Pectus carinatum (PC) is a chest wall deformity characterized by the anterior projection of the sternum that typically manifests in adolescence and may result in notable psychosocial morbidity despite insubstantial physiological signs. Historically considered less common than pectus excavatum, recent trends suggest that PC may be underdiagnosed, with increasing recognition and referrals to specialized pectus clinics. The main objective of this review is to provide a comprehensive understanding of the role of bracing, particularly the dynamic compression system, in the non-surgical management of PC. Traditionally, a surgical condition, PC is currently being treated more often with dynamic compression bracing, especially in younger, more flexible chest wall patients. This evidence-based review aims to analyze the optimal time to start bracing, using current literature on anatomical correction, compliance, and psychosocial outcomes. It is known that early treatment, ideally at the pre-pubertal or early pubertal stage, can result in better-bracing success, shorter treatment time, and more favorable cosmetic and emotional outcomes. The key determinants of treatment effectiveness are age, severity of deformity at the start of treatment, pressure limits, brace type, and patient cooperation. Further, physiotherapy and psychosocial support have been found to have a positive impact on adherence and quality of life. However, there is no standard protocol for bracing. As outlined in this review, the proposed solution is a patient-centered, multidisciplinary approach that combines clinical timing and personalized care to develop feasible guidelines for effective and timely bracing in adolescents with pectus carinatum.
Objectives:To investigate the incidence, etiological factors, predictors, and clinical outcomes of acute kidney injury (AKI) in patients with acute intracerebral hemorrhage (ICH). Methods:This retrospective cohort study included patients with ICH who were admitted to the ICU of Rashid Hospital, Dubai, between 2019 and 2024. Patients were grouped into AKI and non-AKI groups depending on the occurrence of AKI according to KDIGO clinical practice guidelines. Demographic characteristics, comorbidities, potential risk factors, and clinical outcomes were compared between both groups. Results:A total of 418 patients were included (median age: 44 years; males: 79.2%). Of these, 138 patients developed AKI (33%). AKI was more common in patients with spontaneous ICH (P = 0.016), males with hypertensive crisis, lower Glasgow Coma Scale (GCS) scores, and higher APACHE II scores (for all, P < 0.001). Significant etiological factors included hypertensive crisis (P = 0.005), hypotension (P = 0.024), high intracranial pressure (P = 0.004), blood transfusion (P = 0.002), diabetes insipidus (P < 0.001), and rhabdomyolysis (P = 0.017). Lower GCS scores on admission was associated with AKI (rpb : -0.23; P < 0.001). Factors that were independently associated with the development of early AKI were history of chronic kidney disease (OR: 4.79, 95% CI: 2.29-10.04; P < 0.001), diabetes insipidus (OR: 3.97, 95% CI: 1.95-8.10; P < 0.001), and hypertensive crisis (OR: 2.09, 95% CI: 1.21-3.61; P < 0.008). AKI was associated with lower GCS score at ICU discharge (P < 0.001) and increased length of ICU stay (P = 0.017), requirement for and duration of mechanical ventilation, incidence of brain death, 28-day mortality (for all, P < 0.001), and >28-day mortality (P = 0.004). Conclusions:Acute kidney injury (AKI) develops in about one third of patients with acute intracerebral hemorrhage (ICH). Lower GCS score, chronic kidney disease history, diabetes insipidus and hypertensive crisis are independently associated with increased odds of AKI. AKI is associated with an increase in morbidity and mortality in ICH patients.
Background:Spine pain conditions, such as low back pain (LBP) and neck pain, are prevalent musculoskeletal disorders. The autonomic nervous system (ANS) has been implicated as a potential contributor to pain. However, research investigating the impact of physiotherapy interventions on ANS function in patients with spinal pain disorders remains limited. Objective:This review aims to examine the influence of physiotherapy interventions on the ANS in patients with spinal pain conditions. Methods:A comprehensive literature search was conducted in PubMed, CINAHL, Web of Science, Ovid, and the Cochrane Controlled Trials Register to identify eligible randomized clinical trials. For meta-analysis, a random-effects model was used to compare the effects of physiotherapy interventions on ANS outcomes to comparison interventions. Results:A total of 16 studies were included in the systematic review, of which 11 were eligible for meta-analysis. Nine studies focused on participants with LBP, while seven studies focused on neck pain. The included studies investigated a variety of physiotherapy interventions compared to various control interventions. The meta-analysis revealed no statistically significant difference in ANS-related parameters between physiotherapy and comparison groups for LBP (pooled standardized mean difference [SMD] = 0.12; 95% CI: -0.10, 0.32; I2 = 55%) or neck pain (SMD = 0.09; 95% CI: - 0.29, 0.46; I2 = 74%). Conclusions:This systematic review and meta-analysis found no evidence that physiotherapy interventions induce ANS modulation compared to other interventions. Funding:None. Registration:PROSPERO (registration no.: CRD42023460760).
Travel has been increasing globally since the COVID-19 pandemic ended, including travel from the Gulf Cooperation Council (GCC) countries to international destinations. This creates unique risks for travelers, who may return with various infectious diseases. Travel medicine is a well-established medical specialty worldwide; however, it has only recently been introduced within the GCC, with limited healthcare and public awareness of the importance of these services in preventing infectious diseases among international travelers. This document presents travel medicine recommendations for practicing clinicians in the GCC to help prevent these diseases through pre-travel consultation.
Osteoarthritis (OA) is the most prevalent degenerative joint disease and a leading cause of chronic pain and disability worldwide, particularly among aging populations. It is characterized by progressive degeneration of articular cartilage, synovial inflammation, subchondral bone remodeling, and metabolic alterations in the infrapatellar fat pad, reflecting pathology across the entire joint microenvironment. The onset and progression of OA are driven by complex interactions among mechanical stress, aging, obesity, and metabolic dysregulation, which collectively disrupt joint homeostasis. Mechanical injury and cartilage damage induce the release of damage-associated molecular patterns, activating innate immune receptors on chondrocytes and synovial cells. This promotes the production of pro-inflammatory mediators, including interleukin-1β, tumor necrosis factor-α (TNF-α), interleukin-6, and interleukin-17, which contribute to extracellular matrix degradation and cartilage deterioration. MicroRNAs (miRNAs), small non-coding RNAs that regulate gene expression post-transcriptionally, have emerged as key modulators in OA pathogenesis. They regulate chondrocyte proliferation, apoptosis, extracellular matrix turnover, inflammation, and osteochondral remodeling. Notably, certain miRNAs exhibit mechanosensitive properties, responding to altered biomechanical loading and translating mechanical stimuli into gene regulatory responses. This review synthesizes current evidence on the roles of miRNAs in OA, focusing on their regulatory functions across joint tissues, including cartilage, synovium, subchondral bone, and the infrapatellar fat pad. Key miRNAs such as miR-140, miR-146a, miR-27b, miR-34a, miR-155, and mechanosensitive miR-365 are discussed, along with their interactions with major inflammatory and degenerative signaling pathways. Their potential as diagnostic biomarkers and therapeutic targets is also highlighted.
