Clinical presentation and organ-based outcomes of Multifocal fibrosclerosis: A systematic review.

Objectives: Multifocal fibrosclerosis is a rare disorder causing progressive fibrosis of multiple organ systems. Existing data on the disease show that there are multiple manifestations of the disease, with different outcomes. However, quantitative data are scarce, prompting the need for our investigation. Method: A comprehensive systematic review was performed from inception to November 16, 2022, with the restriction of English language, not including review articles. Article screening and extraction was performed independently, and shortlisted articles were assessed for bias. Analysis was performed using SPSS Version 25 (IBM® SPSS® Statistics; Chicago, IL, USA). Data were presented as frequencies and percentages, with a confidence interval of 95%. Result: This review included 134 patients, with 78 (58.2%) males. Mean age was 53.6 years and included two pediatric patients. The most common comorbidity was diabetes (9.7%). Prevalent presenting symptoms included pain (47.8%) and swelling (35.1%). A mean of 2.51 organs or anatomical sites was affected, retroperitoneum (64.2%) being most affected. The pancreas (30.0%) and digestive system (47.0%) were the organs/organ systems most affected. Patients had favorable outcomes in 79.1% of cases, 87.3% had no relapse, and 91.8% of patients survived the condition. Conclusion: The findings in this study provide a quantitative measurement of the demographics, presentations, organ manifestations, and outcomes of multifocal fibrosclerosis. We found the disease to be prevalent in males in Japan or the United States, with the abdomen and its organs being commonly involved.

Risk of Gynecological Cancers in Women With Polycystic Ovary Syndrome and the Pathophysiology of Association.

Polycystic ovary syndrome (PCOS) is an endocrine disorder increasingly affecting women in the reproductive age group. The women usually present with menstruation irregularities, hirsutism, weight gain, and acne. There has been ongoing research about the increased risk of gynecological cancers in women with polycystic ovary syndrome compared to those without it. This review aimed to understand the risk of gynecological cancers, endometrial, ovarian, and breast cancer in PCOS, and to study in detail the underlying mechanisms involved. We searched PubMed and Google Scholar databases for studies and selected 10 articles from a total of 19,388 relevant articles. We found an increased risk of endometrial cancer in women with PCOS whereas the risk of ovarian and breast cancer was not increased. A recent study has even reported a reduced risk of ovarian cancer in genetically predicted PCOS. In understanding various medical conditions possibly leading to cancer in these women we found that hyperandrogenism, hyperinsulinemia, unopposed estrogen action, chronic inflammation, and dyslipidemia were major contributors. There is a need for more large-scale cohort studies which will take into consideration other factors leading to cancers in women with PCOS, such as smoking, alcohol, and family history, to substantiate the significance of these associations further. The interventions used to treat PCOS might also affect the risk of cancer and require further probing. This review is an attempt to analyze the risk of cancers of the reproductive system in females with PCOS in coherence with understanding the mechanisms leading to the respective cancers.

Zika Virus: A Systematic Review of Teratogenesis, Congenital Anomalies, and Child Mortality.

Zika virus infection (ZIKV) was one of the most catastrophic epidemics. ZIKV in nonpregnant women is mild and sometimes asymptomatic. However, infection during pregnancy leads to congenital malformations in the fetus, while maternal signs of infection are preceded by a rash. The maternal-fetal infection begins with a rash that occurs early during pregnancy. The most severe pathologies were related to the first trimester of gestation, including microcephaly, musculoskeletal, genitourinary, craniofacial, ocular, and pulmonary manifestations. The prognosis may not be encouraging. Herd immunity increases CD8+ (cytotoxic T-lymphocytes) earlier and decreases in the resolution phase. However, CD4+ (T-helper cells) remains higher after infection. Recent ongoing vaccine development shows good immunity, control of the vector (Aedes mosquitoes), and treatment. ZIKV, anomalies, mortality, herd immunity, and vaccine were our main keywords. This systematic review demonstrates the teratogenesis of ZIKV in children, congenital anomalies, mortality, and a view of the future and behavior of ZIKV.

The Efficacy of Safinamide in the Management of Parkinson's Disease: A Systematic Review.

Parkinson's disease (PD) is a chronic neurodegenerative disease that is challenging to treat due to its progressive nature and its weaning response to therapy. Safinamide, a monoamine oxidase type-B inhibitor (MAOB-I), has shown promise in managing dyskinesias caused by levodopa (L-dopa), carbidopa, and PD features such as pain and depression. This systematic review aimed to evaluate safinamide's efficacy as a monotherapy and an add-on in tackling these issues. We composed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Our group searched the following databases: Manchester University Library, ScienceDirect, Google Scholar, PubMed, PubMed Central, and MedLine for articles produced in the last ten years using various search terms and criteria, which we outlined in the search strategy and eligibility criteria sections. We excluded 722 out of the initially screened 730 records for multiple reasons, such as titles and abstracts being irrelevant to the topic, articles without free full access, articles originally not in the English language, and articles that did not score 70% or above on their respective quality assessment tools. The studies explored supported safinamide's use in managing motor fluctuations, pain, depression, and improving patients' quality of life.

A Systematic Review of the Gastrointestinal Microbiome: A Game Changer in Colorectal Cancer.

Colorectal cancer (CRC) is a malignant condition of the colon and rectum. Generally, malignancies constitute a significant health threat to humans, and the result can be devastating. CRC is no exception. The gastrointestinal (GI) microbiome has long been suspected of impacting CRC. This review seeks to explore whether there is a connection between the two or not. For screening purposes, relevant articles were culled from various databases using key terms and phrases. Following a thorough search, the inclusion and exclusion criteria were applied, and a quality assessment was conducted. The articles retained were comprehensively studied, and revealed imbalances of the GI microbiome do indeed exhibit an association with CRC.

Treatment Options That Reduce the Duration of Sickle Cell Vaso-Occlusive Crises: A Systematic Review.

Most patients with sickle cell disease (SCD) seek hospital care because of pain symptoms. While some patients opt to treat themselves at home, some prefer to seek treatment in a hospital setting. There are, however, some patients with more complicated effects of the disease who seek treatment so often that they have been termed "super-users." This paper seeks to determine, across the board, the treatments available for vaso-occlusive crisis (VOC), the most common complication of SCD. Due to the frequency and unpredictable nature of VOC, it is no surprise that the lives of so many patients dealing with SCD are constantly disrupted by this complication. Treatments that reduce the frequency of VOC and the need for hospital admissions will help these patients find some semblance of balance in their quality of life.

New-Onset Refractory Status Epilepticus Secondary to COVID-19 Infection in Adults: A Systematic Review.

Background: New-onset refractory status epilepticus (NORSE) has been reported in the scientific literature as a phenomenon associated with the COVID-19 infection. Given the resurgence of the newer variants of COVID-19 added with its multi-system manifestations, this project was conducted to study the clinical picture of NORSE secondary to COVID-19 infection. Methods: Three electronic databases were searched using an extensive search strategy from November 2019 to December 2021. Patients reporting NORSE secondary to COVID-19 were included in this review. The status epilepticus severity score (STESS) was calculated by the study authors for individual patients. Statistical analysis was performed using SPSS version 26 with a p-value <0.05 as statistically significant. Results: After screening, 12 patients were included in this study with a mean age of 61.6 ± 19.0-year olds. The most common type of status epilepticus reported in our study population was non-convulsive status epilepticus (NCSE) (7 out of 12 patients, 58.3%). The linear regression model revealed that STESS scores were significantly influenced by patients' age (p = 0.004) and intra-hospital occurrence (IHO) of status epilepticus (p = 0.026). Overall, 8 patients (66.7%) were discharged without complications. Conclusion: Given the observed association of STESS with the aging population and IHO of status epilepticus, special attention is due to the caretakers of this population, while further studies are needed to further build upon this review.

Is Tocilizumab Effective and Safe in Polymyalgia Rheumatica and Giant-Cell Arteritis With Polymyalgia Rheumatica?

Polymyalgia rheumatica (PMR) and giant-cell arteritis (GCA) with symptoms of PMR share some pathophysiologic features. Interleukin 6 (IL-6) levels are elevated in both groups. We investigated the effect of tocilizumab (TCZ), an IL-6 inhibitor, in both populations and whether there were any differences regarding effectiveness and safety between them. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching the following databases: PubMed, PMC, Medline, Scopus, Cochrane Library, and ClincalTrials.gov. We found eight articles including one systematic review, one randomized controlled trial (RCT), one posthoc analysis of an RCT, and five observational studies. A total of 668 patients were included in this study. After a comprehensive analysis, we can only infer that there is insufficient evidence to suggest TCZ as monotherapy. Nevertheless, using TCZ in combination with glucocorticoid can be an effective therapeutic option.

Effectiveness of Prophylactic Interventions in Neurogenic Heterotopic Ossification (NHO): A Systematic Review.

Neurogenic heterotopic ossification (NHO) is the formation of mature lamellar bone in peri-articular tissues following a neurological insult, most commonly traumatic brain injury (TBI) or spinal cord injury (SCI). NHO is a debilitating condition associated with significant morbidity and reduced quality of life. However, its pathophysiology remains poorly understood. While surgery is the mainstay of treatment once NHO has been diagnosed, prophylactic options are limited and not well studied. This review aimed to determine the efficacy of various interventions used in the primary prevention of NHO. We conducted an electronic literature search using five databases (PubMed, Embase, ScienceDirect, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) for records published until April 10, 2022. We identified 2,610 potentially eligible records across all databases. Nine reports met our eligibility criteria and were included in this review. Four were clinical trials (three randomized control trials, one nonrandomized trial), four were observational studies, and one was a systematic review/meta-analysis. The medications/interventions used included: warfarin, pulse low-intensity electromagnetic field therapy (PLIMF), bisphosphonates, and nonsteroidal anti-inflammatory drugs (NSAIDs). We did not find conclusive evidence to recommend the use of bisphosphonates and warfarin in the prevention of NHO. On the contrary, we found NSAIDs and PLIMF as effective prophylactic options based on the results of high-quality randomized control trials. Further prospective randomized studies with prolonged follow-ups are needed to confirm the long-term efficacy of these preventive interventions.

Submental Intubation in Maxillofacial Procedures: A More Desired Approach Than Nasotracheal Intubation and Tracheostomy.

To achieve adequate airway management in maxillofacial procedures, the right intubation technique should be employed. This is because the surgeons and the anesthesiologists will need to work in the same surgical field to ensure a successful procedure. The type of intubation method used can either complicate either's role or pose some difficulties in the surgery itself. Nasotracheal intubation and orotracheal intubation may often be contraindicated in different types of maxillofacial surgeries and due to the complications associated with a tracheostomy, this method is often utilized as a last resort. Submental intubation has become very popular and favored alternative and has been associated with fewer complications. This literature review was conducted to explore the indications, complications, and contraindications of the different intubation methods. Sources were gathered from PubMed Central, PubMed, and Google scholar and included articles published between 2012 and 2022. A mix of literature reviews, case base studies, retrospective studies, prospective studies, and a few systematic reviews were examined. It was found that the use of submental intubation was preferred due to its less invasive nature, minimal intraoperatively and postoperatively complications, and greater patient compliance compared to tracheostomy. In addition, it is the best method when Nasotracheal intubation is contraindicated.

Just When We Thought That COVID Was Over: A Systematic Review.

As the globe continues to grapple and scuffle with new emerging strains of COVID every day, a set of recovered patients continue to show persistent enervating symptoms. Many patients never fully recovered after COVID and had neurological and psychiatric symptoms for weeks or months. The emphasis of our study is on these long haulers, particularly on the two critical organ systems of the body, i.e., the central nervous system and the muscular system. Depending upon the severity of the disease, many signs and symptoms continue to linger, ranging from weeks to months. A total of 29 studies are included in our review after thorough screening, application of inclusion and exclusion criteria, and quality appraisals. The total number of patients included is 6012. We found many long-term effects, but the emphasis of our study continued to remain on the two main organ systems that resulted in prolonged COVID with debilitating symptoms and thus affected the quality of life of these patients. Various factors and underlying pathophysiologic manifestations result in the predominance of these signs and symptoms. Furthermore, the patient's underlying medical conditions and other environmental factors may add to it. More focus is required on the quality of life post-COVID, and this requires a team of specialists. There are still many unanswered questions like which ethnicity is affected more, why females are more prone to the long symptoms, and the effects of various treatments on the long-term signs and symptoms.

A Systematic Review on the Efficacy and Safety of Selective Serotonin Reuptake Inhibitors in Gastrointestinal Motility Disorders: More Control, Less Risk.

Gastrointestinal motility disorders have been thought to occur due to an imbalance in the interaction of the gut-brain axis, which is regulated by serotonin. This recent discovery can be exploited to find newer therapeutic agents such as selective serotonin reuptake inhibitors for functional gastrointestinal disorders. PubMed, PubMed Central (PMC), and Medline databases were used to obtain the data. Meta-analyses, systematic reviews, randomized control trials, and reviews were included and analyzed in the data. Of the 19240 studies, 23 were extracted, and after appropriate quality assessment, they were utilized in this systematic review. They included two meta-analyses, four systematic reviews, two randomized control trials, and 15 review articles. The systematic review focuses on the efficacy of selective serotonin reuptake inhibitors (SSRIs) as compared to other treatment modalities for disorders of gut-brain interaction. It explores various studies analyzing SSRIs for their mechanism of action, their desirable effects for treating irritable bowel syndrome, and their tolerability in patients. SSRIs are effective and safe in treating overall symptoms of gastrointestinal motility disorders, particularly constipation-predominant disorders. They seem to have a better side effect profile than other drugs. This should encourage physicians to prescribe SSRIs early on in the disease.

Oxandrolone Efficacy in Wound Healing in Burned and Decubitus Ulcer Patients: A Systematic Review.

Wounds with delayed or impaired healing represent a considerable challenge in medical practice. These patients develop a sustained hypermetabolic and catabolic state, directly impacting the wound healing process. The use of oxandrolone has been studied to control this metabolic imbalance and protect lean body mass as a beneficial resource in wound healing. This systematic review aims to analyze previously conducted randomized controlled trials to evaluate the evidence of the applicability of oxandrolone therapy. We compared its use in adult patients with burns and adult patients with pressure ulcers in terms of wound healing and healing time of the skin graft donor site in days. The digital searches were done from March 23-28, 2022, within the databases: Google Scholar, PubMed/MEDLINE, and EBSCO (Elton B. Stephens Company). Data from six studies were analyzed and included in this review. Analysis of the available data demonstrated a significant advantage in skin healing using oxandrolone in adult burn patients as an adjunct. For adult patients with pressure ulcers, the drug showed no benefit on wound healing and skin graft site healing. Importantly, we found only one study evaluating the use of oxandrolone in patients with decubitus ulcers that met our eligibility criteria, and the certainty of the evidence was low. Thus, further prospective randomized studies with larger samples and standard wound care protocols are needed to produce more solid results, allowing more definitive conclusions to be made on this theme.

Association of increased pain intensity, daytime sleepiness, poor sleep quality, and quality of life with mobile phone overuse in patients with migraine: A multicenter, cross-sectional comparative study.

BACKGROUND: The number of regular smartphone users has increased dramatically worldwide. Headaches, followed by sleep difficulties, forgetfulness, dizziness, and other ailments, are among the most prevalent complaints among smartphone users during or after use. In addition, migraine is a debilitating disease and is the world's second leading cause of disability. Hence, we performed this study to determine how smartphone overuse influenced migraine patients' level of disability, pain intensity, sleep quality, and overall quality of life. METHODS: In this observational study, the patients were divided into two groups high mobile phone use group (HMPUG) and the low mobile phone user group (LMPUG) using the Mobile Phone Problematic Use Scale. We assessed, for each group, patients' level of disability, pain intensity, sleep quality, daytime sleepiness, and quality of life through the Migraine Disability Assessment Scale, Visual Analogue Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and 24-h Migraine Quality of Life Questionnaire, respectively. RESULTS: Our study showed that the respondents' average age was  27.59 (9.79) years. The average number of family members was 5.98 (2.3251). A total of 65.8% (n = 263) of the 400 participants were female, while 34.3 % (n = 137) were male. Greater pain intensity, poor sleep quality, and reduced medication effectivity were found in HMPUG compared to LMPUG (p < .05). However, increased duration of migraine and medication intake was reported in the LMPUG (p < .05). CONCLUSION: We observed that smartphone overuse could worsen pain, sleep, and reduce treatment efficacy in individuals with migraine. Therefore, controlled smartphone use is recommended to avoid worsening symptoms.

Características clínicas y epidemiológicas de los pacientes adultos con VIH en el Instituto Hondureño de Seguridad Social / Clinical and epidemiological characteristics of adults patients with HIV at the Honduran Social Security Institute

Introducción. Según ONUSIDA, la prevalencia de VIH/SIDA en Honduras es de 1.5%, siendo el segundo país más afectado de Centroamérica. Es importante tener en cuenta que se cree que el número de casos conocidos parece estar muy por debajo de la cifra real de casos de SIDA en Honduras. Métodos. Estudio descriptivo transversal, el universo de trabajo fueron todos los pacientes mayores de 18 años diagnosticados con VIH en la Clínica Periférica No. 1 del IHSS en Tegucigalpa desde el primero del 1 de Enero al 31 de Diciembre del 2008. Se recolectaron los datos a través de una encuesta estructurada con preguntas abiertas y cerradas aplicando la técnica de entrevista. Resultados. De 9,739 personas que se realizaron la prueba de ELISA para VIH/SIDA 85 resultaron positivos (0.8%). La mayoría eran adultos masculinos entre 31 y 40 años, predominando la infección en mestizos, personas casadas o en unión libre y nivel sociocultural bajo. La forma de transmisión fue sexual (heterosexual en 85.9% de los casos). Se encontró comorbilidad con otras Enfermedades de Transmisión Sexual. Predominaron los casos VIH sobre los casos SIDA. Conclusión. La frecuencia de VIH en el grupo estudiado alerta sobre la necesidad de educación efectiva para los adultos mayores de 18 años para prevenir el contagio con infecciones de transmisión sexual incluyendo VIH/SIDA...

Características clínicas y epidemiológicas de los pacientes adultos con VIH en el Instituto Hondureño de Seguridad Social / Clinical and Epidemiological Characteristics of Adults Patients with HIV at the Honduran Social Security Institute

Introducción. Según ONUSIDA, la prevalencia de VIH/SIDA en Honduras es de 1.5%, siendo el segundo país más afectado de Centroamérica. Es importante tener en cuenta que se cree que el número de casos conocidos parece estar muy por debajo de la cifra real de casos de SIDA en Honduras. Métodos. Estudio descriptivo transversal, el universo de trabajo fueron todos los pacientes mayores de 18 años diagnosticados con VIH en la Clínica Periférica No. 1 del IHSS en Tegucigalpa desde el primero del 1 de Enero al 31 de Diciembre del 2008. Se recolectaron los datos a través de una encuesta estructurada con preguntas abiertas y cerradas aplicando la técnica de entrevista. Resultados. De 9,739 personas que se realizaron la prueba de ELISA para VIH/SIDA 85 resultaron positivos (0.8%). La mayoría eran adultos masculinos entre 31 y 40 años, predominando la infección en mestizos, personas casadas o en unión libre y nivel sociocultural bajo. La forma de transmisión fue sexual (heterosexual en 85.9% de los casos). Se encontró comorbilidad con otras Enfermedades de Transmisión Sexual. Predominaron los casos VIH sobre los casos SIDA. Conclusión. La frecuencia de VIH en el grupo estudiado alerta sobre la necesidad de educación efectiva para los adultos mayores de 18 años para prevenir el contagio con infecciones de transmisión sexual incluyendo VIH/SIDA...(AU)