The ASIDE Internal Medicine Journal, a cornerstone publication of the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE), is dedicated to advancing the fields of internal medicine and its subspecialties through a lens of diversity, equity, and inclusion. This peer-reviewed, open-access journal publishes a wide range of research articles, reviews, and clinical studies that focus on innovative healthcare solutions, the impact of social determinants on health outcomes, and strategies for enhancing accessibility to medical services for marginalized populations. With a commitment to fostering a more inclusive healthcare environment, the journal serves as a pivotal platform for medical professionals, researchers, and educators worldwide to share insights and discoveries that can lead to more equitable health practices and policies. ASIDE Internal Medicine: ISSN (Print) 3065-9671, ISSN (Online) 3065-968X Publication Frequency: Quarterly (4 issues per year)
American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE)
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Posterior Reversible Encephalopathy Syndrome (PRES) Beyond Hypertension: Triggers, Pathophysiology, Management, and Outcomes
Section: Review Article Categories: Internal Medicine, Neurology Keywords: Posterior Reversible Encephalopathy Syndrome, PRES , Pathophysiology , Hypertension Subjects: Posterior Reversible Encephalopathy Syndrome, PRES, Hypertension, Eclampsia and Preeclampsia, Immunosuppressive Therapy, Autoimmune Diseases, Sepsis-associated Encephalopathy, Neuroimaging, Vasogenic Edema, Endothelial Dysfunction Disciplines: Neurology, Internal Medicine, Neuroradiology, Emergency Medicine, Critical Care Medicine, Obstetrics and Maternal-Fetal Medicine, Nephrology, Immunology, Neuroscience, Clinical Pharmacology Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurovascular disorder characterized by vasogenic edema, most often affecting the parieto-occipital lobes. Although typically reversible, some patients develop lasting neurological sequelae such as cognitive or visual impairment and epilepsy. This review summarizes the current understanding of PRES beyond its classical association with hypertension, emphasizing emerging triggers, mechanisms, and updates in management. Methods: A structured narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Literature was systematically searched in PubMed, Web of Science, and Google Scholar for studies published between January 1996 and June 2025. Fifty-nine relevant publications, including original studies and reviews, were synthesized to integrate evidence on presentation, imaging, pathophysiology, genetics, and management. Results: PRES can be triggered by a broad spectrum of hypertensive and non-hypertensive conditions, such as renal dysfunction, eclampsia, systemic lupus erythematosus, sepsis, and exposure to immunosuppressive agents (e.g., tacrolimus, cyclosporine, rituximab). The syndrome involves multifactorial mechanisms, including endothelial dysfunction, blood–brain barrier disruption, and dysregulated cerebral autoregulation. Emerging data indicate that genetic polymorphisms in endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), and aquaporin genes may influence individual susceptibility, although causality remains unconfirmed. Conclusion: PRES is a multifactorial syndrome that extends beyond hypertension. Early recognition, prompt neuroimaging, and targeted management of underlying triggers are critical for improving outcomes. Future studies should focus on clarifying genetic associations, standardizing diagnostic criteria for atypical cases, and optimizing therapeutic strategies through personalized medicine approaches.
Posterior Reversible Encephalopathy Syndrome
Copyright (c) 2025 Mohamed Fawzi Hemida, MD, Pranjal Kumar Singh, MBBS, Alyaa Ahmed Ibrahim, MD, Ahmed Harb, MD, Sai Lokesh Moraboina, MD, Geethanjali Prakash, MBBS, Esraa M. Soliman, MBBS, Arun Kumar Maloth, MBBS, Huda Adnan, MBBS, Ravi Virani, MBBS, Sanchit Shailendra Chouksey, MBBS, MD, DM https://creativecommons.org/licenses/by/4.0
Dexmedetomidine as an Adjuvant to Ropivacaine in Thoracic Paravertebral Block: A Systematic Review with Meta-analysis
Section: Original Article Categories: Internal Medicine Keywords: Acute Appendix, Ropivacaine, Thoracic Surger, Paravertebral Block, Postoperative Pain, Meta-analysis Subjects: Dexmedetomidine, Ropivacaine, Thoracic Paravertebral Bloc, Video-Assisted Thoracoscopic Surgery (VATS), Postoperative Pain Management, Regional Anesthesia, Analgesic Adjuvants, Opioid-Sparing Techniques, Randomized Controlled Trials, Meta-Analysis Disciplines: Anesthesiology, Thoracic Surgery, Pain Medicine, Perioperative Care, Clinical Pharmacology, Evidence-Based Medicine, Critical Care, Surgical Anesthesia, Acute Pain Management, Internal Medicine (Thoracic/Perioperative Focus) Background: One of the ongoing challenges in thoracic surgeries, especially video-assisted thoracoscopic surgery (VATS), is effective postoperative pain management. The thoracic paravertebral block (TPVB) using ropivacaine provides targeted analgesia but suffers from a limited duration of effect. This meta-analysis aims to assess the safety of combining dexmedetomidine with ropivacaine in TPVB for thoracic procedures and to explore potential analgesic benefits suggested by individual trials. Method: A systematic review and meta-analysis of randomized controlled trials were conducted to compare the combination of dexmedetomidine and ropivacaine (PRD) with ropivacaine alone (PR) in thoracic procedures. Outcomes assessed included adverse effects (bradycardia, dizziness, hypotension, nausea, and vomiting). Analgesic and opioid-sparing effects were reported narratively, as data were heterogeneous and unsuitable for pooled analysis. Result: Five studies were included. No statistically significant differences were found between PRD and PR in the incidence of bradycardia (RR: 2.14; 95% CI: 0.71–6.40; p=0.1750), dizziness (RR: 1.52; 95% CI: 0.71–3.27; p=0.2833), hypotension (RR: 0.78; 95% CI: 0.40–1.53; p=0.4676), nausea (RR: 1.15; 95% CI: 0.65–2.03; p=0.6018), or vomiting (RR: 1.04; 95% CI: 0.54–2.02; p=0.9122). Some individual trials suggested reduced postoperative pain scores and opioid use with dexmedetomidine, but these findings could not be synthesized quantitatively. Conclusion: Adding dexmedetomidine to ropivacaine in TPVB for thoracic surgery appears safe, with no significant increase in adverse effects. While some individual trials indicated potential analgesic and opioid-sparing benefits, these results remain heterogeneous and cannot be confirmed by pooled evidence. Further high-quality, standardized trials are needed.
Video-Assisted Thoracoscopic Surgery (VATS)
Internal Medicine (Thoracic/Perioperative Focus)
Copyright (c) 2025 Mohamed Wagdy, Abdelrahman Abdalla Mohamed, Abdalla Ahmed Mohamed, Ziad ElDosoky Farouk, Mahmoud Abd El Nasser, Abdelrahman A. Ebaid Ebaid, Abdelrhman Waleed Kotb , Mostafa AbdElmawla Mohamed https://creativecommons.org/licenses/by/4.0
National-Level Outcomes of Diabetic Ketoacidosis with and without Coma: A Retrospective Analysis of 2.3 Million U.S. Hospitalizations
Section: Original Article Categories: Endocrinology Keywords: Diabetic ketoacidosis, Coma, Length of stay, Hospital charges, National Inpatient Sample, Mortality Subjects: Diabetic ketoacidosis (DKA), DKA mortality predictors, Consciousness level in DKA, Hospital outcomes, Type 1 diabetes complications, Type 2 diabetes complications, Healthcare resource utilization, Length of stay, In-hospital mortality, Hospital charges, National Inpatient Sample, Demographic factors in DKA, Coma in diabetes, Hospital characteristics, Age-related DKA outcomes, Gender differences in DKA, Racial/ethnic disparities in diabetes, Socioeconomic factors in DKA, Insurance status and DKA, Medicare outcomes, Critical care in diabetes Disciplines: Internal Medicine, Endocrinology, Critical Care Medicine, Emergency Medicine, Health Services Research, Epidemiology, Hospital Medicine, Public Health, Health Disparities Research, Medical Education, Healthcare Administration, Health Policy, Health Economics, Clinical Outcomes Research, Population Health, Diabetes Care, Metabolic Disorders, Healthcare Quality Improvement, Social Determinants of Health, Medical Informatics Background: Diabetic ketoacidosis (DKA) remains a significant complication of diabetes associated with substantial morbidity and mortality. We aimed to evaluate clinical outcomes among patients with DKA, both with and without coma, using a nationally representative database and to identify associated factors. Methods: We analyzed 2,381,619 DKA hospitalizations from the National Inpatient Sample (2016-2022), comparing outcomes between patients with (n=47,355, 1.99%) and without coma (n=2,334,264, 98.01%). Primary outcomes included length of stay (LOS), in-hospital mortality, and total hospital charges. Multivariable regression models adjusted for demographic, clinical, and hospital-level factors. Results: Patients with DKA-related coma had significantly worse outcomes: longer LOS (8.65 vs. 4.91 days), higher mortality (16.36% vs. 3.12%), and higher hospital charges ($119,080 vs. $61,240) compared to non-comatose patients. After adjustment, coma remained strongly associated with adverse outcomes (an additional 3.23 days of LOS, 5.38-fold higher mortality odds, $51,060 higher charges). Age >65 years, Type 2 diabetes, Asian/Pacific Islander race, and treatment at urban teaching hospitals were independently associated with worse outcomes. Female gender was associated with slightly better outcomes across all measures, with a significant interaction between gender and coma status. Conclusion: Consciousness level is among the strongest independent predictors of adverse DKA outcomes. Age, diabetes type, race/ethnicity, and hospital characteristics also significantly impact mortality, length of stay, and hospital charges. These factors should be considered in the clinical management of DKA and hospital resource planning.
Copyright (c) 2025 Mahmoud Nassar, Mohamed Hatem Ellabban, Mohamed R. Murad, Omar Nassar, Nuha ElSayed https://creativecommons.org/licenses/by/4.0
Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA
Section: Original Article Categories: Internal Medicine, Cardiology, Public Health Keywords: Angina, Trends, Mortality, Ischemic heart disease (IHD), Cardiovascular Subjects: Angina Pectoris, Ischemic Heart Disease, Cardiovascular Mortality, Elderly Population, Age-Adjusted Mortality Rate, Retrospective Cohort Study, Joinpoint Trend Analysis, CDC WONDER Database, Sex and Racial Disparities, United States Epidemiology Disciplines: Cardiology, Internal Medicine, Public health, Geriatric Medicine, Epidemiology, Preventive Cardiology, Health Disparities, Biostatistics, Population Health, Clinical Research Introduction: Angina is one of the ischemic heart diseases (IHD) that contributes to major cardiovascular complications up to death. We aim to assess angina-related mortality among adults aged ≥65 years in the U.S. Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥65 with angina. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression analysis was utilized to evaluate average annual percent changes (AAPCs). Results: From 1999 to 2023, a total of 36,544 deaths occurred among the elderly with angina in the U.S. The overall AAMR per 100,000 decreased from 7.52 in 1999 to 3.73 in 2023 (AAPC of -3.18; 95%CI: -3.79 to -2.75; p < 0.001). The AAMR for men decreased from 8.22 in 1999 to 4.75 in 2023 (AAPC of -2.53%; 95%CI: -3.02 to -2.09), and for women decreased from 6.95 in 1999 to 3.02 in 2023 (AAPC: -3.55%; 95%CI: -4.12 to -3.09). Across racial/ethnic groups, the highest overall rates were observed among NH-White individuals, 3.56. Overall, AAMRs were highest in the West, 4.00. The majority of deaths occurred in medical facilities (40.19%). Between 1999 and 2020, rural areas had a higher overall AAMR of 4.37 compared to urban areas, which had a rate of 3.02. Conclusion: Trends in angina-related mortality declined from 1999 to 2023. Higher mortality rates were observed in men, rural areas, the West region, and among NH White individuals. Our findings indicated that these categories require targeted interventions to reduce mortality.
Copyright (c) 2025 Mohamed Fawzi Hemida, Alyaa Ahmed Ibrahim, Anika Goel, Mirna Hussein, Krish Patel, Muhammad Raza Sarfraz, Omar Y. Alkasabrah, MD, Maryam Saghir, Komal Karmani, Eshal Saghir, Zahin Shahriar, Safeya Fawzi, Ahmed Bahnasy, Muhammad Faizan Ali, Amro Ali, Ahmad M. Abdelkhalek, Raheel Ahmed, MBBS, MRCP, PhD https://creativecommons.org/licenses/by/4.0
Disparities and Trends in Polycythemia Vera–Related Mortality in U.S. Adults Aged ≥45 Years from 1999 to 2023
Section: Original Article Categories: Internal Medicine, Hematology, Public Health Keywords: Polycythemia Vera, Mortality, Trends, Myeloproliferative Neoplasms Subjects: Polycythemia Vera, Mortality Trends, Myeloproliferative Neoplasms, Hematologic Malignancies, Disparities in Health Outcomes, Age-specific Mortality, Gender Differences, Racial/Ethnic Disparities, Epidemiology, United States Population Disciplines: Hematology, Oncology, Internal Medicine, Public Health, Epidemiology, Biostatistics, Geriatrics, Health Disparities Research, Preventive Medicine, Medical Demography Background: Polycythemia vera (PV) is a rare myeloproliferative neoplasm characterized by excessive red blood cell production, leading to increased risk of thrombosis and other complications. Despite its clinical significance, trends in PV mortality across demographic groups in the US remain understudied. Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥45 with PV. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated for variables. Joinpoint regression analysis was utilized to evaluate annual percent changes (APCs). Results: From 1999 to 2023, a total of 24,236 deaths occurred among adults with PV in the U.S. The overall AAMR decreased from 1.15 in 1999 to 0.73 in 2023 (AAPC: -1.96; 95% CI: -2.28 to -1.73; p < 0.001). The AAMR for men decreased from 1.38 in 1999 to 0.87 in 2023 (AAPC-1.88; 95% CI: -2.36 to -1.37; p < 0.001), and for women decreased from 1 in 1999 to 0.62 in 2023 (AAPC: -2.03; 95% CI: -2.66 to -1.43; p < 0.001). Across racial/ethnic groups, AAMR was highest in non-Hispanic White (0.93 per 100,000). Overall, AAMRs were highest in the Midwest (0.95). The majority of deaths occurred in medical facilities (39.36%). Rural areas had a higher overall AAMR (0.91) compared to urban areas (0.82). Conclusion: Trends in (PV) mortality declined overall from 1999 to 2023—higher trends observed in men, rural areas, the Midwest region, and NH White.
Copyright (c) 2025 Alyaa Ahmed Ibrahim, Mohamed Fawzi Hemida, MD, Mirna Hussein, Maryam Saghir, Mohammad Rayyan Faisal, FNU Kritika, Krish Patel, Amro Ali, MD, Eshal Saghir, Mahmoud Tablawy, Abdelrhman H. Mohamed, Amr Arafa, MD https://creativecommons.org/licenses/by/4.0
A Pairwise and Network Meta-Analysis Comparing the Efficacy and Safety of Ribonucleic Acid Interference Therapeutics in the Management of Hypertension
Section: Review Article Categories: Cardiology Keywords: Hypertension, Ribonucleic acid interference therapeutics, Blood pressure management Subjects: Hypertension, Blood pressure management, Small interfering RNA (siRNA), RNA interference therapeutics, Zilebesiran, IONIS-AGT-LRx, Angiotensinogen (AGT), Renin-angiotensin-aldosterone system (RAAS), Ambulatory blood pressure, Network meta-analysis Disciplines: Cardiology, Systematic Reviews, Cardiovascular medicine, Internal medicine, Pharmacology, Molecular therapeutics, Genomic medicine, Evidence-based medicine, Clinical trials, Systematic review, Biostatistics, Translational medicine Background: Small interfering RNA (siRNA) and antisense agents targeting angiotensinogen are emerging antihypertensives. We synthesized their efficacy and safety. Methods: We searched PubMed, Web of Science, Scopus, and CENTRAL through 25 Nov 2024. Eligible studies were randomized controlled trials in adults with hypertension comparing RNA-interference therapeutics with placebo. Primary outcomes were the change in ambulatory and office systolic/diastolic blood pressure. We conducted random-effects pairwise meta-analyses and a network meta-analysis with SUCRA ranking, and appraised certainty with GRADE. Results: Four trials (n=486) met criteria. Versus placebo, RNA-interference therapy reduced ambulatory SBP (mean difference [MD] −15.46 mmHg; 95% CI −18.79 to −12.12) and DBP (MD −8.45 mmHg; −10.67 to −6.23), and lowered office SBP (MD −8.07 mmHg; −11.58 to −4.56) and DBP (MD −5.18 mmHg; −7.73 to −2.63). Injection-site reactions increased (risk ratio 5.26; 1.01–27.44); other adverse events, potassium, and eGFR were similar. In network analyses, zilebesiran 300 mg ranked highest for blood-pressure lowering; for AGT reduction, 800 mg ranked highest. GRADE certainty was high for blood-pressure outcomes and moderate for AGT, potassium, and eGFR. Few, short-term trials and sparse networks limit precision and generalizability; publication bias was not assessable. Conclusion: siRNAs effectively reduced BP in hypertensive adults with an acceptable safety profile. Despite the indistinguishable efficacy or safety between the doses or types of siRNAs, Zilebesiran 300 mg best reduced BP compared to placebo.
Ribonucleic acid interference therapeutics
Renin-angiotensin-aldosterone system (RAAS)
Copyright (c) 2025 Mohamed E. Haseeb, Zeyad Bady, Hazem E. Mohammed, George Hanen, Mohamed Nasser, Nada S. Jibril, Mohamed Khalafalla Darwish, Heba Aboeldahab https://creativecommons.org/licenses/by/4.0
Improving Inpatient Care for Acute Chronic Obstructive Pulmonary Disease Exacerbations: A Quality Improvement Initiative
Section: Original Article Categories: Internal Medicine Keywords: Acute Exacerbation, Quality Improvement, Electronic Health Record, Pulmonary Rehabilitation, Smoking Cessation Subjects: Chronic Obstructive Pulmonary Disease (COPD), Acute Exacerbation of COPD (AECOPD), Inpatient Care, Pulmonary Rehabilitation, Oxygen Titration, Smoking Cessation, Electronic Health Records (EHR), Corticosteroid Therapy, Antibiotic Stewardship, Hospital Readmissions Disciplines: Internal Medicine, Respiratory Medicine, Pulmonology, Quality Improvement (QI), Clinical Decision Support Systems, Health Services Research, Patient Safety, Evidence-Based Medicine, Clinical Audit, Healthcare Quality and Equity Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for high hospital use; guideline-concordant diagnostics, oxygen titration, and discharge planning are often under-delivered. We aim to measure baseline compliance with eight AECOPD process standards and evaluate whether EHR-embedded prompts plus staff education were associated with observed improvements. Methods: We audited 50 consecutive adult admissions with primary AECOPD (ICD-10 J44.1 or clinician-documented diagnosis) between July and October 2024, implemented EHR prompts, an orderset, and targeted education (Nov–Dec 2024), then re-audited 50 consecutive admissions (Jan–Mar 2025) using identical methods. Primary process measures were pre-specified; analyses were descriptive with 95% Wilson confidence intervals (CIs) for proportions and two-sided Fisher exact tests for pre/post comparisons. This work was performed as a service evaluation/pilot. Results: After implementation, six of eight process standards showed observed increases. Pulmonary rehabilitation referrals rose from 32/50 (64.0%, 95% CI 50.1–75.9%) to 43/50 (86.0%, 95% CI 73.8–93.0%), p = 0.0198. Oxygen titration improved from 40/50 (80.0%, 95% CI 66.0–88.6%) to 46/50 (92.0%, 95% CI 78.6–95.7%), p = 0.148. Other measures (ABG timing, bronchodilator and corticosteroid delivery, appropriate antibiotic use, CXR timing, smoking advice) showed observed improvements; p-values and CIs are reported in the text. Conclusions: Embedding guideline-aligned prompts and an orderset in the EHR, together with staff education, was associated with observed improvements in several AECOPD process measures in this pilot QI project. Findings should be interpreted cautiously, given the pilot design, multiple comparisons, and limited sample size; further controlled and longitudinal evaluation is indicated.
Chronic Obstructive Pulmonary Disease (COPD)
Copyright (c) 2025 Khaqan Ahmed, Afaq Ahmad, Muhammad Saqib, Muhammad Iftikhar, Humna Shahid https://creativecommons.org/licenses/by/4.0
Trends in Mortality from Leukemia and Ischemic Heart Disease: A 22-Year Analysis in the U.S. (1999-2020)
Section: Original Article Categories: Internal Medicine, Cardiology, Hematology, Public Health Keywords: Ischemic heart disease, Leukemia, Mortality, Trends, Disparities Subjects: Leukemia, Ischemic Heart Disease (IHD), Mortality Trends, Cardiovascular Mortality, Cancer Mortality, United States Population, Time-Series Analysis, Epidemiology, Age-Adjusted Mortality Rates, Public Health Disciplines: Internal Medicine, Cardiology, Hematology, Oncology, Epidemiological Research, Health Statistics, Population Health, Chronic Disease Outcomes, Medical Data Analysis, Healthcare Policy Introduction: Leukemia and ischemic heart disease (IHD) are major U.S. mortality causes. This study analyzes national mortality trends from 1999 to 2020 to assess the impact of public health efforts in leukemia-associated IHD mortality rates. Methods: This retrospective study analyzed death certificate data from the CDC-WONDER database spanning 1999 to 2020, focusing on leukemia (ICD-10: C91–C95) and ischemic heart disease (ICD-10: I20–I25) as multiple causes of mortality in the U.S. population. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 population were calculated. JoinPoint analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2020, there were 53,603 deaths from combined leukemia and ischemic heart disease among U.S. adults aged 25+, with the AAMR declining from 1.39 to 1.09 per 100,000 (AAPC= -1.30%; 95% CI: -1.90 to -0.68; P= 0.000034). A significant decrease occurred from 1999 to 2018 (AAMR: 1.39 to 0.95; APC= -2.1894%; 95% CI: -2.3995 to -1.9788, P < 0.000001), followed by a period where the trend shifted upward which is statistically significant for the certain subgroups, except men and older adults. Men had higher AAMR than women (1.87 vs. 0.62). Regional AAMRs were highest in the Midwest (1.3). Non-Hispanic Whites had the highest AAMR (1.25). Adults 65+ had a CMR of 5.27 vs. 0.26 for ages 45–64. Conclusion: Significant health disparities exist, as mortality from combined leukemia and IHD is highest among men, older adults, rural populations, and non-Hispanic White individuals.
Copyright (c) 2025 Mohamed Fawzi Hemida, Ayesha Khan, Alyaa Ahmed Ibrahim, Anika Goel, Krish Patel, Zahin Shahriar, Ahmed W. Hageen, Mustafa Alsaadi, Saif Ur Rahman, Amr Arafa, Zeyad Kholeif, Ahmed Bahnasy https://creativecommons.org/licenses/by/4.0
Probiotics: A Promising Ally in Burn Treatment
Section: Review Article Categories: Internal Medicine, Gastroenterology, Infectious Diseases, Public Health Keywords: Probiotics, Burns, Inflammation, microbiota Subjects: Probiotics and burns, Probiotics and Microbiome, Burn Injury and Wound Healing, Immunomodulation, Clinical Trials and Evidence-Based Medicine, Infectious Diseases and Antimicrobial Resistance, Skin and Gut Axis, Pediatric Burn Care, Inflammation and Immune Response, Nutrition in Critical Care, Regenerative Medicine and Tissue Engineering Disciplines: Medicine, Biology, Nursing, Pharmacy and Pharmacology, Public Health, Immunology, Microbiology, Nutrition and Dietetics, Biomedical Engineering, Surgery This review explores the potential therapeutic benefits of probiotics in the treatment of burn injuries, with the aim of addressing the limitations of traditional therapeutic approaches. It offers a comprehensive analysis of burn pathophysiology, including a wide range of burn forms and the biological reactions they induce, such as pain, inflammation, fluid imbalance, and metabolic alterations. It also specifically explains the mechanisms by which probiotics contribute to the improved healing of wounds and modified gut microbiota, as they are particularly effective in these two directions. This study looks at the ways probiotic treatment can facilitate the regeneration of the skin, which is crucial for accelerating burn recovery . Furthermore, it examines the barriers and limits of probiotic therapy, such as strain regularity and safety issues in immunocompromised patients, while emphasizing the interdependent benefits of probiotics and nutrition in promoting burn healing. This review highlights the advantages of probiotics in burn management and their potential as an adjuvant therapy for enhancing treatment results and patient well-being in the burn care context.
Clinical Trials and Evidence-Based Medicine
Infectious Diseases and Antimicrobial Resistance
Regenerative Medicine and Tissue Engineering
Copyright (c) 2025 Kholoud Al Jebawi, Jobran Toami, Adel Ayash, Razan Salha, Mira Al Shoufy, Jamil Nasrallah , Naseeb Danaf, Lea El Ghawi, Layal Msheik, Hiba Hamdar https://creativecommons.org/licenses/by/4.0
Prolonged Immunosuppressive Therapy in Immune Complex-Membranoproliferative Glomerulonephritis: A Case Report of Sustained Partial Remission Over Three Years
Section: Case Report Categories: Internal Medicine Keywords: Membranoproliferative Glomerulonephritis , Mycophenolic acid, Remission induction Subjects: Glomerulonephritis, Idiopathic Glomerulonephritis, Immunosuppressive Therapy, Mycophenolate Mofetil (MMF), Prednisone Treatment, Chronic Kidney Disease (CKD), Proteinuria and Albuminuria, Renal Biopsy and Histopathology, Case Report – Nephrology, Membranoproliferative Glomerulonephritis (MPGN) Disciplines: Nephrology, Internal Medicine, Pathology, Clinical Medicine, Renal Pharmacology, Immunology, Histopathology, Evidence-Based Medicine, Chronic Disease Management, Clinical Case Studies The prevalence of membranoproliferative glomerulonephritis (MPGN) is very low among primary glomerulonephritis. Once MPGN is diagnosed, it is essential to classify the type of MPGN [immune complex (IC), complement-mediated, and without complement or IC deposition]. In cases of IC-MPGN, secondary causes should be thoroughly investigated. However, there are no randomised controlled prospective trials for the optimal treatment regime for primary IC-MPGN. Here, we present a report of primary IC-MPGN that achieved partial remission after 3 years of mycophenolate mofetil treatment, even though significant fibrosis was present in the kidney biopsy. This report may support consideration of prolonged immunosuppression in selected cases with primary IC-MPGN.
Membranoproliferative Glomerulonephritis
Membranoproliferative Glomerulonephritis (MPGN)
Copyright (c) 2025 Kubra Kaynar, Yasin Dilek, Mert Köse, Sevdegül Aydın Mungan https://creativecommons.org/licenses/by/4.0
Migraine Headache in Patients with Allergic Rhinitis: A Systematic Review and Meta-Analysis of Observational Studies
Section: Original Article Categories: Neurology Keywords: Migraine, Allergic Rhinitis, Meta-Analysis, Headache Subjects: Migraine, Allergic Rhinitis, Headache Disorders, Immunological Comorbidity, Meta-Analysis, Systematic Review, Atopic Conditions, IgE-Mediated Inflammation, Histamine Pathways, Comorbidity in Chronic Diseases Disciplines: Neurology, Allergy and Immunology, Epidemiology, Clinical Medicine, Otolaryngology (ENT), Public Health, Internal Medicine, Evidence-Based Medicine, Medical Statistics, Health Sciences Background: Migraine is a condition characterized by recurrent episodes of unilateral headache. Allergic rhinitis (AR) is an IgE-mediated inflammatory condition of the nasal mucosa that is triggered by exposure to allergens. Migraine and AR may share underlying immunological mechanisms, including histamine release and mast cell activation. Despite the growing interest in the immunological interplay between allergic conditions and neurological symptoms, the specific relationship between AR and migraine remains underexplored. Methods: PubMed, Scopus, and Web of Science were systematically searched to identify relevant studies. Pooled odds ratio (OR) and pooled risk ratio (RR) were calculated with 95% confidence intervals (CI) using a random-effects model. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Heterogeneity assessment and subgroup analysis were also performed. Results: Eleven studies involving 4,704,591 participants were included. The pooled OR for migraine in individuals with AR was 2.94 (95% CI: 2.02–4.29; p < 0.0001; I² = 95.62%). The pooled RR from two cohort studies was 2.27 (95% CI: 1.10–4.65; p = 0.026; I² = 99.72%). Subgroup analysis revealed significant differences in the pooled OR regarding the source of individuals with AR and the method of AR assessment, with a higher pooled OR in hospital patients (OR = 7.32) and when using skin tests (OR =6.93), respectively. Conclusion: Migraine headaches are significantly associated with AR, particularly in hospital settings and when objectivemethodsareusedforARdiagnosis.Thefindingsofthisstudyshouldbeinterpreted cautiously owing to the high heterogeneity.
Copyright (c) 2025 Ahmed Talaia, Khaled Kettaneh, Ayoub Ait lahcen, Abdeljalil El Hilali, Mohamed Magdi, Marwa Amayem, Mohamed Wagdy, Shrouk Mahmoud Elghazaly https://creativecommons.org/licenses/by/4.0
Concurrent Diabetic Ketoacidosis and Acute Coronary Syndrome: A Systematic Review of Case Reports
Section: Original Article Categories: Cardiology, Endocrinology Keywords: Diabetic Ketoacidosis, Acute coronary syndrome , Systematic Review , Case reports Subjects: Diabetic Ketoacidosis, Acute Coronary Syndrome, Myocardial Infarction, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Cardiovascular Complications, Systematic Review, Case Reports, SGLT2 Inhibitors, Cardiac Biomarkers Disciplines: Endocrinology, Cardiology, Internal Medicine, Emergency Medicine, Critical Care Medicine, Diabetes Research, Clinical Epidemiology, Pharmacology, Metabolic Disorders, Evidence-Based Medicine Background: Diabetic ketoacidosis (DKA) and acute coronary syndrome (ACS) represent serious medical emergencies with a complex bidirectional relationship. The clinical presentations and outcomes of these conditions when they co-occur remain incompletely characterized in the literature. We aim to investigate this correlation. Methods: We systematically searched the PubMed, Scopus, and Web of Science databases, using terms related to acute coronary syndrome (including myocardial infarction, unstable angina, STEMI, and NSTEMI) combined with diabetic ketoacidosis terms, from inception to April 2025, for case reports. The CARE checklist was applied to assess the risk of bias in the included reports. Results: Twenty-one case reports met inclusion criteria, describing 11 males and 9 females (one unspecified) with a mean age of 51 years. Patients had both type 1 (42.8%) and type 2 (57.1%) diabetes mellitus. Chest pain was the most common presenting symptom (52.3%), but was absent in nearly half of the cases. Six patients (28.5%) on sodium-glucose cotransporter-2 (SGLT2) inhibitors presented with euglycemic DKA. ST-segment elevation was observed in 61.9% of patients, while five patients had normal coronary arteries despite elevated troponin levels. All patients survived after receiving standard DKA management and appropriate cardiac interventions. Conclusion: This systematic review highlights the importance of maintaining high clinical suspicion for concurrent DKA and ACS, even when typical symptoms such as chest pain or hyperglycemia are absent. We recommend routine cardiac evaluation, including ECG, troponin assessment, and echocardiography, for all DKA patients to ensure early recognition and appropriate management of these potentially life-threatening conditions.
Copyright (c) 2025 Ahmed Elbataa Elbataa, Ahmed Farid Gadelmawla, Laila Mohamed Akr, Mohamed Yasser Elnaggar, Mohamed Mahmoud, Omar Nassar, Alaa Abdrabou Abouelmagd, Ahmed Hassan https://creativecommons.org/licenses/by/4.0
Esophageal Stenting and Endoscopic Vacuum Therapy for Esophageal Defects: A Systematic Review and Meta-Analysis
Section: Review Article Categories: Internal Medicine, Gastroenterology Keywords: Esophageal Stenting, Endoscopic Vacuum Therapy, Esophageal Defects, Meta-analysis, Observational Studies Subjects: internal medicine, gastroenterology, endoscopy, meta-analysis, Esophageal Stenting, Boerhaave Syndrome, Esophageal Leak, Anastomotic Leak, Minimally Invasive Surgery, Gastrointestinal Endoscopy Disciplines: Gastroenterology, Medicine, Internal Medicine, Endoscopy, Thoracic Surgery, Emergency Medicine, Critical Care, Digestive Disease, Clinical Research Background: Spontaneous esophageal perforation, particularly Boerhaave syndrome, is a life-threatening condition associated with high morbidity and mortality. Traditional surgical management is increasingly being supplemented by minimally invasive approaches, including esophageal stenting and endoscopic vacuum therapy (EVT). However, the optimal treatment strategy remains debated due to variations in reported outcomes and the lack of randomized controlled trials. This systematic review and meta-analysis aim to evaluate the efficacy and safety of esophageal stenting and EVT in managing esophageal defects by specifically assessing sealing rates, failure rates, and mortality. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library up to March 24, 2025. Only observational studies and case series were included. The primary outcomes were the pooled sealing rate, failure rate, and mortality for esophageal stenting, and the closure rate for EVT. Data were analyzed using a random-effects model, and heterogeneity was assessed using the I² statistic. Results: Fourteen studies on esophageal stenting demonstrated a pooled sealing rate of 86.1% (95% CI: 80.2–92.0%) with a failure rate of 14.9% (95% CI: 8.5–21.3%). Mortality associated with stenting was 7.4% (95% CI: 3.5–11.4%). EVT studies reported a closure rate ranging from 80% to 94%. Conclusion: Both esophageal stenting and EVT show high efficacy in sealing esophageal defects. Although EVT exhibits promising closure rates, further comparative studies are needed to establish definitive treatment guidelines.
Copyright (c) 2025 Muhammad Saqib, Muhammad Iftikhar, Khaqan Ahmed, Humna Shahid, Shehr I Yar Khan, Muhammad Aamir Iqbal, Hassan Mumtaz https://creativecommons.org/licenses/by/4.0
A Comprehensive Review of Fluid Resuscitation Techniques in Sepsis in Patients with Heart Failure
Section: Review Article Categories: Cardiology, Infectious Diseases Keywords: Challenges in fluid resuscitation, Fluid Resuscitation, Heart failure, Sepsis Subjects: Fluid Resuscitation, Sepsis, Septic Shock, Hemodynamic Monitoring, Volume Overload, Critical Care, Intravenous Therapy, Ejection Fraction, Sepsis Management Guidelines Disciplines: Critical Care Medicine, Internal Medicine, Emergency Medicine, Cardiology, Infectious Diseases, Intensive Care, Clinical Pharmacology, Health Outcomes Research, Evidence-Based Medicine, Hospital Medicine Introduction: Fluid management in sepsis patients with pre-existing heart failure presents a complex clinical challenge, as these patients require adequate resuscitation while avoiding fluid overload that could worsen cardiac function. This article aims to explore optimal fluid resuscitation strategies for patients with pre-existing heart failure who develop sepsis, a group at high risk for fluid management complications. Methods: We conducted a narrative review of studies published between 2010 and 2024, utilizing PubMed, ScienceDirect, and Google Scholar. We employed Boolean formulas and search terms that evolved from broad to specific, refining the focus on fluid resuscitation in septic heart failure patients. Human studies focusing on fluid resuscitation, sepsis management, and outcomes in heart failure were included. Exclusion criteria included animal studies, non-English articles, and case reports. Results: Guideline-recommended fluid resuscitation (≥30 mL/kg within 3 hours) shows a neutral or positive effect on mortality in sepsis patients with pre-existing heart failure when monitored appropriately. Patients with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF) exhibit different tolerances to fluids. Advanced hemodynamic monitoring — including bedside echocardiography, lactate clearance, central venous pressure, and BNP levels — is essential for personalizing fluid therapy. Conclusion: Early guideline-compliant fluid resuscitation followed by a conservative, individualized fluid strategy guided by hemodynamic monitoring optimizes outcomes in sepsis patients with heart failure. Future prospective studies are needed to develop standardized protocols.
Copyright (c) 2025 Mallikarjuna S. oruganti, Sameena Tabassum, Anushree V. Murthy, Navya.Miriyala, Nitasha, Sunil Timislina https://creativecommons.org/licenses/by/4.0
Clinical Efficacy and Safety of Fluvoxamine in COVID-19 Patients: An Umbrella Review of Systematic Reviews and Meta-Analyses
Section: Original Article Categories: Infectious Diseases, Public Health Keywords: Fluvoxamine, COVID-19, Cytokine storm, IL-6, Hospitalization, Disease progression Subjects: Fluvoxamine, COVID-19, Cytokine storm, IL-6, Hospitalization, Disease progression, Selective Serotonin Reuptake Inhibitor (SSRI), Antiviral Therapy, Inflammatory Response, Meta-Analysis Disciplines: Infectious Diseases, Public Health, Internal Medicine, Pharmacology, Epidemiology, Pulmonary Medicine, Critical Care Medicine, Clinical Trials, Psychiatry, Translational Medicine Introduction: Fluvoxamine is an agonist for the sigma-1 receptor, through which it controls inflammation. It helps reduce the cytokine storm associated with the COVID-19 virus by regulating the production of IL-6 and gene expression. This review of systematic reviews (SRs) aims to summarize the effects of fluvoxamine in treatment of COVID-19. Methods: This umbrella review (CRD42025592203) of SRs and meta-analyses investigated the safety and efficacy of fluvoxamine for treatment in COVID-19 patients, irrespective of disease severity and age. Comprehensive searches were conducted from inception to December 12, 2024, covering PubMed, Cochrane CENTRAL, Google Scholar, and Cochrane COVID-19 resources. A qualitative synthesis of evidence was performed. The AMSTAR2 tool was used to assess the methodological quality of the included SRs. Results: Eleven reviews published in 12 publications that reported the use of fluvoxamine in COVID-19 patients were finally included as part of the synthesis. The studies reported a lower mortality rate with fluvoxamine than with placebo, but only four studies reported statistical significance. Five reported a statistically significant reduction in hospitalization risk for patients treated with fluvoxamine compared to controls. Only one review evaluated COVID-19 progression, reporting a non-significant decrease in the risk of disease progression with fluvoxamine compared to placebo. Higher dosages of fluvoxamine compared to lower doses yielded better outcomes. Conclusion: Although fluvoxamine may have potential benefits in reducing COVID-19-associated mortality and hospitalization, our findings do not support a significant role in preventing disease progression or clinical deterioration. Further research is needed to compare the efficacies of different dosages.
Selective Serotonin Reuptake Inhibitor (SSRI)
Copyright (c) 2025 Omar Irfan, Muhammad Jansher, Wania Moeen, Muhammad Sohaib Khan, Muhammad Bin Hammad, Rubaid Dhillon, Nabira Khan, Abia Abdullah, Mohammad Aadil Qamar, Ayesha Rashid, Javaid Ahmed Khan, Ali Bin Sarwar Zubairi https://creativecommons.org/licenses/by/4.0
Dual association of autoimmune encephalitis with anti-NMDAR and anti-GAD65 antibodies: A Case Report with Literature Review
Section: Case Report Categories: Neurology Keywords: Anti-GAD65, Anti-NMDAR, Autoimmune encephalitis, Immunotherapy, Case report Subjects: Anti-GAD65, Anti-NMDAR, Autoimmune encephalitis, Immunotherapy, Autoimmune Diseases, Infectious Diseases, Neurology, Endocrinology, Immunology, Hematology Disciplines: Neurology, Internal Medicine, Critical Care Medicine, Clinical Research, Translational Medicine, Molecular Biology, Medical Education Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis, whereas anti-glutamic acid decarboxylase 65 (antiGAD65) encephalitis is a rare autoimmune condition. The coexistence of these two conditions has been rarely reported. In this article, we will discuss this rare association through a case report and attempt to determine its main characteristics. We report the case of an 18-year-old male with no medical history, admitted to the medical Intensive Care Unit (ICU) with a decreased level of consciousness, bizarre behavior, and abnormal movements for one week. These symptoms followed the progression of initial signs such as delirium, which had begun two months earlier. Laboratory analysis revealed an inflammatory syndrome with rhabdomyolysis. Cerebral angio-MRI findings were unremarkable. The electroencephalogram (EEG) showed slow, non-reactive activity. Cerebrospinal fluid (CSF) analysis and infectious studies were normal. However, immunological testing using the immunofluorescence technique revealed the presence of anti-NMDAR antibodies in both serum and CSF, as well as anti-GAD65 antibodies in the serum. The positron emission tomography (PET) scan screening for neoplasm was negative. Therapeutically, the patient was treated with anticonvulsants, antipsychotics, intravenous immunoglobulins, corticosteroids, plasma exchanges, cyclophosphamide, and rituximab. Consequently, he demonstrated a remarkable gradual clinical improvement. This case highlights an aspect of autoimmune dysregulation that may lead to atypical and severe clinical presentations. The co-occurrence of anti-NMDAR and anti-GAD65 encephalitis is a rare condition that can lead to severe manifestations. Early diagnosis using a broad antibody panel facilitates timely and appropriate management.
Copyright (c) 2025 Oumaima Rian, Wafa Ammouri, Latifa Oualili, Mouna Maamer, Tarek Dendane, Hicham Harmouche, Khalid Abidi https://creativecommons.org/licenses/by/4.0
Acute Myeloid Leukemia Presenting as Bilateral Proptosis: A Case Report with Literature Review
Section: Case Report Categories: Internal Medicine, Hematology Keywords: Acute Myeloid Leukemia, Myeloid Sarcoma, Bilateral proptosis, M6 subtype, RUNX1-RUNX1T1, Di Guglielmo syndrome Subjects: Oncology, Lukemia, case report, Hematologic Disciplines: hematology, Oncology Introduction: Acute myeloid leukemia (AML), constituting 30% of pediatric malignancies, is the most common childhood cancer. This paper explores the rare presentation of AML with extramedullary involvement, specifically bilateral proptosis, in a 15-year-old boy. Case report: The patient initially presented with worsening shortness of breath, palpitations, extreme fatigue, and bruising. Examination revealed bilateral proptosis, watery discharge from the right eye, and petechial rash. Blood investigations revealed low hemoglobin, severe thrombocytopenia, and high WBC count. Computed tomography (CT) revealed bilateral orbital infiltrative soft tissue lesions. Leukemia fusion gene screening identified RUNX1-RUNX1T1 later. The patient was admitted, received transfusions, and started on antibiotics. Despite initial improvement, he later developed sepsis, septic shock, and severe pancytopenia, necessitating intensive care and specific AML M2 targeting therapy. Conclusion: Bilateral proptosis in AML, termed myeloid sarcoma (MS), is rare but responsive to chemotherapy. Orbital MS has higher responsiveness and survival rates in pediatric cases. The case highlights the importance of identifying AML subtypes, like RUNX1-RUNX1T1-positive AML, for tailored treatment strategies. This case underscores the challenges in diagnosing and treating pediatric AML with extramedullary involvement. Early recognition of AML subtypes is crucial for prognosis prediction and treatment tailoring.
Copyright (c) 2025 Ahmed Mostafa Youssef , Mohamad Monif Assker, Farah Alkhaleefa , Mahasin Shaheen https://creativecommons.org/licenses/by/4.0
Human Readers versus AI-Based Systems in ASPECTS Scoring for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis with Region-Specific Guidance
Section: Original Article Categories: Neurology Keywords: Ischemic Stroke, Artificial Intelligence, ASPECTS, Machine Learning, Imaging Subjects: Stroke, Machine Learning, Imaging, Acute Ischemic Stroke, Artificial Intelligence in Medicine, Computed Tomography (CT), Radiology, Diagnostic Imaging, ASPECTS Scoring, Thrombectomy, Interobserver Variability, Neuroimaging, Systematic Review, Meta-Analysis, Clinical Decision Support Systems, Health Informatics Disciplines: Neurology, Radiology and Diagnostic Imaging, Emergency Medicine, Health Technology Assessment, Internal Medicine, Medical Informatics, Evidence-Based Medicine, Neurosurgery, Clinical Epidemiology Introduction: The Alberta Stroke Program Early CT Score (ASPECTS) is widely used to evaluate early ischemic changes and guide thrombectomy decisions in acute stroke patients. However, significant interobserver variability in manual ASPECTS assessment presents a challenge. Recent advances in artificial intelligence have enabled the development of automated ASPECTS scoring systems; however, their comparative performance against expert interpretation remains insufficiently studied. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched multiple scientific databases for studies comparing automated and manual ASPECTS on Non-Contrast Computed Tomography (NCCT). Interobserver reliability was assessed using pooled interclass correlation coefficients (ICCs). Subgroup analyses were made using software types, reference standards, time windows, and computed tomography-based factors. Results: Eleven studies with a total of 1,976 patients were included. Automated ASPECTS demonstrated good reliability against reference standards (ICC: 0.72), comparable to expert readings (ICC: 0.62). RAPID ASPECTS performed highest (ICC: 0.86), especially for high-stakes decision-making. AI advantages were most significant with thin-slice CT (≤2.5mm; +0.16), intermediate time windows (120-240min; +0.16), and higher NIHSS scores (p=0.026). Conclusion: AI-driven ASPECTS systems perform comparably or even better in some cases than human readers in detecting early ischemic changes, especially in specific scenarios. Strategic utilization focusing on high-impact scenarios and region-specific performance patterns offers better diagnostic accuracy, reduced interpretation times, and better and wiser treatment selection in acute stroke care.
Copyright (c) 2025 Ahmed Y Azzam, Ibrahim Hadadi, Leen M. Al-Shahrani, Ummkulthum A. Shanqeeti, Noor A. Alqurqush, Mohammed A. Alsehli, Rudaynah S. Alali, Rahaf S. Tammar, Mahmoud M. Morsy, Muhammed Amir Essibayi https://creativecommons.org/licenses/by/4.0
Challenges and Infectious Complications in Living Donor Liver Transplantation in Egypt: A Comprehensive Review
Section: Review Article Categories: Internal Medicine, Gastroenterology Keywords: Living donor liver transplantation, Infectious complications, Hepatitis C virus, Donor selection, Organ donation awareness Subjects: Living Donor Liver Transplantation (LDLT), Infectious Complications, Hepatitis C Virus (HCV), Donor Selection, Organ Donation Awareness, End-Stage Liver Disease (ESLD), Liver Transplantation in Egypt, Deceased Donor Liver Transplantation (DDLT), Pediatric Liver Transplantation, Healthcare Providers' Knowledge, Liver Transplantation Challenges, Post-Transplant Infections, Bacterial Infections in Transplant Recipients, COVID-19 and Liver Transplantation, Sepsis in Transplant Patients, Hospital-Acquired Infections (HAIs), Donor Morbidity and Mortality, Public Awareness and Media Coverage, Religious and Cultural Attitudes Toward Organ Donation, Quality of Life After Transplantation, Medical Education and Organ Donation, Liver Transplantation in Low-Resource Settings, Transplant Tourism, Multi-Drug Resistant Bacteria in Transplant Recipients, Cytomegalovirus (CMV) Infections in Transplantation Disciplines: Hepatology , Gastroenterology , Transplant Surgery , Epidemiology , Infectious Diseases, Public Health , Critical Care Medicine, Pediatrics , Immunology , Microbiology , Virology , Medical Ethics, Sociology of Health, Psychology , Health Policy and Systems Research, Global Health Background: Living donor liver transplantation (LDLT) is a crucial therapeutic option for patients with end-stage liver disease in Egypt, where deceased donor grafts are scarce. This study aims to investigate the challenges and infectious complications associated with LDLT in Egypt. Methods: A comprehensive review of relevant literature was conducted, focusing on factors affecting donor selection, the prevalence of infections in recipients, and the impact of healthcare providers' knowledge on organ donation. The study included data on complications affecting donors and recipients in the context of LDLT. Results: The high prevalence of the hepatitis C virus and poverty in Egypt negatively impact the live donor pool. Lack of knowledge about liver donation, inadequate media coverage, and family pressure contribute to the low number of liver donors. Infectious complications play a significant role in the outcomes of LDLT, with bacterial infections being the most common. Donors also experience complications, with intraabdominal collections and pneumonia being the most frequent. Healthcare providers' knowledge and attitudes toward organ donation need improvement, and educational efforts should be tailored to the cultural and religious context. Conclusion: Addressing the challenges in donor selection, raising public awareness about organ donation, and improving healthcare providers' knowledge are essential steps toward optimizing LDLT outcomes in Egypt. Moreover, it is crucial to monitor and manage infectious complications in both donors and recipients to ensure the success of the transplantation process.
Living Donor Liver Transplantation (LDLT)
Deceased Donor Liver Transplantation (DDLT)
Bacterial Infections in Transplant Recipients
Religious and Cultural Attitudes Toward Organ Donation
Liver Transplantation in Low-Resource Settings
Multi-Drug Resistant Bacteria in Transplant Recipients
Cytomegalovirus (CMV) Infections in Transplantation
Copyright (c) 2025 Ahmed Mohamed Ali Aref, Ahmed H. Abdelwahed, Abdelrahman Nassar, Mohamed Elshennawy, Maryam Massoud , Nada Madkour, Esraa Awad, Fatma Aljalawy, Mohamed Akram Abdelwahab Hassan Khalil, Mohammed Y. Youssef, Omar Nassar, Mostafa Alfishawy https://creativecommons.org/licenses/by/4.0
Efficacy and Safety of Penehyclidine Hydrochloride in Postoperative Nausea and Vomiting Prevention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Section: Original Article Categories: Internal Medicine Keywords: Penehyclidine hydrochloride, Postoperative nausea and vomiting, Systematic Review, Meta-analysis Subjects: Postoperative nausea and vomiting, Internal Medicine, Anesthesiology, Pharmacology, Surgery, Systematic Reviews and Meta-Analyses, Postoperative Care Disciplines: Medicine and Health Sciences, Internal Medicine, Anesthesiology and Pain Medicine, Surgery, Pharmacology and Toxicology, Evidence-Based Medicine, Systematic Reviews Introduction: Postoperative nausea and vomiting (PONV) is a common complication following anesthesia. Penehyclidine hydrochloride (PHC), an anticholinergic medication, selectively inhibits the M1 Muscarinic and M3 Muscarinic receptors involved in the nausea and vomiting pathways. This study aims to evaluate the efficacy of PHC in preventing PONV and its potential advantages over existing treatments. Methods: This study investigated the efficacy and safety of PHC in preventing PONV by analyzing randomized controlled trials (RCTs) identified through a comprehensive search of the PubMed, Scopus, Web of Science, and Cochrane Library databases up to December 2024. Results: Five RCTs involving 979 patients were included. Compared to the control group, PHC reduced the incidence of PONV in the first 24-72 hours after surgery (RR: 0.64, 95% CI [0.50, 0.82], p = 0.0004) and the requirement of rescue antiemetics (RR: 0.46, 95% CI [0.22, 0.96], p = 0.04). However, PHC significantly increased the incidence of dry mouth (RR: 2.64, 95% CI [1.98, 3.5], p < 0.00001). No significant differences were observed between the two groups regarding other secondary outcomes. Risk of bias assessment was done using RoB2. Conclusions: PHC shows promising efficacy in reducing PONV and the need for antiemetic medications. Further large-scale RCTs are necessary to verify these results and determine the optimal dose.
Copyright (c) 2025 Ahmed Magdy, Eithar Alqady, Mohamed Wagdy, Ahmed T.shalby, Mahmoud Abdelkader, Karim Osamy, Alaa Anter, IhabTarik, Manar Samy, Sherif Eltawansy, Ahmed Hassan https://creativecommons.org/licenses/by/4.0
Antibiotic Knowledge, Perception, and Practice of Intern Doctors in Turkey: A Survey Study
Section: Original Article Categories: Infectious Diseases Keywords: Antibiotic knowledge, Antibiotic resistance, Antibiotic stewardship, Intern doctors, Survey study, Turkey Subjects: Antibiotic Resistance, Clinical Surveys, Medical Education, Antibiotic Stewardship, Healthcare Policy, Public Health, Infectious Disease Management, Pharmaceutical Practices, Clinical Decision-Making, Antimicrobial Consumption Disciplines: Medicine, Pharmacology, Public Health, Epidemiology, Health Policy, Medical Education, Clinical Sociology, Behavioral Science Background: This study aimed to measure intern doctors' knowledge, attitudes, and perceptions about antibiotic treatment and determine the situation on the subject. Methods: A 34-question questionnaire was prepared for the study, and volunteers were administered the questionnaire face-to-face or via a Google form on a mobile WhatsApp application. Prospectively, 221 volunteer physicians participated in the survey, which was conducted between March 15-22, 2024 in Turkey. Results: Of the participants, 118 (53.4%) were male and 103 (46.6%) were female. The mean age (mean ± SD) was 24 years (24.46±1.83). Many participants had good antibiotic knowledge but a poor antibiotic use percentage. The knowledge that misuse of antibiotics causes resistance was quite high, and there were deficiencies in the mechanisms of resistance. The misconceptions identified were stopping treatment when the clinical condition improved, regardless of the duration, or giving treatment every time the fever was high. There was a significant and positive correlation between age level-antibiotic knowledge and age-level-resistance awareness (rs=0.190, p=0.002 and rs=0.152, p=0.007, respectively). A significant difference was also found between gender-attitude scores (p=0.004). There was a significant (rs=0.247, p=0.003) and positive correlation between antibiotic knowledge and resistance awareness, and a significant (rs=0.610, p<0.001) and positive correlation between antibiotic knowledge and attitude and perception scores. Conclusion: In order to increase the resistance awareness of the intern doctors and to decrease the wrong attitudes and perceptions, there is a need to develop social programs, practical applications, and patient-oriented practices together with some educational program curriculum changes.
Copyright (c) 2025 AHMET DOĞAN, Azra SÖNMEZ, Beyza DİŞLİ, Hasan Şamil ÇELİK, Chingiz RUSTAMLİ, Ecem Berra NAZLIOĞLU, Zuhat ABDULKERİMOĞLU, Mustafa Talha ALTUNBAŞ, Rumeysa ÖZER https://creativecommons.org/licenses/by/4.0
TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research
Section: Review Article Categories: Internal Medicine Keywords: TriNetX, Clinical Research, Medical Research, Research Database, Real-World Evidence Subjects: Real-World Evidence, TriNetX, Observational Studies, Clinical Research, Data Quality, Coding , EHR Coding Accuracy, Bias in Research, Research Methodology, Healthcare Disparities Disciplines: Medical Informatics, Clinical Research, Epidemiology, Public Health, Health Services Research, Biomedical Informatics, Data Science Introduction: The increasing utilization of real-world data platforms in medical research necessitates a comprehensive understanding of their methodological strengths and limitations. TriNetX has emerged as a significant platform for exploring large healthcare datasets. This review aims to critically evaluate the methodological framework and limitations of TriNetX, assess the impact of electronic health record coding accuracy on data reliability, and analyze the platform's capacity for generating generalizable real-world evidence in clinical research. Methods: We conducted a comprehensive review examining TriNetX's data architecture, quality metrics, and research applications, focusing on data integrity, platform architecture, and the external validity of research findings. Results: The analysis reveals significant methodological considerations. TriNetX's reliance on retrospective data introduces biases such as selection bias and confounding variables. The coding accuracy of electronic health records, which have not been independently validated, is a critical determinant of data reliability. The demographic representation is limited, affecting the generalizability of results. Discussion: Despite its extensive use, TriNetX's effective utilization requires careful consideration of its inherent limitations. The platform's data, predominantly from insured populations in academic and acute care settings, may not fully represent broader demographic groups. Addressing these methodological constraints is crucial for enhancing the reliability and applicability of research findings derived from TriNetX. Conclusions: TriNetX is a valuable resource for healthcare research. However, its limitations must be acknowledged, and future research should focus on standardizing data collection and enhancing data validation processes to mitigate platform-specific biases and improve the quality and applicability of the findings.
Copyright (c) 2025 Mahmoud Nassar, Hazem Abosheaishaa, Khaled Elfert, Azizullah Beran, Abdellatif Ismail, Mouhand Mohamed, Anoop Misra, Muhammed Amir Essibayi, David J. Altschul, Ahmed Y. Azzam https://creativecommons.org/licenses/by/4.0
Impact of Serum Adiponectin Level on Insulin and hs-CRP in Patients with Type 2 Diabetes: A Case-Control Study
Section: Original Article Categories: Internal Medicine, Endocrinology Keywords: Adiponectin, Insulin, hs-CRP, Type 2 Diabetes Mellitus (T2D), HOMA-IR, Fasting Serum Glucose, Overweight Subjects: Adiponectin, Insulin Sensitivity and Resistance, Inflammatory Markers, Serum Markers, Case-Control Study, Epidemiological Data on Diabetes Disciplines: Endocrinology, Biochemistry, Epidemiology, Diabetology, Biostatistics, Public Health Introduction: Type 2 diabetes mellitus (T2DM) is marked by insulin resistance, hyperglycemia, and systemic inflammation. Adiponectin—a hormone produced mainly by adipose tissue—enhances insulin sensitivity and exhibits anti‐inflammatory properties. This study evaluated serum adiponectin and related metabolic markers in Iraqi patients with T2DM versus healthy controls. Methods: In a case-control design, 84 Iraqi subjects were recruited (45 patients with T2DM and 39 controls). Fasting blood samples were obtained to measure adiponectin, insulin, high-sensitivity C-reactive protein (hs-CRP), fasting serum glucose (FSG), and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) using standardized ELISA and biochemical assays. Correlations between adiponectin and anthropometric parameters were also analyzed. Results: Controls showed significantly higher serum adiponectin and insulin levels (p < 0.05) compared to patients with T2DM. In contrast, hs-CRP, FSG, and HOMA-IR were significantly elevated in the diabetic group (p < 0.05). Moreover, adiponectin demonstrated significant negative correlations with both height and weight among controls, with their lower body weight suggesting enhanced fatty acid oxidation. Conclusions: These findings indicate that elevated adiponectin is associated with improved insulin sensitivity and reduced inflammatory markers. The data support the potential role of adiponectin in mitigating insulin resistance, hyperglycemia, and overweight risks in T2DM, warranting further investigation into its therapeutic utility.
Copyright (c) 2025 Hind F Jawad, Shatha H Ali, Mustafa S Jawad https://creativecommons.org/licenses/by/4.0
Investigating the Impact of Primary Education on Birth Control Practices in Bangladesh: A Primary Study
Section: Original Article Categories: Internal Medicine Keywords: Birth Control, Contraceptive Methods, Primary Education, Socio-economic Factors, Primary study, Survey, Bangladesh Subjects: Public Health, Family Medicine Disciplines: Internal Medicine, Public Health, Reproductive Health Introduction: Bangladesh faces significant challenges due to overpopulation, impacting essential resources such as healthcare, employment, and education. This study investigates the role of primary education in influencing contraceptive adoption and examines the socio-economic and educational factors affecting birth control practices in Bangladesh. Methods: A cross-sectional study was conducted in four districts (Sylhet, Habiganj, Sunamganj, and Moulvibazar). These areas were selected to provide a diverse representation of both urban and rural populations. A stratified random sampling technique was used to select 160 service recipients. A validated questionnaire was administered face-to-face by trained data collectors. Statistical methods included Chi-square tests, logistic regression modeling, and sensitivity analysis to control for confounding variables. Results: Higher education levels were significantly associated with increased contraceptive use (OR = 2.31, 95% CI: 1.58-3.47, p < 0.01). Multivariate analysis confirmed that income, religion, and geographic location were significant predictors of contraceptive adoption. Specifically, 41% of service recipients had secondary education, and 56% earned between 4000-5000 Taka per month. Discussion: This study underscores the importance of primary education in contraceptive adoption and identifies key socio-economic determinants affecting family planning choices. Despite methodological limitations, such as sample size constraints, the findings suggest a need for targeted interventions to enhance educational access and contraceptive awareness, particularly among lower-income groups. Conclusion: Expanding primary education is a critical strategy for population control in Bangladesh. This study provides valuable insights for policymakers and public health professionals, emphasizing the necessity of data-driven interventions and expanded educational programs to enhance birth control awareness and adoption.
Copyright (c) 2025 Md Rakibul Hasan, Kanij Fatema Rabu, Moryom Akter Muna, Sajid Hassan, Saifur Rahman https://creativecommons.org/licenses/by/4.0
Epidemiological Patterns of Diabetes Mellitus in The United States of America: An Observational Multicenter Analysis From 1990 to 2024
Section: Original Article Categories: Endocrinology Keywords: Diabetes Mellitus, Epidemiology, United States, Disparities, Healthcare, TriNetX Subjects: Diabetes Mellitus , Type 2 Diabetes Mellitus (T2D), Public health Disciplines: Endocrinology, Epidemiology, Internal Medicine Introduction: Diabetes mellitus represents a significant public health challenge, however, the current trends in its epidemiology remain incompletely characterized. This study aimed to analyze epidemiological changes and demographic patterns in diabetes incidence and prevalence across the United States from 1990 to 2024. Methods: We conducted a retrospective cohort study utilizing the TriNetX Global Health Research Network, analyzing de-identified electronic health records from 52,922,301 patients across 92 U.S. healthcare organizations. Time-based changes in disease trends regarding diabetes incidence and prevalence were targeted, and stratified by age, sex, race, and diabetes type. Results: Combined diabetes incidence increased from 3.98 per 1,000 in 1990-1994 to 60.98 per 1,000 in 2020-2024, while prevalence doubled from 6.26% to 12.00%. T2DM showed a twenty-fold increase in incidence (3.52 to 59.30 per 1,000), while T1DM peaked at 7.46 per 1,000 in 2010-2014 before declining to 4.59 per 1,000. Significant disparities were observed across demographic groups, with the highest rates among Native Hawaiians/Pacific Islanders (incidence: 94.75 per 1,000; prevalence: 20.65%) and consistent male predominance (incidence: 69.40 vs 54.07 per 1,000). Conclusions: These findings reveal concerning trends in diabetes epidemiology, characterized by a prominent and significant elevation in disease burden and persistent demographic disparities. The results call for the urgent need for optimized preventive strategies, targeted interventions for high-risk populations, and systematic changes in healthcare delivery to address this growing public health challenge effectively.
Copyright (c) 2025 Ahmed Y Azzam, Luis Medina Mora, Mahmoud M. Morsy, Muhammed Amir Essibayi, David J. Altschul, Mahmoud Nassar https://creativecommons.org/licenses/by/4.0
The Impact of Idiopathic Intracranial Hypertension on Cardiovascular Disease Risk Among UK Women: An Obesity-Adjusted Analysis
Section: Original Article Categories: Internal Medicine, Neurology Keywords: Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Stroke, Ischemic Stroke, Cardiovascular Disease Subjects: neurology, Epidemiology Disciplines: neurology Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls. Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk. Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls. Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.
Copyright (c) 2024 Ahmed Y. Azzam, Mahmoud M. Morsy, Mohamed Hatem Ellabban, Ahmed M. Morsy, Adham Adel Zahran, Mahmoud Nassar, Omar S. Elsayed, Adam Elswedy, Osman Elamin, Ahmed Saad Al Zomia, Hana J. Abukhadijah, Hammam A. Alotaibi, Oday Atallah, Mohammed A. Azab, Muhammed Amir Essibayi, Adam A. Dmytirw, Mohamed D. Morsy, David J. Altschul https://creativecommons.org/licenses/by/4.0
Safety and Efficacy of Metformin for Idiopathic Intracranial Hypertension: A U.S.-Based Real-World Data Retrospective Multicenter Cohort Study
Section: Original Article Categories: Internal Medicine, Neurology Keywords: Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Intracranial Pressure, Metformin, Metabolic Syndrome Subjects: neurology Disciplines: Neurology Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety. Methods: We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months. Results: Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin’s safety profile was comparable to the control group. Conclusions: The study indicates metformin’s potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin’s role in IIH management and its mechanisms of action.
Copyright (c) 2024 Ahmed Y. Azzam, Mahmoud Nassar, Ahmed Saad Al Zomia, Adam Elswedy, Mahmoud M. Morsy, Adham A. Mohamed, Osman Elamin, Omar S. Elsayed, Mohammed A. Azab, Muhammed Amir Essibayi, Jin Wu, Adam A. Dmytirw, David J. Altschul https://creativecommons.org/licenses/by/4.0
Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Case Report With Vertigo, Dysmetria, And Impaired Tandem Gait
Section: Case Report Categories: Internal Medicine, Neurology Keywords: SMART syndrome, Radiotherapy, Migraine, subcortical enhancement, cortical laminar necrosis Subjects: SMART syndrome, Stroke-like migraine attacks, Radiation-induced complications, Proton beam radiotherapy, Cortical laminar necrosis, Craniopharyngioma, Subcortical hyperintensity, Vertigo, Dysmetria, Impaired tandem gait Disciplines: Neurology, Neuroradiology, Radiation oncology, Pediatric oncology, Neuro-oncology, Clinical case reports, Neuroimaging, Headache medicine, Neurovascular disorders, Medical diagnostics SMART syndrome is a rare, delayed complication of brain radiation. The acronym SMART stands for stroke-like migraine attacks following radiation therapy. This case is one of the first to describe episodic vertigo, dysmetria, and impaired tandem gait following proton beam radiotherapy for a craniopharyngioma. An 18-year-old male presented with migraine headaches, upper and lower limb weakness, episodic vertigo, and dysmetria with impaired tandem gait. This occurred following proton-beam radiotherapy, which was completed at around 11 years of age for recurrent craniopharyngioma. Magnetic resonance imaging (MRI) of the brain demonstrated a T1 hyperintense signal in the cortex of the right parietal and temporal lobes consistent with SMART syndrome. In addition, a subcortical hyperintense signal was seen in the right parietal, temporal, and frontal lobes. Atypical presentations of SMART syndrome are out there, and it is essential to recognize them in patients presenting with neurological symptoms following radiation therapy so that diagnosis and treatment can be done.
Copyright (c) 2025 Ali Al Yasari, Mahdia Alhaidar, Mohamad Assker https://creativecommons.org/licenses/by/4.0
Epidemiological Assessment of Risk Factors for Inguinal Hernia Among Male Patients in Iraq: A Case-Control Study
Section: Original Article Categories: Public Health Keywords: Epidemiology, Inguinal hernia, Iraq, Males, Risk factors Subjects: Epidemiology, Preventive Medicine, Inguinal Hernia, Risk Factors, Heavy Lifting, Chronic Cough, Smoking, Male Health, Family History, Body Mass Index (BMI) Disciplines: Epidemiology, Public Health, General Surgery, Internal Medicine, Family Medicine, Community Medicine, Preventive Medicine, Urology, Health Sciences, Clinical Research Introduction: Inguinal hernia is one of the most common surgical conditions, particularly among males. Despite its prevalence, limited regional data exist on the associated risk factors in Iraq. This study aimed to identify socio-demographic, lifestyle, and clinical risk factors contributing to inguinal hernia among male patients. Methods: A case-control study was conducted on 250 male patients diagnosed with inguinal hernia at multiple public hospitals and surgical clinics across three major cities in Iraq: Wasit, Baghdad, and Basra. Compared with a 250-member control group. Data were collected using structured questionnaires covering socio-demographic details, occupational exposure, lifestyle habits, medical history, and family history. Univariate and logistic regression analyses were performed to identify significant risk factors. Results: Most patients (57.5%) were between 41 and 60 years old. Heavy lifting (63.6%), smoking(62.0%), chronic cough (38.6%), and constipation (32.4%) were frequently reported. A positive family history was noted in 22.4% of cases. Univariate analysis revealed significant associations between inguinal hernia and heavy lifting (p < 0.001), smoking (p < 0.001), chronic cough (p = 0.002), constipation (p = 0.020), and a family history of inguinal hernia (p = 0.001). Logistic regression confirmed heavy lifting (OR=2.78), family history (OR=2.46), smoking (OR=1.69), and chronic cough (OR=1.54) as independent risk factors. Conclusion: Heavy lifting, smoking, chronic cough, and family history were significantly associated with increased risk of inguinal hernia among Iraqi males. Public health strategies that focus on prevention, early identification, and lifestyle modification are essential for reducing the incidence and recurrence of this condition.
Copyright (c) 2025 Ali Abdul Jabbar Mahdi, Taqi Mohammed Jwad Taher, Rami Bahaa Saadi https://creativecommons.org/licenses/by/4.0
Bridging the Gap: Addressing Language Barriers to Advance Equity in Internal Medicine
Section: Review Article Categories: Public Health Keywords: Public health impact, equity, language barriers, cultural competence Subjects: Language barriers in healthcare, Health equity, Communication in internal medicine, Diversity and inclusion, Limited English proficiency (LEP) Disciplines: Internal Medicine , Health Communication , Public Health, Health Policy and Systems, Medical Humanities Language barriers in healthcare are a persistent challenge that disproportionately affect patients with limited English proficiency (LEP), contributing to disparities in care, poor health outcomes, and patient dissatisfaction. In internal medicine, where effective communication is essential for diagnosis, management, and chronic disease follow-up, these barriers hinder quality and equity. This review synthesizes the current evidence on the impact of language discordance in internal medicine, explores effective mitigation strategies including interpreter services, culturally competent care, and technological tools and offers policy and practice recommendations to promote equitable healthcare delivery.
Copyright (c) 2025 Jayashree Ravikumar, Divya Ravikumar https://creativecommons.org/licenses/by/4.0