Annals of Medicine and Surgery最新文献

Introduction: The pilosebaceous unit is impacted by the prevalent chronic inflammatory skin condition known as acne vulgaris. The formation of comedones, papules, and pustules are among the clinical signs of acne. Acne is usually thought to be harmless, yet it can leave disfiguring scars and have psychological effects.

Methods: In our cross-sectional study with 386 participants, we examined acne severity and scarring in relation to variables such as age, gender, family history of acne, and dietary habits (especially fast food and dairy products). The assessments were conducted by a trained medical team and validated by a dermatologist. Statistical analysis was performed using SPSS version 16, with significance set at P < 0.05. Associations were expressed as odds ratios with 95% confidence intervals.

Results: Moderate acne was the most common presentation (66.6%), followed by mild (31.6%) and severe (1.8%) cases. Scarring was mostly Grade 2 (65.3%), with fewer participants having Grades 1, 3, or 4. In bivariate analysis, higher acne severity was significantly associated with younger age and male gender (P < 0.001). However, multivariate logistic regression revealed no statistically significant associations between acne severity or scarring and age, gender, family history, fast food consumption, or dairy intake.

Conclusions: In this cohort, no statistically significant association was observed between the consumption of fast foods or dairy products and acne severity. However, these findings should be interpreted cautiously given the methodological limitations. Further research is needed to clarify the potential role of diet in acne development.

Background and objective: Adolescence is a pivotal stage in the development of physical and mental health. Mind-body interventions, such as laughter yoga, have garnered increasing attention as innovative methods for enhancing overall well-being, particularly in the context of improving cardiorespiratory function. This study examined the impact of an 8-week laughter yoga intervention on the cardiorespiratory performance of adolescent girls.

Methods: This semi-experimental study utilized a pretest-posttest control group design conducted during the 2023-2024 academic year. A total of 64 female students aged 13-15 years from Shahrekord were randomly allocated to an intervention group (laughter yoga) or a control group. The intervention comprised sixteen 40-min laughter yoga sessions. Cardiac, pulmonary, and metabolic indices were assessed pre- and postintervention. Data were analyzed using statistical package for the social sciences software with a significance threshold of P < 0.05.

Results: In the intervention group, significant reductions were observed in fasting blood sugar (P = 0.001), triglyceride (P = 0.003), total cholesterol (P = 0.002), systolic blood pressure (P = 0.003), diastolic blood pressure (P = 0.041), and heart rate (P = 0.002) levels. High-density lipoprotein levels were significantly increased (P = 0.027). Regarding cardiac function, the stroke volume (P = 0.031) and cardiac output index (P = 0.004) showed significant improvements. In terms of respiratory indices, forced expiratory volume in 1 second (FEV1) (P = 0.015), FEV1/FVC (P = 0.035), and forced expiratory flow 25-75% (P = 0.002) significantly increased, while forced expiratory time decreased (P = 0.001).

Conclusion: Laughter yoga may be considered a calm, accessible, and nonpharmacological approach to enhancing cardiorespiratory and metabolic health in adolescent girls.

Introduction and importance: Iatrogenic Cushing syndrome is a multisystemic endocrinological disorder. It is caused by prolonged exposure to exogenous corticosteroids and remains an underdiagnosed endocrine disorder, particularly in low-resource settings where unsupervised self-administration and misuse of Over The Counter (OTC) steroid injections is common.

Case presentation: We present a 57-year-old woman with a 20-year history of type 2 diabetes mellitus who presented to the notice of a clinician with multifocal recurrent left arm, leg, and breast cellulitis; diarrhea; bilateral pedal edema; and atrial fibrillation. The history of the patient was long-term treatment with insulin and frequent self-administered steroid injections for self-treated musculoskeletal pain, not prescribed. Despite classic Cushingoid features, her laboratory findings paradoxically revealed hypocortisolism and suppressed gonadotropins, consistent with hypothalamic pituitary adrenal (HPA) axis suppression. Management consisted of steroid withdrawal under observation, broad-spectrum antibiotics in cellulitis, hyperglycemia control with aggressive insulin, and supportive care.

Clinical discussion: This case demonstrates the diagnostic challenge of exogenous Cushing syndrome, in which biochemical findings of low cortisol can mask clinical hypercortisolism. It underscores the systemic complications which include metabolic decompensation, infection susceptibility, and cardiovascular disease due to unregulated steroid use. Of interest is that the case demonstrates the public health significance of uncontrolled steroid access in low- and middle-income nations like Pakistan, where over-the-counter misuse mainly contributes to underdiagnosed iatrogenic Cushing syndrome.

Conclusion: Clinicians should consider iatrogenic Cushing syndrome in patients with unexplained multisystem problems. Regulatory control of over-the-counter steroid access and patient education are crucial to preventing such cases.

Background: Polycystic ovarian syndrome (PCOS) is a genetically diverse endocrine disorder affecting 5-20% of reproductive-aged women worldwide. It is a significant cause of hyperandrogenism, anovulatory infertility, menstrual dysfunction, and hirsutism. This meta-analysis assesses the effectiveness of sequential letrozole and gonadotropin therapy as compared to other ovulation induction regimens in women with PCOS.

Methods: A comprehensive search was conducted through the PubMed, Embase, Cochrane, Scopus, and ClinicalTrials.gov databases for articles relevant from inception up to March 2024. Pooled outcome estimates were reported as odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous data, and as mean differences (MD) and 95% CI for continuous data. Statistical heterogeneity was assessed using I ² and χ ² statistics. All calculations were performed using RevMan 5.4.

Results: This meta-analysis included 8 randomized controlled trials involving 932 anovulatory infertile women with PCOS diagnosed by the Rotterdam Criteria. We found a statistically significant increase in ovulation rates (OR 1.74; 95% CI 1.02-2.99; P = 0.04; I ² = 27%) in the treatment group compared to other ovulation induction regimens. There was no difference in pregnancy rates (OR 1.11; 95% CI 0.66-1.87; P = 0.69; I ² = 60%) and number of dominant follicles (MD 0.36; 95% CI -0.18 to 0.91; P = 0.19; I ² = 97%). The treatment group showed a statistically significant reduction in the size of dominant follicles (mm) (MD -0.27; 95% CI -0.95 to 0.41; P = 0.04; I ² = 88%) and an increase in endometrial thickness (mm) (MD 0.78; 95% CI 0.19-1.38; P = 0.010; I ² = 97%).

Conclusion: The treatment group saw a significant rise in ovulation rates and endometrial thickness. Sequential letrozole and gonadotropin therapy (LE + G) may hold clinical significance, but further large-scale, high-quality studies are necessary to establish conclusive evidence.

Background: Sepsis is a life-threatening organ dysfunction syndrome, with an overall mortality rate of 32.8%. Platelets have been shown to have a central role in the pathogenesis of a diverse array of immune-mediated and infectious diseases, and both thrombocytopenia and platelet hyperreactivity independently correlate with elevated sepsis-related morbidity and mortality.

Methods: From February 2021 to June 2022, patients diagnosed with sepsis (according to the Sepsis 3.0 criteria) from the emergency department were screened and enrolled in a prospective observational cytokine analysis cohort. "Bio-Plex Pro Human Cytokine Grp I Panel 17-plex" was used for cytokines analysis. Patients were stratified into high- and low-platelet groups using a discharge platelet threshold of 150 × 10⁹/L. Data were analyzed with R 4.4.0 and GraphPad Prism 9, calculating medians and frequencies for variables.

Results: Fifty-seven patients were enrolled and were classified into high- and low-platelet groups (31 vs 26). IL-6 had a significant difference between the two groups after adjusting for admission platelet level and length of stay in hospital (2072 vs 107.1, q < 0.05). Receiver operating characteristic curve also showed IL-6 had high degrees of sensitivity and specificity for predicting higher platelet levels.

Conclusion: Higher IL-6 levels at admission for sepsis were associated with higher platelet levels at discharge.

Introduction and importance: Nicolaides-Baraitser syndrome (NCBRS) is a rare autosomal dominant disease characterized by developmental delay, distinctive craniofacial features, sparse hair, and is caused by de novo mutations in the SMARCA2 gene.

Case presentation: We report the case of an 11-year-old male with NCBRS presenting with bilateral congenital glaucoma. The diagnosis was based on clinical presentation, such as attention deficit hyperactivity disorder, cognitive delay, and characteristic craniofacial features, and confirmed by the presence of a de novo mutation in the SMARCA2 gene through whole-exome sequencing.

Clinical discussion: This case of a child with bilateral congenital glaucoma contributes further evidence of abnormal ocular features associated with the phenotypic spectrum of NCBRS, marking only the third such case reported in the literature.

Conclusion: This rare association of NCBRS with bilateral congenital glaucoma highlights the importance of ophthalmologic screening in patients with NCBRS.

Background: Ischemic heart disease (IHD) and liver cancer (LC), traditionally managed as separate clinical entities, are increasingly linked by the global rise of metabolic syndrome. However, the epidemiological footprint of this comorbidity remains uncharacterized on a global scale. To provide a comprehensive epidemiological assessment of IHD and LC comorbidity, this investigation was designed to map their global co-occurrence patterns, distinguish their underlying shared and unique risk determinants, and evaluate the resultant disease burden.

Methods: In this global, cross-sectional ecological analysis, we used 2021 data from the Global Burden of Disease study for 200 countries and territories. We developed a novel classification system to categorize countries into three comorbidity archetypes (IHD-dominant, LC-dominant, or consistent) based on relative age-standardized incidence rates. Machine learning models (Random Forest with Shapley Additive Explanations analysis) were employed to identify and rank the relative importance of environmental, dietary, and metabolic risk factors. The population attributable fraction was calculated to quantify the preventable burden associated with these factors.

Results: Our analysis revealed three distinct geographical archetypes: an LC-dominant pattern in high-income nations and China; an IHD-dominant pattern in Russia and South Asia; and a consistent pattern in diverse regions like Egypt and Indonesia. Spatiotemporal analysis from 1990 to 2021 showed a widening inequity, with developing nations facing a persistent and severe dual burden. While high sodium intake was the most strongly associated factor for IHD and low whole grain intake for LC, air pollution emerged as a significant shared correlate. We also identified profound gender disparities: females were disproportionately burdened by air pollution and secondhand smoke, whereas males bore a greater burden from high red meat and sodium intake.

Conclusion: The comorbidity of IHD and LC is a defining feature of the modern epidemiological landscape, challenging the traditional single-disease paradigm. The findings compel a shift from siloed interventions toward integrated, gender-sensitive public health strategies that address shared metabolic and environmental roots, thereby profoundly diminishing their global public health impact.