A critical review of health and financial implications of obesity during the COVID-19 pandemic.

The COVID-19 was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900 000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271 700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest computed tomography (CT) were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing BMI. Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Redefining Pulmonary Arterial Hypertension Treatment: Sotatercept's FDA Priority Review.

A biologics license application (BLA) for sotatercept, a therapeutic agent targeting activin receptor signaling implicated in pulmonary arterial hypertension (PAH), has been granted priority review status by the FDA. This advancement underscores the critical need for novel pharmacological interventions for this rare and severe condition, potentially transforming the therapeutic landscape of PAH.

Measles resurgence in Armenia: unmasking health system vulnerabilities and crafting comprehensive eradication strategies - a review.

Measles is an acute febrile illness associated with rashes, fever and life-threatening complications. It is a vaccine-preventable disease with the Measles Mumps Rubella(MMR) vaccine but a recent global trend unveils a resurgence of measles in various parts of the world including Armenia. Measles was declared eliminated from Armenia in 2021 before reports of local outbreaks surfaced in 2023. The WHO identified discrepancies in the vaccination coverage during COVID-19. Measles also poses a great financial burden as a public health issue worldwide. Sociocultural factors impacting measles transmission are maternal education, healthcare access, migration, vaccine hesitancy, and socioeconomic status (Table 3). Efforts to control and eradicate measles from Armenia are run by a collaborative approach of national and international health bodies such as United Nations Children's Fund (UNICEF), WHO, Global Vaccine Alliance (GAVI), and the Ministry of Health. Thus, the resurgence of measles can be managed through widespread patient education, innovative approaches, strengthening the healthcare system and addressing vaccine hesitancy, sociocultural barriers, and humanitarian emergencies. This review investigates the complicated dynamics of measles inside Armenia's health system in depth. A thorough examination of measles incidence and immunization patterns highlights the shift from few cases and high vaccination rates to a comeback caused by imported viruses. The causes of its recurrence have been thoroughly investigated, including reduced immunization programs and vaccine hesitancy. The research delves further into the 'One Health' idea, assessing the possibility of interspecies transmission among nonhuman primates and examining the environmental factors that influence measles transmission. Among the challenges are weaknesses within Armenia's health system as well as the possibility of interruptions from the COVID-19 outbreak. In measles vaccination status, the combination of maternal education, postnatal care, and socioeconomic variables exposes the larger drivers at work. The study concludes with a comprehensive set of public health policy recommendations covering vaccination promotion, surveillance, healthcare provider education, public awareness, international collaboration, data analysis, law enforcement, emergency preparedness, research, and coordination. The research sheds light on the tangled web of measles dynamics, health system resilience, and contextual subtleties via this multifaceted approach, inviting readers to investigate the multiple strategies required for eliminating measles in Armenia.

Bilateral femoral shaft fractures in osteomalacia: A case report and literature review.

INTRODUCTION AND IMPORTANCE: When two non-traumatic femoral shaft fractures happen at the same time, they are usually not caused by high-energy trauma or medical conditions like osteomalacia caused by poor nutrition, long-term bisphosphonate medication use, or steroid use. Because this phenomenon is connected to inadequate bone mineralization and bone metabolism, it occurs when a bone is consistently under high stress. CASE PRESENTATION: A 40-year-old lady with a medical history of osteomalacia, including continuous vitamin D replacement therapy, showed up at the emergency room complaining of discomfort and swelling in her right thigh caused by a fall. During the emergency examination, X-rays showed a subtrochanteric fracture with a short oblique fracture line and a displaced oblique fracture in the right femoral shaft, but no fragmentation in the left femoral shaft. Osteomalacia caused the bilateral femoral shaft fracture in which the patient was identified as being displaced. We planned a surgical correction that included a closed reduction with intramedullary nailing and distal static screws on the right side, as well as intramedullary nailing followed by locking screw insertion on the left. Following the operation, the avoidance of bisphosphonate medications gained precedence. CLINICAL DISCUSSION: Patients of any age who come with bone pain, non-traumatic fractures, and muscle weakness should have their blood vitamin D, ALP levels, and BMD evaluated for osteomalacia. If a conventional X-ray shows normal, an MRI or bone scan of both hips is recommended to rule out any underlying fatigue fractures. Finding and treating the underlying cause of osteomalacia can help improve the prediction. CONCLUSION: Intramedullary nailing with screws is the most effective treatment for femoral shaft fractures. Improving patient outcomes relies on identifying and treating the underlying cause of osteomalacia. Given the patient's history and condition, avoiding bisphosphonate medicines following surgery was a primary priority in this case.

Advancements in Early Detection and Screening Strategies for Pancreatic Cancer: From Genetic Susceptibility to Novel Biomarkers.

Pancreatic cancer is a rare but lethal cancer due to its biologically aggressive nature, advanced stage at the time of diagnosis, and poor response to oncologic therapies. The risk of pancreatic cancer is significantly higher to 5% in certain high-risk individuals with inherited genetic susceptibility. Screening for pancreatic cancer in these individuals from high-risk groups can help with the early detection of pancreatic cancer as well as the detection of precursor lesions leading to early surgical resection and improved overall outcomes. The advancements in radiological imaging as well as advanced endoscopic procedures has made a significant impact on the early diagnosis, surveillance, and staging of pancreatic cancer. There is also a significant advancement in the development of biomarkers for the early detection of pancreatic cancer, which has also led to the development of liquid biopsy, allowing for microRNA detection in serum and circulating tumor cells. Various societies and organizations have provided guidelines for pancreatic cancer screening and surveillance in high-risk individuals. In this review, we aim to discuss the hereditary risk factors for developing pancreatic cancer, summarize the screening recommendations by different societies, and discuss the development of novel biomarkers and areas for future research in pancreatic cancer screening for high-risk individuals.

Reducing Surgeon Fatigue Through Ergonomics: Importance and Benefits in Laparoscopic Surgeries.

Laparoscopy, despite enhancing surgical outcomes, presents ergonomic challenges, such as visual-motor axis dissociation and increased cognitive load, leading to inefficiency and fatigue. Ergonomics, optimizing tasks and environments to fit human capabilities, can address these issues by designing user-friendly instruments, improving surgeon positioning, and enhancing operating room setups. These interventions reduce suturing time, alleviate discomfort, and decrease musculoskeletal disorders among surgeons. Ergonomic training for surgical teams further minimizes risk factors and promotes better body mechanics. Prioritizing ergonomics in surgical environments may lead to improved patient outcomes, greater surgeon well-being, and increased job satisfaction, highlighting its critical importance in modern surgery.

Suspected large gall bladder mucocele extending from right hypochondrium up to right iliac region turned out to be gall bladder perforation in a patient with schizophrenia: A rare case report and literature review.

Key Clinical Message: This is a challenging case where the surgeon has initially thought it is a gallbladder (GB) mucocele. The surprise finding of a mucocele during an emergency laparotomy highlights the deceptive nature of certain clinical manifestations within the hepatobiliary domain. The intraoperative discovery of a 1×1 cm GB hole on the right lateral wall of the GB fundus revealed an unexpected and significant deviation from the hypothesized pathogenesis. Abstract: This case report provides a complicated diagnosis scenario for a hepatobiliary illness aggravated by schizophrenia. Arriving with frequent nausea and vomiting, a 70-year-old female patient with schizophrenia missed typical symptoms of gallbladder (GB) disease, including fever and stomach discomfort. This odd look and corroborative imaging showing a cystic lesion in the right belly led to a diagnostic suspicion of a sizable GB mucocele. But a surprising result from an emergency laparotomy revealed a significant GB perforation, different from the previous diagnosis. This case highlights the difficulties in identifying atypical GB diseases, particularly in individuals with mental comorbidities that could conceal or alter the expression of physical symptoms. To confirm or rule out differential diagnosis and allow early and tailored treatments, it emphasizes the need for thorough diagnostic tests, including a complete clinical history, physical examinations, laboratory analysis, imaging modalities, and surgical procedures. This case emphasizes the importance of careful examination in complex medical contexts by stressing the requirement of thorough assessments and comprehensive diagnostic frameworks in navigating challenging clinical situations.

Surgical Dilemma in Approaching Parapharyngeal Space Pleomorphic adenoma- Transcervical or Transoral Route - A Case Report.

A case of pleomorphic adenoma of deep lobe of parotid in parapharyngeal space presented as intra oral swelling. FNAC showed features of pleomorphic adenoma. Surgery done through transcervical route. HPE of excised mass confirmed pleomorphic adenoma.

Advanced Imaging Techniques for Complex Endovascular Aortic Repair: Preoperative, Intraoperative and Postoperative Advancements.

BACKGROUND: Endovascular aortic repair (EVAR) requires extensive preoperative, intraoperative, and postoperative imaging for planning, surveillance, and detection of endo-leaks. There have been manyadvancements in imaging modalities to achieve this purpose. This review discussed different imaging modalities used at different stages of treatment of complex EVAR. METHODS: We conducted a literature review of all the imaging modalities utilized in EVAR by searching various databases. RESULTS: Preoperative techniques include analysis of images obtained via modified central line using analysis software and intravascular ultrasound. Fusion imaging (FI), carbon dioxide (CO2) angiography, intravascular ultrasound, and Fiber Optic RealShape (FORS) technology have been crucial in obtaining real-time imaging for the detection of endo-leaks during operative procedures. Conventional imaging modalities like computed tomography (CT) angiography (CTA) and magnetic resonance (MR) angiography are still employed for postoperative surveillance along with computational fluid dynamics and contrast-enhanced ultrasound (CEUS). The advancements in artificial intelligence (AI) have been the breakthrough in developing robust imaging applications. CONCLUSIONS: This review explains the advantages, disadvantages, and side-effect profile of the abovementioned imaging modalities.

A comprehensive review of phytoconstituents in liver cancer prevention and treatment: targeting insights into molecular signaling pathways.

Primary liver cancer is a type of cancer that develops in the liver. Hepatocellular carcinoma is a primary liver cancer that usually affects adults. Liver cancer is a fatal global condition that affects millions of people worldwide. Despite advances in technology, the mortality rate remains alarming. There is growing interest in researching alternative medicines to prevent or reduce the effects of liver cancer. Recent studies have shown growing interest in herbal products, nutraceuticals, and Chinese medicines as potential treatments for liver cancer. These substances contain unique bioactive compounds with anticancer properties. The causes of liver cancer and potential treatments are discussed in this review. This study reviews natural compounds, such as curcumin, resveratrol, green tea catechins, grape seed extracts, vitamin D, and selenium. Preclinical and clinical studies have shown that these medications reduce the risk of liver cancer through their antiviral, anti-inflammatory, antioxidant, anti-angiogenic, and antimetastatic properties. This article discusses the therapeutic properties of natural products, nutraceuticals, and Chinese compounds for the prevention and treatment of liver cancer.

Urgent call for holistic action: Addressing the Crimean-Congo hemorrhagic fever (CCHF) crisis in Pakistan's healthcare system.

•Urgent plea for global collaboration as Crimean-Congo Hemorrhagic Fever ravages Pakistan's healthcare system.•Crisis deepens with 41 confirmed cases, 15 fatalities, and a call to fortify healthcare infrastructure.•Government measures in Balochistan deemed a prelude; urgent actions and long-term strategies imperative.•Strategic recommendations unveiled for a holistic approach: from healthcare infrastructure to rapid response teams.

Planetary health and its relevance in the modern era: A topical review.

Planetary health is a relatively new concept that has gained traction in recent years due to the urgent need to address the health of our planet and its inhabitants. It refers to the interdependent health of both humans and the environment, recognizing that the two are inseparable and that the health of one is intricately linked to the health of the other. This article aims to advocate changes in how health care for both the environment and humans is envisaged, and aligned with sustainable development goals using ethically sound, solution-oriented, and practical approaches to education. Rapid industrialization, urbanization, and population growth led to environmental degradation and climate change in this era. These factors have profound implications for human health, with the World Health Organization estimating that 23% of global deaths are linked to environmental factors. Climate change and extreme weather events are exacerbating existing health problems. Air pollution, water pollution, and toxic chemicals are additional environmental factors that add to it and lead to health issues, including non-communicable diseases and death. A collaborative and interdisciplinary approach is needed to address planetary health challenges, including working across sectors and investing in research to understand better the complex interactions between human health and the environment. By promoting sustainable development and protecting the planet's health and inhabitants, we can ensure a healthy future for generations.

Addressing the Crimean-Congo Hemorrhagic Fever Crisis in Pakistan's Healthcare System: An Urgent Call for Holistic Action.

The recent resurgence of the Crimean-Congo hemorrhagic fever (CCHF) in Pakistan's Balochistan province has significantly impacted both the medical community and the general population. Initially perceived as a concerning development, the situation has deteriorated, culminating in the infection and mortality of healthcare workers directly engaged in managing this virulent outbreak. This critical situation necessitates an urgent and collective response, transcending national boundaries to involve the international healthcare community.

Gender Bias in Leadership Roles in General Surgery: A South Asian Perspective.

This article addresses the significant issue of gender bias in leadership roles within the realm of general surgery, with a particular focus on the South Asian context. The persistence of cultural norms, entrenched gender stereotypes, and discriminatory practices in this region significantly limits the opportunities available to female surgeons. It calls on all stakeholders, including medical institutions, governing bodies, and surgeons, to take an active role in eliminating gender bias and fervently supporting diversity and inclusivity in leadership positions. By doing so, it argues, we can create a more equitable and promising future for the field of general surgery in South Asia.

Therapeutic Potential of Buprenorphine in Depression: A Meta-Analysis of Current Evidence.

Background: Emerging research indicates buprenorphine, used in management of opioid use disorder, has attracted interest for its potential in treating a variety of psychiatric conditions. This meta-analysis aimed to determine the efficacy of buprenorphine in treating symptoms of depression. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a search was conducted of several databases until April 25, 2022, for English language articles related to buprenorphine and its use in treating various mental health conditions. Standardized mean differences (SMDs) and its 95% confidence intervals (CIs) were reported for the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS) scores. Statistical analyses were performed using Cochrane RevMan 5. Results: Of the 1,347 identified studies, six clinical trials were included. MADRS-10 least square mean difference (LSMD) inter-group assessment favored buprenorphine over placebo, but it lacked statistical significance. Similarly, MADRS scores as well as HAM-D inter-group assessment were in favor of buprenorphine, however, were not statistically significant. These findings suggest a potential therapeutic role for buprenorphine in treating depression, albeit with caution due to the observed lack of statistical significance and the potential for confounding factors. Conclusions: Preliminary evidence suggests potential efficacy of buprenorphine at lower doses in improving improving outcomes specifically related to depression. However, due to limitations in statistical significance and possible confounding factors, entail cautious interpretation. Further rigorous research is needed to investigate the long-term effects, optimal dosing, and determine the role of adjuvant drug therapy.

Giant Pleomorphic Adenoma of Submandibular Gland.

Pleomorphic adenoma is a benign tumor of salivary glands which is relatively rare among head & neck neoplasms. Parotid gland is the most common site of occurrence whereas submandibular gland is rarely affected. We present a case of a giant pleomorphic adenoma of submandibular gland.

LentiGlobin Administration to Sickle Cell Disease Patients: Effect on Serum Markers and Vaso-Occlusive Crisis.

LentiGlobin, an innovative gene therapy, introduces a modified beta-globin gene that yields an anti-sickling hemoglobin variant. It boosts total hemoglobin levels, mitigates hemolysis, curtails inflammation, and addresses iron overload by reducing transfusion requirements. These changes, in turn, provide insights into disease mechanisms and treatment outcomes. Alterations in serum markers, such as hemoglobin levels and inflammatory biomarkers, can illuminate the therapeutic effectiveness of LentiGlobin and its impact on mitigating complications such as vaso-occlusive crises. Therefore, the purpose of this narrative review is to discuss the effects of LentiGlobin administration on diverse serum biomarkers and its correlation with vaso-occlusive crises in individuals with sickle cell disease (SCD).