Objectives: The purpose of this article is to provide a narrative review on the management of DKA.

Methods: A PubMed search was performed with clinical queries using the key term “diabetic ketoacidosis”. The search strategy included randomized controlled trials, clinical trials, meta-analyses, observational studies, guidelines, and reviews. The search was restricted to English literature and the age range of 18 years and younger. Moreover, we reviewed and compared major guidelines.

Results: Selected international guidelines for DKA, namely International Society for Pediatric and Adolescent Diabetes (ISPAD), National Institute for Health and Care Excellence (NICE), British Society for Paediatric Endocrinology and Diabetes (BSPED), and South Thames Retrieval Service (STRS) were reviewed. There are considerable differences in the management approaches for DKA between different countries. One of the main areas of differences between guidelines is the administration of fluid, with most guidelines adopting a restrictive approach. This is based on the concern over cerebral oedema, a lethal sequela allegedly to be caused by excessive fluid administration. However, recent new clinical studies suggest that there is no causal relationship between intravenous fluid therapy and DKA-related cerebral injury. The British Society of Paediatric Endocrinology updated its guideline in 2020 to adopt a more permissive approach to fluid administration, which has sparked controversy among some paediatricians.

Conclusion: The management of DKA involves early recognition, accurate diagnosis, meticulous fluid and insulin treatment with close monitoring of blood glucose, ketones, electrolytes, renal function, and neurological status. There is still limited clinical evidence to support either a restrictive or permissive approach in the fluid management of paediatric DKA patients. Clinicians should exercise caution when applying different guidelines in their clinical practice, considering the specific circumstances of individual paediatric patients.

Methods: A total of 37 consecutive patients with clinically suspected ovarian venous disorders were included. All the patients underwent colour Doppler sonography. CTV was performed in 31 patients, while retrograde phlebography was performed in 6 patients. CT/phlebography was the established diagnostic criterion for ovarian vein disorders. The SPSS 22.0 program was used for statistical analysis. Sensitivity, specificity, and positive and negative predictive values for colour Doppler sonography were calculated. k-test was used to evaluate consistency between colour Doppler sonography and CT/phlebography.

Results: In the 37 patients,18 cases were positive for ovarian vein disorders and 19 cases were negative, as assessed with colour Doppler sonography. The associated lesions included ovarian vein thrombosis (7 cases), ovarian varicocele (3 cases), and ovarian venous leiomyoma (8 cases). The calculated values of sensitivity, specificity, and positive and negative predictive value were 94.4%, 94.7%, 94.4%, and 94.7%, respectively. The overall accuracy rate was 94.9%. The K level of the degree of agreement between CT/phlebography and colour Doppler sonography was 0.892.

Conclusion: Colour doppler sonography can provide sufficient imaging information. In clinical ultrasonography, attention should be paid to recognizing and detecting ovarian venous lesions.

Methods: This retrospective research included 36 patients with pathologically confirmed NSCLC who underwent dual-energy enhanced CT scans. The quantitative parameters of DECT were analyzed, including iodine concentration, water concentration, the CT values corresponding to 40keV, 70keV, 100keV, and 130keV in arterial and venous phases, and the normalized iodine concentration and the slope of the energy spectrum curve were calculated. Postoperative specimens underwent HIF immunohistochemical staining by two pathologists. Spearman correlation analysis was adopted as the statistical methodology. The data were analyzed by SPSS26.0 statistical software.

Results: Water concentration (r=0.659, P<0.001 and r= 0.632, P<0.001, the CT values corresponding to 100keV (r=0.645, P<0.001 and r= 0.566, P<0.001) and 130keV (r=0.687, P<0.001 and r= 0.682, P<0.001) in arterial and venous phases, and CT value of 70keV in arterial phase (r=0.457, P=0.005) were positively correlated with HIF-1α expression level. There was no correlation among iodine concentration, standardized iodine concentration, CT value of 40keV, λHU, and HIF-1α expression in arterial and venous levels (P >0.05).

Conclusion: The quantitative parameters of DECT have a certain correlation with HIF-1α expression in NSCLC. Moreover, it has been demonstrated that DECT can be used to predict hypoxia in tumor tissues and the prognosis of lung cancer patients.

Case Presentation: We report a case of a 53-year-old female with chest pain who was found to have filling defects in pulmonary vein branches on CCTA that were initially treated as thromboses. However, follow-up cardiac MRI was negative for thrombi, and pseudo-thrombosis was therefore diagnosed.

Conclusion: Pulmonary vein pseudo-thrombosis should be considered in the differential diagnosis of pulmonary vein filling defects.

Objective: To compare automatic liver segmentation and manual sampling strategies (manual whole liver segmentation and standardized manual region of interest) for performance in quantifying liver volume and MRI-proton density fat fraction (MRI-PDFF), identifying steatosis grade, and time burden.

Methods: Fifty patients with obesity who underwent liver biopsy and MRI between December 2017 and November 2018 were included. Sampling strategies included automatic and manual whole liver segmentation and 4 and 9 large regions of interest. Intraclass correlation coefficient (ICC), Bland–Altman, linear regression, receiver operating characteristic curve, and Pearson correlation analyses were performed.

Results: Automatic whole liver segmentation liver volume and manual whole liver segmentation liver volume showed excellent agreement (ICC=0.97), high correlation (R²=0.96), and low bias (3.7%, 95% limits of agreement, -4.8%, 12.2%) in liver volume. There was the best agreement (ICC=0.99), highest correlation (R²=1.00), and minimum bias (0.84%, 95% limits of agreement, -0.20%, 1.89%) between automated whole liver segmentation MRI-PDFF and manual whole liver segmentation MRI-PDFF. There was no difference of each paired comparison of receiver operating characteristic curves for detecting steatosis (P=0.07–1.00). The minimum time burden for automatic whole liver segmentation was 0.32 s (0.32–0.33 s).

Conclusion: Automatic measurement has similar effects to manual measurement in quantifying liver volume, MRI-PDFF, and detecting steatosis. Time burden of automatic whole liver segmentation is minimal among all sampling strategies. Manual measurement can be replaced by automatic measurement to improve quantitative efficiency.

Objective: To investigate the prediction performance of MRI radiomics for MVI in HCC.

Methods: Original studies focusing on preoperative prediction performance of MRI radiomics for MVI in HCC, were systematically searched from databases of PubMed, Embase, Web of Science and Cochrane Library. Radiomics quality score (RQS) and risk of bias of involved studies were evaluated. Meta-analysis was carried out to demonstrate the value of MRI radiomics for MVI prediction in HCC. Influencing factors of the prediction performance of MRI radiomics were identified by subgroup analyses.

Results: 13 studies classified as type 2a or above according to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis statement were eligible for this systematic review and meta-analysis. The studies achieved an average RQS of 14 (ranging from 11 to 17), accounting for 38.9% of the total points. MRI radiomics achieved a pooled sensitivity of 0.82 (95%CI: 0.78 – 0.86), specificity of 0.79 (95%CI: 0.76 – 0.83) and area under the summary receiver operator characteristic curve (AUC) of 0.88 (95%CI: 0.84 – 0.91) to predict MVI in HCC. Radiomics models combined with clinical features achieved superior performances compared to models without the combination (AUC: 0.90 vs 0.85, P < 0.05).

Conclusion: MRI radiomics has the potential for preoperative prediction of MVI in HCC. Further studies with high methodological quality should be designed to improve the reliability and reproducibility of the radiomics models for clinical application.

The systematic review and meta-analysis was registered prospectively in the International Prospective Register of Systematic Reviews (No. CRD42022333822).

Methods: The clinical data and ultrasound images of 160 patients with superficial lymphadenopathy (58 benign lymph nodes, 62 lymphoma, 40 metastatic lymph nodes) admitted to our hospital from January 2020 to November 2022 were retrospectively studied. Patients were randomly divided into a training set and test set according to the ratio of 6:4. Firstly, the radiomics features of each lymph node were extracted, and then a series of statistical methods were used to avoid over-fitting. Then, the gradient boosting machine(GBM) was used to build the model. The area under receiver(AUC) operating characteristic curve, precision, recall rate and F1 value were calculated to evaluate the effectiveness of the model.

Results: Ten robust features were selected to build the model. The AUC values of benign lymph nodes, lymphoma and metastatic lymph nodes in the training set were 1.00, 0.98 and 0.99, and the AUC values of the test set were 0.96, 0.84 and 0.90, respectively.

Conclusion: It was a reliable and non-invasive method for the differential diagnosis of lymphadenopathy based on the model constructed by machine learning.

Objective: This study aimed to assess the efficacy of CEUS in LVA surgery and provide a novel approach for the clinical assessment and localization of superficial lymphatic vessels.

Methods: Retrospective analysis of imaging and surgical data was performed on 20 LVA patients. Among them, 10 cases underwent evaluation and localization using indocyanine green (ICG) lymphatic imaging (Group A), while 10 cases were evaluated and localized using CEUS (Group B). The differences in surgical data between the two groups were compared and analyzed.

Results: All 20 patients were female (mean age, 57.7 years ± 6.3 [SD]). CEUS demonstrated superior visualization and localization of superficial lymphatic vessels. The average diameter of lymphatic vessels identified in the CEUS group was significantly greater than that in the ICG group (0.78±0.06 vs. 0.52±0.05mm; P<0.001). The duration of operation in group B was significantly shorter than that in group A (4.47±0.37 vs. 6.70±0.45mm; P<0.001). The number of anastomosed lymphatic vessels in group B was less than that in group A [5.0(4.0, 6.0) vs. 9.5 (9.0, 11.3); P<0.001].

Conclusion: CEUS can serve as a viable alternative to ICG lymphatic imaging, facilitating improved lymphatic venous anastomosis surgery.

Methods: Ninety patients with head-neck CTA were prospectively selected and randomly divided into a control group and a test group, with 45 patients in each group. The control group was scanned conventionally. With a tube voltage of 100 kVp and detector width of 40 mm, a 70 ml contrast agent was injected at a flow rate of 5.0 ml/s. The test group used GSI. With a tube current fixed of 445 mAs and a detector width of 80 mm, the contrast agent was injected at a flow rate of 3.5 ml/s and 0.6 ml/kg body weight, and the 55 keV virtual monoenergetic images (VMIs) were automatically reconstructed. Finally, the target vessel CT values, background noise (BN), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective scores, contrast agent dose, CT dose index volume (CTDIvol), and dose length product (DLP) were recorded. The DLP was converted to the effective dose (ED).

Results: The target vessel CT values, BN, SNR, CNR, and subjective scores of the two groups were not statistically significant (all P > 0.05), and the image quality of both groups was the same and met the diagnostic requirements. The contrast agent dose and effective dose (ED) in the test group were approximately 44% and 26% lower than that of the control group, respectively (all P < 0.05).

Conclusion: In head-neck CTA examination, the Revolution CT GSI combined with an 80 mm wide-body detector can reduce the contrast agent dose and radiation dose while ensuring image quality.

Objective: To investigate the ultrasonographic features and diagnostic value of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents.

Materials and Methods: The clinical and ultrasonographic data of 10 patients with renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion confirmed by pathology in our hospital were analyzed retrospectively. The age ranged from 3 to 18 years old, including 7 males and 3 females. The tumor location, size, boundary, echo, hemorrhage, cystic change, calcification, blood flow, lymph node status and metastasis were mainly observed, and the results were compared with the pathological results.

Results: There were 10 masses in 10 cases of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion, including 4 in the right kidney and 6 in the left kidney; the maximum diameter line is 5-23cm; 9 cases had clear mass boundary (90%); 9 masses (90%) showed mixed cystic and solid masses with high echo of solid components, and 1 mass (10%) showed huge multilocular cystic mass with multiple septations; necrosis and cystic changes were seen in all 10 masses (100%); calcification in 5 masses (50%); blood flow signals were seen in the solid components of the mass (100%).

Conclusion: Renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents are mostly large cystic and solid mixed echo masses, with high echo of solid components, and often accompanied by cystic changes and calcification. Its ultrasonic manifestations have certain characteristics. Color Doppler ultrasound has a certain diagnostic value for this disease.

Introduction: To assess the clinical value of deep vein thrombosis (DVT) density on computed tomography (CT) venography for predicting PTE.

Methods: From 2016 to 2021, patients with DVT diagnosed on lower-extremity CT venography were included. Of these patients, those without PTE were classified into ‘DVT-only group’ and those with PTE were classified into the ‘DVT with PTE group’. The DVT Hounsfield unit (HU) density was measured by drawing free-hand region-of-interests within the thrombus at the most proximal filling defect level. The risk factors associated with PTE were identified by using multivariate logistic regression analysis. A receiver operating characteristic (ROC) analysis was used to evaluate the value of DVT density for predicting the risk of PTE.

Results and Discussion: This study included 177 patients with a mean age of 41.7 ± 10.3 years (DVT-only group: 105 patients; DVT with PTE group: 72 patients). DVT density was significantly higher in DVT with the PTE group than DVT-only group (66.8HU ± 8.7 vs. 57.9HU ± 11.1, p < 0.001). The ROC analysis revealed that the area under the curve (AUC), sensitivity, and specificity for predicting the risk of PTE were 0.737, 72.2%, and 66.7%, respectively, at a DVT density cutoff of 63.0 HU. On univariate and multivariate analysis, DVT density was the only significant risk factor associated with PTE.

Conclusion: Higher DVT density was a significant risk factor for PTE. In addition, DVT density could be a predictive factor for PTE.

Methods: In this retrospective study, a total of 70 patients diagnosed with pulmonary embolism by computed tomography pulmonary angiography (CTPA) from January 2016 to May 2021 in Anhui Chest Hospital were included. Among them, 35 patients with pulmonary embolism combined with pulmonary tuberculosis were set as the study group, and the other 35 patients with pulmonary embolism only were set as the control group. The imaging findings of chest CT examination, the incidence of pulmonary hypertension, the level of N-terminal proto-B-type brain natriuretic peptide (NT-proBNP), and the prognosis of patients were compared between the two groups. The incidence of deep venous embolism was evaluated by ultrasonography of the lower extremity.

Results: In the study group, the median age of patients was 71 years, and the ratio of males to females was 2.5 to 1. In the control group, the median age was 66 years old, and the male-to-female ratio was 2.2 to 1. There were 16 cases (16/35, 45.71%) in the study group and 10 cases (10/35, 28.57%) in the control group with an increased level of NT-proBNP. Pulmonary hypertension occurred in 10 patients (10/35, 28.57%) in the study group and 7 patients (7/35, 20.00%) in the control group. Patients who lost follow-up included 5 in the study group (5/35, 14.29%) and 3 in the control group (3/35, 8.57%). There were 17 cases (17/35, 48.57%) in the study group and 3 cases (3/35, 8.57%) in the control group with pulmonary artery widening, and the difference was significant (P < 0.001). There were 13 deaths in the study group (13/35, 37.14%) and 1 death in the control group (1/35, 2.86%), and the difference was significant (P <0.001).

Conclusion: Special signs of pulmonary artery widening, pulmonary hypertension of varying degrees, and increased levels of NT-proBNP of varying degrees can be found in patients with pulmonary tuberculosis complicated with pulmonary embolism, and the three signs are positively correlated. The mortality of patients with pulmonary tuberculosis complicated with pulmonary embolism is significantly higher than that of patients with pulmonary embolism alone. Pulmonary tuberculosis and pulmonary embolism both occur in the ipsilateral lung, causing clinical symptoms to cover each other, thereby making diagnosis difficult.

Objective: The objective of this review is to explore and summarize various herbs used in managing menopausal symptoms as an alternative to hormone replacement therapy. Methods: For this review, we conducted a literature survey spanning from 1998 to 2023. We used keywords such as menopause, endocrinology, hormone replacement therapy, and herbs used for reducing menopausal symptoms to search databases such as Google Scholar, PubMed, and SciDirect. Relevant data were sourced from various journals like Plos One, JAMA, Frontier, Drug in Context, MDPI, Molecules, BMC Women's Health, Research Gate, Heliyon, Elsevier, Taylor & Francis, Nutrients, JMM, Wiley, OXFORD, Hindawi, Clinical Phytoscience, Pharmaceuticals, Phytomedicine, and Menopause: The Journal of The North American Menopause Society.

Results: The literature review encompassed 40 research articles and 200 review articles, including randomized controlled trials. The findings revealed that several herbal plants, including Curcuma longa, Zingiber officinale, Foeniculum vulgare, Trigonella foenum, Actaea racemosa, Glycyrrhiza glabra, Oenothera biennis, Trifolium pratense, Humulus lupulus, Vitex agnus-castus, Valeriana officinalis, Linum usitatissimum, Cannabis sativa, and Asparagus racemosus, have shown efficacy in treating menopausal symptoms.

Conclusion: In conclusion, medicinal plants can play a significant role in managing acute menopausal syndrome. The intent of this review is to highlight the most recent research on estrogenic plants for medicinal purposes and their therapeutic impact on cognitive deficiencies brought on by estrogen shortage during menopause and aging.

With an emphasis on lung illnesses, this article will offer an in-depth understanding of dextran-based delivery systems in respiratory illnesses.

Aims: The study aimed to assess the role of baseline anamnestic information, clinical parameters, instrumental examination, and serum biomarkers in predicting adverse outcomes of COVID-19 in a hospital setting of Internal Medicine.

Methods: Fifty-two inpatients consecutively admitted to the Unit of Internal Medicine “Baccelli,” Azienda Ospedaliero – Universitaria Policlinico of Bari (February 1 - May 31, 2021) due to confirmed COVID-19 were grouped into two categories based on the specific outcome: good prognosis (n=44), patients discharged at home after the acute phase of the infection; poor prognosis, a composite outcome of deaths and intensive care requirements (n=8). Data were extracted from medical records of patients who provided written informed consent to participate.

Results: The two study groups had similar demographic, anthropometric, clinical, and radiological characteristics. Higher interleukin 6 (IL-6) levels and leucocyte count, and lower free triiodothyronine (fT₃) levels were found in patients with poor than those with good prognosis. Higher IL-6 levels and leucocyte count, lower fT₃ concentration, and pre-existing hypercholesterolemia were independent risk factors of poor outcomes in our study population. A predicting risk score, built by assigning one point if fT₃ < 2 pg/mL, IL-6 >25 pg/mL, and leucocyte count >7,000 n/mm³, revealed that patients totalizing at least 2 points by applying the predicting score had a considerably higher risk of poor prognosis than those scoring <2 points (OR 24.35 (1.32; 448), p = 0.03). The weight of pre-existing hypercholesterolemia did not change the risk estimation.

Conclusion: Four specific baseline variables, one anamnestic (pre-existing hypercholesterolemia) and three laboratory parameters (leucocyte count, IL-6, and fT3), were significantly associated with poor prognosis as independent risk factors. To prevent adverse outcomes, the updated 4-point score could be useful in identifying at-risk patients, highlighting the need for specific trials to estimate the safety and efficacy of targeted treatments.

In this State-of-the-Art review, we provide comprehensive insights into the complex pathobiology of PAH to provide understanding and insights for the practicing clinician. We review the pathology of PAH and the cells involved and their impact in driving pathological abnormalities (pulmonary artery endothelial cells, smooth muscle cells, fibroblasts and pericytes) as well as the role of the extracellular matrix. Inflammation and immune dysfunction are considered important drivers of PAH and are comprehensively discussed. Another pathway relates to TGFβ/ bone morphogenic protein (BMP) imbalance, which is highlighted, as well as a new novel agent, sotatercept that impacts this imbalance. Genetic factors underlying heritable PAH (HPAH) are addressed, as well as epigenetic influences. Other important pathways highlighted include growth factor signaling, ion channels/channelopathy, hypoxia signaling pathways, and altered metabolism and mitochondrial dysfunction. We also address the “estrogen paradox”, whereby PAH is more common in women but more severe in men. The basis for drug-induced PAH is discussed, including the new methamphetamine epidemic. We briefly provide insights into DNA damage and senescence factors in pathobiology and highlight commonalities between PAH and cancer pathobiology. Furthermore, we provide concluding insights for the treating physician. In conclusion, we need to pose the right questions to motivate novel and effective treatment strategies for the management of PAH based on pathobiological principles and understanding.

Objectives: The present study evaluated the pharmacokinetics and safety of Prusogliptin in subjects with mild or moderate hepatic impairment compared with healthy subjects.

Methods: According to the liver function of the subjects, we divided them into a mild liver dysfunction group, a moderate liver dysfunction group and a normal liver function group. All subjects in three groups received a single oral dose of Prusogliptin 100-mg tablets. Pharmacokinetics and safety index collection was carried out before and after taking the drug. Plasma pharmacokinetics of Prusogliptin were evaluated, and geometric least- -squares mean (GLSM) and associated 90% confidence intervals for insufficient groups versus the control group were calculated for plasma exposures.

Results: After a single oral administration of 100 mg of Prusogliptin tablets, the exposure level of Prusogliptin in subjects with mild liver dysfunction was slightly higher than that in healthy subjects. The exposure level of Prusogliptin was significantly increased in subjects with moderate liver dysfunction. There were no adverse events in this study.

Conclusion: The exposure level of Prusogliptin in subjects with liver dysfunction was higher than that in healthy subjects. No participant was observed of adverse events. Prusogliptin tablets were safe and well tolerated in Chinese subjects with mild to moderate liver dysfunction and normal liver function.

The potential role of paroxysmal atrial fibrillation and its contribution to clinical course have been also discussed in a hypothetical manner to elucidate the pathophysiology of CS and support further treatment modalities.

Objective: The aim of the study was to assess the presence of differentiating features between “scleroderma” pattern in SSc and “scleroderma-like” pattern in other rheumatic diseases.

Methods: 684 capillaroscopic images demonstrating a “scleroderma” and “scleroderma-like” pattern have been analysed in the current retrospective cross-sectional study. 479 capillaroscopic pictures were obtained from 50 SSc patients, 105 from 7 DM patients, 38 from 10 rheumatoid arthritis (RA) patients, 36 images from 5 patients with SLE, and 26 images from 9 patients with UCTD. All capillaroscopic images used in the current analysis have fulfilled the criteria for “sclerderma/scleroderma-like” pattern, as the pathological changes in the capillaroscopic parameters have also been confirmed by quantitative measurement of capillary diameters, capillary density, and intercapillary distance. All the images have been categorized into one of the following groups, i.e., “early”, “active” and “late” phases (according to the definition of Cutolo et al.), or “other” findings, the latter being specifically described as they could not be attributed to one of the other three categories.

Results: 479 capillaroscopic pictures were obtained from 50 scleroderma patients. 31 of them showed an “early”, 391 an “active” phase, and 57 a “late” phase “scleroderma” type microangiopathy. In 69 images assessed as an “active” pattern, neoangiogenesis was found. In 43 out of 105 capillaroscopic pictures from DM patients, an “active” phase was detected; in 2 of the images, a “late” pattern was found, and in 60 capillaroscopic pictures, neoangiogenesis in combination with giant capillary loops was observed. Early microangiopathy was not found in this group. Among capillaroscopic images from SLE patients, “late” phase microangiopathy was not found. “Early” phase was present in 3 images, “active” phase in 29, neoangiogenesis in “active” phase in 4 pictures. Early microangiopathy was detected in 11 capillaroscopic pictures from RA patients (8 out of 9 patients), an “active” phase in 4 images (3 patients), and in 23 capillaroscopic images, neoangiogenesis with mild capillary derangement and capillary loss and single giant capillaries (“rheumatoid neoangiogenic pattern”) were observed. Classic “late” type microangiopathy was not found in RA patients as well as among patients with UCTD. The predominant capillaroscopic pattern in UCTD patients was early microangiopathy (n = 23). The rest images from UCTD exhibited features of the “active” phase.

Conclusion: In conclusion, early microangiopathy was observed in RA, SLE, and UCTD patients, but not in patients with DM. An “active” phase “scleroderma” type capillaroscopic pattern was detected in all patient groups other than SSc, i.e., DM, SLE, RA, and UCTD. “Late” phase “scleroderma” type microangiopathy was present in patients with scleroderma and DM and was not observed in SLE, RA, and UCTD. Despite the fact that in some cases, microangiopathy in scleroderma and other rheumatic diseases may be indistinguishable, the results of the current research have shown the presence of some differentiating features between “scleroderma” and ”scleroderma-like” microangiopathy that might be a morphological phenomenon associated with differences in the pathogenesis and the degree of microvascular pathology in various rheumatic diseases.

Methods: A search was undertaken of the PubMed, Scopus, Web of Science, Embase, and Google Scholar electronic databases up to 15 July 2022. Primary endpoints focused on plasma homocysteine levels. Data were quantitatively analyzed using fixed or random- effect models, as appropriate. Subgroup analyses were conducted based on the drugs and hydrophilic-lipophilic balance of statins.

Results: After screening 1134 papers, 52 studies with a total of 20651 participants were included in the meta-analysis. The analysis showed a significant decrease in plasma homocysteine levels after statin therapy (WMD: -1.388 μmol/L, 95% CI: [-2.184, -0.592], p = 0.001; I2 = 95%). However, fibrate therapy significantly increased plasma homocysteine levels (WMD: 3.459 μmol/L, 95% CI: [2.849, 4.069], p < 0.001; I2 = 98%). The effect of atorvastatin and simvastatin depended on the dose and duration of treatment (atorvastatin [coefficient: 0.075 [0.0132, 0.137]; p = 0.017, coefficient: 0.103 [0.004, 0.202]; p = 0.040, respectively] and simvastatin [coefficient: -0.047 [-0.063, -0.031]; p < 0.001, coefficient: 0.046 [0.016, 0.078]; p = 0.004]), whereas the effect of fenofibrate persisted over time (coefficient: 0.007 [-0.011, 0.026]; p = 0.442) and was not altered by a change in dosage (coefficient: -0.004 [-0.031, 0.024]; p = 0.798). In addition, the greater homocysteine- lowering effect of statins was associated with higher baseline plasma homocysteine concentrations (coefficient: -0.224 [-0.340, -0.109]; p < 0.001).

Conclusion: Fibrates significantly increased homocysteine levels, whereas statins significantly decreased them.

Objective: To reduce drug attrition rates, drug metabolism and pharmacokinetics studies are fully integrated into modern drug discovery research, and the structure-property relationship illustrates how the modification of the chemical structure influences the pharmacokinetic and toxicological properties of drug compounds. Understanding the structure- property relationships of clinically approved protease inhibitor drugs and their analogues could provide useful information on the lead-to-candidate optimization strategies.

Methods: About 70 inhibitors against human or pathogenic viral proteases have been approved until the end of 2021. In this review, 17 inhibitors are chosen for the structure- property relationship analysis because detailed pharmacological and/or physicochemical data have been disclosed in the medicinal chemistry literature for these inhibitors and their close analogues.

Results: The compiled data are analyzed primarily focusing on the pharmacokinetic or toxicological deficiencies found in lead compounds and the structural modification strategies used to generate candidate compounds.

Conclusion: The structure-property relationships hereby summarized how the overall druglike properties could be successfully improved by modifying the structure of protease inhibitors. These specific examples are expected to serve as useful references and guidance for developing new protease inhibitor drugs in the future.

Objective: The study aimed to report on the rare use of hand and forearm fasciotomies in Australia in October 2021 following snakebite, and highlight the resultant extended morbidity experienced by the patient.

Patient Account: Common mulga snake (Pseudechis australis) bite has been reported in the Pilbara region, Western Australia by a 39-year-old male snakebite victim, with his narrative detailing the events prior to the snakebite until the completion of his outpatient treatment.

Conclusion: The consensus worldwide is that antivenom is the primary treatment for venomous snakebite and, although a patient may present with symptoms mimicking compartment syndrome, this disease is extremely rare, especially in Australia, where the fangs of endemic snakes are generally too small to penetrate sufficiently deep to cause other than shallow subcutaneous swelling. The avoidance of surgical intervention in snakebite treatment resulted in much better outcomes for the patient.

Aim: To this date, no single treatment method provides pathological correction of the mechanisms associated with tissue reorganization observed in later-stage breast cancer-related lymphedema (BCRL).

Methods: To define a personalized approach to the management of patients with iatrogenic lymphedema, we performed a systematic review of literature without a comprehensive meta-analysis to outline existing molecular- genetic patterns, overview current treatment methods and their efficacy, and highlight the specific tissue-associated changes in BCRL conditions and other bio-engineering approaches to develop personalized therapy.

Results: Our results show that several tissue-specific and pathological molecular markers may be found, yet current research does not aim to define them.

Conclusion: As such, currently, a strong foundation for further research into molecular-genetic changes in lymphedema tissue exists, and further research should focus on finding specific targets for personalized treatment through bio-engineering approaches.

Objective: The objective of this review is to give a comprehensive overview on the role of micronutrients in the treatment of broad-spectrum diseases and also give insightful knowledge regarding the numerous food sources for obtaining nutrients, their dietary reference values, and their deficiencies. In this review, the authors have also highlighted the role of micronutrients in COVID- 19.

Findings: A properly balanced diet provides an acceptable amount of nutrients in the body. Deficiency and excessive nutrients in an individual’s diet may cause diseases or abnormal conditions. An improper diet may be responsible for the occurrence of deficiencies in iron, calcium, and iodine. Minerals like iron, boron, calcium, cobalt, phosphorous, and vitamins like K, E, A, D, and Riboflavin can cure and treat fatal diseases like Alzheimer’s, bone development conditions, osteoporosis, anemia, inflammatory bowel, and HIV Infections.

Conclusion: Micronutrients are essential for metabolism and tissue function. Sufficient consumption is thus required, but providing additional supplements to persons who do not require them may be detrimental. Large-scale studies of varied micronutrient dosages with accurate outcome indicators are needed to optimize intakes in different patient groups and the general population at large. In this review, the authors have highlighted the crucial role of micronutrients in health and disease.

Methods: By searching electronic databases, such as the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure Database (CNKI), the China Science and Technology Journal Database, Wanfang, PubMed, Embase, and the Cochrane Library, all randomized controlled trials (RCTs) published before 14 July, 2022, and published in Chinese or English languages were selected. Statistical analysis was performed using Review Manager 5.4 calculation software to calculate the odds ratio (OR), mean difference (MD), 95% confidence interval (CI), and p values.

Results: 13 articles that included 1,243 patients were identified; in 646 of them, the Huo Xue Hua Yu method combined with aspirin has been administered, while 597 have only been administered aspirin therapy. The combined treatment significantly improved clinical efficacy (OR: 4.41, 95% CI: 2.90 to 5.84, p < 0.001, I² = 0), as assessed by the National Institutes of Health Stroke Scale score (MD = -4.18, 95% CI: -5.69 to -2.67, p < 0.001, I² = 94%), Barthel score (MD = -2.23, 95% CI: -2.66 to -1.81, p < 0.001, I² = 82%), the China Stroke Scale score (MD = 6.74, 95% CI: -3.49 to 16.96, P = 0.20, I² = 99%), packed cell volume (MD = -8.45, 95% CI: -8.81 to -8.09, p < 0.001, I² = 98%), fibrinogen levels (MD = -0.93, 95% CI: -1.23 to -0.63, p < 0.001, I² = 78%) and plasma viscosity (MD = -0.51, 95% CI: -0.72 to -0.30, p < 0.001, I² = 62%).

Objective: To analyze pathophysiological characteristics/co-morbidities precipitating myocardial ischemia in patients with HTN LVH and provide a rationale for recommending beta-blockers (BBs) to prevent/treat ischemia in LVH.

Methods: We searched PubMed, SCOPUS, PubMed, Elsevier, Springer Verlag, and Google Scholar for review articles and guidelines on hypertension from 01/01/2000 until 01/05/2022. The search was limited to publications written in English.

Results: HTN LVH worsens ischemia in coronary artery disease (CAD) patients. Even without obstructive CAD, several pathophysiological mechanisms in HTN LVH can lead to myocardial ischemia. In the same guidelines that recommend BBs for patients with HTN and CAD, we could not find a single recommendation for BBs in patients with HTN LVH but without proven CAD. There are several reasons for the proposal of using some BBs to control ischemia in patients with HTN and LVH (even in the absence of obstructive CAD).

Conclusion: Some BBs ought to be considered to prevent/treat ischemia in patients with HTN LVH (even in the absence of obstructive CAD). Furthermore, LVH and ischemic events are important causes of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death; these events are another reason for recommending certain BBs for HTN LVH.

Patients and Methods: All patients with ischemic stroke in the Bezmialem Stroke Registry over a 4- year period were retrospectively analyzed in this study. Patients with acute ischemic stroke and additional diagnoses of solid and active malignancy (excluding hematologic malignancies) were included in the analysis. We investigated whether there was a relationship between the etiology of patients with cancer-related stroke according to the stroke etiologic classification and the diffusion restriction patterns on MRI.

Results: In this registry, 32 of 1472 patients were diagnosed as having active cancer. Fourteen patients were evaluated as having definite cardioembolism, eight patients as probable cardioembolism, and four patients had inadequate examinations. Only one patient was classified as having an atherothrombotic stroke. Isolated acute infarction was seen in 15 of 32 patients. In patients with multiple acute infarct areas (n=17), acute lesions characterized by micro embolisms in a single vessel area were detected in four patients, and acute lesions characterized by bilateral (anterior and/or posterior system) micro embolisms in more than one vessel area in 13 patients.

Conclusion: The most common etiology of stroke in patients with cancer was found to be embolic/ cardioembolic. This is important for the treatment plans for ischemic stroke in patients with cancer.

Methods: Calcium, α-Klotho, parathyroid hormone (PTH), calcyphosin, vitamin D3, phosphorous, fibroblast growth factor receptor 2 (FGFR2), as well as iron and erythron biomarkers were measured in 60 children with TDT and 30 healthy control children.

Results: A meaningful part of TDT patients showed lowered α-Klotho levels, and those children also showed low serum total and ionized calcium concentrations. TDT patients showed increased PTH, FGFR2, and calcyphosin and lowered vitamin D3 as compared with healthy children. The α-Klotho levels were significantly correlated with total and ionized calcium (positively) and with iron overload and transfusions biomarkers (inversely). Partial Least Squares path analysis showed that 40.1% of the variance in serum total calcium could be explained by the regression on α-Klotho, vitamin D3 (both positively), and calcyphosin (inversely) and that the effects of the latter are mediated by iron overload and the number of blood transfusions.

Conclusion: In conclusion, the iron overload in TDT and its consequences may induce lowered levels of α-Klotho which in turn may lead to lower calcium thereby explaining at least in part the effects of TDT on bone metabolism including spontaneous pathological fractures, osteoporosis, osteopenia, and skeletal deformities.

Methods: In compliance with evidence-based medicine, combined with clinical practice, clinical pharmacists participated in the formulation of the perioperative anticoagulant clinical medicine pathway. The PDCA cycle was strictly implemented. Urologic Department, Affiliated Hospital of Qingdao University, Qingdao Shandong, China, served as a pilot department for the evaluation of the effect of drug clinical pathway implementation.

Results: The anticoagulant clinical medicine pathway for the urologic department was formulated and implemented from October 2020 to August 2021. The entry rate gradually increased, and the accuracy of thrombosis risk assessment improved. The proportion of drugs in the department and the per capita drug cost decreased significantly.

Conclusion: The perioperative VTE prophylactic anticoagulant pathway showed significant achievements in the rational use of urologic anticoagulant drugs, lowering the cost of medical care. Therefore, it could be considered a novel long-term mechanism for rational analgesia drug use.

Objective: We mainly discuss the application of machine learning technology in the prediction of pharmacokinetic parameters, which are mainly related to the quantitative study of drug absorption, distribution, metabolism and excretion in the human body, such as bioavailability, clearance, apparent volume of distribution and so on.

Methods: This paper first introduces the pharmacokinetic parameters, the relationship between the quantitative structure-activity relationship model and machine learning, then discusses the application of machine learning technology in different prediction models, and finally discusses the limitations, prospects and future development of the machine learning model in predicting pharmacokinetic parameters.

Results: Unlike traditional pharmacokinetic analysis, machine learning technology can use computers and algorithms to speed up the acquisition of pharmacokinetic parameters to varying degrees. It provides a new idea to speed up and shorten the cycle of drug development, and has been successfully applied in drug design and development.

Conclusion: The use of machine learning technology has great potential in predicting pharmacokinetic parameters. It also provides more choices and opportunities for the design and development of clinical drugs in the future.]]> https://www.benthamscience.comarticle/128076 https://www.benthamscience.comarticle/120816Background: To evaluate the perfusion status of patients with acute stroke, different imaging tools are used depending on the condition. CT-CT Angiography and MRI are indispensable imaging tools to diagnose and manage stroke patients. Susceptibility-weighted imaging (SWI) also has been used lately to evaluate vascular structures and consequences of stroke in the brain. We aimed to compare CE-MRI, SWI, and CTA with DSC-MRP in terms of perfusion.

Methods: Stroke cases of CE-MRI, SWI, CTA and DSC-MRP of 44 patients were included. Collateralization was assessed on CTA; leptomeningeal-pial collateralization (LPC) and parenchymal enhancement (PE) on CE-MRI; prominent vessel sign (PVS) and hemorrhagic transformation on SWI. Results were compared with MRP maps and the ratio of penumbra/infarct core.

Results: LPC was correlated with increased CBV (p<0,001), decreased CBF (p=0,026), and prolonged MTT and TTP (p=0,001 and p=0,003). LPC was observed more often in cases with infarct zones with penumbra compared to those without penumbra (p=0,024). PE was positively correlated with prolonged MTT and TTP (p=0,015 and p=0,031). Moreover, there was a positive relationship between PE and increased penumbra ratio over the infarct core (p=0,037). Ipsilateral PVS was associated with increased CBV (p=0,004) and decreased CBF (p=0,002). No relationship was found between collateralization grading on CTA and perfusion metrics or penumbra ratio.

Conclusion: In conclusion; ipsilateral PVS can be a measure of CBV and CBF. LPC on CE-MRI can be a sign of an increase in CBV. PE can show larger penumbra. CE-MRI with SWI can be used to evaluate perfusion status.

Case Presentation: We report a case series of patients with advanced kidney disease and baclofen-induced encephalopathy that settled with discontinuation of the drug and hemodialysis sessions.

Conclusion: We report this cluster of patients with baclofen toxicity to highlight the common occurrence of neurotoxicity after its use in patients with end-stage renal disease and its resolution after cessation of the drug and hemodialysis sessions.]]> https://www.benthamscience.comarticle/126141 https://www.benthamscience.comarticle/125662Background: Passiflora L. is a genus belonging to the Passifloraceae family, with many species widely used in folk medicine and several pharmacological activities described in the scientific literature, being a major target for the development of new therapeutic products. Studies have identified several bioactive compounds in their composition as responsible for these activities, mainly C-glycoside flavonoids.

Objective: The aim of this study was to carry out a review of patents related to the genus and its application in several pharmacological activities, important for the development of new drugs and formulations.

Methods: The search was carried out in 5 specialized databases, INPI, EPO, WIPO, Latipat and Derwent, using the term ‘Passiflora’ combined with ‘A61K and A61P', subclasses of section A of the International Patent Classification (IPC), which are destined to medical, dental or hygienic purposes, and therapeutic activity of chemical compounds or medicinal preparation, respectively.

Results: 1,198 patents citing the genus in the title or abstract have been found, 508 being duplicates. After exclusion and inclusion criteria, 23 patents written in English, Portuguese and Spanish were selected, which demonstrated biological assays in vivo with species of Passiflora as the only active constituent or incorporated in formulations with other compounds.

Conclusion: The findings of this search showed growing interest in research and industrial areas in the pharmaceutical development with species of Passiflora, suggesting that the different bioactive compounds present in the genus can be considered as an important tool for the development of new effective and safe products with pharmacological potential.

Methods: Eight databases were searched for studies reporting the effects of MSCs on acetaminophen hepatoxicity. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. SYRCLE’s risk of bias tool for animal studies was applied to assess the methodological quality. A meta-analysis was performed by using RevMan 5.4 and STATA/ SE 16.0 software.

Results: Eleven studies involving 159 animals were included according to PRISMA statement guidelines. Significant associations were found for MSCs with the levels of alanine transaminase (ALT) (standardized mean difference (SMD) - 2.58, p < 0.0001), aspartate aminotransferase (AST) (SMD - 1.75, p = 0.001), glutathione (GSH) (SMD 3.7, p < 0.0001), superoxide dismutase (SOD) (SMD 1.86, p = 0.022), interleukin 10 (IL-10) (SMD 5.14, p = 0.0002) and tumor necrosis factor-α (TNF-α) (SMD - 4.48, p = 0.011) compared with those in the control group. The subgroup analysis showed that the tissue source of MSCs significantly affected the therapeutic efficacy (p < 0.05).

Conclusion: Our meta-analysis results demonstrate that MSCs could be a potential treatment for acetaminophen- related liver injury. The protocol for this meta-analysis was prospectively registered in PROSPERO (Number: CRD42020212677).

Methods: A total of 18 patients with obstructive jaundice and 12 non-jaundiced patients scheduled for bile duct surgery were enrolled in the study. Etomidate 0.333 mg/kg was administered by IV bolus for anesthetic induction. Arterial blood samples were drawn before, during, and up to 300 minutes after the bolus. Plasma etomidate concentrations were determined using a validated high-performance liquid chromatography-tandem mass spectrometry assay. A nonlinear mixed-effects population modeling approach was used to characterize etomidate pharmacokinetics. The covariates of age, gender, height, weight, Body Surface area (BSA), Body Mass Index (BMI), Lean Body Mass (LBM), Total Bilirubin (TBL), Alanine Aminotransferase (ALT), aspartate aminotransferase (AST), total bile acid (TBA), creatinine (CR), and blood urea nitrogen (BUN) were tested for significant effects on parameters using a multiple forward selection approach. Covariate effects were judged based on changes in the Objective Function Value (OFV).

Results: A three-compartment disposition model adequately described the pharmacokinetics of etomidate. The model was further improved when height was a covariate of total clearance [Cl1=1.30+0.0232(HT-162), ΔOFV=-7.33; P<0.01)]. The introduction of any other covariates, including bilirubin and total bile acids, did not improve the model significantly (P>0.01). For the height of 162cm, the final pharmacokinetic parameter values were as follows: V1=1.42 (95% CI, 1.01-1.83, L), V2=5.52 (95% CI, 4.07-6.97, L), V3=63.9 (95% CI, 41.95-85.85, L),Cl1= 1.30 (95% CI, 1.19-1.41, L/min), Cl2= 1.21 (95%CI, 0.95-1.47, L/min), and Cl3=0.584 (95%CI, 0.95-1.21, L/min), respectively.

Conclusion: A 3-compartment open model might best describe the concentration profile of etomidate after bolus infusion for anesthesia induction. The pharmacokinetics of etomidate did not change by the presence of obstructive jaundice.

Methods: This prospective interventional study was carried out in Benha University hospitals between January 2019 and May 2020. The study included all consecutive HCV patients with simultaneous ED coming to the hepatology outpatient clinic. Patients were divided into a study group who received sofosbuvir-based therapy (group A) or a control group who received silymarin therapy (group B). The International Index of Erectile Function-5 (IIEF-5) was used for the assessment of erectile function at different time points (pretreatment, 6 months, and 12 months after treatment). Different variables in both groups have been statistically analyzed.

Results: Overall, 75 patients who received sofosbuvir-based therapy and a control group (n = 35) matched for age and pretreatment variables (Child–Turcotte–Pugh score and Fibrosis‐4 score). There was no significant difference between both groups in the pretreatment data. On the other hand, the posttreatment IIEF-5 was significantly higher in the sofosbuvir arm compared to the silymarin arm both at six months (p<0.001) and at 12 months (p<0.001). Furthermore, the age and the stage of liver fibrosis were negatively correlated with IIEF-5 at all-time points.

Conclusion: The age and the stage of liver fibrosis are significantly correlated with the degree of ED. Furthermore, sofosbuvir-based therapy may be associated with significant improvement in patients with erectile function.

Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the Amniotic Fluid Index (AFI) in comparison to the Single Deepest Vertical Pocket (SDVP).

Methods: We studied abnormal cardiotocograph, meconium stained amniotic fluid, birth weight < 2.5 kg, Apgar score at 5 min < 7, cord blood pH < 7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes.

Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of > 5 cm and SDVP of > 1.9 cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5 kg and avoiding NICU admissions, an AFI of > 5.8 cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries.

Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

Methods: The study was based on bibliometric research between the years 2008 and 2019 using the following keywords: Cancer, Head and Neck Cancer, Chemotherapy, Radiotherapy, Photodynamic Therapy, and Hyperthermia.

Results: A total of 5.151.725 articles were found, 3.712.670 about cancer, 175.470 on Head and Neck Cancer, 398.736 on Radiotherapy, 760.497 on Chemotherapy, 53.830 on Hyperthermia, and 50.522 on Photodynamic Therapy.

Conclusion: The analysis shows that there is still much room for expanding research, especially for alternative therapies since most of the studies still focus on conventional treatments and on the quest to overcome their side effects. The scientific community needs to keep looking for more effective therapies generating fewer side effects for the patient. Currently, the so-called alternative therapies are being used in combination with the conventional ones, but the association of these new therapies shows great potential, in other types of cancer, to improve the treatment efficacy.]]> https://www.benthamscience.comarticle/117123Background: The prevalence of Type 2 Diabetes Mellitus (T2DM) in Indonesia has continued to increase over the years. Management of T2DM is challenging across clinical settings, including primary and tertiary care. Uncontrolled T2DM puts patients at risk of the development of T2DM complications, especially early-stage dry skin that is neglected by most of the patients. This study aimed to investigate the comparison between the T2DM management profile and dry skin clinical profile of T2DM patients in primary care and tertiary care settings.

Methods: The study was conducted as a cross-sectional epidemiological study by comparing T2DM patient profiles in primary and tertiary care. The data collected included sociodemographic, clinical, and laboratory data that were correlated with T2DM and early dry skin related-T2DM. This study included early dry skin within the SRRC score of 3-11 and excluded infection, ulcer, and severe erythema.

Results: The patients in primary and tertiary care presented poorly controlled T2DM with median HbA1c levels of 7.8% and 7.6%. The patients in primary care also presented with high triglyceride, 179 mg/dl. Furthermore, several significant differences were found in the duration of T2DM, duration of dry skin, and DM treatment (OAD and insulin).

Conclusion: Significant differences in the duration of T2DM, duration of dry skin, and DM treatment (OAD and insulin) might be affected by the parameter of T2DM glycemic control (Blood pressure (BP), body mass index (BMI), HbA1c, random blood glucose (RBG), and triglyceride).

Introduction: Among the various complications, treatment of diabetic foot and ulcers is one of the major concerns in patients who are suffering from diabetes. The causative factors for this condition include increased oxidative stress, high blood glucose levels, vascular insufficiency, and microbial infections, and many a time, if left untreated, it may even lead to amputations of the lower extremities. The present therapy for the treatment of diabetic wounds mainly involves the use of synthetic moieties and other biotechnology-derived biomolecules, including growth factors. Few plant products are also useful in the treatment of wounds.

Methods: Essential oils derived from various herbs are reported to possess significant wound healing potential and promote blood clotting, help to fight infections, and accelerate the wound healing process. Hence, the present review is a systematic analysis of all the available data on the use of the natural oils with their biological source, active phytochemical constituents present, and the probable mechanism of action for the treatment of chronic and diabetic wounds in suitable animal models. A methodical collection of data was performed, and information was searched up to April 2020 in entirety. Key phrases used for the data search include the pathophysiology of wounds, diabetic foot wound and its complications, natural oils for chronic and diabetic wound treatment.

Results: This review summarizes the natural oils which are reported in the literature to be beneficial in the treatment of chronic wounds, while some oils have been specifically also studied against wounds in diabetic rats. Essential oils are said to interact with the body pharmacologically, physiologically and psychologically and help in rapid wound healing. However, the majority of the literature studies have demonstrated wound healing activity only in animal models (preclinical data), and further clinical studies are necessary.

Conclusion: This review provides a platform for further studies on the effective utilization of natural oils in the treatment of chronic and diabetic wounds, especially if oils are to receive credibility in the management of chronic wounds.

Methods: This review follows the PICOS framework and the PRISMA guidelines. Pub- Med/MEDLINE, Scopus, and the Cochrane library were searched to identify the published literature from inception to September 2020, and a reference search was performed for additional relevant studies. The English language studies addressing the use of NAC in rodenticide poisoning were considered for the review. We considered all experimental and observational studies due to the insufficient number of interventional studies.

Results: Ten studies (two RCTs, four observational, and four descriptive) out of 2,178 studies with 492 participants were considered for the review. Only six studies (two RCTs, one prospective, and three retrospective studies) reported recovery and mortality. Pooled results of RCTs (n=2) showed a significant recovery rate (Odds Ratio [OR]: 3.97; 95% Confidence Interval [CI]:1.69-9.30), whereas summary estimates of prospective and retrospective studies recorded a non-significant effect. Metaanalysis of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI: 0.15-0.78; n=3) showed a significant reduction in mortality, whereas pooled analysis of prospective studies recorded a non-significant effect. A significant reduction in intubation or ventilation (OR: 0.25; 95% CI: 0.11-0.60; 2 RCTs) and a non-significant (P=0.41) difference in duration of hospitalization was observed with NAC when compared to the non-NAC treated group. The quality of the included studies appeared to be moderate to high.

Conclusion: Our findings indicate that NAC showed better survival and lower mortality rate when compared to non-NAC treated group; hence NAC can be considered for the management of rodenticide poisoning.

Introduction: Consecutive abdominal and pelvic Computed Tomography (CT) scans in adult female patients not diagnosed with PCS and collected over a period of 3 years were evaluated retrospectively to determine the prevalence of underestimated Pelvic Congestion (PC).

Methods: 500 consecutive abdominal and pelvic CT scans collected from female patients aged 18-80 years were retrospectively analyzed for the presence of PC.

Results: 90 of the CT scans examined showed the presence of PC (18%). These patients were divided into two groups: Group I had 52 scans with unilateral PC, while Group II had 38 scans with the bilateral enlarged Ovarian Vein (OV). Left and right OV diameters were measured as 7.14±2.15 and 5.56±1.87 mm, respectively. Co-occurrence of additional vascular anomalies, such as nutcracker- type compression of the left renal vein, and May Thurner, was significantly higher in Group I than Group II (p<0.001). The diameter of the OV remained wide irrespective of age in Group I, but showed a decrease with increasing age in Group II. The most common complaint was abdominal pain; these patients required an average of six referrals to two different clinics (primarily general surgery and internal medicine) before being diagnosed with PC.

Conclusion: The diagnosis of PCS remains to be an important problem for patients because of insufficient perception of physicians. PCS should be considered in female patients with complaints of chronic abdominal and pelvic pain and CT may be a valuable examination tool for diagnosis.

Objective: The aim of targeted drug delivery is to make the required amount of the drug available at its desired site of action. Drug targeting can be accomplished in a number of ways that include enzyme mediation, pH-dependent release, use of special vehicles, receptor targeting, among other mechanisms. Intelligently designed targeted drug delivery systems also offer the advantages of a low dose of the drug along with reduced side effects which ultimately improves patient compliance. Incidences of dose dumping and dosage form failure are negligible. A focused drug transport aims to have a safe drug interaction with the diseased tissue.

Conclusion: This review focuses on the available targeting techniques from experiment to perfection for delivery to the colon, brain, and other sites of interest. Overall, the article should make an excellent read for the researchers in this area. Newer drug targets may be identified and exploited for successful drug targeting.

Objective: To identify published guidance reports by national and international societies regarding thromboprophylaxis strategies in COVID-19 patients in different settings (outpatients, hospitalized, post-discharge).

Methods: A systematic review of the literature (Pubmed/EMBASE) was conducted independently by two investigators.

Results: Among 1942 initially identified articles, 33 guidance documents were included: 20 published by national and 13 by international societies. These documents provide recommendations mainly for hospitalized (97% of reports) and post-discharge (75%) COVID-19 patients, and less so for outpatients (34%). Thrombotic and bleeding risk stratification prior to any treatment decision is the cornerstone of all suggested thromboprophylaxis strategies; 81% of the documents recommend thromboprophylaxis for all hospitalized patients with a prophylactic dosage of low molecular weight heparin irrespective of VTE risk. Intermediate or therapeutic dose intensity is recommended in high VTE risk patients by 56% and 28% of documents, respectively. Mechanical thromboprophylaxis is suggested in case of high bleeding risk or contraindication to pharmacological thromboprophylaxis (59% of documents). Extended pharmacological thromboprophylaxis is recommended for patients with high VTE risk after hospital discharge (63% of documents). For non-hospitalized outpatients, 28% of documents recommend pharmacological thromboprophylaxis for high VTE risk.

Conclusion: The current guidance identifies thromboprophylaxis in COVID-19 patients, especially during hospitalization, as of major importance for the prevention of VTE. Recommendations are derived from limited evidence from observational studies.

Objective: The current study aimed to compare the postpartum hemoglobin and hematocrit levels in deliveries carried out with conventional and physiological delivery methods at Fatemieh Hospital of Hamedan.

Methods: This quasi-experimental study was conducted on 400 pregnant women candidates for physiological delivery and 400 pregnant women for conventional vaginal delivery in 2019. Mothers in the physiological delivery group were provided with the necessary training. In the conventional vaginal delivery group, the mother went through the usual procedures upon hospitalization. All mothers' venous blood samples were analyzed for hemoglobin and hematocrit levels at the time of hospitalization and six hours after delivery. The significance level was considered at p = 0.05.

Results: The outcomes indicated that by controlling the confounding variables, the mean of hemoglobin in the physiologic delivery group was significantly higher than conventional vaginal delivery, 11.93 (1.20) and 11.64 (1.20) respectively (P <0.001), but the Cohen's d value of 0.25 indicated a weak relationship between the mean of hemoglobin level six hours after delivery and the type of delivery. The results also indicated that by controlling the effect of confounding variables, the mean of hematocrit in the physiological group was significantly more than conventional vaginal delivery (36.53 (3.33) and 35.50 (3.33) respectively) (p <0.001) but the Cohen's d value of 0.31 indicated a weak relationship between mean hematocrit 6 hours after delivery and the type of delivery.

Conclusion: The results indicated that physiologic delivery did not show a valuable/considerable or the expected effect on improving postpartum maternal hemoglobin and hematocrit levels compared to conventional delivery.

Materials and Methods: A cohort of 166 consecutive adult patients with HBV-related cirrhosis was recruited in this retrospective study from two high-volume liver centers in China between April 2015 and April 2017. The performance of PVV and other non-invasive parameters for diagnosing CSPH and predicting the risk of VH was studied.

Results: PVV demonstrated the best performance for diagnosing CSPH (defined as an HVPG ≥10 mmHg) in patients with HBV-related cirrhosis among the included non-invasive predictors with the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity of 0.745, 50%, and 93.5%, respectively. Other non-invasive markers, including APRI, AAR, LS, FIB-4, and diameter of the portal vein, did not show sufficient performance with the AUCs of 0.565, 0.560, 0.544, 0.529, and 0.474, respectively. With regard to predicting the risk of VH (defined as an HVPG ≥12 mmHg), PPV also exhibited a moderate performance with an AUC of 0.762, which was superior to that of the aforementioned markers. By using two cutoff values of PVV to rule-out (11.65 cm/s) and rule-in (20.20 cm/s) CSPH, 30 (33.7%) patients showed definite results categories, with 23 (76.7%) patients were well classified and 7 (23.3%) were misclassified. Fifty-nine (66.3%) patients were with indeterminate results. By using PVV values of 13.10 cm/s and 21.40 cm/s to rule-out and rule-in HVPG ≥ 12mmHg, 34 (38.2%) patients has definite results, among whom 26 (76.5%) were well classified and 8 (23.5%) were misclassified. And 55 (61.8%) patients required further evaluation.

Conclusion: PPV is insufficient to serve as a non-invasive parameter for identifying CSPH and predicting the risk of VH in patients with HBV-related cirrhosis.

Methods: Volunteers with advanced-stage, histopathologically proven HNSCC, indicated to have radiotherapy/chemoradiotherapy, were evaluated for CT and PET/CT for radiotherapy planning. The attenuation and SUVmax of the primary lesion and the largest, possibly metastatic lymph node, and the round index and volume of the lymph node were calculated. The relationship between lymph node/primary lesion attenuation and SUVmax ratios was investigated. The differences in CT findings between the SUVmax < and ≥3 groups were examined.

Results: Thirty-two cases with adequate diagnostic quality were studied. There was a very strong positive correlation between the primary lesion and lymph node attenuation (r=0.817, p<0.001), a strong correlation between the lymph node volume and SUVmax (r=0.681, p<0.001), and a moderate negative correlation between lymph node/primary lesion SUVmax and attenuation (r=-0.503, p=0.004). In patients with ≥3 SUVmax, lymph node volume and lymph node/primary lesion SUVmax were significantly higher, and the attenuation ratio was close to 1 (PPV 94.1, 86.3%, respectively).

Conclusion: In HNSCC, the lymph node/primary lesion attenuation ratio can be used instead of SUVmax if supported by other conventional CT findings. Metastasis should be considered if lymph node attenuation is similar to primary mass attenuation and excluded if higher. CT attenuation rate can be used as a supportive finding if PET/CT cannot be performed or lymph node SUVmax is close to the acceptable cut-off for metastasis.

Results: Many deaths attributing to COVID-19 are actually caused by mistakes made in the prescription of medications, leading to the deterioration of the conditions of the patients, the most serious of which is the prescription of corticoids. Additionally, it has not been properly researched whether some drugs, such as NSAIDs, are indicated for use in COVID-19 or not.

Conclusion: On the other hand, the application of some valuable medicinal herbs, such as peppermint and chamomile, in the treatment of this disease has not received enough attention, despite the fact that they may have valuable and remarkable effects in the treatment of this disease.]]> https://www.benthamscience.comarticle/114316Cobb Syndrome (Spinal Arteriovenous Metameric Syndrome 1-31 (SAMS 1-31)) is a rare, non-hereditary disorder. Approximately 100 cases of CS have been described to date. The actual incidence may be much higher since only symptomatic patients were documented. In particular, post mortem studies suggest a possibly higher incidence of this syndrome. The main clinical manifestations of this syndrome include skin stains of vascular nature on the torso, in combination with spinal vascular malformations localized in one and the same metameric or spinal segment. A rare diagnosis of this syndrome in patients over 18 is probably related to the fact that the disease may be asymptomatic throughout a long period of time, while patients may tend to disregard the skin lesions. As a result, most publications on this pathology are based on separate case reports.

Significant variability of clinical manifestations as well as prolonged progress of the disease often cause errors in diagnosis. What follows is a case report of a young patient with Cobb Syndrome, who was admitted to a regional vascular centre with a misdiagnosis of stroke.

20 patients of young age (from 20 to 35 years old), with a diagnosis of stroke, who were admitted to a University Clinic (of the Russian National Research Medical University Named After Pirogov N.I., Moscow). Among this group of patients, a patient with Cobb syndrome was identified. Patient P., of 22 years, presented with acute, intensive cervical spinal pain, predominantly on the right, numbness and weakness in the arms and legs. About 3 weeks before admission to the hospital, the patient had ARVI with a fever of up to 37.5°C: two weeks before the onset of symptoms, he had undergone extirpation of 2 teeth, for which reason he spent over 2 hours in a forced position with his head thrown back (prolonged overextension in the cervical spine). Multiple skin angiomas on the chest spreading to the shoulder and scapula region. Tetraparesis up to 4 points: tetraparesis in hands with low muscle tone, low reflexes, tetraparesis in legs with high muscle tone, high reflexes, foot clonus when causing Achilles reflexes, tremor in the extremities and no plantar reflex pathology were detected, sensitivity disorders in the hands “the high gloves” and no pelvic disorders were detected. Given the presence and exacerbation of neurological symptoms and cutaneous angiomas, MRI with a contrast agent of the cervical spine was recommended. MR-image of an advanced arteriovenous malformation (AVM) of the cervical spinal cord with signs of gliosis and spinal cord oedema at the C2-C7 level. Endovascular embolization of the AVM in the cervical spinal cord was performed. The treatment led to the complete reversal of neurological symptoms. In the presence of skin lesions, the diagnosis of CS does not present particular difficulties, so in children and young patients with skin angiomatosis, it is advisable to conduct a comprehensive examination using selective spinal angiography or MR angiography to exclude arteriovenous malformations in the spinal cord.

Objective: To identify all the potential adverse reactions due to minocycline and analyze them in terms of the number of cases reported so far, salient features, severity and clinical outcome.

Methods: Comprehensive PubMed search of English and non-English literature for case reports of adverse reactions to minocycline was conducted.

Results: A total of 550 cases were identified from over 200 publications. The major reported adverse events caused by minocycline are drug reaction with eosinophilia and systemic symptoms syndrome, autoimmune syndromes like hepatitis, lupus and vasculitis, acute eosinophilic pneumonia, pseudotumor cerebri, hyperpigmentation, serum sickness-like reaction, Sweet’s syndrome and drug fever. Several other reactions involving multiple organ systems have also been reported. These show an overlap of clinical features and may be associated with multiple events causing considerable morbidity. Eight of these cases resulted in the death of the patients.

Conclusion: In view of the evident potential of minocycline to cause long-lasting and severe adverse effects, significant morbidity and even mortality, it should be prescribed with caution in the first-line treatment for moderate to severe acne.