metabolic markers were evaluated. Results: Irisin levels were significantly higher in the PCOS+IR group, while betatrophin levels were significantly lower in both PCOS groups compared to controls. Irisin showed a positive correlation with body mass index (BMI), whereas betatrophin showed no significant correlation with BMI. No correlation was observed between irisin and betatrophin. Conclusion: Irisin and betatrophin exhibit distinct and independent alterations in PCOS. These biomarkers may contribute to improved metabolic phenotyping and risk assessment in PCOS.
Objectives: Automation of quantitative analysis of breast cancer (BC) immunohistochemistry (IHC) specimens is important to optimize pathologists' workflow and improve diagnostic reproducibility. This is especially important in low-and middle-income countries where there is a shortage of highly trained pathologists. However, existing approaches face challenges in implementing fully automated quantitative IHC due to the difficulty of both delineating tumor areas, including discrete areas, especially in IHC slides with poor quality. Moreover, accurate identification of invasive carcinoma areas and accurate quantification of positive and negative cells in the specimen are critical for quantitative analysis. Methods and results: This study presents a method to automatically identify types of carcinoma areas in whole slide IHC images of BC, focusing on quantifying IHC images on realms of Kazakhstan. The used model is a combination of morphological characteristics and boundary features, which provides high accuracy of segmentation of tumor zones of images of mild and low quality. We used several methods includes convolutional neural network based on the Keras framework, k-nearest neighbors machine learning methods, and self-developed image analysis methods. The developed model showed high accuracy, where the results corresponded to the diagnoses of pathologists. As expected, the method proved to be ineffective when applied to severely degraded slides, such as those with insufficient staining or inadequate washing. Slides of inferior quality were excluded from analysis, which negatively affected the statistical robustness. On slides of moderate quality, the reliability of nucleus segmentation dropped significantly. Conclusions: The combination of models we used showed high accuracy in differentiating BC cells between the basal-like subtype of BC and its invasiveness and recurrence in Kazakhstan. However, IHC specimens with low DPI or low-quality IHC need further optimizations and improvements in algorithm design. The main issue can be considered methodological differences between the approaches of AI and humans: AI operates in a large number of cases (more than 10,000), yet its accuracy is relatively low. In contrast, humans work with a much smaller number of cases but achieve a level of precision that AI cannot currently match. This discrepancy necessitates a revision of the methodology of IHC analysis for AI, including the development of new requirements, methods, and thresholds from scratch. This approach provides analysis of the entire area of the slide, increases the speed of interpretation of IHC results, and reduces human errors in diagnosis, especially in low-and middle-income countries.
Neuromyelitis optica spectrum disorder (NMOSD) is a rare, severe inflammatory autoimmune disease of the central nervous system, identified with the discovery of aquaporin-4 immunoglobulin G antibodies. Its ability to mimic other conditions often leads to misdiagnosis and delayed treatment. We report a 25-year-old woman with recurrent urinary tract infection symptoms. Despite antibiotics, her condition worsened with progressive myelitis symptoms such as urinary retention, back pain and lower limbs weakness. She was admitted to further imaging and blood investigations that confirmed NMOSD diagnosis. With appropriate treatment, she improved significantly. This is the diagnostic challenges of NMOSD in primary care. It is important to explore other symptoms such as neurological features as myelitis, in patients with recurrent urinary symptoms. Early recognition and intervention can substantially improve outcomes and quality of life.
Femoral-facial syndrome (FFS) is a rare congenital disorder characterized by femoral hypoplasia and distinctive craniofacial anomalies, and it is frequently associated with maternal diabetes. We report the first documented Malaysian case of FFS in a neonate born to a 36-year-old Malay woman with gestational diabetes and obesity. Early antenatal ultrasound examinations did not detect any abnormalities. Fetal anomalies only became evident later in pregnancy when breech presentation and anhydramnios were noted, highlighting the difficulty of early prenatal diagnosis, particularly among high-risk mothers. Afemale infant was delivered via caesarean section at 35 weeks' gestation. She exhibited multiple dysmorphic features, including micrognathia, cleft palate, low-set ears, absence of the femur, hemivertebrae, and polydactyly. Despite multidisciplinary neonatal management, the infant died at two months of age due to severe nosocomial infection.
Sister Mary Joseph nodule is a rare manifestation of metastatic umbilical malignancy, most commonly associated with gastrointestinal and genitourinary cancers. It often signifies advanced disease and carries a poor prognosis. Early recognition is critical, yet diagnostic delays may occur due to nonspecific presentations in primary care. We report a case of a 63-year-old Malay woman with a history of diabetes mellitus, hypertension, and hyperlipidemia, presented with an 8-month history of progressive umbilical skin growth, mild abdominal discomfort, and constitutional symptoms, such as loss of weight and loss of appetite over two months. Retrospectively, she noticed an erythematous nodular skin lesion over the umbilicus, which had slowly increased in size over the last 8 months. She visited health clinics four times, where the lesion was treated as eczema, and she was prescribed steroid creams. However, her symptoms persisted. One month before referral, she developed significant weight loss, prompting her doctor to refer her to a dermatology clinic for suspected skin cancer. We aim to enhance clinical awareness among primary care providers about recognizing and promptly treating the disease to prevent further deterioration.
Chronic pulmonary aspergillosis (CPA) is a chronic fungal disease caused by aspergillus species frequently affecting immunocompromised patients or those with underlying lung disease. We present a 53-year-old Malay man with well-managed diabetes who presented with three months of recurrent hemoptysis. He had no previous history of tuberculosis or lung disease, but he was exposed to bird droppings from rearing over 100 birds. The preliminary sputum tests and chest X-rays yielded inconclusive results. High-resolution computed tomography identified a cavitary lesion with soft tissue density suggestive of aspergilloma. A positive serum galactomannan test confirmed chronic cavitary pulmonary aspergillosis, subsequent to which he received antifungal medication and responded well. This case highlights the diagnostic difficulties of CPA in the absence of classic risk factors and emphasizes the significance of environmental exposure. Early diagnosis through a comprehensive approach and immediate antifungal intervention are essential for enhancing patient outcomes.
Skin cancer is one of the most common types of cancer found globally. Malignant melanoma (MM) (4-6%) is rare but very aggressive, accounting for about 75% of deaths from skin cancer. This is a retrospective study that aims to make an update on the information available, in the light of the latest developments in the literature, to retrospectively describe the demographics, clinical features, histopathology, and management of MM cases treated at a single oncology center. Sixteen patients were diagnosed with MM, accounting for 19.05% of the total number of hospitalized skin cancers. The patient group included 81.25% of patients over 55 years of age, 75% of those originating from the urban areas and 68.75% being females. Smoking and actinic keratosis were found in a percentage of 31.25% of patients. Axillary lymph node metastases were found in 31.25% of cases, while cerebral ones in 18.75%. The most common primary location was the extremities (50%). Sentinel lymph node biopsy was performed in 87.50% of patients. Palliative radiotherapy was done for all cases while chemotherapy was performed only in 18.75% patients, and immunotherapy in 37.50% of them. Although significant progress has been made in understanding both the biology and genetics of melanoma and its therapeutic approaches, this malignancy is still a major problem worldwide due to its high incidence and lack of curative treatment for advanced stages.
This retrospective observational study assessed the US Agency for International Development-health quality accelerator activity data from 2022 to mid-2024 to examine the impact of the point of care quality improvement (POCQI) model on maternal, neonatal, and child health in Jordan. Significant improvements were made to 356 different POCQI initiatives enrolled in various healthcare facilities. In maternal health, antenatal care improved from 23.8% to 71.4%; anemia screening and treatment increased from 50.6% to 79.1%; and family planning services increased from 40.6% to 74.4%. Neonatal health outcomes improved, with delayed cord clamping rates increasing from 12.3% to 77.8% and immediate drying rate increasing from 35.3% to 82.9%. Child health outcomes also improved, with growth and development screening rates increasing from 27.4% to 63.3%. All improvements in outcomes results were statistically significant (p < 0.05). In conclusion, the POCQI model has significantly improved health outcomes and reduced preventable health challenges with more research needed for sustainability and integration long-term.
