The Bidirectional Relationship Between Sleep Disturbance and Functional Dyspepsia: A Systematic Review to Understand Mechanisms and Implications on Management.

Functional dyspepsia (FD) is a prevalent chronic digestive disorder that significantly impacts patients' quality of life. Sleep disturbance (SD) is common among FD patients, yet the relationship between SD and FD remains poorly characterized. This systematic review explores the bidirectional relationship between FD and SD, investigating underlying mechanisms and implications for management. A rigorous and comprehensive systematic search was conducted across PubMed, PubMed Central (PMC), Google Scholar, Cochrane Library, and ScienceDirect using select keywords related to SD and FD. Only studies published in English from the past 10 years that met inclusion and exclusion criteria were included. Quality assessment tools specific to study types were employed to minimize bias. After applying inclusion and exclusion criteria and quality assessments, the review encompassed 30 studies. The key findings reveal that FD is frequently associated with SD, with a significant proportion of FD patients reporting poor sleep quality. The mechanisms linking SD and FD are complex, involving the circadian rhythm, visceral hypersensitivity, immune responses, and psychological factors. Nonpharmacological treatments like cognitive behavioral therapy (CBT), acupuncture, and pharmacological neuromodulators have shown promise in managing FD and SD, offering hope for improved patient outcomes. SD and FD share a significant bidirectional relationship, influenced by a complex interplay of physiological, psychological, and lifestyle factors. Addressing SD in FD patients may improve overall symptom management. Further research is crucial, as it should focus on isolating specific SD causes and their direct impacts on FD and other functional gastrointestinal disorders (FGIDs), opening up new avenues for understanding and treatment.

Anti-Smith Antibodies as a Predictive Factor for Developing Lupus Nephritis in Systemic Lupus Erythematosus Patients: A Systematic Review.

Lupus nephritis (LN) is the most frequent and lethal complication of systemic lupus erythematosus (SLE), often presenting with subtle or no initial symptoms. Therefore, it is crucial to identify SLE patients who are at risk of developing LN to ensure they receive timely intervention. Significant scientific efforts have been made to identify various genes and antibodies that could increase the risk of LN. Our objective is to review the role of anti-Smith antibodies in this disease and evaluate their potential as a predictive marker for LN. This review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched for different study types from 2019 onwards as per our inclusion and exclusion criteria, to look for the significance of anti-Smith antibodies. The following databases were used: PubMed, PMC, Google Scholar, Science Direct, and Scopus. Twenty-two studies were checked for eligibility, of which 17 studies passed, based on the commonly used quality assessment tool for each of the corresponding studies. The study results indicated that anti-Smith antibodies are highly specific for SLE and are part of its classification criteria. In addition, we observed that positive titers correlate with disease activity. The presence of anti-Smith antibodies is influenced by ethnicity being most common among Black patients. However, the data regarding their effectiveness as a predictive marker for LN is not fully established. A more sensitive investigation and larger cohorts on diverse ethnic populations could provide a definitive answer regarding the role of anti-Smith antibodies in LN, highlighting the need for additional research.

A Comprehensive Narrative Review of the Impact of Pelvic Radiotherapy on Pelvic Bone Health: Pathophysiology, Early Diagnosis, and Prevention Strategies.

Radiotherapy is a commonly used modality in pelvic malignancies such as prostate, gastrointestinal, or gynecological, either as a primary treatment or an adjuvant post-surgery. Despite its positive impact on the prognosis of these patients, it was found in several studies that it contributes to insufficiency fractures in different sites of the pelvis, more commonly in the sacral ala. This is particularly true for elderly patients. There are several hypotheses on how radiotherapy affects bone health, as it destroys the bone matrix and causes obliterative vasculitis. Several imaging techniques, particularly magnetic resonance imaging (MRI), help detect the radiotherapy-induced fracture and distinguish it from metastases. Some modalities, such as intensity-modulated radiotherapy (IMRT) and brachytherapy, have decreased fracture risk by escaping the adjacent structures to the targeted organ. Pharmacological interventions such as amifostine and desferrioxamine are promising in terms of bone protection, which necessitates further studies to confirm their mechanism of action.

Effectiveness of Pneumococcal Conjugate Vaccines Over Antibiotic-Resistant Acute Otitis Media in Children: A Systematic Review.

One of the most prevalent childhood illnesses in the world, acute otitis media (AOM), is mainly brought on by Streptococcus pneumoniae, which has resulted in a significant increase in the use of antibiotics and the emergence of antibiotic-resistant (ABR) strains. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria served as the foundation for this systematic review. We conduct a comprehensive literature search across five primary databases, including PubMed, PubMed Central, Cochrane, Science Direct, and Google Scholar, to identify eligible studies assessing the impact of pneumococcal conjugate vaccines (PCVs) on AOM incidence and ABR. Data on AOM rates, shifts in serotype distribution, and the prevalence of ABR pneumococcal strains in children under the age of 18 after PCV implementation are taken from all kinds of studies that assessed any pneumococcal conjugate vaccines (PCV 7, 10, and 13) as interventions. Eighteen records are identified as eligible for the final review. Other articles are excluded by assessing the title and abstract relevancy, applying inclusion criteria, and using critical appraisal tools. Implementing PCVs among children in the national immunization programs in most countries, particularly PCV13 has led to substantial decreases in ABR S. pneumoniae strains. However, serotype replacement has emerged as a challenge, with non-vaccine serotypes becoming more prevalent. Despite this, the overall burden of antibiotic resistance and AOM has decreased, underscoring the positive impact of PCVs on public health. PCVs effectively reduce the incidence of AOM and the prevalence of ABR S. pneumoniae in children. The vaccines play a crucial role in antibiotic stewardship by decreasing the need for broad-spectrum antibiotics. Continued surveillance and development of next-generation vaccines are essential to address serotype replacement and sustain the benefits of PCVs in combating antibiotic-resistant AOM.

The Long-Term Impact of Cardiac Rehabilitation on Cognitive Function in Older Patients With Myocardial Infarction: A Systematic Review.

Myocardial Infarction (MI) is an obstruction in the coronary arteries, resulting in restricted blood flow and oxygen supply to the heart, leading to damage to the heart's tissues. Beyond the cardiovascular system, the impact of MI extends to potentially affecting cognitive abilities, especially in elderly populations. To optimize patient recovery and long-term outcomes, timely cardiac interventions and subsequent rehabilitation programs are essential. This systematic review aims to assess the potential benefits of cardiac rehabilitation (CR) in enhancing cognitive function among elderly individuals who have experienced an MI. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and utilizes PubMed, PubMed Central, Cochrane, Google Scholar, and ScienceDirect databases. Studies included in the review encompass meta-analyses, controlled trials, systematic/narrative reviews, randomized/nonrandomized trials, observational studies, and research articles published within the past five years. Only accessible, full-text English-language studies meeting the inclusion criteria are selected, while books, documents over five years old, animal studies, and individuals under 65 are excluded. Following a predefined template, the initial search identifies 4,915 studies. From this pool, 27 free full-text articles are then selected for quality appraisal based on relevance. After performing a quality assessment on each survey, 12 high-quality studies are included in this systematic review. The research studies demonstrate notable cognitive improvements among elderly patients who have experienced an MI and participated in CR programs. Additional clinical trial studies are recommended to substantiate these findings further and advance our understanding.

Knowledge, practice, and infection status of prisoners toward dermatomycosis: a study in Nepal.

Background: Dermatophytosis, commonly known as tinea, poses a significant public health concern worldwide, especially in environments with poor hygiene and overcrowding, such as prisons. Despite its prevalence and impact on quality of life, there is a lack of research on the knowledge and hygiene practices regarding dermatophytosis among prisoners, particularly in Nepal. Objective: The study aimed to assess prisoners' knowledge, hygiene practice and infection status regarding dermatophytosis in Central Prison, Nepal. Methods: A descriptive cross-sectional study with a sample size of 184 respondents was designed to collect data using a validated pre-tested questionnaire from September 2023 to January 2024. The collected data was then analyzed using IBM SPSS version 21. Knowledge and hygiene practices were measured on an eight and 11-point scale and rated as poor (≤4) and sound (>4), bad (≤6), and good (>6), respectively. Summary data were presented by descriptive, while Chi-square and logistic regression were used for inferential statistics at p < 0.05. Results: The findings revealed moderate knowledge among prisoners regarding dermatophytosis, with significant gaps in understanding its spread and prevention. While most prisoners recognized the importance of treatment, there were misconceptions about the inevitability of contracting dermatophytosis and the role of personal hygiene. Conclusion: Despite good knowledge levels, adherence to recommended hygiene practices was suboptimal, highlighting the need for targeted interventions. The study underscores the importance of addressing knowledge gaps, changing attitudes, and promoting hygienic practices to mitigate the burden of dermatophytosis among prisoners.

Assessment of Shortcomings of Candidates in the Fellowship of College of Physicians and Surgeons (FCPS)-II (Board/Exit) Examination: A Qualitative Analysis of Dermatology Candidates' Short and Long Cases With Suggestions for Improvement.

Background Clinical examination is the final step for the assessment of a candidate in the Fellowship of College of Physicians and Surgeons-II exam and several stressors are associated with it. After a certain level, the stressors and myths related to this exam increase the chances of poor performance. This study aimed to identify the shortcomings of candidates' short and long cases with suggestions for improvement. Methodology This qualitative research with a thematic analysis approach was conducted at the College of Physicians and Surgeons of Pakistan, Regional Center, Lahore. The data were collected from 20 examiners who assessed 88 candidates' short and long cases of dermatology through observation and cross-questioning. Results The major themes that emerged with more subcategories were poor history taking, poor examination, and poor time management while updated knowledge, rationalization, and enhancement of presentation skills were also highlighted in long cases. The major suggestions to improve the short and long cases were to focus on the command given, maintain the privacy of the patient, and improve training. Conclusions This study highlighted many major shortcomings the candidates showed while performing the long and short cases which may facilitate the forthcoming candidates to avoid these weaknesses by following the suggestions for improvements.