Annals of Medicine and Surgery最新文献

Background: Differentiating follicular thyroid carcinoma (FTC) from follicular adenoma (FA) is challenging due to their histological similarities. This systematic review and meta-analysis aimed to assess the difference in Ki-67 expression between FTC and FA to evaluate its diagnostic utility.

Methods: We conducted a comprehensive search of PubMed, Embase, Scopus, and Web of Science databases for studies reporting Ki-67 expression in FTC and FA. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was applied to calculate the pooled mean difference of the Ki-67 index, with heterogeneity assessed by the Cochran Q and I-squared tests. Meta-regression was used to explore sources of heterogeneity, and publication bias was evaluated using Egger's test, Begg's test, and funnel plot.

Results: The meta-analysis revealed a pooled mean difference in Ki-67 expression between FTC and FA of 1.13 (0.63-1.63), indicating a significant difference. In addition, the difference in the Ki-67 index between minimally invasive follicular carcinoma and FA was 0.56 (0.12-1.00), which was also statistically significant. The heterogeneity among included studies was due to variations in Ki-67 index calculation methods. The reviewed studies demonstrated low sensitivity but high specificity of Ki-67 for differentiating FTC vs. FA, although diagnostic cut-offs were inconsistent.

Conclusions: This study demonstrates a significant difference in Ki-67 expression between FTC and FA, supporting its potential role as a diagnostic marker. Further research is required to establish standardized diagnostic cut-offs and evaluate Ki-67's sensitivity and specificity in clinical practice.

Background: Hybrid coronary revascularization (HCR), a combination of percutaneous coronary intervention and coronary artery bypass grafting (CABG), is an emerging treatment for patients with multivessel coronary artery disease (MVCAD). While traditional CABG is considered the standard, HCR may mitigate issues like saphenous vein graft failure.

Methods: We systematically searched PubMed, Scopus, Web of Science, and Embase until September 2024, targeting randomized controlled trials (RCTs) that evaluated HCR against CABG in MVCAD patients. The quality of included studies was assessed using the ROB2 tool, and data were analyzed using RevMan 5.4. Four RCTs (n = 382) involving 382 participants were analyzed using a random-effects model. Risk of bias was assessed using the ROB2 tool.

Results: Four RCTs (n = 382) met inclusion criteria. At 30 days, there were no statistically significant differences between HCR and CABG in all-cause death (risk ratios [RR] = 1.35, P = 0.74), stroke (RR = 0.99, P = 0.99), myocardial infarction (RR = 1.17, P = 0.74), or blood transfusion (RR = 0.70, P = 0.14), with zero heterogeneity (I ² = 0%). At 1-year follow-up, pooled analyses showed no significant differences in all-cause death (RR = 1.37, P = 0.62) or myocardial infarction (RR = 1.29, P = 0.56), also with consistent homogeneity (I ² = 0%).

Conclusion: HCR demonstrates comparable safety and effectiveness to CABG for MVCAD, with similar rates of key outcomes at both 30 days and 1 year. Further research with larger samples and longer follow-up is recommended to confirm these findings.

Background: In this systematic review, we aimed to evaluate the impacts of probiotics on psychological issues and other symptoms, such as pain and fatigue, in people with fibromyalgia.

Materials and methods: On 19 January 2025, PubMed, Scopus, and Web of Science were searched to identify relevant records. We included studies that evaluated the effects of probiotics, either alone or in combination with other treatments, in individuals diagnosed with fibromyalgia, compared to the placebo or any other form of treatment. The quality of the included studies was assessed using the JBI critical appraisal tools for randomized controlled trials and quasi-experimental studies. We used a qualitative approach for the synthesis in this study.

Results: From a total of 186 articles retrieved in our search, five reports from four studies were included in this review. In total, 209 people with fibromyalgia were included in these studies, with 103 (49.3%) being in the experimental (probiotic) group. All studies fulfilled the majority of the JBI critical appraisal tool criteria. Although some studies reported reductions in anxiety and depression among individuals with fibromyalgia who used probiotics, the findings were not consistent across all studies. Only one study assessed adverse events associated with probiotics compared to placebo, finding no significant differences between the groups in the incidence of at least one adverse event (P > 0.05).

Conclusions: Overall, we cannot make a definitive recommendation for or against the use of probiotics in the treatment of individuals with fibromyalgia, and future studies are needed in this regard.

Periodontitis is a chronic inflammatory disorder that has been recognized as a significant public health concern worldwide. An imbalance between the protective oral microbiota and numerous oral pathogens has been implicated in its pathogenesis. Periodontitis not only impacts an individual's oral health but also has systemic implications. The pathogenesis of periodontitis and these respiratory infections has been shown to be intricately linked. Numerous clinical research and animal studies have highlighted that the oral health of a population is closely related to their systemic health. It has been suggested that the periodontal pockets can act as a reservoir for oral pathogens, which can later migrate into the respiratory tract through aspiration or systemic circulation. This is a narrative review conducted after a wide literature search on databases such as PubMed, Cochrane, and Google Scholar with keywords including "Periodontitis," "Respiratory," "Infections," "Tuberculosis," 'COVID-19', "Pneumonia," "Asthma," and "COPD" published in the last 15 years. The cornerstone of this comprehensive review lies in deciphering the pathogenesis and epidemiology of periodontitis and how these periodontal bacteria contribute to respiratory infections through numerous biological mechanisms, inflammatory pathways, and the potential pathways of infection transmission. We also explore the empirical evidence through research studies supporting the periodontitis-respiratory infections link and also studies with conflicting or inconclusive results. By connecting the dots between this crucial oral-systemic link, we hope to uncover the gaps in the current research and find new avenues for developing cost-effective, targeted, transformative preventive and therapeutic strategies that will not only improve oral health but will also support respiratory health and help reduce the global burden of respiratory infections. Strengthening oral hygiene programs could reduce the burden of respiratory diseases, particularly in elderly and high-risk populations.

Background: Essentially crucial in early diagnosis and treatment of depression are the somatic symptoms, which can significantly decrease the morbidity and mortality associated with these symptoms and depression, as well as decrease the costs of investigation and treatment for the primary healthcare system. We conducted this study to determine the socio-demographic correlates of somatic symptoms in depression in a Pakistani population.

Methods: This cross-sectional study was conducted at the Department of Psychiatry, PIMS Hospital, Islamabad, during the period April 2025 to August 2025. A total of 243 male and female patients aged 12-60 years diagnosed with depression were enrolled. The patients were evaluated for somatic symptoms by conducting an interview based on the PHQ-15 questionnaire. Data was analyzed using SPSS v.26. The primary objective was to determine the prevalence of somatic symptom severity using PHQ-15 categories among patients with DSM-5-diagnosed depression. Secondary objectives were to examine associations between PHQ-15 severity and key sociodemographic predictors including age, gender, education, residence, and marital status.

Results: Gender wise distribution of the patients revealed that 74 males (30.5%) and 169 females (69.5%). In terms of age distribution, the largest age group was 12-25 years (n = 131, 53.9%), followed by 26-35 years (n = 63, 25.9%). Among the symptoms that bothered the patients a lot, low energy was most frequently reported by 144 patients (59.3%), followed by troubled sleeping by 117 (48.1%). Painful sexual intercourse was least commonly reported by 9 patients (3.7%). High PHQ-15 score was recorded in 52 patients (39.7%), aged 12-25 years, 26 (41.3%) patients aged 26-35 years, 12 (48.0%) patients aged 36-45 years, and 17 (70.8%) patients aged 46-60 years, respectively (P-value 0.011).

Conclusion: Most frequently reported somatic symptoms significantly bothering the patients were low energy and trouble sleeping. Age was significantly associated with the degree of somatization, and patients with advanced age were more frequently having a high degree of somatization.

Introduction and importance: Severe hypercalcemia typically produces QT interval shortening or ventricular arrhythmias, whereas bradyarrhythmias are exceptionally rare. The coexistence of hypercalcemia with acute kidney injury (AKI) - a condition that usually causes hypocalcemia - further underscores diagnostic complexity.

Case presentation: An 85-year-old man presented with AKI, confusion, and symptomatic sinus bradycardia (40 bpm) without atrioventricular block or QT prolongation. Laboratory studies showed markedly elevated corrected calcium, suppressed parathyroid hormone, and increased parathyroid hormone-related peptide. Chest CT revealed a 7 × 8 mm right-lung nodule. These findings are suggestive of humoral hypercalcemia of malignancy, although the etiology remains unconfirmed in the absence of tissue diagnosis. Treatment with intravenous hydration and zoledronic acid led to normalization of calcium, restoration of sinus rhythm (61 bpm), and improvement of renal function, obviating the need for pacing.

Discussion: This case is distinctive for demonstrating reversible sinus bradycardia in the setting of severe hypercalcemia and acute kidney injury - an atypical and physiologically unexpected combination. The biochemical profile raises suspicion for a paraneoplastic process, though this remains unconfirmed. The case underscores the importance of recognizing hypercalcemia as a reversible cause of bradyarrhythmia and considering malignancy in the appropriate clinical context when PTH is suppressed.

Conclusion: Hypercalcemia-induced bradycardia, though rare, is fully reversible with prompt metabolic correction. Awareness of this atypical presentation can prevent misdiagnosis, unnecessary pacemaker implantation, and delayed recognition of paraneoplastic disease.

Introduction and importance: Parapharyngeal space (PPS) tumors are uncommon, accounting for 0.5%-1% of head and neck neoplasms. Diagnosis and treatment of parotid pleomorphic adenomas (PPA) extending to the PPS are difficult because the PPA is situated deep in the tissue.

Case presentation: A 49-year-old woman presented with a sore throat, odynophagia, and foreign body sensation in the throat for 6 weeks. Physical examination revealed a bulge in the oropharynx. Imaging revealed a clearly demarcated lesion in the right PPS of the neck. PPA diagnosis was confirmed using fine-needle aspiration cytology. Surgical removal of the tumor was performed via a transcervical transparotid approach with preservation of the facial nerve. Histopathological examination confirmed the diagnosis of pleomorphic adenoma, and the patient's symptoms were alleviated, with no recurrence at 8 months of follow-up.

Clinical discussion: The clinical onset is typically insidious and is characterized by a gradually enlarging mass in the parotid or upper neck, while oropharyngeal signs, such as dysphagia, snoring, dysphonia, or airway compromise, develop late in the course of the disease when the mass is sufficiently large or manifests as an intraoral bulge in the tonsillar or paratonsillar region.

Conclusion: This case highlights the importance of meticulous diagnosis using radiography and tailored surgical treatment for PPA in PPS. The transcervical transparotid approach enables tumor removal while preserving facial nerve function.

Obesity is a growing global health crisis with wide-ranging effects beyond metabolic and cardiovascular disorders. A substantial body of international evidence has linked excess adiposity to increased risk for various cancers. In Saudi Arabia, where obesity rates are among the highest globally, the relationship between obesity and cancer remains insufficiently characterized. This narrative review synthesizes global and regional literature on obesity-associated cancers, with a specific focus on the epidemiologic and research landscape in Saudi Arabia. A targeted search of PubMed, Google Scholar, and official databases from the World Health Organization, International Agency for Research on Cancer, and GLOBOCAN was conducted for English-language articles published between 1990 and 2023. The review highlights several cancers - postmenopausal breast, colorectal, liver, endometrial, kidney, and pancreatic - with convincing or probable associations with obesity. Alarmingly, many of these cancers also rank among the most common and fatal malignancies in Saudi Arabia, as shown in GLOBOCAN 2022 data. However, local research quantifying this link is limited. National cancer registries lack obesity-related variables, and longitudinal cohort studies are scarce. These gaps hinder the ability to implement evidence-based, obesity-targeted cancer prevention strategies. Given the convergence of high obesity prevalence and rising incidence of obesity-related cancers, urgent attention is needed to integrate obesity metrics into national cancer surveillance. Strategic investments in population-based cohort studies and registry reform are essential to inform tailored public health interventions and reduce the burden of obesity-related cancers in the Kingdom.

Introduction and importance: Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, commonly presenting with abdominal pain, diarrhea, and peripheral eosinophilia. Corticosteroids are traditionally considered the mainstay of treatment.

Case presentation: A 45-year-old female presented with epigastric abdominal pain. Laboratory tests revealed marked peripheral eosinophilia, and upper endoscopy with biopsies confirmed mucosal-type EGE. The patient declined corticosteroid therapy and was commenced on montelukast 10 mg daily. She achieved complete symptom resolution within 2 weeks and maintained remission over a 12-month follow-up.

Clinical discussion: Corticosteroids remain the standard treatment for EGE, effectively reducing eosinophil counts and inflammatory mediators. In patients unable or unwilling to receive steroids, leukotriene receptor antagonists, such as montelukast, offer a viable alternative, demonstrating rapid symptom relief and potential for sustained remission.

Conclusion: Physicians should recognize EGE and its therapeutic complexities. Montelukast may serve as an effective corticosteroid-sparing strategy, enabling early symptom resolution and long-term remission.