Embolic stroke is connected to a higher risk of hemorrhagic transformation (HT), functional disability, and mortality. There is a gap of knowledge regarding the predictors of long-term post-alteplase functional outcomes, especially in patients with atrial fibrillation (AF), which limits delivering adequate care and support to stroke survivors. We aimed to assess the predictors of long-term post-thrombolysis unfavorable functional outcomes in patients with atrial fibrillation who presented with first-ever embolic stroke in the Middle East and North Africa (MENA). Our prospective cohort study was conducted between May 2021 and May 2025 and included patients with AF who presented with first-ever embolic stroke and received thrombolytic therapy, and who were recruited from Kafr Elsheikh University Hospital, Kafr Elsheikh General Hospital, Al-Sahel Teaching Hospital, NMC Royal Hospital, and Al-Obour Hospital in the period from May 2021 to May 2023. Our longitudinal study included two groups; the unfavorable outcomes group, and the favorable outcomes group. A total of 580 patients completed the 2-year follow-up period. National institute of health stroke scale (NIHSS) at the time of admission [odds ratio (OR), 2.06; 95% CI, 1.86-4.39; P=0.03], sustained atrial fibrillation (OR, 1.98; 95% CI, 1.42-3.80; P=0.03), heart failure (OR, 1.79; 95% CI, 1.23-2.96; P=0.03), HAS-BLED score (OR, 1.64; 95% CI, 1.41-3.65; P=0.03), CHA2DS2VASc score (OR, 1.72; 95% CI, 1.72-3.53; P=0.04), post-thrombolysis intracranial hemorrhage (OR, 2.89; 95% CI, 1.74-3.63; P=0.02), and recurrent symptomatic stroke (OR, 1.98; 95% CI, 1.22-3.73; P=0.04) were predictors of long-term post-thrombolysis unfavorable outcomes. Higher baseline NIHSS, heart failure, post-thrombolysis intracranial haemorrhage, and recurrent symptomatic stroke were independent predictors of long-term post-thrombolysis unfavorable functional outcome in embolic stroke patients. Novelly, higher HAS-BLED and CHA2DS2-VASc scores were independent predictors of long-term post-thrombolysis unfavorable functional outcome in Arabian patients. Moreover, sustained AF was an independent predictor of long-term post-thrombolysis unfavorable functional outcome.

Scented candles are widely used in the Middle East, particularly in the Arab Gulf region, to enhance indoor environments. However, limited ventilation in enclosed air-conditioned spaces can cause emissions to accumulate, posing health risks. Although the chemical composition of candle emissions has been examined, their in vivo toxicological effects under realistic exposure conditions remain unclear. This study evaluated the toxicity of scented candle emissions in male Wistar rats. Fifty-four rats were divided into nine groups (n = 6/group): controls exposed to fresh air, unscented candle emissions, or scented candle emissions for 1, 3, or 6 h daily, 5 days per week for 8 weeks under indoor-like conditions. GC-MS analysis identified 20 volatile organic compounds (VOCs) in unscented and 60 in scented candles. In silico ADMET profiling predicted toxicity for several compounds. Biochemical assays showed elevated serum TNF-α and IL-6, increased MDA, and reduced CAT and T-SOD activities in lung tissue, indicating systemic inflammation and oxidative stress. qRT-PCR and immunohistochemistry confirmed upregulation of inflammatory markers (TNF-α, COX-2). Histopathology revealed inflammatory infiltration, fibrosis, and necrobiotic changes, particularly in scented candle-exposed groups. Chronic scented candle exposure in poorly ventilated spaces causes inflammation, oxidative stress, and lung injury.

Purpose Vitiligo is a chronic, acquired disease that advances the immune system hostility against melanocytes. Nonsegmental vitiligo (NSV) is the most common form of vitiligo. It is characterized by asymptomatic, variable- sized, well‐circumscribed, round to oval‐shaped whitish patches involving both sides of the body. MicroRNA-146a (miR-146a) was considered an important modulator of innate and adaptive immunity, suggesting a potential role in developing various immune-mediated disorders. Forkhead box protein 3 (Foxp3) is an important transcription factor that governs regulatory T cells, which are essential in preventing autoimmune diseases. Patients and methods A total of 48 patients diagnosed with NSV and 48 healthy control subjects were recruited for this study. Peripheral blood samples were collected from all participants. Real-time reverse transcriptase PCR (RT-PCR) was employed to quantify the messenger RNA (mRNA) expression levels of Foxp3 and miR-146a. Results Our analysis revealed a significant upregulation of miR-146a expression in NSV patients compared with controls. Conversely, Foxp3 expression levels were demonstrably lower in the NSV group. Furthermore, a negative correlation was observed between Foxp3 and miR-146a expression levels within the NSV patient cohort. Additionally, Foxp3 expression exhibited a negative correlation with disease activity as measured by the vitiligo disease activity score, while a positive correlation was found with miR-146a expression. Notably, no significant correlation was detected between gene expression and the vitiligo area scoring index score, which reflects disease severity. Conclusion Foxp3 and miR-146a may be involved in the pathophysiology and deterioration of NSV.

Reduction mammoplasty is a common aesthetic and reconstructive breast procedure. Pyoderma gangrenosum (PG) is a rare inflammatory, non-infectious neutrophilic dermatosis. Post-surgical PG is characterized by ulcerative lesions at surgical sites commonly misdiagnosed as wound infection. The present systematic review was conducted to retrieve the potential factors and outcomes of post-reduction mammoplasty PG with a case report. An extensive systematic literature review was implemented from inception to 18 October 2024. All clinical studies that included patients with PG after reduction mammoplasty were included for systematic review. A female patient presented ten days after reduction mammoplasty with bilateral wound dehiscence. Thirty-nine days after the operation, the wound showed a second dehiscence for which immunosuppressive drugs were prescribed. The patient responded to the latest regimen with complete healing of the ulcerative lesions of the right and left breasts. The present systematic review included 41 cases, encompassing the present case report. The median time to initial presentation of PG was 6.5 days. The median time to the diagnosis of PG was 15.5 days. The wound was healed by secondary intention among 26 (59.06%) patients. Skin grafting was performed for six (13.63%) patients, while three (6.81%) patients received skin substitutes. PG after reduction mammoplasty is a devastating condition associated with poor cosmetic outcomes. The condition is difficult to diagnose, and the majority of cases are misdiagnosed and potentially subjected to ineffective medical therapy and unnecessary surgical debridement that worsen the prognosis of PG. Patients with existing immunological disorders and patients with a history of breast cancer were at higher risk of developing PG after reduction mammoplasty. The risk of PG after reduction mammoplasty still existed despite undergoing previous breast or abdominal surgeries. Patients with post-reduction mammoplasty PG mostly presented with erythema, severe pain, and fever. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

More than one-third of all ischemic strokes are induced by large vessel occlusion (LVO). All the wide-scale trials that assessed the impacts of cilostazol versus clopidogrel in stroke management have been conducted in Asia and involved patients with minor stroke or TIA. Our trial is the first-ever study to evaluate cilostazol versus clopidogrel in acute LVO with moderate to severe ischemic stroke in North Africa. We assessed the efficacy and safety of cilostazol versus clopidogrel in first-ever LVO moderate and moderate to severe ischemic stroke patients. 580 moderate and moderate-to-severe LVO ischemic stroke participants were randomly enrolled to receive loading and maintenance doses of cilostazol or clopidogrel. 580 patients were included in the intention-to-treat analysis. 29 (10.0%) participants in the cilostazol arm and 43 (14.8%) participants in the clopidogrel arm experienced a new stroke (HR 0.37; 95% CI, 0.29-0.73; P-value = 0.03). Eight participants (2.8%) in the cilostazol arm and 17 patients (5.9%) in the clopidogrel arm had drug-related hemorrhagic complications (HR 0.29; 95% CI, 0.18-0.63; P-value = 0.008). Patients who experienced acute LVO moderate and moderate-to-severe ischemic stroke and received loading and maintenance doses of cilostazol within the first 24h after stroke onset had better clinical outcomes based on recurrent stroke rates and better safety outcomes regarding hemorrhagic transformation of brain infarction and drug-induced peripheral hemorrhagic side effects compared to those who received loading and maintenance doses of clopidogrel. There were no significant differences between the two groups regarding death due to vascular events and unfavorable mRS after three months of stroke onset. Retrospectively registered on ClinicalTrials.gov, NCT06242145, 27-01-2024.

IntroductionAll large studies evaluating the role of cilostazol versus other antiplatelet agents in stroke prevention have been conducted in Asia and included patients with minor stroke or transient ischemic attack (TIA). Ours is the first-ever trial to evaluate the safety and efficacy of cilostazol versus clopidogrel in moderate and moderate-to-severe ischemic stroke in North Africa. Accordingly, in this study we assess the role of cilostazol as an alternative to clopidogrel in Egyptian patients with first-ever non-cardioembolic moderate or moderate-to-severe ischemic stroke.MethodsA total of 870 patients with moderate and moderate-to-severe acute ischemic stroke (AIS) were randomly assigned to administration of loading and maintenance doses of cilostazol or clopidogrel.ResultsOf the 870 patients included in our trial, 37 (8.7%) in the cilostazol arm and 59 (13.6%) in the clopidogrel arm experienced a new stroke (HR 0.53; 95% CI, 0.33–0.84; P = 0.007). Twelve participants (2.8%) in the cilostazol group and 25 patients (5.7%) in the clopidogrel group experienced drug-related hemorrhagic complications (HR 0.25; 95% CI, 0.12–0.53; P = 0.001). Patients with hypertension who received cilostazol had significantly lower rates of recurrent hemorrhagic and ischemic stroke.ConclusionEgyptian patients with non-cardioembolic moderate and moderate-to-severe ischemic stroke who received cilostazol within the first 24 h of symptoms had significantly lower rates of hemorrhagic transformation of brain infarction and peripheral hemorrhagic complications than those who received clopidogrel. Patients with hypertension achieved the greatest benefit from cilostazol, as they experienced a significant reduction in recurrent ischemic and hemorrhagic infarction. There were no significant differences between the two groups regarding the modified Rankin scale (mRS) score after 3 months or in the non-hemorrhagic side effects. Our results were derived from a single-blinded study; a more extensive, double-blinded, multinational study is needed for the results to be generalizable worldwide.Trial Registration: Retrospectively registered, ClinicalTrials.gov, NCT06242132, 27-01-2024.

Background and aim Nonalcoholic fatty liver disease has emerged as a major public health challenge, with limited approved pharmacological therapies. Pioglitazone has been investigated as a potential treatment for nonalcoholic fatty liver disease, particularly in the context of metabolic dysfunction-associated fatty liver disease (MAFLD). So, this study aimed to evaluate the efficacy of pioglitazone in treating MAFLD by assessing changes in hepatic steatosis, fibrosis, liver enzymes, lipid profiles, and other metabolic parameters. Patients and methods A randomized controlled study was conducted on 100 nondiabetic patients with MAFLD, divided into two groups: group A (n=50) received pioglitazone (30 mg/day) for 24 weeks, and group B (n=50) served as the control group. Clinical, biochemical, and radiological assessments, including transient elastography, were performed at baseline and after 24 weeks. Results The Pioglitazone group showed significant improvements compared with the control group, including reductions in the proportion of severe steatosis (grade S3) from 62 to 12% with pioglitazone. Controlled attenuation parameter scores decreased from 300.5±39.76 to 251.7±35.22 dB/m with pioglitazone. Liver enzymes alanine aminotransferase and aspartate aminotransferase improved significantly. Total cholesterol declined from 220.3±74.34 to 180.5±47.71 mg/dl with pioglitazone. Serum uric acid also decreased, from 5.1±1.08 to 4.7±0.85 pioglitazone. However, no significant differences were observed in hepatic fibrosis grades. Conclusion Pioglitazone demonstrated therapeutic potential in managing MAFLD by alleviating hepatic steatosis and ameliorating metabolic dysregulation. These findings support the use of these intervention as adjunctive therapies for MAFLD, warranting further investigation into their long-term efficacy and impact on hepatic fibrosis.