ASIDE Internal Medicine is published and owned by the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE), 16192 Coastal Highway, Lewes, Delaware 19958, USA. ASIDE Internal Medicine, a cornerstone publication of the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE), is dedicated to advancing the fields of internal medicine and its subspecialties through a lens of diversity, equity, and inclusion. This peer-reviewed, open-access journal publishes a wide range of research articles, reviews, and clinical studies that focus on innovative healthcare solutions, the impact of social determinants on health outcomes, and strategies for enhancing accessibility to medical services for marginalized populations. With a commitment to fostering a more inclusive healthcare environment, the journal serves as a pivotal platform for medical professionals, researchers, and educators worldwide to share insights and discoveries that can lead to more equitable health practices and policies. ASIDE Internal Medicine: ISSN (Print) 3065-9671, ISSN (Online) 3065-968X Publication Frequency: Quarterly (4 issues per year). Accepted articles may be published online before assignment to a regular issue. The online publication date represents the official first publication date. When articles are later assigned to a regular issue, the article record is updated with the final volume, issue, and pagination or article identifier. The DOI remains unchanged.
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Fatal Septic Shock with Presumed Urinary Source in a Patient with Clinically Suspected, Previously Undiagnosed Von Hippel–Lindau Disease: A Case Report and Literature Review
Section: Case Report Categories: Internal Medicine, Hematology Keywords: Array, Array, Array, Array, Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Von Hippel-Lindau disease is a rare form of autosomal dominant cancer syndrome that affects multiple organs, such as the retina and brain hemangioblastoma, renal disease, and other visceral malignancies. Delayed diagnosis is a significant reason for avoidable mortality and morbidity. Case Presentation: We present a case of a 47-year-old male presenting with fever, vomiting, hypotension, and pus discharge from his urethral catheter, developing into septic shock with multiple organ dysfunction syndrome. He had several decades of progressive symptoms clinically compatible with possible VHL syndrome, consisting of bilateral blindness secondary to globe enucleations performed since childhood, multifocal spinal cord lesions resulting in quadriparesis and neurogenic bladder, and a family history of retinoblastoma, brain tumors, and renal lesions. MRI of the spine showed extensive multifocal intramedullary enhancing lesions, from the cervicomedullary junction to T11, associated with dilated cord due to cystic changes, compression of the posterior medulla leading to obstructive hydrocephalus, and an occipital lesion. These findings favored multiple spinal hemangioblastomas. A corticomedullary cyst of the right kidney was seen. Despite intensive supportive therapy and appropriate broad-spectrum antibiotics, he succumbed to septic shock complicated by a presumed urinary source on hospital day 4. Conclusion: This particular case illustrates the potential of unidentified genetic tumors resulting in significant neurological problems and infections leading to death. Early detection of multifocal hemangioblastomas and retinal problems can lead to early identification of patients at risk of developing VHL disease.
Copyright (c) 2026 Talha Khan, Hasnain Wajeeh Saqib, Syed Tahir Hussain , Ahmad Mustafa Butt, Muhammad Hassaan Javaid, Awais Hussain Kazim, Aqsa Ibrahim , Saif Ali Khan , Noor Ül-Izza, Abdullah Abbas https://creativecommons.org/licenses/by/4.0
Psychological Burden in Behçet Disease: A Narrative Review Across Mucocutaneous, Articular, and Ocular Manifestations
Section: Review Article Categories: Internal Medicine, Neurology Keywords: Array, Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Behçet disease is a chronic, relapsing, multisystem inflammatory vasculitis in which mucocutaneous, articular, and ocular manifestations may coexist with substantial psychological burden. Methods: This narrative review synthesized English-language literature identified through structured searches of PubMed/MEDLINE, Scopus, and Google Scholar, supplemented by reference-list screening. Searches were updated through 31 January 2026 and focused on depression, anxiety, stress, fatigue, sleep disturbance, and quality-of-life outcomes in non-neuro-Behçet contexts. Results: The available literature suggests that depression and anxiety are frequent in Behçet disease and are associated with disease activity, pain, fatigue, sleep disturbance, and reduced quality of life. Mucocutaneous symptoms may contribute through pain, visible lesions, embarrassment, and impaired self-image; articular involvement through pain, stiffness, fatigue, and reduced mobility; and ocular disease through visual threat, repeated treatment, and impaired visual function. Sleep disturbance, fatigue, and reduced quality of life are closely interrelated and appear to amplify overall psychosocial burden. Conclusions: Psychological burden is an important dimension of Behçet disease. Although direct evidence for a rigorously defined combined mucocutaneous-articular-ocular phenotype remains limited, the current literature supports a converging burden model across these domains.
Copyright (c) 2026 Ahmed Ismael, Ahmed Mabrouk, Mahmoud Zeinhom Ramadan, Hussein Eldamery, Assem Amer, Mohamed Fouad M Ragab, Sherif Helal, Elsadek Helal E. Mahdi, Sherin A Ghaith, Mahmoud M Saber Abdelwahed, Mohammad M. Badran, Ashraf E.M. Ebaid https://creativecommons.org/licenses/by/4.0
Community-Based Harm Reduction Programs for Opioid Use Disorder: A Narrative Systematic Review of Effectiveness, Implementation Barriers, and Policy Implications
Section: Review Article Categories: Public Health Keywords: Array, Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: This systematic review synthesizes evidence on community-based harm reduction programs and their role in addressing the opioid crisis. Methods: A narrative synthesis was conducted of 78 studies published between January 2012 and April 2023; meta-analysis was precluded by heterogeneity across interventions, populations, and outcomes. Eligible designs included quantitative observational studies, qualitative/mixed-methods studies, program evaluations, and existing systematic/scoping reviews. Interventions examined included syringe service programs (SSPs), overdose education and naloxone distribution (OEND), overdose prevention centers (OPCs), drug-checking services, and low-barrier medications for opioid use disorder (MOUD). Outcomes included overdose mortality, infectious disease transmission, treatment linkage, and feasibility/acceptability. Results: OEND scale-up was associated with reduced opioid overdose mortality at county and state levels. SSPs were consistently linked to reduced HIV and HCV transmission. OPCs reported no on-site fatal overdoses despite high volumes of supervised consumption. Integrated SSP-MOUD models improved MOUD initiation and retention, though association strength varied by setting and design. Combined approaches showed favorable cost-effectiveness. Persistent barriers included punitive paraphernalia laws, regulatory constraints, stigma, and rural service gaps. Conclusion: Key gaps remain in implementation science, longitudinal efficacy of newer interventions (OPCs, drug-checking), and stigma-reduction strategies. Policy implications include integrating harm reduction into mainstream health infrastructure via sustained funding, deregulation to expand providers, mobile/mail-based rural access, and public communication to build legitimacy. Across a heterogeneous evidence base, community-based harm reduction consistently associates with reduced overdose mortality and infectious disease burden. Translating this evidence into equitable, sustainable implementation remains the central challenge for public health policy and practice.
Copyright (c) 2026 Eloghosa Aisosaa Nosa-Ihaza, Ssembuusi Allan Francis https://creativecommons.org/licenses/by/4.0
Adjunctive Remotely Supervised tDCS in Multiple Sclerosis: A GRADE-Assessed Meta-analysis of Sham-Controlled Trials on Cognitive, Fatigue, Mobility, and Quality-of-Life Outcomes
Section: Review Article Categories: Neurology Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Multiple sclerosis (MS) is an immune-mediated disorder characterized by demyelination within the central nervous system, resulting in fatigue, pain, cognitive dysfunction, and motor impairment. Remotely supervised transcranial direct current stimulation (RS‑tDCS) is a noninvasive, low-cost, home-based intervention that modulates neuronal excitability and enhances neural network function, potentially benefiting individuals with MS. This meta-analysis aimed to evaluate the efficacy of RS‑tDCS in MS. Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) evaluating RS‑tDCS in MS. The primary outcome was information‑processing speed. Statistical analyses were performed using R software (version 4.5.0) and a random‑effects model to calculate pooled standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane ROB‑2 tool. Results: Five RCTs, most featuring co-interventions alongside RS-tDCS in both study arms and one specifically targeting MS patients with cannabis use disorder, including 291 participants, were analyzed. Active RS‑tDCS did not significantly improve information‑processing speed (SMD = 0.20; 95% CI: –0.06 to 0.45; P = 0.13, n studies: 4). No significant effects were observed for secondary outcomes. Conclusion: Evidence from five heterogeneous RCTs, predominantly featuring co-interventions, shows no clear benefit of RS-tDCS for MS cognitive or functional outcomes (very low to low certainty). This highlights substantial uncertainty; larger standalone trials are required.
Copyright (c) 2026 Omar Khaled Abdelsalam, Mousa Almasalma, Ali Nagy Shelbaya, Ahmed Raja Albishti, Mohamed H. Khalil, Hamza Khelifa, Ahmed Abdelsalam, Asmaa Zakria Alnajjar https://creativecommons.org/licenses/by/4.0
Short-Term Changes in Hematologic Inflammatory Indices During Exenatide Therapy in Patients with Type 2 Diabetes Mellitus
Section: Original Article Categories: Endocrinology Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Inflammation plays an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and the development of complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used to treat T2DM. Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are simple biomarkers of inflammation. This study evaluated the effects of six-month exenatide therapy on these parameters. Methods: This single-center retrospective cohort study evaluated 100 adult patients with type 2 diabetes who initiated exenatide treatment and maintained a stable baseline treatment regimen for 6 months (no medication changes for at least 6 months). Clinical, biochemical, and blood count parameters were compared at the start of treatment (month 0) and at months 3 and 6. Results: At the start of treatment, patients' weight decreased from 111.1±24.4 kg to 104.7±20.8 kg after 6 months (p<0.001). Initial HbA1c values decreased from 68.6±20.3 mmol/mol (8.43±1.86%) to 60.9±16.1 mmol/mol (7.72±1.47%) at 6 months (p<0.001). NLR remained unchanged throughout the study, while PLR showed a transient increase at 3 months (p=0.03) but returned to baseline at 6 months. Furthermore, ALT values were significantly lower at 6 months compared to baseline (p=0.048). Conclusions: These findings suggest that exenatide therapy may be associated with improvements in metabolic parameters and a modest reduction in MPV. However, given the retrospective design and the lack of direct assessment of treatment adherence and persistence, these results should be interpreted with caution.
Copyright (c) 2026 Cigdem Cindoglu, Hüseyin Karaaslan, Nida Uyar, Ali Gökçe, Burcu Dikeç Gökçe, Mehmet Ali Eren https://creativecommons.org/licenses/by/4.0
Periprosthetic Joint Infection in Egypt: A Narrative Review of the Current Landscape and Knowledge Gaps
Section: Review Article Categories: Infectious Diseases Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Periprosthetic joint infection (PJI) is one of the most serious complications of total joint arthroplasty (TJA). This review synthesizes the available local evidence of PJI in Egypt to identify the current landscape and knowledge gaps in the Egyptian healthcare system. Methods: A literature review was conducted by searching PubMed, Scopus, and Google Scholar for studies on PJI in Egypt, with articles published up to January 2026. Search terms included "periprosthetic joint infection," "PJI," "Arthroplasty," and "Egypt." We included 9 primary studies for synthesis and excluded review papers. Results: This paper summarizes PJI studies from Egypt and highlights the limited existing knowledge, specific local issues, and gaps. Main findings were limited epidemiological data indicating that rates of PJI in a key study appear higher than in high-income countries, with Staphylococci as the most common organism across studies. Critical gaps exist in national epidemiological data, risk factors, patient demographics, the detailed microbiological spectrum and antimicrobial resistance patterns, as well as long-term patient outcomes, and standardized national guidelines for diagnosis and management. Conclusion: Based on this review, there is limited local evidence on many aspects of PJI in Egypt. Our proposed priorities include further research into the highlighted gaps, the establishment of a national registry, the development of multidisciplinary care models, standardized antimicrobial prescribing protocols, and the implementation of evidence-based national guidelines tailored to the Egyptian healthcare system.
Copyright (c) 2026 Asem Mohsen, Mostafa Alfishawy https://creativecommons.org/licenses/by/4.0
Long-Term Trends in Sepsis Mortality Among Older U.S. Adults with Chronic Kidney Disease, 1999–2023
Section: Original Article Categories: Infectious Diseases, Public Health Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Sepsis causes 1 in 3 U.S. hospital deaths, especially deadly among adults ≥65 with CKD, affecting over 30% of over-70s. Long-term trends in this group are understudied. This study examines the national mortality trends (1999–2023) among older U.S. adults with sepsis and CKD. Methods: We conducted a retrospective cohort study using the CDC WONDER database (1999–2023). Older adults with sepsis and CKD were identified using ICD-10 codes for sepsis (A40-41) and chronic kidney disease (N18). Mortality rates were stratified by geography and demographics. Age-adjusted mortality rates (AAMRs) per 100,000 and 95% confidence intervals were calculated. Annual percent change (APC) and average APC (AAPC) were derived using Joinpoint regression software to assess temporal trends. Results: Among 201,637 deaths from CKD and sepsis, 83.00% occurred in medical facilities. AAMRs rose from 14.45 (1999) to 20.68 (2023) (AAPC: 1.37%; 95% CI: 0.78-1.97). Men’s average AAMR (22.72) exceeded women’s (15.64). Non-Hispanic Whites had the highest AAPC, and Blacks had the highest AAMR. AAMRs were higher in metropolitan areas, with faster increases in non-metropolitan areas (available only for 1999-2020). The South had the highest average AAMR (19.94), while the Midwest recorded the steepest rise. Substantial variation in AAMRs was observed across U.S. states. Conclusion: Mortality involving sepsis among older adults with CKD increased between 1999 and 2023. Considerable demographic and geographic disparities were observed, underscoring the need for targeted interventions in high-risk populations.
Copyright (c) 2026 Umar Aziz, Roshni Riaz Memon, Muhammad Mussawir Khuhro, Huda Ahmed, Sarah Azhar, Hamama Waseem, Maryam Waqar, Muhammad Waaiz, Mominah Majid, Raveen Mujeeb https://creativecommons.org/licenses/by/4.0
Biomarkers in Hemophilia: Diagnostic, Prognostic, and Treatment-Selection Utility: A Narrative Review of the Literature
Section: Review Article Categories: Hematology Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Hemophilia A and B are inherited bleeding disorders in which outcomes are shaped by factor levels, inhibitor development, inter-individual pharmacokinetics, and progressive joint disease. With the emergence of extended half-life therapies, non-factor therapies, and gene therapy, there is an increasing need for biomarkers to support diagnosis, risk stratification, treatment selection, and monitoring. Methods: We conducted a narrative review of English-language studies indexed in PubMed, Scopus, Web of Science, and Google Scholar (January 2000 to October 2025). We prioritized primary studies, trials, registries, and assay-validation reports on diagnostic, prognostic, predictive, or monitoring biomarkers in hemophilia A/B; guidelines were used for context. Results: Established biomarkers include FVIII/FIX activity assays, inhibitor testing (Bethesda/Nijmegen-modified), F8/F9 genotyping, and imaging-based joint assessment. Emerging candidates include global hemostasis assays (thrombin generation, viscoelastic testing), PK/PD metrics for prophylaxis individualization, and exploratory inflammatory/angiogenic and tissue-turnover markers linked to arthropathy. Conclusions: Evidence for biomarkers in hemophilia is heterogeneous, and many non-traditional markers remain exploratory; standardized assays and prospective multicenter validation with clinically meaningful endpoints are needed before routine adoption. Limitation: This narrative synthesis was conducted in English and did not include a formal risk-of-bias assessment.
Copyright (c) 2026 Dalia Atef Abouda, Elsayed S. Moubarak, Fatma ElBadrawy , Malak A. Hassan, Mohamed Mohsen Helal, Abdallah M. Ibrahim , Hassan H. Eladl, Mohammad Mahadin , Mohamed Elsaid‎ https://creativecommons.org/licenses/by/4.0
Losartan Monotherapy vs Combination Regimens in IgA Nephropathy: A Systematic Review and Network Meta-analysis
Section: Original Article Categories: Internal Medicine Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: IgA nephropathy (IgAN) is a disorder in which Immunoglobulin A (IgA) antibodies build up, causing kidney damage. Losartan, an Angiotensin Receptor Blocker (ARB), has shown promise in patients with IgAN. However, a comparison of losartan with other IgAN therapies is missing. This study investigates the efficacy of losartan compared to different regimens. Methods: A systematic search of four electronic databases was conducted till January 2025. The study was registered in PROSPERO (CRD42025634499). Risk of bias assessment was performed using the ROB-2 tool. Results: The study included five RCTs in the quantitative analysis. Although losartan + temocapril ranked first in systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions at 12 months [surface under the cumulative ranking curve (SUCRA) = 97% and 86%, respectively], pairwise comparisons versus losartan were not statistically significant, so clinical superiority is uncertain. Additionally, compared to temocapril, losartan + temocapril and losartan demonstrated statistically significant reductions in SBP at 12 months. Regarding proteinuria reduction, none of the interventions demonstrated a statistically significant difference compared to losartan at 3 and 6 months. However, mizoribine and mizoribine + losartan showed a statistically significantly greater reduction in proteinuria than losartan at 12 months. Conclusions: Among patients with IgAN from East Asian cohorts, mizoribine and mizoribine + losartan best reduced proteinuria at 12 months. Regarding BP, losartan + temocapril best reduced SBP and DBP at 12 months. However, clinical superiority is uncertain, and estimates were imprecise due to limited power.
Copyright (c) 2026 Mohamed E. Haseeb, Hazem E. Mohammed, Anas Hussein Heiba, George Hanen, Nada Ali Omar Abd Elaziz, Mohamed Nasser https://creativecommons.org/licenses/by/4.0
Efficacy and Safety of Isotretinoin Plus Desloratadine versus Isotretinoin Alone for Acne Vulgaris: Systematic Review and Meta-analysis
Section: Original Article Categories: Internal Medicine Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Introduction: Acne vulgaris is a common inflammatory skin disorder affecting the sebaceous glands–rich areas, including the face, chest, and back. It typically arises during adolescence but can persist or appear in adulthood. Recent findings suggest that histamine, via H1 receptors on sebocytes, further contributes to inflammation and sebum secretion. Desloratadine, an H1 receptor antagonist, has anti-inflammatory effects and reduces sebum squalene levels, supporting potential as an adjunctive acne therapy. We assessed whether adding desloratadine to isotretinoin improves outcomes compared to isotretinoin monotherapy. Methods: Following PRISMA guidelines, we searched PubMed, Web of Science, and Scopus targeting randomized controlled trials (RCTs) comparing isotretinoin plus desloratadine versus isotretinoin alone. Eligible studies reported the Global Acne Grading System (GAGS) score, inflammatory lesion count, or non-inflammatory lesion count. Results were pooled and expressed as differences (MD) with 95% confidence intervals (CI). Results: Six RCTs, including 424 patients, met the inclusion criteria. Combination therapy demonstrated greater improvement in GAGS score (pooled MD −1.81, 95% CI [−2.52; −1.1], P < 0.00001). However, no significant differences were observed in inflammatory lesions (pooled MD 0.26, 95% CI [−1.01; 1.54], P = 0.68) or non-inflammatory lesions (pooled MD 0.30, 95% CI [−2.24; 2.84], P = 0.82). The addition of desloratadine to isotretinoin improved treatment efficacy and showed trends toward fewer flares and dry lips, although these differences did not reach statistical significance. Conclusion: Desloratadine appears to enhance the efficacy and tolerability of isotretinoin, supporting its position as a promising adjunctive therapy for acne management.
Copyright (c) 2026 Ahmed S Mohamed, Mazen Kafienah, Meena Rabi, Paul Fabian, Ali Gebril Ali, Mohamed Ali Abdel Rahman, Ayla Amjad, Eslam seddik https://creativecommons.org/licenses/by/4.0
HIV in Egypt: from Silent Emergence to Concentrated Epidemic - A Narrative Review of Past, Present and Future
Section: Review Article Categories: Infectious Diseases Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array Introduction: Human immunodeficiency virus (HIV) continues to represent one of the most significant public health challenges, with Egypt facing a rapidly and silently growing epidemic masked by its low-prevalence classification. This narrative review tracks the historical trajectory of HIV in Egypt, from its silent beginning in 1986 to its current status. It aims to provide critical insight into how more effective and equitable interventions and policies can be framed to address this public health challenge. Methods: We synthesized data from a non-systematic search including national and international reports, estimates, surveys, and peer-reviewed papers addressing epidemiology, trends, social determinants, and health-system performance related to Egypt. Literature was identified through PubMed, Google Scholar, and reports from UNAIDS, WHO, and the Egyptian Ministry of Health. We prioritized literature published on data specific to Egypt. Where local data were unavailable, regional and global data were used to provide context and identify research gaps. Results: The review revealed Egypt’s transition to a concentrated epidemic. It identified significant gaps in local research and long-term health outcomes and showed that, despite National AIDS Program efforts, the availability of free antiretroviral therapy, and the adoption of a “Treat All” policy, gaps persist. Conclusion: The 40-year story of HIV in Egypt revealed rising incidence, critical gaps in the treatment cascade, and a lack of local data on non-infectious comorbidities. Addressing these challenges, promoting early diagnosis, reducing stigma, expanding access to treatment, and adopting innovative prevention strategies are essential to reverse current trends.
Low-Grade Inflammation and Oxidative Stress as Drivers of Obesity-Related Complications: A Narrative Review
Section: Review Article Categories: Internal Medicine Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: The global prevalence of obesity continues to rise, with incidence rates differing markedly between regions. This narrative review synthesizes current evidence on how adipocyte dysfunction connects inflammatory and oxidative pathways to obesity-related complications, particularly cardiometabolic diseases. Methods: A narrative search of PubMed and Google Scholar was conducted to identify recent publications on the roles of inflammation and oxidative stress in obesity, providing context for the evidence discussed in this review. Results: The literature reveals that, in obesity, inflammation and oxidative stress are closely related processes originating from adipocyte dysfunction. This dysfunction increases proinflammatory cytokine secretion and triggers inflammatory immune responses. As a result, immune cells in adipose tissue—especially macrophages, but also T cells and neutrophils—adopt proinflammatory phenotypes, contributing to cytokine production and tissue remodeling. Together, impaired immune responses, chronic low-grade inflammation, and oxidative stress disrupt insulin signaling and contribute to metabolic dysfunction. Conclusion: Adipocyte dysfunction in obesity triggers immune and oxidative stress responses, driving cardiometabolic complications such as insulin resistance, type 2 diabetes, and cardiovascular diseases. Understanding these mechanisms is essential for the development of targeted therapy.
Copyright (c) 2026 Kazheen Majeed, Hazhmat Ali https://creativecommons.org/licenses/by/4.0
Demographic Factors of Colorectal Cancer Patients with Paralytic Ileus Among Adults in the United States: A Retrospective Study for Mortality Trends
Section: Original Article Categories: Internal Medicine Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Paralytic ileus is a serious postoperative complication among individuals with colorectal cancer (CRC). Although mortality trends for CRC and paralytic ileus have been described separately, long-term national patterns involving both conditions have not been examined. Methods: We analyzed U.S. mortality data for adults aged ≥45 years from 1999–2023 using CDC WONDER Multiple Cause-of-Death records. CRC was identified using ICD-10 codes C18–C20, and paralytic ileus using K56.0 and K56.7. Age-adjusted mortality rates (AAMRs) were calculated and standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC). Subgroup analyses were descriptive; formal between-group slope comparisons were not performed. Results: A total of 31,363 deaths involved both CRC and paralytic ileus. The national AAMR declined from 1.48 per 100,000 in 1999 to 1.00 in 2023 (AAPC –1.50%; 95% CI –1.73 to –1.28). A significant decline occurred through 2012 (APC =– 3.27%), followed by a nonsignificant upward trend thereafter (APC = 0.63%; p = 0.057). Declines varied by sex, age group, race/ethnicity, and region, with the largest reductions among adults ≥65 years and in the Northeast. Most deaths occurred in inpatient settings (56%). Conclusion: Mortality involving CRC and paralytic ileus declined substantially through 2012, then plateaued. Rising mortality among adults aged 45–64 years and persistent racial and geographic disparities highlight opportunities for improved perioperative quality initiatives, ERAS implementation, and opioid-sparing strategies.
Copyright (c) 2025 Waheed Qaisi, Mirna Hussein, Pakeezah Tabasum, Mohamed Wagdy, Nidal Mutawodeh, Abdallah Abdallah , Mohammed Mereb, Youssef Heikal https://creativecommons.org/licenses/by/4.0
Infective Endocarditis with Severe Aortic Regurgitation Complicated by Type A Aortic Dissection in a Tricuspid Aortic Valve: A Case Report
Section: Case Report Categories: Cardiology Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Infective endocarditis (IE) is a severe infection of the endocardial surface, most commonly affecting cardiac valves. Aortic dissection (AD) is a rare but life-threatening complication of IE. We report a case of IE with severe aortic regurgitation (AR) complicated by Type A AD in a tricuspid aortic valve, presenting without chest pain. A 40-year-old male with no comorbidities presented with intermittent low-grade fever for 4 months and progressive dyspnea for 5 days. Examination revealed blood pressure discrepancy (90/60 mmHg right arm, 110/70 mmHg left arm) and a diastolic murmur. Laboratory tests showed a WBC count of 15,000/µL, a CRP level of 15 mg/L, an ESR of 28 mm/hr, and a troponin level of 540 ng/L. Transthoracic echocardiography demonstrated a thickened tricuspid aortic valve with large vegetations, severe AR, and an intimal flap consistent with Type A AD. Blood cultures grew Streptococcus viridans. The patient received intravenous Penicillin G and Gentamicin for 2 weeks and underwent emergent surgical repair. The coexistence of IE and AD is extremely rare, particularly in patients without bicuspid aortic valve or connective tissue disorders. Proposed mechanisms include microbial invasion of the aortic wall and hemodynamic stress from severe AR. This case underscores the importance of maintaining a high index of suspicion for AD in IE patients, even in the absence of chest pain. Early echocardiographic evaluation, rapid surgical intervention, and culture-directed antibiotics are critical for survival in IE complicated by AD.
Copyright (c) 2025 Zubair Ahmed, Farhan Ali, Muqadas Fatima, Falak Naz, Shaista Ali, Jawad Asad, Vinta https://creativecommons.org/licenses/by/4.0
Multiple Myeloma and Chronic Kidney Disease–Related Mortality, 1999–2023: A Population-Based Time-Trend Analysis
Section: Original Article Categories: Hematology, Public Health Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Multiple Myeloma (MM) is the second most common hematological cancer, with chronic kidney disease (CKD) representing a major complication. This study aims to analyze national mortality trends, demographic differences, and geographic variation related to MM and CKD. Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥45 with MM (C90.0) and CKD (N18); Deaths recorded anywhere on the death certificate (multiple-cause). Age-adjusted mortality rates (AAMRs) per 100,000 populations were calculated for variables. Joinpoint regression analysis was utilized to evaluate annual percent changes (APCs). Results: From 1999 to 2023, a total of 24,606 deaths occurred among adults with MM and CKD in the U.S. The overall AAMR increased from (0.65) in 1999 to (0.86) in 2023 (AAPC: 1.22; 95% CI: 0.54 to 2.00; p<0.001). Males had a higher overall AAMR (1.09) and a more rapid increase (AAPC: 1.40; p<0.001) compared to females (AAMR: 0.60; AAPC: 0.71; p=0.027). Racially, NH Blacks had the highest AAMR (2.14). Regionally, the highest AAMRs were in the South (0.83). Metropolitan areas had a higher overall AAMR 0.81 than Non-metropolitan areas 0.77 (available 1999–2020 only). Most deaths occurred in inpatient medical facilities (46.27%). Among adults aged ≥65 years, overall CMR was 1.80 per 100,000. Conclusion: Mortality from MM and CKD is increasing in the U.S from 1999 to 2023. NH Blacks, males, urban areas and the South region face high burden of death, underscoring the need for targeted strategies to reduce these substantial disparities.
Copyright (c) 2025 Alyaa Ahmed Ibrahim, Mohamed Fawzi Hemida, Amro Ali, Raveen Mujeeb, Mohammad Rayyan Faisal, Mahmoud Tablawy, Krish Patel, Maryam Saghir, Eshal Saghir, Sara Hasanin, Ahmed Atef Mohamed, Safeya Fawzi, Arwa Khaled Dessouky, Ahmed Khairy, Asmaa Mohamed, Abdelrhman H. Mohamed, Abdullah Farahat Elbanna https://creativecommons.org/licenses/by/4.0
Posterior Reversible Encephalopathy Syndrome (PRES) Beyond Hypertension: Triggers, Pathophysiology, Management, and Outcomes
Section: Review Article Categories: Internal Medicine, Neurology Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurovascular disorder characterized by vasogenic edema, most often affecting the parieto-occipital lobes. Although typically reversible, some patients develop lasting neurological sequelae such as cognitive or visual impairment and epilepsy. This review summarizes the current understanding of PRES beyond its classical association with hypertension, emphasizing emerging triggers, mechanisms, and updates in management. Methods: A structured narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Literature was systematically searched in PubMed, Web of Science, and Google Scholar for studies published between January 1996 and June 2025. Fifty-nine relevant publications, including original studies and reviews, were synthesized to integrate evidence on presentation, imaging, pathophysiology, genetics, and management. Results: PRES can be triggered by a broad spectrum of hypertensive and non-hypertensive conditions, such as renal dysfunction, eclampsia, systemic lupus erythematosus, sepsis, and exposure to immunosuppressive agents (e.g., tacrolimus, cyclosporine, rituximab). The syndrome involves multifactorial mechanisms, including endothelial dysfunction, blood–brain barrier disruption, and dysregulated cerebral autoregulation. Emerging data indicate that genetic polymorphisms in endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), and aquaporin genes may influence individual susceptibility, although causality remains unconfirmed. Conclusion: PRES is a multifactorial syndrome that extends beyond hypertension. Early recognition, prompt neuroimaging, and targeted management of underlying triggers are critical for improving outcomes. Future studies should focus on clarifying genetic associations, standardizing diagnostic criteria for atypical cases, and optimizing therapeutic strategies through personalized medicine approaches.
Copyright (c) 2025 Mohamed Fawzi Hemida, MD, Pranjal Kumar Singh, MBBS, Alyaa Ahmed Ibrahim, MD, Ahmed Harb, MD, Sai Lokesh Moraboina, MD, Geethanjali Prakash, MBBS, Esraa M. Soliman, MBBS, Arun Kumar Maloth, MBBS, Huda Adnan, MBBS, Ravi Virani, MBBS, Sanchit Shailendra Chouksey, MBBS, MD, DM https://creativecommons.org/licenses/by/4.0
Dexmedetomidine as an Adjuvant to Ropivacaine in Thoracic Paravertebral Block: A Systematic Review with Meta-analysis
Section: Original Article Categories: Internal Medicine Keywords: Array, Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: One of the ongoing challenges in thoracic surgeries, especially video-assisted thoracoscopic surgery (VATS), is effective postoperative pain management. The thoracic paravertebral block (TPVB) using ropivacaine provides targeted analgesia but suffers from a limited duration of effect. This meta-analysis aims to assess the safety of combining dexmedetomidine with ropivacaine in TPVB for thoracic procedures and to explore potential analgesic benefits suggested by individual trials. Method: A systematic review and meta-analysis of randomized controlled trials were conducted to compare the combination of dexmedetomidine and ropivacaine (PRD) with ropivacaine alone (PR) in thoracic procedures. Outcomes assessed included adverse effects (bradycardia, dizziness, hypotension, nausea, and vomiting). Analgesic and opioid-sparing effects were reported narratively, as data were heterogeneous and unsuitable for pooled analysis. Result: Five studies were included. No statistically significant differences were found between PRD and PR in the incidence of bradycardia (RR: 2.14; 95% CI: 0.71–6.40; p=0.1750), dizziness (RR: 1.52; 95% CI: 0.71–3.27; p=0.2833), hypotension (RR: 0.78; 95% CI: 0.40–1.53; p=0.4676), nausea (RR: 1.15; 95% CI: 0.65–2.03; p=0.6018), or vomiting (RR: 1.04; 95% CI: 0.54–2.02; p=0.9122). Some individual trials suggested reduced postoperative pain scores and opioid use with dexmedetomidine, but these findings could not be synthesized quantitatively. Conclusion: Adding dexmedetomidine to ropivacaine in TPVB for thoracic surgery appears safe, with no significant increase in adverse effects. While some individual trials indicated potential analgesic and opioid-sparing benefits, these results remain heterogeneous and cannot be confirmed by pooled evidence. Further high-quality, standardized trials are needed.
Copyright (c) 2025 Mohamed Wagdy, Abdelrahman Abdalla Mohamed, Abdalla Ahmed Mohamed, Ziad ElDosoky Farouk, Mahmoud Abd El Nasser, Abdelrahman A. Ebaid Ebaid, Abdelrhman Waleed Kotb , Mostafa AbdElmawla Mohamed https://creativecommons.org/licenses/by/4.0
National-Level Outcomes of Diabetic Ketoacidosis with and without Coma: A Retrospective Analysis of 2.3 Million U.S. Hospitalizations
Section: Original Article Categories: Endocrinology Keywords: Array, Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Diabetic ketoacidosis (DKA) remains a significant complication of diabetes associated with substantial morbidity and mortality. We aimed to evaluate clinical outcomes among patients with DKA, both with and without coma, using a nationally representative database and to identify associated factors. Methods: We analyzed 2,381,619 DKA hospitalizations from the National Inpatient Sample (2016-2022), comparing outcomes between patients with (n=47,355, 1.99%) and without coma (n=2,334,264, 98.01%). Primary outcomes included length of stay (LOS), in-hospital mortality, and total hospital charges. Multivariable regression models adjusted for demographic, clinical, and hospital-level factors. Results: Patients with DKA-related coma had significantly worse outcomes: longer LOS (8.65 vs. 4.91 days), higher mortality (16.36% vs. 3.12%), and higher hospital charges ($119,080 vs. $61,240) compared to non-comatose patients. After adjustment, coma remained strongly associated with adverse outcomes (an additional 3.23 days of LOS, 5.38-fold higher mortality odds, $51,060 higher charges). Age >65 years, Type 2 diabetes, Asian/Pacific Islander race, and treatment at urban teaching hospitals were independently associated with worse outcomes. Female gender was associated with slightly better outcomes across all measures, with a significant interaction between gender and coma status. Conclusion: Consciousness level is among the strongest independent predictors of adverse DKA outcomes. Age, diabetes type, race/ethnicity, and hospital characteristics also significantly impact mortality, length of stay, and hospital charges. These factors should be considered in the clinical management of DKA and hospital resource planning.
Copyright (c) 2025 Mahmoud Nassar, Mohamed Hatem Ellabban, Mohamed R. Murad, Omar Nassar, Nuha ElSayed https://creativecommons.org/licenses/by/4.0
Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA
Section: Original Article Categories: Internal Medicine, Cardiology, Public Health Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Introduction: Angina is one of the ischemic heart diseases (IHD) that contributes to major cardiovascular complications up to death. We aim to assess angina-related mortality among adults aged ≥65 years in the U.S. Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥65 with angina. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression analysis was utilized to evaluate average annual percent changes (AAPCs). Results: From 1999 to 2023, a total of 36,544 deaths occurred among the elderly with angina in the U.S. The overall AAMR per 100,000 decreased from 7.52 in 1999 to 3.73 in 2023 (AAPC of -3.18; 95%CI: -3.79 to -2.75; p < 0.001). The AAMR for men decreased from 8.22 in 1999 to 4.75 in 2023 (AAPC of -2.53%; 95%CI: -3.02 to -2.09), and for women decreased from 6.95 in 1999 to 3.02 in 2023 (AAPC: -3.55%; 95%CI: -4.12 to -3.09). Across racial/ethnic groups, the highest overall rates were observed among NH-White individuals, 3.56. Overall, AAMRs were highest in the West, 4.00. The majority of deaths occurred in medical facilities (40.19%). Between 1999 and 2020, rural areas had a higher overall AAMR of 4.37 compared to urban areas, which had a rate of 3.02. Conclusion: Trends in angina-related mortality declined from 1999 to 2023. Higher mortality rates were observed in men, rural areas, the West region, and among NH White individuals. Our findings indicated that these categories require targeted interventions to reduce mortality.
Copyright (c) 2025 Mohamed Fawzi Hemida, Alyaa Ahmed Ibrahim, Anika Goel, Mirna Hussein, Krish Patel, Muhammad Raza Sarfraz, Omar Y. Alkasabrah, MD, Maryam Saghir, Komal Karmani, Eshal Saghir, Zahin Shahriar, Safeya Fawzi, Ahmed Bahnasy, Muhammad Faizan Ali, Amro Ali, Ahmad M. Abdelkhalek, Raheel Ahmed, MBBS, MRCP, PhD https://creativecommons.org/licenses/by/4.0
Disparities and Trends in Polycythemia Vera–Related Mortality in U.S. Adults Aged ≥45 Years from 1999 to 2023
Section: Original Article Categories: Internal Medicine, Hematology, Public Health Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Polycythemia vera (PV) is a rare myeloproliferative neoplasm characterized by excessive red blood cell production, leading to increased risk of thrombosis and other complications. Despite its clinical significance, trends in PV mortality across demographic groups in the US remain understudied. Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥45 with PV. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated for variables. Joinpoint regression analysis was utilized to evaluate annual percent changes (APCs). Results: From 1999 to 2023, a total of 24,236 deaths occurred among adults with PV in the U.S. The overall AAMR decreased from 1.15 in 1999 to 0.73 in 2023 (AAPC: -1.96; 95% CI: -2.28 to -1.73; p < 0.001). The AAMR for men decreased from 1.38 in 1999 to 0.87 in 2023 (AAPC-1.88; 95% CI: -2.36 to -1.37; p < 0.001), and for women decreased from 1 in 1999 to 0.62 in 2023 (AAPC: -2.03; 95% CI: -2.66 to -1.43; p < 0.001). Across racial/ethnic groups, AAMR was highest in non-Hispanic White (0.93 per 100,000). Overall, AAMRs were highest in the Midwest (0.95). The majority of deaths occurred in medical facilities (39.36%). Rural areas had a higher overall AAMR (0.91) compared to urban areas (0.82). Conclusion: Trends in (PV) mortality declined overall from 1999 to 2023—higher trends observed in men, rural areas, the Midwest region, and NH White.
Copyright (c) 2025 Alyaa Ahmed Ibrahim, Mohamed Fawzi Hemida, MD, Mirna Hussein, Maryam Saghir, Mohammad Rayyan Faisal, FNU Kritika, Krish Patel, Amro Ali, MD, Eshal Saghir, Mahmoud Tablawy, Abdelrhman H. Mohamed, Amr Arafa, MD https://creativecommons.org/licenses/by/4.0
A Pairwise and Network Meta-Analysis Comparing the Efficacy and Safety of Ribonucleic Acid Interference Therapeutics in the Management of Hypertension
Section: Review Article Categories: Cardiology Keywords: Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Small interfering RNA (siRNA) and antisense agents targeting angiotensinogen are emerging antihypertensives. We synthesized their efficacy and safety. Methods: We searched PubMed, Web of Science, Scopus, and CENTRAL through 25 Nov 2024. Eligible studies were randomized controlled trials in adults with hypertension comparing RNA-interference therapeutics with placebo. Primary outcomes were the change in ambulatory and office systolic/diastolic blood pressure. We conducted random-effects pairwise meta-analyses and a network meta-analysis with SUCRA ranking, and appraised certainty with GRADE. Results: Four trials (n=486) met criteria. Versus placebo, RNA-interference therapy reduced ambulatory SBP (mean difference [MD] −15.46 mmHg; 95% CI −18.79 to −12.12) and DBP (MD −8.45 mmHg; −10.67 to −6.23), and lowered office SBP (MD −8.07 mmHg; −11.58 to −4.56) and DBP (MD −5.18 mmHg; −7.73 to −2.63). Injection-site reactions increased (risk ratio 5.26; 1.01–27.44); other adverse events, potassium, and eGFR were similar. In network analyses, zilebesiran 300 mg ranked highest for blood-pressure lowering; for AGT reduction, 800 mg ranked highest. GRADE certainty was high for blood-pressure outcomes and moderate for AGT, potassium, and eGFR. Few, short-term trials and sparse networks limit precision and generalizability; publication bias was not assessable. Conclusion: siRNAs effectively reduced BP in hypertensive adults with an acceptable safety profile. Despite the indistinguishable efficacy or safety between the doses or types of siRNAs, Zilebesiran 300 mg best reduced BP compared to placebo.
Copyright (c) 2025 Mohamed E. Haseeb, Zeyad Bady, Hazem E. Mohammed, George Hanen, Mohamed Nasser, Nada S. Jibril, Mohamed Khalafalla Darwish, Heba Aboeldahab https://creativecommons.org/licenses/by/4.0
Improving Inpatient Care for Acute Chronic Obstructive Pulmonary Disease Exacerbations: A Quality Improvement Initiative
Section: Original Article Categories: Internal Medicine Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for high hospital use; guideline-concordant diagnostics, oxygen titration, and discharge planning are often under-delivered. We aim to measure baseline compliance with eight AECOPD process standards and evaluate whether EHR-embedded prompts plus staff education were associated with observed improvements. Methods: We audited 50 consecutive adult admissions with primary AECOPD (ICD-10 J44.1 or clinician-documented diagnosis) between July and October 2024, implemented EHR prompts, an orderset, and targeted education (Nov–Dec 2024), then re-audited 50 consecutive admissions (Jan–Mar 2025) using identical methods. Primary process measures were pre-specified; analyses were descriptive with 95% Wilson confidence intervals (CIs) for proportions and two-sided Fisher exact tests for pre/post comparisons. This work was performed as a service evaluation/pilot. Results: After implementation, six of eight process standards showed observed increases. Pulmonary rehabilitation referrals rose from 32/50 (64.0%, 95% CI 50.1–75.9%) to 43/50 (86.0%, 95% CI 73.8–93.0%), p = 0.0198. Oxygen titration improved from 40/50 (80.0%, 95% CI 66.0–88.6%) to 46/50 (92.0%, 95% CI 78.6–95.7%), p = 0.148. Other measures (ABG timing, bronchodilator and corticosteroid delivery, appropriate antibiotic use, CXR timing, smoking advice) showed observed improvements; p-values and CIs are reported in the text. Conclusions: Embedding guideline-aligned prompts and an orderset in the EHR, together with staff education, was associated with observed improvements in several AECOPD process measures in this pilot QI project. Findings should be interpreted cautiously, given the pilot design, multiple comparisons, and limited sample size; further controlled and longitudinal evaluation is indicated.
Copyright (c) 2025 Khaqan Ahmed, Afaq Ahmad, Muhammad Saqib, Muhammad Iftikhar, Humna Shahid https://creativecommons.org/licenses/by/4.0
Trends in Mortality from Leukemia and Ischemic Heart Disease: A 22-Year Analysis in the U.S. (1999-2020)
Section: Original Article Categories: Internal Medicine, Cardiology, Hematology, Public Health Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Introduction: Leukemia and ischemic heart disease (IHD) are major U.S. mortality causes. This study analyzes national mortality trends from 1999 to 2020 to assess the impact of public health efforts in leukemia-associated IHD mortality rates. Methods: This retrospective study analyzed death certificate data from the CDC-WONDER database spanning 1999 to 2020, focusing on leukemia (ICD-10: C91–C95) and ischemic heart disease (ICD-10: I20–I25) as multiple causes of mortality in the U.S. population. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 population were calculated. JoinPoint analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2020, there were 53,603 deaths from combined leukemia and ischemic heart disease among U.S. adults aged 25+, with the AAMR declining from 1.39 to 1.09 per 100,000 (AAPC= -1.30%; 95% CI: -1.90 to -0.68; P= 0.000034). A significant decrease occurred from 1999 to 2018 (AAMR: 1.39 to 0.95; APC= -2.1894%; 95% CI: -2.3995 to -1.9788, P < 0.000001), followed by a period where the trend shifted upward which is statistically significant for the certain subgroups, except men and older adults. Men had higher AAMR than women (1.87 vs. 0.62). Regional AAMRs were highest in the Midwest (1.3). Non-Hispanic Whites had the highest AAMR (1.25). Adults 65+ had a CMR of 5.27 vs. 0.26 for ages 45–64. Conclusion: Significant health disparities exist, as mortality from combined leukemia and IHD is highest among men, older adults, rural populations, and non-Hispanic White individuals.
Copyright (c) 2025 Mohamed Fawzi Hemida, Ayesha Khan, Alyaa Ahmed Ibrahim, Anika Goel, Krish Patel, Zahin Shahriar, Ahmed W. Hageen, Mustafa Alsaadi, Saif Ur Rahman, Amr Arafa, Zeyad Kholeif, Ahmed Bahnasy https://creativecommons.org/licenses/by/4.0
Probiotics: A Promising Ally in Burn Treatment
Section: Review Article Categories: Internal Medicine, Gastroenterology, Infectious Diseases, Public Health Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array This review explores the potential therapeutic benefits of probiotics in the treatment of burn injuries, with the aim of addressing the limitations of traditional therapeutic approaches. It offers a comprehensive analysis of burn pathophysiology, including a wide range of burn forms and the biological reactions they induce, such as pain, inflammation, fluid imbalance, and metabolic alterations. It also specifically explains the mechanisms by which probiotics contribute to the improved healing of wounds and modified gut microbiota, as they are particularly effective in these two directions. This study looks at the ways probiotic treatment can facilitate the regeneration of the skin, which is crucial for accelerating burn recovery . Furthermore, it examines the barriers and limits of probiotic therapy, such as strain regularity and safety issues in immunocompromised patients, while emphasizing the interdependent benefits of probiotics and nutrition in promoting burn healing. This review highlights the advantages of probiotics in burn management and their potential as an adjuvant therapy for enhancing treatment results and patient well-being in the burn care context.
Copyright (c) 2025 Kholoud Al Jebawi, Jobran Toami, Adel Ayash, Razan Salha, Mira Al Shoufy, Jamil Nasrallah , Naseeb Danaf, Lea El Ghawi, Layal Msheik, Hiba Hamdar https://creativecommons.org/licenses/by/4.0
Prolonged Immunosuppressive Therapy in Immune Complex-Membranoproliferative Glomerulonephritis: A Case Report of Sustained Partial Remission Over Three Years
Section: Case Report Categories: Internal Medicine Keywords: Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array The prevalence of membranoproliferative glomerulonephritis (MPGN) is very low among primary glomerulonephritis. Once MPGN is diagnosed, it is essential to classify the type of MPGN [immune complex (IC), complement-mediated, and without complement or IC deposition]. In cases of IC-MPGN, secondary causes should be thoroughly investigated. However, there are no randomised controlled prospective trials for the optimal treatment regime for primary IC-MPGN. Here, we present a report of primary IC-MPGN that achieved partial remission after 3 years of mycophenolate mofetil treatment, even though significant fibrosis was present in the kidney biopsy. This report may support consideration of prolonged immunosuppression in selected cases with primary IC-MPGN.
Copyright (c) 2025 Kubra Kaynar, Yasin Dilek, Mert Köse, Sevdegül Aydın Mungan https://creativecommons.org/licenses/by/4.0
Migraine Headache in Patients with Allergic Rhinitis: A Systematic Review and Meta-Analysis of Observational Studies
Section: Original Article Categories: Neurology Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Migraine is a condition characterized by recurrent episodes of unilateral headache. Allergic rhinitis (AR) is an IgE-mediated inflammatory condition of the nasal mucosa that is triggered by exposure to allergens. Migraine and AR may share underlying immunological mechanisms, including histamine release and mast cell activation. Despite the growing interest in the immunological interplay between allergic conditions and neurological symptoms, the specific relationship between AR and migraine remains underexplored. Methods: PubMed, Scopus, and Web of Science were systematically searched to identify relevant studies. Pooled odds ratio (OR) and pooled risk ratio (RR) were calculated with 95% confidence intervals (CI) using a random-effects model. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Heterogeneity assessment and subgroup analysis were also performed. Results: Eleven studies involving 4,704,591 participants were included. The pooled OR for migraine in individuals with AR was 2.94 (95% CI: 2.02–4.29; p < 0.0001; I² = 95.62%). The pooled RR from two cohort studies was 2.27 (95% CI: 1.10–4.65; p = 0.026; I² = 99.72%). Subgroup analysis revealed significant differences in the pooled OR regarding the source of individuals with AR and the method of AR assessment, with a higher pooled OR in hospital patients (OR = 7.32) and when using skin tests (OR =6.93), respectively. Conclusion: Migraine headaches are significantly associated with AR, particularly in hospital settings and when objectivemethodsareusedforARdiagnosis.Thefindingsofthisstudyshouldbeinterpreted cautiously owing to the high heterogeneity.
Copyright (c) 2025 Ahmed Talaia, Khaled Kettaneh, Ayoub Ait lahcen, Abdeljalil El Hilali, Mohamed Magdi, Marwa Amayem, Mohamed Wagdy, Shrouk Mahmoud Elghazaly https://creativecommons.org/licenses/by/4.0
Concurrent Diabetic Ketoacidosis and Acute Coronary Syndrome: A Systematic Review of Case Reports
Section: Original Article Categories: Cardiology, Endocrinology Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Diabetic ketoacidosis (DKA) and acute coronary syndrome (ACS) represent serious medical emergencies with a complex bidirectional relationship. The clinical presentations and outcomes of these conditions when they co-occur remain incompletely characterized in the literature. We aim to investigate this correlation. Methods: We systematically searched the PubMed, Scopus, and Web of Science databases, using terms related to acute coronary syndrome (including myocardial infarction, unstable angina, STEMI, and NSTEMI) combined with diabetic ketoacidosis terms, from inception to April 2025, for case reports. The CARE checklist was applied to assess the risk of bias in the included reports. Results: Twenty-one case reports met inclusion criteria, describing 11 males and 9 females (one unspecified) with a mean age of 51 years. Patients had both type 1 (42.8%) and type 2 (57.1%) diabetes mellitus. Chest pain was the most common presenting symptom (52.3%), but was absent in nearly half of the cases. Six patients (28.5%) on sodium-glucose cotransporter-2 (SGLT2) inhibitors presented with euglycemic DKA. ST-segment elevation was observed in 61.9% of patients, while five patients had normal coronary arteries despite elevated troponin levels. All patients survived after receiving standard DKA management and appropriate cardiac interventions. Conclusion: This systematic review highlights the importance of maintaining high clinical suspicion for concurrent DKA and ACS, even when typical symptoms such as chest pain or hyperglycemia are absent. We recommend routine cardiac evaluation, including ECG, troponin assessment, and echocardiography, for all DKA patients to ensure early recognition and appropriate management of these potentially life-threatening conditions.
Copyright (c) 2025 Ahmed Elbataa Elbataa, Ahmed Farid Gadelmawla, Laila Mohamed Akr, Mohamed Yasser Elnaggar, Mohamed Mahmoud, Omar Nassar, Alaa Abdrabou Abouelmagd, Ahmed Hassan https://creativecommons.org/licenses/by/4.0
Esophageal Stenting and Endoscopic Vacuum Therapy for Esophageal Defects: A Systematic Review and Meta-Analysis
Section: Review Article Categories: Internal Medicine, Gastroenterology Keywords: Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array Background: Spontaneous esophageal perforation, particularly Boerhaave syndrome, is a life-threatening condition associated with high morbidity and mortality. Traditional surgical management is increasingly being supplemented by minimally invasive approaches, including esophageal stenting and endoscopic vacuum therapy (EVT). However, the optimal treatment strategy remains debated due to variations in reported outcomes and the lack of randomized controlled trials. This systematic review and meta-analysis aim to evaluate the efficacy and safety of esophageal stenting and EVT in managing esophageal defects by specifically assessing sealing rates, failure rates, and mortality. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library up to March 24, 2025. Only observational studies and case series were included. The primary outcomes were the pooled sealing rate, failure rate, and mortality for esophageal stenting, and the closure rate for EVT. Data were analyzed using a random-effects model, and heterogeneity was assessed using the I² statistic. Results: Fourteen studies on esophageal stenting demonstrated a pooled sealing rate of 86.1% (95% CI: 80.2–92.0%) with a failure rate of 14.9% (95% CI: 8.5–21.3%). Mortality associated with stenting was 7.4% (95% CI: 3.5–11.4%). EVT studies reported a closure rate ranging from 80% to 94%. Conclusion: Both esophageal stenting and EVT show high efficacy in sealing esophageal defects. Although EVT exhibits promising closure rates, further comparative studies are needed to establish definitive treatment guidelines.
Copyright (c) 2025 Muhammad Saqib, Muhammad Iftikhar, Khaqan Ahmed, Humna Shahid, Shehr I Yar Khan, Muhammad Aamir Iqbal, Hassan Mumtaz https://creativecommons.org/licenses/by/4.0
A Comprehensive Review of Fluid Resuscitation Techniques in Sepsis in Patients with Heart Failure
Section: Review Article Categories: Cardiology, Infectious Diseases Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Introduction: Fluid management in sepsis patients with pre-existing heart failure presents a complex clinical challenge, as these patients require adequate resuscitation while avoiding fluid overload that could worsen cardiac function. This article aims to explore optimal fluid resuscitation strategies for patients with pre-existing heart failure who develop sepsis, a group at high risk for fluid management complications. Methods: We conducted a narrative review of studies published between 2010 and 2024, utilizing PubMed, ScienceDirect, and Google Scholar. We employed Boolean formulas and search terms that evolved from broad to specific, refining the focus on fluid resuscitation in septic heart failure patients. Human studies focusing on fluid resuscitation, sepsis management, and outcomes in heart failure were included. Exclusion criteria included animal studies, non-English articles, and case reports. Results: Guideline-recommended fluid resuscitation (≥30 mL/kg within 3 hours) shows a neutral or positive effect on mortality in sepsis patients with pre-existing heart failure when monitored appropriately. Patients with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF) exhibit different tolerances to fluids. Advanced hemodynamic monitoring — including bedside echocardiography, lactate clearance, central venous pressure, and BNP levels — is essential for personalizing fluid therapy. Conclusion: Early guideline-compliant fluid resuscitation followed by a conservative, individualized fluid strategy guided by hemodynamic monitoring optimizes outcomes in sepsis patients with heart failure. Future prospective studies are needed to develop standardized protocols.
Copyright (c) 2025 Mallikarjuna S. oruganti, Sameena Tabassum, Anushree V. Murthy, Navya.Miriyala, Nitasha, Sunil Timislina https://creativecommons.org/licenses/by/4.0
Clinical Efficacy and Safety of Fluvoxamine in COVID-19 Patients: An Umbrella Review of Systematic Reviews and Meta-Analyses
Section: Original Article Categories: Infectious Diseases, Public Health Keywords: Array, Array, Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Disciplines: Array, Array, Array, Array, Array, Array, Array, Array, Array, Array Introduction: Fluvoxamine is an agonist for the sigma-1 receptor, through which it controls inflammation. It helps reduce the cytokine storm associated with the COVID-19 virus by regulating the production of IL-6 and gene expression. This review of systematic reviews (SRs) aims to summarize the effects of fluvoxamine in treatment of COVID-19. Methods: This umbrella review (CRD42025592203) of SRs and meta-analyses investigated the safety and efficacy of fluvoxamine for treatment in COVID-19 patients, irrespective of disease severity and age. Comprehensive searches were conducted from inception to December 12, 2024, covering PubMed, Cochrane CENTRAL, Google Scholar, and Cochrane COVID-19 resources. A qualitative synthesis of evidence was performed. The AMSTAR2 tool was used to assess the methodological quality of the included SRs. Results: Eleven reviews published in 12 publications that reported the use of fluvoxamine in COVID-19 patients were finally included as part of the synthesis. The studies reported a lower mortality rate with fluvoxamine than with placebo, but only four studies reported statistical significance. Five reported a statistically significant reduction in hospitalization risk for patients treated with fluvoxamine compared to controls. Only one review evaluated COVID-19 progression, reporting a non-significant decrease in the risk of disease progression with fluvoxamine compared to placebo. Higher dosages of fluvoxamine compared to lower doses yielded better outcomes. Conclusion: Although fluvoxamine may have potential benefits in reducing COVID-19-associated mortality and hospitalization, our findings do not support a significant role in preventing disease progression or clinical deterioration. Further research is needed to compare the efficacies of different dosages.
Copyright (c) 2025 Omar Irfan, Muhammad Jansher, Wania Moeen, Muhammad Sohaib Khan, Muhammad Bin Hammad, Rubaid Dhillon, Nabira Khan, Abia Abdullah, Mohammad Aadil Qamar, Ayesha Rashid, Javaid Ahmed Khan, Ali Bin Sarwar Zubairi https://creativecommons.org/licenses/by/4.0