Effect of hot saline irrigation on the operative field during endoscopic sinus surgery: a randomized controlled trial.

BACKGROUND: Control of bleeding is very important during endoscopic sinus surgery. Saline heated up to 50 °C causes dilatation of vessels and edema without nasal mucosa necrosis. It also promotes the clotting cascade so helps in having a bloodless procedure. METHODS AND MATERIALS: This randomized controlled trial was conducted on 60 patients divided into two groups (30 each). Group A was the interventional group in which patients were irrigated with saline of 50 °C during surgery. Group B was the control group where room-temperature saline was used. The operative field was assessed using the Boezaart score, duration of surgery, and bleeding in ml. RESULTS: The Boezaart score in group A came out to be 2.23 ± 0.72 whereas it was 3.43 ± 0.72 in group B. Most of the patients who were in the interventional group had their surgery completed within 60 min with comparatively less bleeding (mean bleeding = 221.83 ml). Patients of the control group had increased duration of surgery mostly and bleeding (mean = 265.67 ml). Our study showed a strong correlation amongst the Boezaart score, duration of surgery, and bleeding in ml with a p value of < 0.001 where all three variables significantly improved in the interventional group due to a good operative field provided by warm saline heated up to 50 °C. CONCLUSION: Normal saline heated up to 50 °C is a cost-effective way to achieve a bloodless operative field during endoscopic sinus surgery. Reduced bleeding also decreases the duration of surgery.

Genetic Markers of Susceptibility in Gastric Cancer: A Comprehensive Systematic Review.

This systematic review synthesizes findings from various studies that examine genetic markers associated with susceptibility to gastric cancer. By conducting a comprehensive search across multiple databases, we analyzed studies on the relationship between specific genetic polymorphisms and the risk of developing gastric cancer. Our review highlights significant genetic markers, including mucin 1 (MUC1), prostate stem cell antigen (PSCA), tumor necrosis factor-alpha (TNF-α), DNA methyltransferases (DNMTs), matrix metalloproteinase-7 (MMP-7), and interleukin-8 (IL-8), emphasizing their roles across different ethnic and demographic contexts. The findings demonstrate a robust association between these markers and gastric cancer susceptibility, particularly noting variations in risk among diverse populations. Such variations could inform personalized treatment and screening strategies. The review also underscores the need for further research to explore how these polymorphisms influence cancer development and to confirm their potential clinical applications. We discuss the implications of these genetic markers for global health strategies and personalized medicine, highlighting the importance of integrating genetic testing into current gastric cancer management protocols.

Discovery of Small Molecule Inhibitors Targeting CTNNB1 (ß-catenin) for Endometrial cancer: Employing 3D QSAR, Drug-Likeness Assessment, ADMET Predictions, Molecular Docking and Simulation.

BACKGROUND: Endometrial carcinoma (EC) is a type of cancer that originates in the lining of the uterus, known as the endometrium. It is associated with various treatment options such as surgery, radiation therapy, chemotherapy, and hormone therapy, each presenting unique challenges and limitations. Beta-catenin, a protein involved in the development and progression of several cancers, including EC, plays a crucial role. Abnormal beta-catenin signaling is often linked to the emergence of specific EC subtypes, affecting tumor growth and invasion. OBJECTIVES: The study's objective is to identify compounds targeting the beta-catenin protein for treating endometrial cancer (EC) using in silico drug design. Our approach includes molecular docking to evaluate binding affinities, ADME profiling for pharmacokinetic properties, toxicity assessments, and molecular dynamics simulations to assess compound stability and interactions. METHODS: Approximately one thousand anti-cancer phytochemicals were sourced from PubChem and subjected to molecular docking simulations against the beta-catenin protein. The compounds were evaluated based on their binding affinities, with the top five selected for further analysis. These five molecules underwent toxicity and ADME profiling. The Prediction of Activity Spectra for Substances (PASS) tool was used to identify compounds targeting CTNNB1. Comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA) were employed to establish quantitative structure-activity relationship (QSAR) models for the five CTNNB1 antagonist molecules. RESULTS: The selected five compounds, namely Pazopanib, Binimetinib, Telatinib, 4-(2,3-Dihydrobenzo[ b][1,4]dioxin-6-yl)-3-((5-nitrothiazol-2-yl)thio)-1H-1,2,4-triazol-5(4H)-one, and Ribavirin, demonstrated efficacy against CTNN1. MD simulations of the docked complexes confirmed the stability of these drugs in binding to the target protein. All five molecules showed promising safety and effectiveness profiles according to their ADME and toxicity evaluations. CONCLUSION: Through a comprehensive screening process employing in silico drug design methods, this study successfully identified five potential human anticancer drug candidates targeting the beta-catenin protein. These findings offer a foundation for further experimental validation and development towards the treatment of EC.

Letter to editor: Trends and disparities in cardiovascular deaths in systemic lupus erythematosus: A population-based retrospective study in the United States from 1999 to 2020.

This letter addresses key limitations in the article "Trends and disparities in cardiovascular deaths in systemic lupus erythematosus: A population-based retrospective study in the United States from 1999 to 2020." While the article provides valuable insights into cardiovascular mortality among SLE patients, it overlooks critical factors such as medication adherence and sex-specific treatment responses, which could influence the reported outcomes. Additionally, the study's focus on cardiovascular deaths sidelines other relevant causes of mortality like infections and renal failure. Incorporating these considerations, along with a deeper exploration of socioeconomic disparities and healthcare infrastructure, could enhance future studies, offering a more comprehensive understanding of mortality trends in SLE patients.

Emerging research trends in artificial intelligence for cancer diagnostic systems: A comprehensive review.

This review article offers a comprehensive analysis of current developments in the application of machine learning for cancer diagnostic systems. The effectiveness of machine learning approaches has become evident in improving the accuracy and speed of cancer detection, addressing the complexities of large and intricate medical datasets. This review aims to evaluate modern machine learning techniques employed in cancer diagnostics, covering various algorithms, including supervised and unsupervised learning, as well as deep learning and federated learning methodologies. Data acquisition and preprocessing methods for different types of data, such as imaging, genomics, and clinical records, are discussed. The paper also examines feature extraction and selection techniques specific to cancer diagnosis. Model training, evaluation metrics, and performance comparison methods are explored. Additionally, the review provides insights into the applications of machine learning in various cancer types and discusses challenges related to dataset limitations, model interpretability, multi-omics integration, and ethical considerations. The emerging field of explainable artificial intelligence (XAI) in cancer diagnosis is highlighted, emphasizing specific XAI techniques proposed to improve cancer diagnostics. These techniques include interactive visualization of model decisions and feature importance analysis tailored for enhanced clinical interpretation, aiming to enhance both diagnostic accuracy and transparency in medical decision-making. The paper concludes by outlining future directions, including personalized medicine, federated learning, deep learning advancements, and ethical considerations. This review aims to guide researchers, clinicians, and policymakers in the development of efficient and interpretable machine learning-based cancer diagnostic systems.

Common pediatric surgical conditions and associated health-seeking behaviors in Pakistan: An urban and rural comparative assessment.

Approximately five billion people do not have access to necessary surgical treatment globally and up to 85% of children in LMICs are affected with conditions requiring surgical care by the age of 15 years. It is crucial to identify common surgical conditions in children in Pakistan to inform healthcare professionals and policymakers for effective resource allocation. This representative cross-sectional household survey conducted on children aged 5-10 years assessed existing surgical diseases and healthcare-seeking behaviors in the two largest provinces (Sindh and Punjab) of Pakistan. The data was collected through a validated cross-sectional survey tool [Surgeons OverSeas Assessment of Surgical Need (SOSAS)]. Caregivers were asked about their child's recent and past surgical conditions in six distinct anatomical regions and pictures were taken of identified conditions after appropriate consent for further diagnosis. Health-seeking behaviors including the kind of treatment sought, the nature of care received, and the reasons for not receiving care were noted. 13.5% of children surveyed reported a surgical condition, with a similar distribution across urban (13.2%) and rural (13.7) areas and the most common cause was trauma. The greatest number of surgical conditions were found to be on the head and neck region (57.7%), while the back accounted for the least number of conditions (1.7%). Our results outline a need for organizing all entities (governmental, non-governmental, and private) involved in child health to ensure efficient resource allocation to cater to existing surgical problems.

Discovery of potent anti-MRSA components from Dalbergia odorifera through UPLC-Q-TOF-MS and targeting PBP2a protein through in-depth transcriptomic, in vitro, and in-silico studies.

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Co-encapsulation of borage seed oil and peppermint oil blends within ultrasound-assisted soy protein isolate/purity gum ultra complex nanoparticles: Fabrication, structural interaction mechanisms, and in vitro digestion studies.

This study aimed at co-encapsulating borage seed oil (BSO)- and peppermint oil (PO) blends in ultrasound-assisted complex nanoparticles stabilized by soy protein isolate (SPI) and purity gum ultra (PGU) in different ratios: SPI/PGU-1:0 (NP1), 0:1 (NP2), 1:1 (NP3), 1:3 (NP4), and 3:1 (NP5). The BSO- and PO-loaded SPI/PGU complex nanoparticles (BP-loaded SPNPs) coded as NP4 (SPI-PGU-1:3) revealed a zeta potential of -33.27 mV, a PDI of 0.14, and the highest encapsulation efficiency (81.38 %). The main interactions observed among SPI, PGU, BSO, PO, and a blend of BSO and PO, as determined by FTIR and molecular docking, involved hydrophobic effects, electrostatic attraction, and H-bonding. These interactions played crucial roles in the production of BP-loaded SPNPs. XRD results validated the alterations in the structure of BP-loaded SPNPs caused by varying proportions of SPI and PGU. The thermal capacity of BP-loaded SPNPs (NP4), as determined by TGA, exhibited the lowest amount of weight loss compared to other BP-loaded SPNPs. Morphological results revealed that NP4 and NP5 exhibited a spherical surface and two distinguishable layers, indicating successful coating of PGU onto the droplet surface. In addition, BP-loaded SPNPs (NP4) exhibited a higher antioxidant effect due to their improved progressive release and prolonged release of co-encapsulated BSO and PO during in vitro digestion. The comprehensive investigation of the co-encapsulation of BSO and PO in complex nanoparticles, dietary supplements, and double-layered emulsified systems provides valuable insights into the development of functional foods.

The Influence of Obesity on Cholecystectomy Outcomes: A Systematic Review of Laparoscopic and Open Approaches.

This systematic review evaluates the impact of obesity on the outcomes of laparoscopic versus open cholecystectomy, analyzing data from five key studies. The review explores differences in operative times, complication rates, conversion rates, and recovery times among obese patients undergoing these surgical procedures. The findings indicate that while laparoscopic cholecystectomy in obese patients tends to require longer operative times, it does not significantly increase complication rates compared to open cholecystectomy. However, the risk of conversion to open surgery is modestly elevated. The review highlights the necessity for surgical guidelines to adapt to the challenges posed by obesity, recommending advanced training and innovative technologies to improve surgical outcomes. Limitations such as study design heterogeneity and variability in defining obesity underscore the need for further research. This review contributes to optimizing surgical care strategies and improving patient outcomes in the growing demographic of obese surgical patients.

Evaluating Modern Therapeutic Interventions for Migraine Management: A Systematic Review.

This systematic review evaluates the efficacy and safety of contemporary migraine treatments, synthesizing evidence from recent randomized controlled trials (RCTs). The focus is on both pharmacological interventions, such as calcitonin gene-related peptide (CGRP) monoclonal antibodies and non-specific oral migraine preventives, and non-pharmacological approaches like myofascial release. Through a detailed examination of the studies, this review identifies superior strategies for acute and preventive migraine management, assessing their impact on patient-reported outcomes and determining the prevalence of associated adverse events. Findings suggest that while CGRP monoclonal antibodies show promise as first-line treatments due to their efficacy and safety, myofascial release offers considerable benefits for pain and disability in tension-type and cervicogenic headaches. Challenges such as the variability in individual response and potential side effects emphasize the need for personalized treatment plans. This review underscores the importance of integrating new therapeutic discoveries into clinical practice to enhance the quality of care for migraine sufferers.

Role of Responsive Neurostimulation in Managing Drug-Resistant Epilepsy: A Systematic Review of Clinical Outcomes.

Drug-resistant epilepsy remains a substantial challenge in neurology, affecting patients who do not respond to conventional antiepileptic drugs. Responsive neurostimulation (RNS) has emerged as a promising therapeutic approach, yet comprehensive reviews synthesizing its clinical outcomes are sparse. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and involved a comprehensive database search through PubMed, Medline, Embase, the Cochrane Library, and Scopus, covering literature up to April 2024. The review targeted peer-reviewed articles evaluating the efficacy, safety, and quality of life impacts of RNS in patients with drug-resistant epilepsy. Key inclusion criteria encompassed clinical trials, cohort studies, and meta-analyses, while exclusion criteria included non-peer-reviewed and irrelevant studies. We identified five studies meeting our inclusion criteria. These studies collectively demonstrated that RNS significantly reduces seizure frequency and improves quality of life, while maintaining a favorable safety profile. Despite small sample sizes and potential selection biases, the benefits of RNS appeared consistent across diverse patient demographics. RNS represents a viable and effective treatment option for drug-resistant epilepsy, offering significant improvements in seizure control and patient quality of life. Future research should focus on long-term outcomes and refining patient selection to optimize the therapeutic benefits of RNS. The integration of RNS into standard epilepsy management protocols is recommended based on current evidence.

The Impact of Hypertension on Cognitive Decline and Alzheimer's Disease and Its Management: A Systematic Review.

Hypertension, a major risk factor for cardiovascular diseases, has also been linked to cognitive decline and Alzheimer's disease (AD). This systematic review synthesizes the current evidence on how managing hypertension may influence cognitive health, particularly among elderly populations and those with cognitive impairments. By analyzing data from randomized controlled trials (RCTs), clinical trials, and cross-sectional studies, we evaluated the efficacy of various interventions, including pharmacological treatments, lifestyle modifications, and multidomain approaches that address blood pressure (BP) variability and intensive versus standard blood pressure control. Our findings reveal that effective blood pressure management can mitigate cognitive decline and potentially alter the course of Alzheimer's disease. However, the results also highlight complexities, such as the risk of adverse effects from intensive blood pressure control on cognitive processing and hippocampal volume. This review underscores the need for tailored hypertension management strategies that balance cardiovascular health with cognitive outcomes, suggesting that stabilizing blood pressure variability could play a crucial role. Future research should focus on longitudinal studies to refine these management strategies and enhance treatment guidelines, improving overall outcomes for patients at risk of cognitive decline.

Artificial Intelligence and Machine Learning in Predicting Intradialytic Hypotension in Hemodialysis Patients: A Systematic Review.

Intradialytic hypotension (IDH) is a common and potentially life-threatening complication in hemodialysis patients. Traditional preventive measures have shown limited effectiveness in reducing IDH incidence. This systematic review evaluates the existing literature on the use of artificial intelligence (AI) and machine learning (ML) models for predicting IDH in hemodialysis patients. A comprehensive literature search identified five eligible studies employing diverse AI/ML algorithms, including artificial neural networks, decision trees, support vector machines, XGBoost, random forests, and LightGBM. These models utilized various features such as patient demographics, clinical data, laboratory findings, and dialysis-related parameters. The studies reported promising results, with several models achieving high prediction accuracies, sensitivities, specificities, and area under the receiver operating characteristic curve values for predicting IDH. However, limitations include variations in study populations, retrospective designs, and the need for prospective validation. Future research should focus on multicenter prospective studies, assessing clinical utility, and integrating interpretable AI/ML models into clinical decision support systems.

Comparison of long-term clinical outcomes of bioabsorbable polymer versus durable polymer drug-eluting stents: a systematic review and meta-analysis.

BACKGROUND: One million individuals in the USA die from acute myocardial infarction (MI), which currently affects 3 million people globally. The available data about the early and late outcomes of both biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents exhibit inconsistency. We performed a meta-analysis comparing the safety and efficacy of BP-DES with DP-DES. METHODS: PubMed, Google Scholar, EMBASE, Cochrane, Ovid Medline, and Clinical Trials.gov databases were used to find out studies comparing BP-DES to DP-DES. All the analyses used the random-effects model. RESULTS: A total of 18 studies were incorporated in this meta-analysis that involved 28,874 patients, out of which 11,997 received the BP Stent, and the rest of 16,578 received the DP stent. Thorough analyses revealed that the risk of all-cause death was significantly higher in the BP-DES group (5.4% vs 2.7%) (RR 1.22, p 0.02) for two years or less than two-year follow-up. For studies with more than two years of follow-up, all-cause death was 9.07% (599/6603) in BP-DES and 9.47% (531/5602) in the DP-DES group but failed to achieve statistically significant levels (RR 0.97, p 0.58). CONCLUSIONS: The study revealed no clinically significant (P value was > 0.05) differences in all-cause death, cardiac death, target lesion revascularization (TLR), late stent thrombosis, device-oriented composite endpoint/target lesion failure (DOCE/TLF), myocardial infarction (MI), target vessel MI, target vessel revascularization (TVR), target vessel infarction (TVI) between BP-DES and DP-DES for more than two years of follow-up. Additionally, all-cause death was only outcomes which found to have a statistically significant difference for less than two years of follow-up, while remaining were statistically non-significant.

Integrated Approaches in the Management of Gastrointestinal Disorders: A Biopsychosocial Perspective.

Gastrointestinal (GI) disorders, including gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), gastritis/peptic ulcer disease (PUD), and celiac disease, significantly impact global health and economic stability. This review synthesizes current literature to elucidate the pathophysiology, clinical manifestations, diagnostic challenges, and management strategies of these prevalent conditions. Through a biopsychosocial lens, we examine the role of the gut microbiome in disease modulation and explore innovative therapeutic advancements, including microbiome-targeting interventions. The review highlights the necessity of a multidisciplinary approach to patient care, integrating medical treatment with dietary, psychological, and lifestyle modifications. By addressing these disorders holistically, the article aims to foster a deeper understanding of their biopsychosocial impacts and encourage more effective, patient-centered treatment paradigms. The findings underscore the imperative for continued research and interdisciplinary collaboration to enhance patient outcomes and reduce healthcare burdens associated with GI disorders.

Effect of Shearing and Annealing on the Pasting Properties of Different Starches.

The functional characteristics of starch can be altered by shear force, which makes the impact on its microstructure of great importance to the food industry. This study investigated the effects of freeze-drying on the gel texture, pasting capabilities, and swelling power of starches made from sweet potatoes (SP), chickpeas (CP), and wheat (WS) combined with Cordia (CG) and Ziziphus gum (ZG). The samples were annealed in water without shearing and in a rapid visco-analyzer (RVA) for 30 min at 60 °C while being spun at 690 rpm. Both native and freeze-dried samples were mixed with 1% or 3% ZG and CG. After annealing, the starches were examined using a texture analyzer and RVA. The results showed that freeze-drying had a substantial (p > 0.05) impact on the starch granule, in addition to the effect of annealing. The peak viscosity of freeze-dried native CP and SP starches increased, but the peak viscosity of freeze-dried wheat starch decreased. The setbacks for CP and WS increased, whereas the setbacks for SP varied slightly. Furthermore, it was demonstrated that annealing in an RVA exhibited a substantially lower peak viscosity than annealing in a water bath; the RVA's shearing effect may have been the cause of this difference. Cordia gum fared better than ZG in terms of peak viscosity, although ZG significantly reduced setback in comparison to CG. Among the various blends, the native WB sample had the lowest hardness (100 ± 4.9 g), while the freeze-dried WB SP sample had the greatest (175.5 ± 4.8 g). Shearing of starches broke up the granules into smaller pieces, which made them gel at lower temperatures. This could be a good thing when they are needed for food uses that require little cooking.

Effective Surgical Site Infection Prevention Strategies for Diabetic Patients Undergoing Surgery: A Systematic Review.

Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical procedures. This systematic review aims to synthesize the current evidence on effective prevention strategies for mitigating SSI risk in this vulnerable population. From inception to March 2024, we comprehensively searched multiple electronic databases (PubMed, Medline, Embase, Cochrane Library, CINAHL) to identify relevant studies evaluating SSI prevention strategies in diabetic surgical patients. Our search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilizing a combination of keywords and Medical Subject Headings (MeSH) terms related to diabetes, surgical site infections, prevention strategies, and surgical procedures. Inclusion criteria focused on peer-reviewed clinical trials, randomized controlled trials, and meta-analyses published in English. The search yielded three studies meeting the eligibility criteria, subject to data extraction and qualitative synthesis. Key findings highlighted the efficacy of interventions such as optimized perioperative glycemic control, timely prophylactic antibiotic administration, and meticulous preoperative skin antisepsis in reducing SSI rates among diabetic surgical patients. The potential for personalized prevention approaches based on individual patient factors, such as diabetes type and surgical complexity, was explored. This systematic review underscores the importance of a multifaceted, evidence-based approach to SSI prevention in diabetic surgical patients, integrating strategies like glycemic control, antibiotic prophylaxis, and preoperative skin antisepsis. Furthermore, our findings suggest the potential benefits of personalized care pathways tailored to individual patient characteristics. Implementing these interventions requires interdisciplinary collaboration, adaptation to diverse healthcare settings, and patient engagement through culturally sensitive education initiatives. This comprehensive analysis informs clinical practice, fosters patient safety, and contributes to the global efforts to enhance surgical outcomes for this high-risk population.