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There are still substantial clinical challenges in treating patients who come with type 2 diabetes and/or obesity in addition to chronic kidney disease (CKD). Retatrutide, an innovative agent, represents a potential advancement in therapy; however, its performance and safety profile specifically in a CKD population are not fully determined yet. This meta-analysis and systematic review sought to consolidate existing research on the use of retatrutide in this comorbid patient group. A comprehensive literature search identified relevant randomized controlled trials for inclusion. Reductions in glycated hemoglobin (HbA1c) and body weight were the primary goals for evaluating effectiveness, whereas adverse events were used to evaluate safety. Eight studies were included in the present research work. A significant mean reduction in HbA1c of -1.04% (95% CI -1.42 to -0.67) and a noticeable loss in weight, reaching up to -24.2%, were both linked with retatrutide treatment. A subgroup analysis indicated that the glycemic benefits were dose-dependent, with lower doses (≤8 mg) demonstrating a greater HbA1c reduction (-1.39%) than higher doses (≥12 mg, -0.65%). Furthermore, secondary analyses pointed toward possible renoprotective effects, evidenced by a reduction in albuminuria. The safety profile is primarily characterized by gastrointestinal adverse events, which is anticipated for this drug class. In conclusion, retatrutide exhibits strong efficacy for improving glucose levels and promoting weight loss in patients with diabetes, obesity and CKD, displaying a distinctive dose-response pattern where lower doses may be more effective for glycemic control. Its potential for kidney protection is promising, though clinicians should be mindful of managing gastrointestinal tolerability.

Introduction: This research utilizes artificial intelligence-based McNamara cephalometric analysis to evaluate skeletal discrepancies in individuals with and without cleft lip and palate (CLP). The study examines gender differences and compares McNamara parameters across cleft types using a comprehensive dataset. Methods: Demographic data and McNamara measurements, including maxillary length (Co-A), mandibular length (Co-Gn) and maxillomandibular differential (MMD), were extracted from 123 individuals. Statistical analyses included independent samples tests, ANOVA, robust testing, and Tukey HSD post-hoc comparisons. Results: The sample comprised 56.9% males and 43.1% females. Cleft distribution: non-cleft (NC) (24.4%), bilateral cleft lip and palate (BCLP) (43.9%), unilateral cleft lip and palate (UCLP) (13.8%), unilateral cleft lip (UCL) (10.6%), unilateral cleft lip and alveolus (UCLA) (7.3%). No significant gender differences were observed in McNamara parameters. Significant differences existed between NC and CLP groups in all parameters (p < 0.001). ANOVA revealed significant differences across cleft types for Co-A (p = 0.002), Co-Gn (p = 0.003) and MMD (p < 0.001). Post-hoc tests identified specific group differences. Conclusion: While gender does not significantly impact McNamara parameters, significant differences exist between NC and CLP individuals and among cleft subtypes. These findings highlight the importance of cleft-specific considerations in orthodontic and craniofacial treatment planning.

Background: Fatigue is one of the most common symptoms in patients with multiple sclerosis (MS), and the cognitive aspect of fatigue is not fully evaluated in these patients. After reviewing existing questionnaires and noting that the fatigue scale for motor and cognitive functions (FSMC) questionnaire has not been validated in Persian, we designed this study to assess the validity and reliability of the Persian version of the FSMC questionnaire in patients with MS.

Methods: One hundred and forty patients and 63 healthy participants who met the inclusion criteria for healthy controls (age-matched with cases, no history of neurological or psychiatric disorders and not taking anti-depressant medications in the past three months) were enrolled in the present study. Both groups completed the FSMC questionnaire, while the patient group was asked to fill out the valid and reliable Persian version of the modified fatigue impact scale (MFIS), fatigue severity scale (FSS) and Beck depression inventory (BDI). Internal consistencies, content, convergent and discriminant validities were evaluated. We considered the MFIS score as the comparator with a cut-off value of 33 to dichotomize fatigued and non-fatigued individuals, then we plotted the ROC curves of total FSMC, cognitive and motor sub-scales to estimate the best cut-off value of FSMC.

Results: The Cronbach's alpha for the total FSMC was calculated as 0.95, for the FSMC cognitive subscale as 0.92, and the motor subscale as 0.94. The ICC for the motor subscale was 0.962, and for the cognitive subscale was 0.963. Content validity index (CVI) and content validity ratio (CVR) for all questions of FSMC questionnaire were 100% (content validity). There were significant positive correlations between FSMC and its subscales with MFIS, FSS, BDI and expanded disability status scale (EDSS) (convergent validity). The FSMC score and its subscales were significantly different between patients and healthy individuals (discriminant validity).

Conclusion: The Persian version of FSMC provides a valid and reliable tool for evaluating motor and cognitive aspects of MS fatigue, which could be applied in clinical practice and research purposes.

Background: Pancreaticoduodenectomy (PD) is the primary curative procedure for malignancies of the pancreatic head and periampullary region. The critical step of reconstructing the pancreatic stump is most commonly performed via pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG). Postoperative pancreatic fistula (POPF) remains the most formidable complication, which drives significant morbidity and mortality. The ongoing debate regarding the optimal reconstruction technique lacks a definitive evidence-based consensus.

Objective: To conduct a rigorous systematic review and meta-analysis comparing the efficacy and safety of PG versus PJ in preventing POPF and other critical postoperative outcomes in patients undergoing PD.

Methods: We systematically searched major electronic databases (CENTRAL, MEDLINE, Embase, CINAHL) and clinical trial registries up to September 2016 for all relevant randomized controlled trials (RCTs). Our primary outcomes were the incidence of POPF (any grade, A-C), clinically significant POPF (grades B & C) and 90-day postoperative mortality. Secondary outcomes encompassed length of hospital stay, re-intervention rates, overall surgical complications, postoperative bleeding, intra-abdominal abscess, quality of life and cost-analysis. Methodological quality was appraised using the Cochrane Risk of Bias tool and the certainty of evidence was graded using the GRADE framework.

Results: Our analysis incorporated 10 RCTs with a pooled cohort of 1,629 participants. The meta-analysis demonstrated no statistically significant difference in the overall incidence of POPF between PJ and PG (24.3% vs. 21.4%; RR 1.19, 95% CI 0.88 to 1.62; low-quality evidence). The evidence for clinically significant POPF was highly uncertain (19.3% vs. 12.8%; RR 1.51, 95% CI 0.92 to 2.47; very low-quality evidence). A comparable postoperative mortality between groups was found (3.9% vs. 4.8%; RR 0.84, 95% CI 0.53 to 1.34; moderate-quality evidence). A notable trade-off was observed: PJ was associated with a significantly lower risk of postoperative bleeding (9.3% vs. 13.8%; RR 0.69, 95% CI 0.51 to 0.93) but a significantly higher risk of intra-abdominal abscess (14.7% vs. 8.0%; RR 1.77, 95% CI 1.11 to 2.81). No significant differences for other secondary outcomes were detected.

Conclusion: The current body of evidence does not establish the superiority of either PJ or PG for pancreatic reconstruction following PD. The choice of technique should be individualized, relying on surgeon expertise and specific patient- and pancreas-related factors, while weighing the distinct risk profiles of each procedure (bleeding vs. abscess).

Objectives: The PCL (posterior cruciate ligament) is the primary stabilizer to prevent posterior translation of the knee. It provides femoral roll-back, stability and proprioception. Pathology of the PCL are limited in the literature. The aim of this study was to histopathologically examine the PCL of patients undergoing total knee arthroplasty for gonarthrosis and to investigate the correlation of PCL histopathology with preoperative functional scores.

Materials and methods: Seventy-three patients (19 males, 54 females) aged 50-75 years, with primary osteoarthritis, where bilateral knee arthroplasty was performed in three patients, resulting in 76 tibial plateaus, were included in the present study. Patients with a history of previous intra-articular knee surgery and rheumatic disease were excluded. Posterior cruciate ligament materials were graded between stages 0 and 4 according to the extent of histopathological changes recorded under light microscopy. Correlation of PCL histopathology with preoperative functional scores. SF-36 limitations of activities and physical health problems, Pain Quality Assessment Scale (PQAS), Lysholm and WOMAC scoring systems were assessed preoperatively.

Results: There were significant correlations between light microscopic histopathologic staging of PCL and preoperative SF-36 limitations of activities (p<0.01), physical health problems (p<0.05); PQAS intense (p<0.05), radiating (p<0.01), throbbing (p<0.05), aching (p<0.05), heavy (p<0.05); Lysholm total (p<0.001); and WOMAC total scores (p<0.01). The correlation between histopathologic staging of PCL and using a cane or crutches of Lysholm and radiating of PQAS was found to be moderately significant (p<0.001, p<0.01).

Conclusion: Despite significant correlations, the commonly used functional scores may not be sufficiently precise for granular preoperative assessment of PCL microscopic degeneration, highlighting the need for PCL-specific scoring systems.

Introduction: Although the prevalence of leprosy has significantly decreased in India, it has been still not eradicated, therefore necessitating ongoing efforts to raise awareness for its control.

Objectives: To determine the diagnostic utility of slit skin smear (SSS) and Fite-Faraco stain (FFS) techniques on histopathology of skin and nerve biopsies for the diagnosis of leprosy in a tertiary care center.

Materials and methods: The present cross-sectional study was carried out on patients clinically suspected to have leprosy consulting in a tertiary care center in Gujarat, India, from January 2022 to December 2024. Statistical analysis was done by using Statistical Package for Social Sciences (SPSS) version 21.0. Continuous variables were presented as mean and categorical variables as numbers and percentages (%). Comparative analysis between various parameters of test effectiveness by using FFS and SSS methods was done.

Results: The age of leprosy cases ranged from 18 to 60 years, with a mean age of 35.2 years. Male to female ratio was 5.5 to 1. Histopathologically lepromatous leprosy (61.6%) and multibacillary type based on World Health Organisation (WHO) classification (77%) were the most common forms of leprosy. When comparing the efficacy of SSS and FFS techniques on tissue sections, FFS was found to be more effective than SSS.

Conclusion: Sufficient knowledge and clinical expertise, along with effective diagnostic techniques, prompt symptom reporting and heightened social awareness to mitigate the stigma associated with the condition from the patient's perspective, can collectively advance the nation towards the goal of leprosy eradication.

Purpose: To evaluate the diagnostic and surgical relevance of anterior segment optical coherence tomography (AS-OCT) in granular, lattice and macular corneal dystrophies in Romania, and to illustrate key imaging features using cases from our centre.

Methods: We searched the PubMed/MEDLINE database for articles published between January 2010 and January 2025 using combinations of the following terms "granular corneal dystrophy", "lattice corneal dystrophy", "macular corneal dystrophy" with "anterior segment optical coherence tomography". We excluded studies that contained no anterior segment optical coherence tomography data. We prioritised peer-reviewed original articles and systematic reviews. Given the rare nature of these dystrophies, case reports were included if they contained relevant AS-OCT data. Representative slit-lamp and AS-OCT images from our clinic were included to contextualize findings.

Results: Stromal dystrophies are rare in Romania and their overlapping clinical features make diagnosis difficult. Anterior segment optical coherence tomography helps by offering depth-resolved visualization of epithelial, Bowman's layer and stromal changes. It allows more reliable differentiation between entities: granular dystrophy shows sharply defined hyperreflective deposits; lattice dystrophy shows linear, branching stromal amyloid; and macular dystrophy shows diffuse stromal hyperreflectivity with associated thinning. These layer-specific patterns improved phenotypic differentiation and, in surgical candidates, helped estimate lesion depth and residual clear stroma, thereby informing the choice of keratoplasty technique and postoperative monitoring.

Conclusions: Anterior segment optical coherence tomography refines diagnosis, enhances early detection and guides surgical decision-making in stromal corneal dystrophies. Its objective imaging markers facilitate monitoring of disease progression and postoperative recurrence. Continued advances in multimodal imaging and automated analysis are expected to further strengthen its role in personalised management.

Background: Plantar fasciitis is the most common cause of chronic heel pain. Accurate diagnosis is essential, as similar symptoms may arise from other conditions. Surgery is considered after six months of failed conservative treatment, with various techniques available. This retrospective study aimed to evaluate the outcomes of percutaneous plantar fascia release under local anesthesia in patients with plantar fasciitis.

Methods: This retrospective study included adult patients diagnosed with plantar fasciitis - based on clinical and radiological evaluation - who underwent percutaneous plantar fascia release under local anesthesia between 2017 and 2020 in our Outpatient Orthopedic Clinic. Patients with previous foot surgeries, infections, tumours, systemic conditions (rheumatoid arthritis), or bilateral involvement were excluded. All had persistent symptoms for over six months despite conservative treatment. Data collected included demographics, symptom duration, body mass index (BMI), pain characteristics and functional limitations. Outcomes were assessed using the visual analog scale (VAS) and subjective patient satisfaction. Statistical analysis was performed using comparisons of means and the Chi-square test.

Results: Twenty-three patients (15 women and eight men with a mean age of 50 years, range 39-78) underwent percutaneous plantar fascia release. The mean preoperative VAS score was 8.9 (range: 8-10) for pain, and 8.5 (range: 8-10) for daily activity limitation,. At six months postoperatively, the average VAS score decreased to 1.9 (range: 1-7) for pain and 1.6 (range: 1-6) for activity limitation, based on a telephone survey using the Benton-Weil questionnaire. Two patients (8.7%) reported persistent pain and dissatisfaction. The remaining 21 patients (91.3%) reported satisfactory outcomes. No correlation between spur size and outcomes was found. Statistical analysis showed a significant improvement in both pain and function (p < 0.05).

Conclusions: Percutaneous plantar fasciotomy is a safe and effective treatment for plantar fasciitis. Further studies are needed to determine the optimal extent of fascial release and to refine patient selection criteria.

Objectives: Endoscopic retrograde cholangio-pancreatography (ERCP) brush-based cytology is a valuable diagnostic tool regarding the biliary system examination and detection of non- or malignant lesions. Diagnostic accuracy and sensitivity of this method demonstrate different ranges in a variety of studies. The aim of the current study was to compare the results of ERCP brush-based cytology with the corresponding histopathological diagnoses.

Materials and methods: We selected and compared cytological and pathological slides derived from sixty-eight (n=68) patients who underwent ERCP brush-based examination between February 2021 and March 2024. Papanicolaou and eosin-hematoxylin staining assays were performed in the corresponding smears and tissues, respectively.

Results: Concerning the initial cytological diagnoses, 38 cases were negative for malignancy, 10 cases atypical, 16 cases suspicious for malignancy and four cases were characterized as positive for malignancy. Histologic correlation confirmed a benign outcome in 39 out of 48 patients, 11 cases were diagnosed as adenoma-dysplasia, whereas 18 cases were considered malignant. The overall concordance between cytology and histology was 66% in sensitivity, 95% in specificity, 84% in accuracy, 90% in positive predictive value and 81% in negative predictive value.

Conclusion: Endoscopic retrograde cholangio-pancreatography brush-based cytology is a useful and significant preoperative method for initially diagnosing pancreatic-biliary lesions. It provides a high level of specificity, accuracy and predictive value (positive/negative), but a lower level of sensitivity compared to histopathology due to differences that cell and tissue substrates demonstrate during the diagnostic process (morphological features and cell configuration/cyto-architecture).

The lumbopelvic junction is a biomechanically complex region that necessitates robust stabilization, especially following spinopelvic dissociation, unstable sacral fractures, or sacrectomy. Lumbopelvic fixation techniques, such as triangular osteosynthesis and dual S2-alar-iliac (S2AI) screw placement, optimize load transfer, restore spinal-pelvic continuity and reduce mechanical failure risks. Triangular osteosynthesis achieves up to 80% of native spine stiffness under load, while dual S2AI screws restore up to 96% stiffness and show lower screw loosening rates than single screws. Comparative studies reveal that S2AI screws outperform traditional iliac screws in biomechanical stability, pullout strength and reduced hardware-related complications. Multi-rod and quad-rod constructs further enhance construct rigidity, distribute mechanical stress and lower the risk of rod breakage and revision surgeries. Novel anchoring strategies, including sacral hooks and clamps, contribute to improved stability in cases with complex fractures or bone loss. The integration of navigation and robotics ensures higher accuracy in screw placement, minimizes complications and enhances surgical precision. Collectively, these advancements facilitate early mobilization, improved fusion rates, superior pain relief and better functional outcomes, underscoring the evolving landscape of lumbopelvic fixation strategies.