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Introduction Electronic consultations (e-consults) refer to digital health technologies that enhance clinical information sharing and improve patients' access to expert healthcare providers. This study aims to describe the current utilization of the Internet/application-based e-consult system and to assess how effectively it resolves clinical questions. Methods Participants were general practitioners (GPs) who had installed the e-consult platform on their personal computers or cell phones. Hospital specialists who responded to the e-consults were previously registered on our e-consult platform and also participated in the study. We have developed and implemented an Internet/application-based e-consult system that GPs can use on their personal computers in Japan. In this descriptive study, GPs used the e-consult platform via an Internet/application to consult hospital specialists. The study period was from May 1, 2020, to October 31, 2021. The outcome measure was the resolution rate, calculated by dividing the number of cases resolved solely through e-consults by the total number of e-consult cases. Another outcome measure was the number of cases in which a plan was determined using e-consults. Other outcome measures were GP satisfaction, assessed using a 5-point Likert scale for e-consults, the number of chats required for a hospital specialist to respond, and the time from the GP's initial question to the hospital specialist's first response. Results Of the 329 e-consult cases identified, 91 conducted by GPs were included in the final analysis. The number of cases resolved using only e-consults was 47, resulting in a resolution rate of 52% in the study. The minor specialists exhibited the highest resolution rate using e-consults alone. The number of cases where a plan was determined using e-consults was 83, accounting for 91% of the total 91 cases. The level of GP satisfaction with the e-consult process was high, with a median satisfaction score of 5 on a 5-point Likert scale. Most e-consults received their initial response within two hours. The number of chats required for hospital specialists to respond was very low, with a median of only one chat being necessary. Conclusion The Internet/application-based e-consult system enabled GPs to address a wide range of medical problems. Further studies with large samples are necessary, even though these results serve as an important benchmark for future research on e-consults in Japan., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethical review board of Showa University Koto Toyosu Hospital issued approval 21-070-A. This study was approved by the ethical review board of Showa University Koto Toyosu Hospital (approval number: 21-070-A) and was conducted in accordance with the Declaration of Helsinki . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: F.H., S.T., S.T., and K.M. have received consulting fees from Medii, Inc., and Y.H. is a CEO of Medii, Inc. T.H., M.T., and S.T. did not receive any form of support or gifts, such as research funding, consulting fees, honoraria, royalties, license fees, or travel/transportation expenses. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Harada et al.)

One significant global health issue that is present in more than 190 nations globally is routine vaccination reluctance. This study aimed to synthesize the current evidence on vaccination hesitancy and its impact on immunization coverage in pediatrics. We searched for relevant studies across four databases (Scopus, Web of Science, PubMed/EMBASE, and Cumulated Index in Nursing and Allied Health Literature). Prespecified inclusion and exclusion criteria were used to extract relevant studies while excluding irrelevant ones. We found 4,085 studies on four different databases in which 23 satisfied the inclusion and exclusion criteria. These 23 relevant studies involving 29,131 parents, guardians, and caregivers from over 30 countries met the inclusion criteria and quality assessment. Studies were assessed for risk bias using the Newcastle-Ottawa scale. Vaccination hesitancy is caused by several factors, such as cultural customs, economic reforms, perceived rumors, myths, misconceptions, physicians and other healthcare professionals, and perceived risks and problems of vaccines. These results highlight the importance of addressing demand-side factors related to socioeconomic determinants and supply-side issues such as improving health literacy, combating misinformation, ensuring clarity in communication, and promoting a consistent, evidence-based message. More observations and research should be conducted regularly to develop strategies for encouraging youngsters to receive immunizations in large quantities., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohamed Elawad et al.)

Chronological age (CA) estimation is essential in medicine, forensics, and law. Teeth are often used for this due to their reliability. The Demirjian and the Nolla methods are used to estimate dental age (DA). Both methods have strengths and weaknesses; the Demirjian method usually overestimates age, whereas the Nolla method underestimates it. Their accuracy varies among different populations. Our objective is to compare the accuracy of these methods across various age groups and to probe the effect of gender. We searched PubMed, Scopus, the Excerpta Medica database (EMBASE), the Cochrane Library, and the Web of Science for relevant articles until March 2024. We then screened for comparative studies using the Demirjian and the Nolla methods. We used the RevMan 5.4 software package (The Cochrane Collaboration, London, UK) to compare the accuracy of both methods in estimating chronological age in both genders across age groups ranging from five to 16 years. All data were pooled using a random effects model, and relevant forest plots were generated. The accuracy was calculated based on the pooled mean difference between the chronological age and that estimated by each method. Our literature search identified 25 articles for inclusion in the review. The Demirjian method overestimated the age in males by 0.71 years in the six to 6.99 age group and an average overestimation of 0.5 years across all age groups. In females, the overestimation was 0.82 years in the 11-11.99 age group, but the average overestimation was 0.5 years. Overall, the Nolla method underestimated the age of males by 0.28 years and females by 0.25 years. Estimations from both methods were 0.7 years apart on average. In conclusion, while the Demirjian and Nolla methods have unique advantages, using them together can provide a more robust and reliable age estimation. Forensic practitioners can determine the best approach by considering population-specific accuracy, age group and gender, and the case context. Combining both techniques offers cross-verification, comprehensive assessment, bias mitigation, and enhanced reliability., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Juhani et al.)

Background: The defining characteristic of posterior reversible encephalopathy syndrome (PRES) is a reversible, predominantly vasogenic edema of the white matter, particularly affecting the parenchyma supplied by the posterior circulation. PRES is most commonly associated with hypertension. We present a case series of seven normotensive patients diagnosed with cancer who had posterior reversible encephalopathy syndrome., Materials and Methods: This series of retrospective cases includes seven patients hospitalized between August 2022 and October 2024, all with a primary oncological condition and diagnosed with PRES either at admission or during their hospital stay. PRES was established according to the diagnostic criteria outlined in the 2012 Berlin Study. Our study concentrated on clinical characteristics, including underlying disease, triggering clinical events, chemotherapy agents, and outcome measures such as reversibility, functional status, and mortality., Results: The median age of patients in this study was 48 years. No patient exhibited significantly elevated blood pressure during their inpatient stay. Altered consciousness with seizures was the primary initial manifestation in most patients, followed by headache. The predominant observation on the MRI was T2 flair hyperintensity in the posterior circulation. All subjects attained nearly full neurological recovery by 28 days, regardless of steroid therapy. The 90-day all-cause mortality rate was 14% (one out of seven patients). There were no fatalities attributable to PRES., Conclusion: Posterior reversible encephalopathy syndrome is a neurological emergency that may evade the discerning attention of the attending physician. Owing to the extensive range of clinical features and MRI findings, the list of differential diagnoses is substantial. The reversibility of symptoms, while not always applicable, is predominantly certain, as demonstrated in our case series. We must extend our focus beyond conventional risk variables such as hypertension to consider additional clinical insults. Delayed diagnosis may lead to worse neurological outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Vydehi Institutional Ethics Committee issued approval VIEC/2024/APP/83. This is to certify that the case series titled "A Pressing Emergency in Oncology: A Case Series of Patients With Posterior Reversible Encephalopathy Syndrome, "submitted by Dr. Vikram L., Assistant Professor, Department of Critical Care, Vydehi Institute of Medical Sciences and Research Centre, is approved by the Vydehi Institutional Ethics Committee. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Narasimhan et al.)

Background: Despite improvements in pregnancy care, preterm birth remains a major cause of neonatal morbidity and mortality worldwide, particularly in developing countries. Maternal inflammation has been recognized as a factor that may induce preterm birth, with various inflammatory markers associated with its pathogenesis. The aim of this study is to evaluate the value of maternal serum amyloid A(SAA) level as a predictive marker for preterm delivery in a Romanian cohort., Methods: This observational study was carried out at a Romanian tertiary care hospital between April 2023 and March 2024. We enrolled 136 pregnant women and divided them into two groups depending on the beginning of labor: preterm (before 37 weeks, n=70) and term (after 37 weeks, n=66). Maternal blood samples were taken upon admission and analyzed using the Atellica® NEPH 630 System (Siemens Healthineers, Erlangen, Germany) to determine SAA levels. The best cut-off value for SAA was determined using receiver operating characteristic (ROC) curve analysis with the Youden index. Logistic regression models were then applied to assess the association between elevated SAA levels and preterm birth, adjusting for potential confounders such as maternal age and history of preterm birth., Results: The median SAA levels were significantly higher in the preterm group (22 mg/L) compared to the term group (7 mg/L) (p<0.001). The ROC curve analysis yielded a moderate predictive value of SAA for preterm birth, with the area under the ROC curve (AUC) being 0.690. The threshold at 15 mg/L was the best cut-off value, achieving a sensitivity of 89% and a specificity of 85%. Elevated SAA levels were associated with a 27.89-fold increased risk of preterm delivery. Further, after adjusting for maternal age, medical conditions during pregnancy, and prior preterm birth, elevated SAA remained a significant predictor of preterm birth (adjusted odds ratio (aOR)=28.966; p=0.001)., Conclusion: Maternal SAA proved to be a strong independent risk factor for preterm birth. This biomarker further narrows the population of pregnant women at higher risk of preterm delivery and opens new perspectives for its clinical role in preterm birth prevention., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of Timisoara Municipal Emergency Clinical Hospital issued approval E-1828/31.03.2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chiriac et al.)

Introduction: Benign prostatic hyperplasia (BPH) is the most common form of lower urinary tract symptoms (LUTS). Vitamin D may be an effective way to treat BPH symptoms because it has anti-proliferative and anti-inflammatory characteristics. Thus, adequate vitamin D levels are vital for overall health. This study aimed to investigate the association of vitamin D with prostate health status in men and determine the diagnostic cut-off of vitamin D levels.  Methods: This analytical cross-sectional study was conducted among men between 45 and 80 years of age who presented to the surgery or urology department with complaints of frequent urination and urinary tract infection. Based on their total prostate-specific antigen (PSA) levels, the participants were categorized into four groups - Group A (total PSA 0-3.9 ng/ml), Group B (total PSA 4-9.9 ng/ml), Group C (total PSA 10 - 19.9 ng/ml), and Group D (total PSA > 20 ng/ml). Total PSA was estimated by a dedicated Beckman Coulter hormone analyzer (UNICEL DXI 600, Beckman Coulter, Inc., California, US) via the chemiluminescence method. Serum vitamin D was estimated with dedicated reagents in the Bio-Rad ELISA (Bio-Rad Laboratories, Inc., California, US). An analysis of variance (ANOVA) post hoc test was utilized to compare quantitative variables. A correlation analysis proved the relation between vitamin D and total PSA. The receiver operating characteristic (ROC) curve was utilized to determine the diagnostic performance of the analyte of interest., Results: In this study, total PSA levels significantly increased in men over 75 years of age. The upper limit of total PSA increased with the age of the men. Total PSA levels were compared between the age groups of 40 to 49, 50 to 59, 60 to 69, and more than 70, and an increase in total PSA levels was observed in those between 60 and 69 years. Total PSA levels were also negatively correlated (r=- 0.31) with vitamin D in this age group. Moreover, vitamin D-deficient individuals had significantly increased total PSA levels (12.57±5.22 ng/ml). Further correlation analysis revealed a significant negative correlation of total PSA with vitamin D levels (r=- 0.245; p=0.022). ROC analysis had an area under the curve of 0.828 for Vitamin D at a cut-off of 20 ng/ml revealing a diagnostic sensitivity of 86% and specificity of 60%.  Conclusion: Vitamin D deficiency is a potential biochemical marker of benign prostate hypertrophy. Vitamin D and total PSA are indicators of prostate health status in men. Screening of total PSA levels reflects the prostate health status of men and this needs to be potentiated with vitamin D supplementation., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. SRM Medical College Hospital and Research Centre issued approval SRMIEC-ST0723-561. IEC approved . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Reddy et al.)

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that imposes significant complications, including diabetic peripheral neuropathy (DPN). DPN is characterized by marked inflammation, and the fibrinogen-to-albumin ratio (FAR) is one of the new markers for systemic inflammation, it has been used in various diabetic micro- and macro-vascular complications. The present study investigates the association between FAR and nerve conduction abnormalities in T2DM patients with DPN., Methods: This was a cross-sectional study conducted on 200 T2DM patients, and 110 (55%) were diagnosed with DPN. Patients were divided into DPN and non-DPN groups. The patient's demographics and the biochemical variables fibrinogen, albumin, and FAR were evaluated and compared among the DPN and non-DPN groups. Nerve conduction studies (NCS) were performed to evaluate motor and sensory nerve functions. Patients were further stratified into FAR tertiles (low, moderate, and high FAR) for subgroup analysis., Results:  The fibrinogen levels were significantly higher (375.65 ± 35.43 mg/dL vs. 342.87 ± 42.12 mg/dL; p<0.001) and albumin levels were lower (3.12 ± 0.41 g/dL vs. 4.07 ± 0.57 g/dL; p<0.001) in DPN as compared to non-DPN patients. Meanwhile, FAR was higher in DPN as compared to non-DPN patients (120.40 ± 26.32 vs. 84.24 ± 12.87; p<0.001). Further, there was a significant negative correlation for conduction velocities and amplitudes and a positive correlation for latencies with FAR across all nerves tested (p<0.05). In addition, high FAR tertile patients showed lower conduction velocities (peroneal nerve: 35.26 ± 5.82 m/s vs. 42.53 ± 5.34 m/s; p<0.001), reduced amplitudes, and prolonged latencies when compared to moderate and low FAR tertile patients (p<0.05)., Conclusion:  Nerve conduction abnormalities in T2DM patients with DPN showed significant association with FAR. Thus, FAR serves as a simple and effective biochemical marker for the assessment of DPN severity., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Namo Medical Education & Research Institute, Silvassa, India issued approval Approval number: IEC/2023/127/225. The study was approved by the institutional ethical committee of Namo Medical Education & Research Institute, Silvassa, India with a protocol number (IEC/2023/127/225). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rathod et al.)

Background and objective Hemophilia A (HA) is a genetic bleeding disorder caused by a lack of factor VIII (FVIII) and is associated with frequent bleeding and joint damage. Traditional intravenous treatments for this condition are cumbersome and can lead to complications. Emicizumab, a bispecific monoclonal antibody, offers a promising subcutaneous alternative with potential safety and efficacy-related benefits. This study aimed to evaluate the impact of emicizumab prophylaxis on bleeding rates, joint health, functional activity, and quality of life (QoL) in patients with congenital HA. Methods A noninterventional, prospective observational study was conducted at the Assam Medical College, a tertiary care center in northeastern India, involving 40 patients with HA (PwHA), who were either on FVIII therapy or newly on emicizumab. Emicizumab was given subcutaneously at 3 mg/kg weekly for the first month, followed by 6 mg/kg every four weeks. Endpoints included changes in annual bleeding rate (ABR), Hemophilia Joint Health Score (HJHS), Functional Independence Score in Hemophilia (FISH), and QoL via European Quality of Life 5-Dimensions 5-Levels (EQ-5D-5L) and visual analog scale (VAS) scores at 24 weeks. Results At 24 weeks, HJHS improved from 12.8 to 4.8 (p<0.001), FISH from 27.5 to 30.6 (p<0.001), and ABR decreased from 11.36 to 0.195. Quality of life scores also improved (EQ-5D-5L index from 0.79 to 0.96, VAS from 72.18 to 92.75, both p<0.001). All 30 patients with target joints had resolved bleeds, and adherence to emicizumab was 100%. Conclusions Based on our findings, emicizumab significantly reduces bleeding, enhances joint health, and improves the quality of life in PwHA. It is associated with high adherence, suggesting its feasibility as a treatment, especially in resource-limited settings. However, long-term studies are needed to validate these results., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee (H) Assam Medical College, Dibrugarh 786002 (Reg. no. ECR/636/Inst/AS/2014) issued approval 2023/AMC/EC/10795. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dutta et al.)

Multiple myeloma (MM) is the second most common hematological malignancy globally. Despite its reputation as an aggressive and fatal disease, recent advancements in treatment have significantly improved patient outcomes. Over the past decade, innovative therapies with fewer side effects have emerged, including proteasome inhibitors (e.g., bortezomib, carfilzomib, ixazomib), monoclonal antibodies (e.g., daratumumab, isatuximab, elotuzumab), immunomodulators (e.g., thalidomide, lenalidomide, pomalidomide), and corticosteroids (e.g., dexamethasone). Additionally, combination regimens utilizing these agents have demonstrated improved efficacy by targeting multiple pathways simultaneously. These therapies are more precise in their ability to attack myeloma cells, leading to enhanced patient quality of life, prolonged remission, and delayed disease progression. This article explores the evolution of MM therapies, highlighting the potential for a cure through ongoing breakthroughs in drug development and combination treatments. The analysis underscores the optimism surrounding the future of MM treatment and the need for continued research to make MM a manageable and potentially curable disease., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zavaleta-Monestel et al.)

Autonomous sensory meridian response (ASMR) is a sensory phenomenon characterized by tingling sensations triggered by specific auditory or visual stimuli, offering a novel approach to anxiety reduction and relaxation. This review explores the therapeutic potential of ASMR in orthodontics by examining its physiological and psychological benefits, neuroscientific basis, and its potential to enhance patient comfort, manage dental anxiety, and improve communication within orthodontic practice. A comprehensive literature review was conducted to evaluate studies on ASMR's physiological, psychological, and clinical effects, focusing on ASMR-induced relaxation, patient-specific triggers, and its integration into orthodontic settings. ASMR has been shown to lower heart rates, improve mood, and reduce stress across clinical and non-clinical populations. Functional MRI (fMRI) studies reveal brain activation in regions associated with reward and emotional processing during ASMR experiences. ASMR's impact on dental anxiety is promising, with studies suggesting its potential to distract patients and foster a sense of calm during procedures. Patient-specific triggers, such as whispering and tapping, can be tailored to individual preferences, offering a non-invasive, cost-effective method for anxiety reduction in orthodontic patients. Incorporating ASMR content during procedures and adopting ASMR-inspired communication techniques may further enhance patient comfort and compliance. By inducing a meditative state, ASMR distinguishes itself from traditional distraction methods like music or television. ASMR holds significant promise as a therapeutic tool in orthodontics, potentially improving patient experiences by reducing anxiety and discomfort. Further research is warranted to investigate its long-term effects, optimize trigger selection for specific populations, and explore its combination with other relaxation techniques., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Roy et al.)

In recent years, there has been a notable increase in the use of robotic technology in medical surgery, especially in heart surgery. Many advancements in surgery have been made possible by the development of these robotic devices, such as the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, United States). These advancements include improved ergonomics, three-dimensional (3D) imaging, and increased dexterity. This research evaluates the advancements, results, and potential applications of robots in heart surgery. A systematic review that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles was carried out. The PubMed and Cochrane databases underwent a thorough search that turned up articles from 2015 to 2023. Nine articles that satisfied the requirements for inclusion were evaluated for quality using the Critical Appraisal Skills Programme (CASP) checklists. Standardized templates and conventional content analysis techniques were used for data extraction and analysis, respectively. Nine studies with a range of approaches, including randomized, prospective, observational, and retrospective investigations, were included in the review. This research included a variety of robotic heart treatments, including mitral valve repair, atrial septal defect (ASD) closure, and coronary artery bypass grafting (CABG). Notable results include identical or shorter operating durations, fatality rates that are comparable to those of conventional techniques, fewer postoperative complications, and shorter hospital stays. Surgeons did, however, face an initial learning curve. Variants of the da Vinci surgical system were the most frequently used robotic systems. Robotic heart surgery has shown encouraging outcomes in terms of effectiveness, safety, and patient recovery. The dependability of robotic procedures is demonstrated by shorter operating times, reduced blood loss, a low incidence of conversion to conventional methods, and a reduction in postoperative complications. Shorter hospital stays suggest better patient outcomes and potential financial advantages. Nonetheless, the need for specific training and knowledge among surgeons is emphasized. Sustained investigation and advancement are essential for the refinement and broader use of robotic heart surgery. Robotic-assisted cardiac surgery has a promising future with a focus on improved patient outcomes, training, and procedural development., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fida et al.)

Background Smoking is recognized as a major public health issue globally; it is widely distributed among people of various origins and races in the world despite hard efforts on cessation programs. Its health hazards extend to dangerous complications, which mostly end in death according to statistics around the world. Tobacco use is influenced by several factors, which may include social pressures from peers, family influences, and media portrayals of smoking. This study aimed to identify the smoking prevalence among Madinah physicians, the influencing factor of their tobacco use, and their tobacco-related attitudes. Methods A cross-sectional study was conducted involving physicians working in selected district hospitals in Madinah. Participants were recruited using a convenience sampling technique and were asked to complete a self-administered questionnaire in English. Statistical analysis was performed using SPSS software, employing a chi-square analysis to assess smoking prevalence and influencing factors. Results The study involved 427 physicians, with 206 (48.2%) Saudi and 277 (64.9%) male. Most participants' ages ranged between 25 and 34 (38%). Smokers accounted for 85 (19.9%) participants, while previous smokers numbered 20 (4.7%). Male gender was significantly associated with smoking. Stress and social influence were the most common influencing factors, 62 (44.2%) and 26 (20.9%), respectively. The most common types of smoking products used among both groups were electronic cigarettes (42, 35.6%), cigarettes (40, 32.2%), and water pipes (22, 19.2%). Most physicians agreed on the importance of physicians serving as role models for the community representing 52 (61.2%) of tobacco users and 286 (83.6%) of non-tobacco users. Conclusion This study provides valuable insights into the prevalence, patterns, and implications of tobacco use among physicians in Madinah. The findings underscore a significant public health concern, revealing that a notable proportion of physicians are current or former tobacco users. Key demographic factors such as gender, age, and nationality demonstrate clear associations with tobacco use, highlighting the need for targeted interventions tailored to these specific groups., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alsawadi et al.)

Anti-vascular endothelial growth factor (VEGF) drugs are used for various diseases with abnormal proliferation of blood vessels. The use of these drugs in wet age-related macular degeneration (AMD) has proven to be highly effective. Various factors contribute to the efficacy of these drugs in different settings. Many studies have proven that these drugs effectively slow disease progress and improve visual outcomes. Factors contributing to the success or failure of the treatment include the genetic makeup of the patient, comorbidities, compliance with the clinic visits and injections, long-term follow-up for the treatment, socioeconomic status, and availability of different drugs. The treatment of choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD) has been revolutionized after the introduction of anti-VEGF therapy. However, there are still some gaps in the literature that require the attention of the researchers. Our literature review has evaluated anti-VEGF use over the years and analyzed the efficiency of drugs in different settings. It showed that all the anti-VEGF drugs depict similar visual results for one to two years. The long-term evaluation of any drug cannot be commented on yet and needs further evidence through different research. These drugs improve visual function and the anatomical results of patients with other eye problems. These drugs' adverse effects are rare but still an important point requiring further research. Clinical outcomes of the drugs must be ascertained through patients' eyes to assess the quality of life improvement appropriately. The cost-effectiveness of the drugs is a substantial debatable topic, as bevacizumab is cost-effective but still requires Food and Drug Administration (FDA) approval., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bidiwala et al.)

Ambiguous genitalia is a rare disorder where it is unclear whether an infant's external genitals are male or female. This can be attributed to various internal and external etiologies, such as androgen receptor abnormalities, gonadal abnormalities (such as gonadal dysgenesis or Klinefelter syndrome where a male has an extra X chromosome), enzymatic defects, etc. Correction of such atypical genitalia requires a multidisciplinary approach, including but not limited to surgeons and therapists. It is important to keep in mind that the treatment plan is tailored according to the specific etiology that is causative of the patient's condition, along with the anticipated perioperative and postoperative complications. Islamically speaking, this topic has been addressed in various Islamic literature and disciplines, including guidelines for dealing with this medical condition. Moreover, follow-up of the patient must be done to allow smooth integration into society., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohammed et al.)

Benign recurrent intrahepatic cholestasis (BRIC) is a rare, autosomal recessive liver disorder characterized by intermittent episodes of cholestasis without progression to chronic liver disease or cirrhosis. Patients experience recurrent jaundice and severe pruritus, significantly impacting their quality of life. This case report presents a 15-year-old boy with a history of recurrent jaundice and pruritus. The patient was successfully managed with ursodeoxycholic acid (UDCA), leading to symptomatic relief and biochemical improvement. BRIC is a rare disorder and should be considered in the differential diagnosis of recurrent cholestasis in adolescents. Early recognition and appropriate treatment can improve patient outcomes and prevent unnecessary investigations., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bansal et al.)

This systematic review and meta-analysis evaluate the comparative outcomes of conservative management versus surgical intervention for anterior cruciate ligament (ACL) injuries. A comprehensive search of PubMed, Cochrane Library, Web of Science, SPORTDiscus, and Google Scholar focused on studies published between 2010 and 2024. Data synthesis employed both thematic analysis for qualitative data and meta-analysis for quantitative outcomes. Key findings indicate that conservative management yields lower reinjury rates and higher quality of life (QoL) scores (64.6 vs. 57.1) compared to surgical intervention, though differences were not statistically significant (p = 0.1483). Both strategies demonstrated comparable return-to-sport (RTS) rates. Meta-regression analysis revealed that longer follow-up durations positively influenced outcomes (p = 0.0288). The average complication rate was 49.83 per study (CI: 25.84-73.82), underscoring significant risks associated with both approaches. Conservative management shows promise as an initial treatment option for certain ACL injuries, particularly regarding reinjury prevention and QoL improvements. However, surgical intervention remains crucial for specific cases requiring enhanced knee stability. The results underscore the importance of individualized treatment planning, long-term follow-up, and further standardization of outcome measures in future research., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Onobun et al.)

Background: Unsafe abortions represent a significant public health issue in Cameroon, often resulting in severe health consequences. This study aimed to investigate the prevalence, motivations, and factors associated with unsafe abortions among women in Yaoundé, Cameroon., Methods: A cross-sectional study was conducted among women of childbearing age attending three urban health facilities in Yaoundé, Cameroon. Participants provided information on their reproductive history, including any previous abortions. Data on reasons for abortion, methods used, and sociodemographic factors were collected. Regression analysis was performed to identify factors associated with unsafe abortions., Results: Among 234 women aged 17 to 43, 51 (21.8%) reported at least one unsafe abortion. The primary reasons cited were fear of parental disapproval (24%) and partner refusal (20%). Physicians were the main providers (39.5%), using suction curettage and/or intravaginal misoprostol (89%). Being single (adjusted odds ratio (aOR): 13.6 (5.39-34.4)), nulliparous (aOR: 5.81 (2.41-13.9)), and secondary school students (aOR: 3.23 (1.06-9.81)) were significantly associated with an increased risk of unsafe abortions., Conclusion: Our study highlights the significant public health problem posed by unsafe abortions in Yaoundé, Cameroon. Single, nulliparous women and secondary school students are at heightened risk. These findings emphasize the urgent need for comprehensive sexual and reproductive health education, increased access to contraception, and safe abortion services targeting these groups., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Comité Institutionnel d'Ethique, Université des Montagnes (CIE-UdM) issued approval 2020/062/UdM/PR/CIE. Our study was reviewed and approved by the Institutional Review Board of the Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fomba Tchoffo et al.)

Background Multimorbidity and polypharmacy are common in older adults and pose a considerable challenge to the health and social care system. They are complex and interrelated concepts in geriatric care that require early detection and patient-centered shared decision-making by multidisciplinary, team-led comprehensive geriatric assessment (CGA) across all health and social care settings. The primary objective of this study is to investigate the economic burden of multimorbidity and polypharmacy among geriatric patients. Methodology A cross-sectional study was conducted from July 2021 to June 2022 involving a total of 470 male and female respondents aged more than 60 years. Five different departments of Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla were selected for the study. Data were collected by interviewing and clinically examining 470 randomly selected geriatric patients who came to different outpatient departments of VIMSAR, Burla. Statistical analysis was performed with SPSS software version 21.0 (IBM Corp., Armonk, NY, USA). P-values <0.05 were considered statistically significant. Results Of the 470 study participants, farming (126, 26.8%)and other (149, 31.7%) occupations were the maximum. Overall, 97 (20.6%) respondents belonged to the upper socioeconomic class, 148 (31.5%) to the upper middle class, 131 (27.9%) to the lower middle class, and 94 (20%) to the lower socioeconomic class. A single chronic disease was higher in respondents from the upper class at 87 (89.69%) and upper middle class at 128 (86.48%). Multimorbidity diseases were higher in the lower middle (28, 21.37%) and lower (24, 25.53%) income group patients. Diabetes was more common in males at 110 (30.81%) in comparison to females at 7 (6.19%). Hypertension was also higher in males at 90 (25.21%) compared to females at 21 (2.65%). Chronic kidney disease was seen in 41 (28.01%) males and 13 (11.50%) females. People with a smokeless tobacco habit (165, 35.11%) and a family history of diabetes (99, 21.06%) and hypertension (117, 24.89%) were suffering from single chronic diseases. Conclusions Multimorbidity has a high incidence in old age. It is associated with substantially higher healthcare utilization and social care costs among older adults in Odisha. With the incidence of multimorbidity rising, especially as the population ages, we require healthcare systems that are developing to deal with the rising challenges related to multimorbidity and the relevant healthcare and societal costs., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Veer Surendra Sai Institute of Medical Science and Research, Burla issued approval 19283/Dt.20.02.20/IFO-273/19. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lakra et al.)

The increase in cesarean section (CS) rates, whether they are classified as unnecessary or elective, has globally raised significant concerns due to the associated risks involving maternal and neonatal outcomes. Although CS can be a lifesaving operation in specific medical cases, its overuse is exposing mothers and neonates to complications like hemorrhage, infections, and long-term consequences such as uterine scarring, infertility, and future pregnancy problems. The contributing factors include maternal preferences for convenience, fear of labor, and financial incentives within the healthcare systems that favor surgical interventions. Defensive medical practices and private healthcare providers further exacerbate this trend. This review discusses the prevalence of CS, highlighting variations between developing and developed regions and the complexity of addressing the rising rates. Moreover, recommendations to reduce unnecessary CS, such as enhancing antenatal education to inform mothers about the risks and benefits associated with different delivery options, promoting supportive care models (midwives), and fostering interdisciplinary cooperation among healthcare providers, will also be addressed. Healthcare systems will gain the ability to reduce the rates of unnecessary Cesarean procedures by directing the main focus on patient education, continuous monitoring, and policy reforms. This will lead to the improvement of both neonatal and maternal health outcomes in addition to lowering the costs of healthcare. In order to provide and ensure evidence-based and safe care for childbirth, a multidisciplinary approach is essential., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Metwali et al.)

Three cases of hemidiaphragmatic paralysis are reported. One case was associated with an interscalene brachial plexus block, another with the insertion of an implantable cardioverter defibrillator, and a third case had undergone a coronary artery bypass grafting operation. In only one of these cases, there was a causal association, while in the other two, it was determined that the paralysis was coincidental. A change in the diaphragmatic position on the chest X-ray needs to be demonstrated, preferably also confirmed by ultrasound or a fluoroscopic sniff test, to show that the paralysis was a clear and immediate consequence of the procedure. One case described was most likely related to cervical nerve C3-C5 root compression confirmed on a magnetic resonance imaging (MRI) scan and not due to the procedure. This case shows that cervical root compression at C3-C5 by disk prolapse should also be considered. This was also suspected in another case; however, an MRI could not be performed after discussing the risks with the patient. When the paralysis has no temporal relationship with the procedure, primary or secondary intrathoracic malignancy and concurrent neurological disease must also be excluded by computed tomography of the thorax. The surgical and interventional causes of phrenic nerve injury and the relative evidence base are discussed., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Darmanin et al.)

Intraosseous (IO) vascular access is a crucial intervention during cardiac arrest scenarios, providing a reliable route for emergency medication administration and fluid resuscitation in the absence of a stable intravenous (IV) line or central line. Despite its established efficacy, our retrospective study at Southampton General Hospital revealed under-utilisation rates of IO insertions during cardiac arrests. Among 131 patients studied over a year, only a minority received IO lines. Our findings underscore the need for improved awareness, training, and institutional support to optimise the use of IO vascular access in critical care settings. Our study also highlights, within the limitations of this study, the positive effect an IO has when utilised effectively, in the absence of an IV, in relation to Return Of Spontaneous Circulation (ROSC) rates highlighting and supporting the usage of IO lines in the event an IV is unattainable or difficult to insert., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Vakil et al.)

This case report highlights the diagnostic process for posterior cutaneous nerve entrapment syndrome (POCNES) in an older adult female patient, with an emphasis on using video demonstrations to guide clinicians. POCNES should be diagnosed based on a combination of specific clinical features, including localized back pain accompanied by pinpoint tenderness lateral to the spinous process, cutaneous sensory abnormalities over the area of pain, severe pain response to pressure on the tender point, and normal clinical and imaging findings. This case demonstrates how these criteria were identified via a thorough physical examination captured on video to provide a visual guide for clinicians. The use of a lidocaine injection at the tender point confirmed the diagnosis, offering immediate relief. The video in this report serves as a practical tool for clinicians to accurately diagnose POCNES, particularly when standard imaging and tests remain inconclusive., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Watari et al.)

Background: Postmenopausal women are often affected by osteoporosis, a disorder that lowers bone density, increases the risk of fractures, and has a major negative influence on quality of life., Objective: This study aimed to assess the efficacy of bisphosphonates in reducing fracture risk among postmenopausal women with osteoporosis by analyzing their impact across various fracture sites, treatment durations, and patient subgroups., Methodology: A retrospective cohort research was conducted between January 2021 and December 2022 at Hayatabad Medical Complex (HMC), Peshawar. Women 50 years of age and older who had been diagnosed with osteoporosis (BMD T-score < -2.5) and receiving bisphosphonates for at least a year were included in the research. We gathered information on treatment adherence, fracture history, and demographics. SPSS version 25 was used to conduct statistical studies, such as logistic regression and paired t-tests., Results: A total of 323 participants were included, with a mean age of 65.40 ± 8.20 years. The incidence of new fractures decreased significantly from 121 patients (37.48%) before therapy to 48 patients (14.85%) post-therapy (p < 0.0001), demonstrating the efficacy of bisphosphonates in fracture prevention. Notably, the most common fracture types were vertebral fractures in 49 patients (15.18%) and hip fractures in 42 patients (12.99%). Logistic regression analysis indicated that age (OR 1.05, 95% CI: 1.02 - 1.09) and baseline BMD T-score (OR 0.78, 95% CI: 0.67 - 0.90) were significantly associated with fracture risk reduction, highlighting the importance of these factors in treatment outcomes., Conclusion: The significance of bisphosphonates in clinical therapy is highlighted by their ability to successfully lower fracture risk in postmenopausal women with osteoporosis., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Review Committee of Hayatabad Medical Complex (HMC), Peshawar issued approval 216/OD/HMC/2020. This is to certify that ethical approval (Approval Number: 216/OD/HMC/2020) has been granted for the research project titled "Efficacy of Bisphosphonates in Reducing Fracture Risk Among Postmenopausal Women with Osteoporosis". The approval confirms adherence to all required ethical standards for conducting this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ullah et al.)

Heart failure due to acute mitral regurgitation (MR) may present with atypical findings on physical examination and transthoracic echocardiography (TTE), making the diagnosis difficult. A 72-year-old male was transferred to our hospital with severe cardiorespiratory failure and was initially suspected to have severe pneumonia based on the acute onset and imaging findings. The patient was eventually diagnosed with acute heart failure secondary to MR. Acute MR can be a fatal disease; clinicians should consider it in the setting of severe respiratory and circulatory failure as it can mimic severe pneumonia and acute respiratory distress syndrome (ARDS)., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sugi et al.)

Background Sickle cell disease (SCD) is a hereditary disorder marked by abnormal hemoglobin (HbS), leading to chronic hemolytic anemia, vaso-occlusive crises (VOCs), and multi-organ complications. In India, the prevalence of SCD is highest among tribal populations in states like Madhya Pradesh, Maharashtra, Odisha, and Assam, with the disease burden exacerbated by limited healthcare access, especially in rural regions. This study provides a comprehensive analysis of the demographic profile, clinical features, and treatment patterns of SCD patients at a tertiary healthcare center in Upper Assam, where the prevalence of SCD is high among the tea tribe communities. Methods This retrospective observational study included 250 patients diagnosed with various SCD subtypes who presented with SCD-related complications at Assam Medical College and Hospital between January 2020 and December 2023. Data were obtained from medical records in the departments of medicine and pediatrics, covering demographic variables (age, gender, ethnicity), clinical characteristics (complications, hemoglobin levels, genotype, history of hospitalizations), and treatment details (frequency and type of blood transfusions, use of hydroxyurea and chelating agents). Descriptive statistics summarized demographic and clinical features, while chi-square tests and t-tests were used for bivariate analysis. Logistic regression identified factors associated with high transfusion requirements. Results The study population had a mean age of 17.2 years, with 54.4% male predominance. Most patients (87%) had sickle cell anemia (HbSS), while the remainder had other genotypes including HbSA, HbSE, and sickle cell thalassemia. The most common presenting symptoms were fever (61.2%) and bone/joint pain (48.4%), indicative of VOCs and frequent infections. Pallor (30%) and abdominal pain (25.6%) were also prominent. Half of the patients (125) received hydroxyurea, though its uptake was limited by availability and cost. A high transfusion burden was noted, with 72.4% of patients requiring between five to 12 transfusions annually. However, only 22.4% received chelation therapy to manage iron overload, reflecting the cost constraints in accessing these agents. Laboratory findings indicated a mean hemoglobin level of 7.19 g/dL and elevated serum ferritin levels due to repeated transfusions. The frequency of blood transfusions was higher compared to Western studies, emphasizing the need for more accessible disease-modifying therapies in resource-limited settings. Conclusions The findings of this study illustrate the significant clinical and transfusion burden experienced by SCD patients in Upper Assam. This population relies heavily on blood transfusions due to limited access to hydroxyurea and other advanced therapies. The study underscores a critical need for improved access to hydroxyurea, expanded availability of chelation therapy, and greater healthcare support for managing SCD-related complications in resource-limited settings. As India's National Sickle Cell Anemia Elimination Mission is implemented, regional studies such as this are essential for tailoring public health interventions to meet the specific needs of high-prevalence areas, especially among underserved tribal communities., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee (H) Assam Medical College Dibrugarh 786002 (Reg.No. ECR/636?Inst/AS/2014) issued approval AMC/EC/1297. This study was approved by the Institutional Ethics Committee (H) Assam Medical College Dibrugarh 786002 (Reg.No. ECR/636/Inst/AS/2014) and the approval number is AMC/EC/1297. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This study was funded by the Indian Council of Medical Research (ICMR) under the National Registry for Rare and other Inherited Disorders (NRROID). Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dutta et al.)

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with a poor prognosis. This poor prognosis is largely attributed to a late-stage diagnosis. Recent advancements in metabolomics have emerged as a promising avenue for biomarker discovery in PDAC. This systematic review evaluates the potential of metabolite biomarkers for early detection of PDAC. Four studies meeting the inclusion criteria were analyzed, encompassing experimental, case-control, and prospective cohort designs. Key findings include the identification of distinct metabolic subtypes in PDAC with varying sensitivities to metabolic inhibitors. A biomarker signature comprising nine metabolites plus CA19-9 showed high accuracy in distinguishing PDAC from chronic pancreatitis, outperforming CA19-9 alone. Another study identified a five-metabolite signature demonstrating high diagnostic accuracy for pancreatic cancer, differentiating it from type 2 diabetes mellitus. A two-metabolite model (isoleucine and adrenic acid) showed superior performance in detecting stage-I PDAC compared to CA19-9. These studies consistently demonstrate altered metabolic pathways in PDAC patients compared to healthy controls and those with benign pancreatic conditions. Integrating metabolomic data with other molecular profiling approaches has become a powerful strategy for improving diagnostic accuracy. However, challenges remain, including the influence of confounding factors, the need for large-scale validation studies, and the standardization of metabolomic methods. The potential of artificial intelligence in interpreting complex metabolomic data offers promising avenues for future research. This review highlights the significant potential of metabolite biomarkers in early PDAC detection while emphasizing the need for further validation and refinement of these approaches., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Eze-odurukwe et al.)

Salivaomics has emerged as a ground-breaking field in the detection and management of oral cancer (OC), offering a non-invasive, efficient, and patient-friendly alternative to traditional diagnostic methods. This innovative approach leverages the comprehensive molecular insights provided by genomics, transcriptomics, proteomics, metabolomics, and microbiomics. The potential of salivaomics lies in its ability to enable early detection, predict malignant transformation, and monitor treatment outcomes and disease recurrence. Advancing salivary diagnostics necessitates the standardization of saliva collection and processing protocols, identification and validation of robust biomarkers, and development of cutting-edge detection technologies. A single biomarker is unlikely to fulfill all diagnostic requirements; thus, research should focus on developing a panel of biomolecules to enhance diagnostic accuracy and management of OC. Salivaomics stands at the forefront of non-invasive diagnostic methods, with the promise to revolutionize early detection and management of OC. Future research directions should emphasize the integration of multi-omics data for superior biomarker discovery, the development of portable and cost-effective point-of-care devices, and the fostering of interdisciplinary collaborations to drive innovation. Overcoming these challenges will facilitate the translation of salivaomics into routine clinical practice, significantly improving early diagnosis, treatment, and prognosis of OC. This review provides a comprehensive overview of salivaomics, detailing the use of saliva as a diagnostic fluid. It covers saliva collection, preparation, transportation, storage methods, and various analytical techniques. Additionally, the review discusses the current challenges and future directions of this transformative technology, emphasizing its potential to enhance clinical outcomes in OC., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Suragimath et al.)

Osteoarthritis (OA) is a prevalent degenerative joint disease that significantly impacts mobility and quality of life (QoL). Exercise interventions, including aerobic training, resistance exercises, and multimodal programs, are widely recommended for managing symptoms. This systematic review and meta-analysis aimed to evaluate the effectiveness of various exercise interventions on pain, physical function, and QoL in individuals with knee and hip OA. A comprehensive search of five databases identified 12 studies involving 4,920 participants. The results revealed that Tai Chi and Baduanjin Qigong benefited older adults, while aerobic training was more effective for younger individuals. Additionally, combining diet with exercise produced the highest effect size (standardized mean difference: 0.70, 95% CI: 0.55-0.85). Personalizing exercise programs based on patient characteristics is essential for achieving sustained improvements. Future research should focus on strategies to enhance long-term adherence and develop standardized guidelines to optimize outcomes for individuals with OA., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nayab et al.)

A 59-year-old woman developed sudden dyspnea after taking non-steroidal anti-inflammatory drugs (NSAIDs) for epigastralgia. She had a history of bronchial asthma after childbirth. Computed tomography showed bilateral peripheral bronchial wall thickening, lumen narrowing, obstruction, and circumferential lower esophageal mucosal edema. The patient was diagnosed with aspirin-exacerbated respiratory disease (AERD), a hypersensitivity reaction. Respiratory symptoms improved with intravenous dexamethasone. Endoscopy confirmed lower esophageal mucosal edema; mucosal biopsy detected eosinophilic infiltration, suggesting eosinophilic esophagitis (EoE). Although EoE is often diagnosed after AERD, the patient was simultaneously diagnosed with AERD and EoE after taking NSAIDs. Thus, EoE should be considered as a potential comorbidity when AERD develops after NSAID administration for abdominal symptoms., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kakehi et al.)

Fractures of the trochanteric mass represent a significant proportion of hip fractures. These fractures often occur in the elderly due to compromised bone quality, leading to a high predisposition for instability at the fracture site. The study was conducted through a retrospective analysis of 1,259 hospitalizations in the Department of Orthopedics and Traumatology of the Bucharest University Emergency Hospital between 2022 and 2023, including patients with various types of trochanteric mass fractures: basicervical, per trochanteric, intertrochanteric, subtrochanteric, and trochanter-diaphyseal fractures. In the selection process, 59 patients who met the specific inclusion criteria for the study were chosen. The study population included 59 patients selected based on the afore-mentioned inclusion and exclusion criteria. For these patients, the demographic and clinical data revealed the following: the age of the patients varied between 26 and 91 years, with a mean of 74.69 years, a median of 80 years, and a standard deviation of 14.94 years. The first quartile was at 71 years, and the third quartile was at 84.5 years, resulting in an interquartile range of 13.5 years. The article aims to study prognostic factors for the risk of cut-out in the surgical treatment of unstable trochanteric fractures. A systematic evaluation of patient characteristics, fracture types, and surgical treatment options could establish the relevant factors in predicting the occurrence of cut-out. The results of this research have the potential to facilitate clinical decision-making, optimize treatment strategies, and improve outcomes for patients with unstable trochanteric fractures undergoing surgery., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of University Emergency Hospital Bucharest issued approval 40550. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of University Emergency Hospital Bucharest. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Iordache et al.)

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare autoimmune disorder that typically presents with neuropsychiatric symptoms and medial temporal lobe involvement. We report the case of a 24-year-old female with no significant medical history, who developed severe anxiety, memory deficits, and confusion over a two-week period. Neurological examination revealed cognitive dysfunction, asymmetric limb movements, and psychosis. MRI showed bilateral medial temporal lobe hyperintensities, more pronounced on the left, and CSF analysis confirmed elevated protein levels and positive anti-NMDA receptor antibodies. Treatment with high-dose corticosteroids and intravenous immunoglobulin led to significant improvement within three weeks, with a follow-up MRI showing a reduction in lesion size. This case underscores the importance of early diagnosis, particularly when atypical presentations, such as asymmetric temporal lobe involvement, are observed. Awareness of this condition, especially in young women, is critical for timely intervention and management, given its potential association with ovarian teratomas., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fatima et al.)

This study evaluated the comparative efficacy of different beta blockers bisoprolol, carvedilol, and metoprolol in reducing mortality and hospitalizations among 120 heart-failure (HF) patients. The sample had an equal gender distribution (50% male, 50% female) with a mean age of 69.28 years. Baseline characteristics, such as systolic blood pressure (mean: 134.36 mmHg) and left ventricular ejection fraction (LVEF) (mean: 40.24%), were comparable across the treatment groups. Patients were treated with either bisoprolol (30%), carvedilol (30%), or metoprolol (40%) for an average of 27.54 weeks. The study utilized Poisson and negative binomial regression models to assess hospitalization rates, and chi-square tests to compare mortality outcomes. Results revealed that mortality was 44.2% across the entire cohort, with no significant differences between the three beta-blocker groups (p = 0.301). Similarly, no significant differences were observed in hospitalizations (p = 0.276) or ICU admissions (p = 0.797). However, patients on bisoprolol and carvedilol exhibited a slight improvement in New York Heart Association (NYHA) class and LVEF, though this was not statistically significant (p = 0.145 and p = 0.477, respectively). Side effects, including bradycardia, fatigue, and hypotension, were noted in 32.5%, 21.7%, and 23.3% of patients, respectively. These findings suggest that all three beta blockers are similarly effective in reducing mortality, though bisoprolol and carvedilol may offer better control of HF symptoms., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of Abbas Institute of Medical Sciences issued approval No: 8718/AIMS/2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: We would like to acknowledge the contributions of the following individuals: Salman Habib Roghani for his leadership in the study's design, conceptualization, and manuscript preparation. Dr. Sanaullah Khan for his expertise in general medicine and his contributions to the clinical aspects, data collection, and analysis. Aatika Shafiq for her input on study design and clinical observations. Amna Akbar for her role in patient coordination, fieldwork, and manuscript preparation. Waqar Mustafa for assisting with data collection and analysis. Syed Qamber Ali Shah for his expertise in general medicine and his contributions to the overall study supervision. Marriam Khan Jr. for her assistance with data analysis and manuscript revisions. Hasnain Ali for his contributions to data collection, patient management, and manuscript revisions. ., (Copyright © 2024, Roghani et al.)

Non-gestational choriocarcinoma is an extremely rare and highly aggressive malignant tumor that arises independent of gestational events, making less than 0.6% of all ovarian germ cell tumors. Unlike the more common gestational choriocarcinoma, which is associated with pregnancy, non-gestational choriocarcinoma originates from germ cells within the ovary. It accounts for a small fraction of ovarian malignancies and is often characterized by elevated levels of serum beta-human chorionic gonadotropin (β-HCG). The rarity and clinical overlap with other ovarian tumors pose significant diagnostic challenges, necessitating a thorough histopathological and immunohistochemical examination for accurate diagnosis. A 39-year-old female presented with a two-week history of right-sided migraine and general malaise, followed by a three-day onset of vision loss in the right eye. Initial evaluation in the emergency department included a chest X-ray, which revealed a 10 cm rounded opacity in the upper lobe of the left lung. A CT scan of the head showed a 4.5 cm rim-enhancing lesion in the left occipital lobe, along with a left middle cerebral artery (MCA) aneurysm. Notably, her serum β-HCG levels were significantly elevated at 5,642 mIU/mL despite the absence of intrauterine or extrauterine pregnancy on abdominal and pelvic ultrasound. Further workup included a CT thorax and MRI of the brain, which confirmed the isolated lung mass and left occipital lobe mass with no other sites of disease, leading to her transfer to the neurosurgery department. The patient underwent a left occipital craniotomy with tumor resection. Histopathological analysis confirmed the diagnosis of choriocarcinoma. Chromosomal analysis showed no evidence of the Y chromosome and confirmed the non-gestational origin of the choriocarcinoma. This case report discusses the non-specific presentation, radiological features, current treatment options, and potential safety strategies for managing this rare condition., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gafar et al.)

This systematic review evaluates the impact of trauma care and emergency preparedness training programs on prehospital primary survey effectiveness. A comprehensive search strategy was employed across multiple databases, including PubMed, Cochrane Library, Embase, and the Cumulated Index to Nursing and Allied Health Literature (CINAHL), focusing on studies involving healthcare professionals such as paramedics, nurses, and emergency medical technicians (EMTs). The review included randomized controlled trials (RCTs), clinical trials, and cohort studies that assessed various training modalities like virtual reality (VR) simulations, case-based learning (CBL), and hands-on workshops. Quality assessment was performed using the Cochrane risk-of-bias (RoB) tool for randomized trials and the Newcastle-Ottawa Scale (NOS) for clinical trials, ensuring methodological rigor and consistency. The findings suggest that CBL significantly improves knowledge retention and prehospital primary survey skills, outperforming other methods such as simulation exercises, which showed mixed results. VR training increased confidence levels but did not demonstrate significant improvements in objective skills compared to traditional methods. The use of supplementary triage assistance teams (physician-nurse supplementary triage team (MDRNSTAT)) was found to be effective during high patient volume hours, though not cost-effective as a daytime strategy. While the review highlights the importance of interactive and scenario-based training programs, limitations such as variability in study designs, publication bias, and language bias were noted, suggesting that caution should be exercised in generalizing the results. Future research should focus on long-term effectiveness, the integration of emerging technologies, and larger, well-designed trials across diverse healthcare settings to strengthen the evidence base., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sajid et al.)

Background Obstructive sleep apnea (OSA) is a common sleep disorder that's characterized by episodes of a complete or partial collapse of the upper airway with an associated decrease in oxygen saturation or arousal from sleep. According to the American Academy of Sleep Medicine (AASM), OSA is categorized based on polysomnography findings into mild, moderate, and severe. Objectives This study aims at determining the prevalence of the severities of OSA in Erbil, Kurdistan Region of Iraq, as well as discovering the predictors for severe OSA. Methods This was a cross-sectional study that was carried out from December 2021 to July 2023 on patients displaying OSA symptoms in a sleep study section of a private clinic in Erbil, Kurdistan Region of Iraq. A detailed questionnaire was designed to collect the data, and IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze it. The polysomnography device used for the diagnosis of OSA was a Philips Respironics Alice NightOne home device, and Philips Respironics Sleepware G3 (Koninklijke Philips N.V., Amsterdam, Netherlands) was used to analyze the sleep data. Results A sample size of 328 OSA cases was analyzed. The results revealed a prevalence of 47% (155) for severe OSA. Apnea-hypopnea index (AHI) was negatively correlated with lowest and average oxygen saturation, while it was positively correlated with time spent with oxygen saturation under 89%, body mass index (BMI), and weight of the participants. Furthermore, stepwise multiple regression tests revealed BMI, age, gender, and heart failure as independent predictors for AHI. Conclusion This study highlights the links between OSA and various chronic health conditions. Furthermore, it underscores the importance of factors like age, obesity, and gender in influencing OSA severity. The identification of predictors for OSA severity can assist in risk assessment and personalized interventions., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Dr Shwan's Cardiology Clinic's Ethics Committee issued approval 1105. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Amen et al.)

Adult-onset Still's disease (AOSD) is an uncommon systemic inflammatory disorder that presents with diverse, overlapping symptoms, complicating the diagnostic process due to its nonspecific clinical features and the absence of a definitive diagnostic test. Diagnosis is often challenging and relies on excluding other conditions while maintaining a high index of suspicion, supported by specific diagnostic criteria such as Yamaguchi or Fautrel. Prompt recognition and a multidisciplinary approach are essential, as AOSD can progress to life-threatening multiorgan dysfunction due to a hyperinflammatory response. We report the case of a 58-year-old male car mechanic with no prior medical history who presented with a three-month history of persistent fever, bilateral hip pain, and systemic symptoms. On examination, he was febrile (39.4°C) with tachycardia, tachypnea, and elevated inflammatory markers with eosinophilia. Despite a comprehensive workup, including imaging and broad-spectrum antibiotics, his condition progressed, marked by the emergence of a characteristic salmon-pink rash, altered mental status, and persistent fever. Significant findings included markedly elevated ferritin levels (43,980 ng/mL), normal creatine kinase, negative autoimmune markers, and PET-CT revealing fluorodeoxyglucose (FDG)-avid intramuscular sites. A muscle biopsy demonstrated perivascular lymphocytic infiltration. A diagnosis of AOSD was established, and high-dose corticosteroids were initiated, leading to initial improvement. However, the patient developed complications, including acute kidney injury, steroid-induced diabetes, resistant hypertension, and cardiopulmonary symptoms, eventually succumbing to acute respiratory failure six weeks post-discharge. This case underscores the severe potential trajectory of AOSD and the complex diagnostic and therapeutic challenges associated with its management., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tariq et al.)

Objective This study aimed to evaluate the role of 2-Deoxy-D-Glucose (2-DG) in moderate to severe Coronavirus Disease 2019 (COVID-19) cases. Methodology This study retrospectively analyzed the effects of 2-DG alongside Standard of Care (SOC) for moderate to severe COVID-19 in 150 patients. Eligible patients were aged 18-65, with confirmed COVID-19, who met clinical criteria for moderate or severe illness. Data collected included demographics, clinical status, treatment details, and outcomes, evaluated using the WHO's 10-point scale. The primary outcome measured was time to clinical improvement, with secondary outcomes including duration of oxygen supplementation, length of hospital stay, and viral clearance. Data analysis employed the Cox proportional hazard model, with significance at p < 0.05. Results In the study, initial oxygen saturation levels upon admission were similar between groups, averaging 92.6% in the 2-DG with SOC group and 91.8% in the SOC-only group (p = 0.97). The WHO ordinal scores, pulse, and respiratory rates improved significantly in the 2-DG group across multiple intervals. Oxygen supplementation needs to be decreased notably, with 2-DG patients requiring an average of 5.1 L/min by Day 5, showing significant reductions compared to the SOC group. The time to clinical improvement and length of hospital stay were also shorter in the 2-DG group (5.2 days vs. 7.5 days; 8.5 days vs. 10.5 days, respectively; p < 0.001). Adverse events were less frequent in the 2-DG group (6.7% vs. 13.3%, p = 0.03). Conclusion In conclusion, 2-DG demonstrates significant efficacy as an adjunct therapy for moderate to severe COVID-19, reducing both time to clinical improvement (5.2 vs. 7.5 days, p < 0.001) and hospital stay duration. Additionally, fewer adverse events were reported, and viral clearance rates were higher in the 2-DG group. These findings highlight 2-DG's potential to improve clinical outcomes in COVID-19 care., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sandepogu et al.)

Pott's disease (PD), also known as spinal tuberculosis, accounts for an extremely low percentage of all tuberculosis (TB) cases and typically manifests secondary to an extra-spinal infection through the hematogenous spread. The thoracolumbar vertebrae are the most affected sites in PD, although other spinal regions can also be involved, albeit less frequently. Back pain is the predominant presenting symptom. Systemic symptoms such as fever and weight loss may occur in PD but are more commonly observed in patients with disseminated disease or concurrent extra-spinal TB. This report presents the case of a 26-year-old Asian woman, born outside the United Kingdom, with no significant past medical history or recent travel to TB-endemic areas, who was diagnosed with spinal TB following a series of medical evaluations. MRI of the spine revealed findings highly suggestive of tuberculous spondylitis. She is currently undergoing treatment and showing significant improvement. This case underscores an atypical patient profile for spinal TB, highlighting the necessity for awareness and consideration of this diagnosis even in unusual patient demographics., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aung et al.)

Fishing is a popular recreational activity worldwide, but complications arise when fishhooks become embedded in the skin. Barbed hooks, due to their design, are particularly challenging to remove. While many individuals attempt self-extraction, some present to emergency departments for medical intervention. Several techniques, including the push-through and needle methods, are commonly employed for hook removal. The String-Yank technique, a simple yet effective approach, is frequently overlooked in clinical settings despite its wide use among fishermen. This case report demonstrates the string-yank technique in a 42-year-old male patient who presented with a 1.5-cm barbed hook embedded in his right little finger. After local anesthesia with lidocaine, the string-yank technique was performed, allowing for the rapid, painless removal of the hook without complications. Post-procedural care included wound disinfection and infection prevention counseling. The string-yank technique offers a minimally invasive, low-pain option for fishhook removal, particularly in superficial injuries. However, its application may be limited in cases of complex injuries or larger hooks. This report aims to provide a clear, step-by-step guide for this underutilized method, emphasizing its benefits in emergency care., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Watari et al.)

The United Kingdom, particularly Scotland, is a key destination for international medical graduates (IMGs), who now make up a substantial part of the National Health Service (NHS) workforce. These IMGs encounter several challenges when integrating into the NHS, with language barriers being especially significant. Although many IMGs are educated in English, they frequently struggle with the intricacies of Scottish languages and dialects, which are vital for good patient care. This review examines Scotland's linguistic environment, focusing on the roles of Gaelic and Scots languages in cultural distinctiveness and patient communication. By means of a literature review and focus group interviews with IMGs, the authors ascertained commonly utilised Scottish colloquialisms and their connotations, highlighting their importance in clinical contexts. The findings indicate that comprehending such colloquialisms can greatly improve doctor-patient communication, decrease misunderstandings, and enhance health outcomes. The article advocates for the formulation of formal training programs to better equip IMGs for the linguistic challenges they will encounter, thus improving their assimilation into the NHS and enhancing patient care. While the Scottish Government's efforts to support international recruitment and workforce assimilation have been exemplary, there remains a pressing need for targeted language orientation to close the communication gap and warrant high-quality healthcare delivery., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Kamali et al.)

Traumatic brain injury (TBI) is a major global health concern, contributing significantly to mortality and long-term disability. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated potential in reducing mortality in trauma patients, but its specific efficacy and safety in TBI management remain under investigation. This systematic review and meta-analysis aim to evaluate the efficacy and safety of TXA in patients with TBI by synthesizing data from randomized controlled trials (RCTs). A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases about the studies conducted from January 2005 up to December 10, 2022. Eligible studies included RCTs involving TBI patients of any age, where the experimental group received TXA, and the control group received a placebo. The primary outcome was total mortality, focusing on the overall survival impact of the intervention. Secondary outcomes included the need for neurosurgical intervention, pulmonary embolism, myocardial infarction, deep venous thrombosis (DVT), and stroke. Data were pooled using the DerSimonian-Laird random-effects model, with heterogeneity evaluated using the Cochrane Q test and I² statistic. Twelve RCTs encompassing 37,482 participants met the inclusion criteria. TXA administration was associated with a significant reduction in total mortality (relative risk (RR) 0.95, 95% confidence interval (CI) 0.90-0.99, P=0.002) compared to placebo, without increasing the risk of thromboembolic events such as DVT (RR 1.07, 95% CI 0.73-1.57, P=0.58) and pulmonary embolism (RR 0.97, 95% CI 0.78-1.22, P=0.82). The analysis showed no significant differences between the TXA and placebo groups concerning the need for neurosurgical intervention, incidence of myocardial infarction, or occurrence of stroke. Additionally, the studies demonstrated low to moderate heterogeneity across the assessed outcomes, indicating consistent findings regarding the treatment intervention and its associated complications. In conclusion, TXA significantly reduces total mortality in TBI patients without elevating the risk of thromboembolic complications. These findings support the integration of TXA into acute TBI management protocols, especially in settings requiring rapid intervention. Nevertheless, further research is necessary to optimize dosing regimens and administration timing and to assess the long-term functional outcomes associated with TXA use in TBI patients., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Meer et al.)

Infective endocarditis (IE) primarily affects the endocardium of the heart valves. One of the common neurological complications of IE is the embolization of endocardial vegetation, which can obstruct the cerebral arteries. We describe the case of a 47-year-old male patient who developed neurological symptoms as a complication of IE. Abiotrophia defectiva , a nutritionally altered  Streptococcus , was identified in his blood culture. Treatment of both neurological and vegetative complications is often challenging and necessitates the involvement of a multidisciplinary team. Given the high mortality rate associated with these complications, the diagnosis of IE should be taken into consideration for individuals presenting with fever and neurological abnormalities., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chinnaraj et al.)

Edema can usually be classified as either systemic (bilateral) or localized (unilateral). Lymphoma-associated leg edema is generally bilateral; there have been several reports of patients presenting with unilateral edema due to unilateral vascular compression. We describe a case of diffuse large B-cell lymphoma (DLBCL) initially presenting with unilateral edema, which rapidly developed into bilateral edema over two weeks due to vascular compression., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shimada et al.)

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a promising class of medications for type 2 diabetes (T2D) management. While their glucose-lowering effects are well-established, their long-term impact on cardiovascular outcomes remains a subject of ongoing research and debate. This systematic review aims to assess the long-term cardiovascular effects of GLP-1 RAs in adults with T2D compared to placebo, standard care, or other glucose-lowering medications. We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies published from database inception to April 2024. Two independent reviewers screened the studies and extracted the data. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. Secondary outcomes included individual components of MACE, hospitalization for heart failure, and all-cause mortality. We included 15 studies (eight RCTs and seven observational studies) involving over 180,000 participants. GLP-1 RAs were associated with a significant reduction in MACE compared to placebo or standard care (risk ratio: 0.88, 95% CI: 0.82-0.94, p<0.001). GLP-1 RAs also demonstrated superior cardiovascular protection compared to DPP-4 inhibitors and sulfonylureas. The benefits were particularly pronounced in reducing the risk of stroke and MI. Notably, some studies found larger cardiovascular benefits in frail patients. The effects on heart failure outcomes were mixed, with potential attenuated benefits in patients with baseline heart failure. GLP-1 RAs also showed promising effects on renal outcomes and metabolic parameters. The quality of evidence ranged from moderate to high across outcomes. This systematic review provides strong evidence that GLP-1 RAs offer significant cardiovascular benefits in adults with T2D, particularly in reducing MACE, stroke, and MI. The findings support current guidelines recommending GLP-1 RAs as preferred agents in patients with established cardiovascular disease or high cardiovascular risk. However, the variability in effects across different patient subgroups underscores the need for personalized treatment approaches. Future research should focus on head-to-head comparisons between different GLP-1 RAs, long-term follow-up studies, and investigation of combination therapies to further optimize the use of these agents in clinical practice., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tariq et al.)

Systemic lupus erythematosus (SLE) is an autoimmune disorder with a complex clinical course and diverse presentations. The immunopathogenesis of SLE has long intrigued physicians and researchers. Despite its extensive global prevalence, there is no specific treatment to prevent and treat SLE, and in the majority of SLE patients, the management involves controlling disease remissions and symptom reactivations or flares. SLE patients suffer from damage to different organs of the body, complicating disease management. They are predisposed to infectious diseases that could contribute to enhanced disease progression. Devising effective management strategies requires a comprehensive understanding of the effects of the disease and its influence on the immune system. SLE affects females more frequently than men. However, male SLE patients often suffer from more severe disease than females. Gender variations have also been noted in clinical manifestations in patients with SLE. In light of this, additional research is needed to understand these variations and promote the progress of gender-specific patient management and treatment strategies. This review aimed to compare the influence of gender on the clinical consequences, immunopathogenesis, and associated consequences between male and female SLE patients. An extensive literature search was conducted to collect relevant data. PubMed, MEDLINE, Embase, and Google Scholar were searched from inception to the present for articles that compared clinical outcomes and associated disorders in terms of gender among SLE patients. We also explored the immunopathogenesis, mechanisms underlying gender-based clinical effects of SLE, and infectious disease-related consequences. Additionally, we provide key updates regarding the treatment and management of SLE., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Varaganti et al.)

This report describes a rare presentation of atypical hemolytic uremic syndrome with multi-system involvement, including unilateral blindness and stroke. Only a few cases of atypical hemolytic uremic syndrome with unilateral blindness as a presentation have been reported and all have been attributed to central retinal artery obstruction (CRAO). This is the first described case to our knowledge of atypical hemolytic uremic syndrome presenting with unilateral blindness, which was caused by grade four hypertensive retinopathy., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Girdhar et al.)

Background: Adherence to antiretroviral therapy (ART) is the most important factor in the management of human immunodeficiency virus (HIV). This study examines the level of nonadherence to ART and the predictors of interventions to improve ART adherence in Jharkhand, a state with a predominance of tribes., Methods: The present study was conducted at the ART center, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand. As it represents most patients from the state and was easily accessible to us, this center was taken as the study site. Considering ART intake, 30 tribal and 30 non-tribal patients were selected. All patients' baseline data was taken from the center and follow-up visits were done at their homes. Information regarding sociodemographic profile, ART regimen, adherence to ART, and reasons for nonadherence was collected. The interviews were recorded on audiotape, transcribed, and translated verbatim. We used a thematic approach to analyze the data., Results: In our study, the prevalence of ART at the RIMS ART center was 21.7%, and the causes of non-adherence were asked in depth. The most common reason for nonadherence to treatment was the traveling distance and cost incurred in travel., Conclusion: Comprehensive research can provide valuable insights into the reasons behind nonadherence and help develop targeted interventions to promote adherence. Some incentives can be provided along with treatment to cover long-distance travel expenses and loss of wages. Delivery of drugs to ART centers can be more regularized., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Rajendra Institute of Medical Sciences, Ranchi issued approval 65, dated May 21, 2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: The study received funding from the Jharkhand State AIDS Control Society, Ranchi. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

In this case report, we present a 24-year-old woman with a previous diagnosis of epilepsy who was admitted to the hospital following loss of consciousness (LOC). It was initially assumed that this was an epileptic seizure based on her previous diagnosis of epilepsy; however, a review of her electrocardiograms (ECGs) revealed a prolonged QT interval. She was admitted to the cardiology ward for continuous ECG monitoring and subsequently developed self-limiting torsades de pointes (TDP). A diagnosis of congenital long QT syndrome (LQTS) was established, her anticonvulsant treatment was withdrawn, and she was managed with nadolol, mexiletine, and an implantable cardioverter defibrillator (ICD). This case underscores the importance of excluding cardiac disease with secondary anoxic seizures in patients with apparent epilepsy and in particular the need for all patients to have a baseline 12-lead ECG as part of their initial assessment., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Irhouma et al.)

Renal cell carcinoma (RCC) of the clear cell type is the most common form of renal malignancy. Malignant pleural effusion (MPE) as the initial presentation of RCC is very rare. This case report presents a case of RCC that initially manifested as a pleural effusion, without the typical symptoms of flank pain, hematuria, or a palpable abdominal mass. The patient, a 45-year-old male, arrived with complaints of dyspnea and a dry cough, with no notable medical history or risk factors. Imaging revealed a left-sided pleural effusion, which was identified as MPE based on pleural fluid analysis, cytology, and immunohistochemistry. Subsequent investigation revealed a large, solid cystic mass in the left kidney, with a biopsy confirming RCC. Uniquely, the patient exhibited pleural metastasis without involvement of the lung parenchyma, a rare scenario in RCC that is linked to a poor prognosis. This case emphasizes the variable presentation of RCC and the need to consider malignancy in patients with unexplained pleural effusion. An indwelling pleural catheter was placed for the patient considering the poor prognosis; furthermore, he declined to undergo sessions of palliative chemotherapy and was subsequently lost to follow-up., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Patil et al.)