Objective: To study the prevalence of insulin resistance among diabetic patients. To analyze the association between insulin resistance and clinically significant macular edema (CSME) development. Material and Methods: Single-centre, cross-sectional comparative study on a hospital-based population of diabetic patients. Patients were grouped based on the presence of CSME (group A) and the absence of CSME (group B). Simple logistic regression and multiple logistic regression analyses were performed to evaluate the association CSME with age, duration of diabetes, HbA1c, insulin resistance, body mass index, and lipid profile. Results: The study cohort comprised 86 patients with type 2 DM, with a mean age of 60+7 years. We included 43 patients in each group A and B respectively. There were 37 patients (86%) in group A, who had diabetes >10 years. In group B, 23 patients (53%) had diabetes >10 years. The mean HbA1c was found to be 8.2+1.3 mmol/ mol in group A and 7.6+0.85 mmol/mol in group B (p=0.01). Increased insulin resistance was present in 74/86 (86 %) of diabetics. Elevated IR of > 3.8 was found in 32/43 patients (74%) of group A and 17/43 (39%) of group B (p= 0.001). None of the patients in group A had normal insulin resistance. The odds ratio for the development of CSME in patients with increased HOMA-IR was found to be >4. Conclusion:We observed positive association between insulin resistance and development of clinically significant macular edema. The odds for the development of macular edema was greater in uncontrolled diabetics with elevated insulin resistance.

Preoperative diagnosis in gynecologic oncology often remains a significant challenge for the medical team, even today, when imaging techniques have reached an advanced stage of development. These difficulties are particularly evident in rare tumors and in locally advanced disease, where establishing the tumor’s origin is complex. Multidisciplinary collaboration in such cases is essential for improving prognosis and optimizing therapeutic management. We present a series of three clinical cases in which the initial diagnosis was redefined after histopathological examination: two cases of ovarian neoplasm, one of which was ultimately identified as an ovarian neuroendocrine tumor – an extremely rare entity worldwide – and one case initially suspected clinically and radiologically as endometrial sarcoma, but postoperatively confirmed as a large benign endometrial polyp. We highlight the usefulness of performing cell block preparations from ascitic or pleural fluid rather than open biopsy in ovarian neoplasms, thereby reducing perioperative risks. This article emphasizes the importance of integrating clinical and paraclinical findings to minimize diagnostic errors, particularly in atypical presentations.

Bone lesions are present in approximately 80–85% of patients with multiple myeloma at diagnosis. The most common sites of osteolysis include the spine (49–70%), ribs (45–50%), skull (35–50%), shoulder (20–35%), pelvis (30–40%), and long bones (13–35%). Bone destruction results from asynchronous bone turnover, characterized by increased osteoclastic resorption without proportional osteoblastic activity. A specific feature is the rare healing of lesions, even in complete remission. Low-dose whole-body computed tomography is currently the gold standard for bone disease assessment in multiple myeloma, offering superior sensitivity and image quality compared to conventional radiography, with a 4–33% higher detection rate. PET-CT shows 90% sensitivity and 70–100% specificity and remains essential for identifying active lesions, monitoring bone disease progression, and evaluating response to therapy, including residual disease detection. MRI allows differentiation between healthy marrow and infiltrated tissue, identifies infiltration patterns and lesion morphology, detects early bone marrow involvement, and surpasses bone scintigraphy in identifying spinal lesions, particularly in unexplained vertebral compression fractures.

Background: European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 proposed a novel primary chronic rhinosinusitis (CRS) phenotype classification. As the endotype and phenotype of primary CRS are highly heterogeneous, clinical evaluation to match these endotypes and corresponding clinical biomarkers with these novel phenotypes is still limited. This study aimed to evaluate the correlation between clinical inflammatory biomarkers and primary CRS phenotype. Materials and Methods: A retrospective study of 78 adult patients diagnosed with primary CRS was conducted. Peripheral eosinophil count, serum-specific immunoglobulin E (ssIgE), and primary CRS phenotyping data were collected from the electronic health record database of Dr. Kariadi General Hospital Semarang. The Chi-square test and phi coefficient were used to assess the correlation between variables. Results: Most patients have polysensitization allergen patterns, predominated by house dust mites (Tyrophagus putrescentiae, Dermatophagoides microceras, and Dermatophagoides farinae) and grass pollens (Bermuda grass,mix grass, and Timothy grass). peripheral eosinophil count and ssIgE are significantly correlated to primary CRS phenotype (r=+0.407, p 0.001; r=+0.342, p=0.002; respectively). We also found a small portion of some peculiar conditional probabilities of having non-eCRS given patients have peripheral eosinophilia and positive ssIgE (6.2% and 17.3%, respectively). Conclusion: peripheral eosinophils count and ssIgE are correlate to the CRS phenotype.

Physical activity (PA) demonstrates its positive long-term effects on physical and mental health and on preventing the onset of non-communicable diseases. However, the short-term effects remain insufficiently studied, particularly in women. Apart from their unique anatomical structure, women exhibit physiological specificities. This study aimed to determine the short-term effects of regular PA on the cardiorespiratory status of women. The study included 24 participants with an average age of 42.54 years. They participated in a two-month organized program of regular physical activity. Measurements were taken before and after exercise, including oxygen saturation, a six-minute walk test, and body mass index. Statistical analysis revealed no significant differences in the BMI of participants between the first and second measurements (p=0.422). The study found significant differences in oxygen saturation before and after exercise (p=0.003). Participants achieved significantly better results in the six-minute walk test (p 0.001). The study shows that a two-month PA program improves the cardiovascular status of women and increases endurance and functional capacity. At the same time, the impact on BMI and body weight is insignificant. The results can emphasize the short-term benefits of exercise and motivate women to exercise by defining the short- and long-term health effects.

Background: Polycystic ovary syndrome (PCOS) is the single most common endocrine-metabolic disorder among reproductive-aged women, characterized by hyperandrogenism (HA), ovulatory dysfunction (IM), and polycystic ovarian morphology (PCO). The antral follicle count (AFC) has been widely used as a diagnostic marker for PCOS, yet optimal cutoff values may vary by population. Objective: This study aims to explore the correlation between AFC and PCOS diagnosis in women from Samawa City, identifying a population-specific AFC threshold associated with infertility. Methods: We conducted a cross-sectional study involving 30 married women with primary or secondary infertility, excluding other common causes of anovulation. Hormonal profiles, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Müllerian hormone (AMH), were assessed alongside transvaginal ultrasound measurements of AFC. According to the international evidence-based PCOS guideline, ultrasound should not be used in patients with a gynecological age of 8 years; thus, we excluded subjects in their teens ( 18 years) and also excluded subjects ( 35 years) to minimize the effect of age. Results: The mean AFC was 21 ± 5 follicles, with significant variation by age (p = 0.014). AFC demonstrated a strong positive correlation with AMH (rho = 0.672, p 0.001) and a moderate correlation with LH (rho = 0.423, p = 0.020), while no significant correlation was found with FSH (rho = - 0.084, p = 0.659). The majority of participants (77%) had secondary infertility. Standard PCOS-associated features included hirsutism (63.3%), acne (56.7%), and alopecia (50%). Conclusion: AFC is positively associated with LH and AMH levels, supporting its role in PCOS diagnosis. Our findings suggest that an AFC threshold specific to the local population may improve diagnostic accuracy and inform reproductive health strategies in Samawa City.

Background: This analysis investigates invasion tactics of Anaplasma phagocytophilum which constitutes a gram-negative bacterial species that causes the tick-borne pathogen known as human granulocytic anaplasmosis (HGA). Aim: This study analyzes structural and molecular dynamic aspects of invasion proteins AipA and OmpA by computational means. These scientific analyzes investigate bacterial adhesion and invasion mechanisms and their receptor-specific bonds to CD13 and Sialyl Lewis x. Materials: SOPMA, VADAR 1.8, MapPred and trRosetta were used to determine secondary and tertiary structures of AipA and OmpA. The docking simulations conducted with AutoDock Vina and HDOCK identified interaction areas between AipA and CD13 and also between OmpA with Sialyl Lewis x. The analysis of residue interactions helped identify the binding sites through visual representation of their dynamical patterns. Results: The compact AipA exhibits four critical residues SER82 and THR91 and ILE150 and PHE155 that enable stable connection with CD13 host receptors. The receptor-mediated internalization process depends on the stable structural configuration of this molecule. The ability of OmpA to bind Sialyl Lewis x effectively stems from flexible composition elements GLU160 and LYS45 and HIS87 which create operative flexibility. The ability of OmpA to adapt its interactions follows both hydrogen bonds and hydrophobic contact establishment patterns. Molecular docking analysis demonstrates that AipA maintains strong binding stability through tight binding interactions yet OmpA shows moderate binding affinity along with flexibility towards different receptor conformations. The analysis establishes how AipA and OmpA use different methods to facilitate their interactions between pathogens and hosts. Conclusions: The outcomes create opportunities to develop targeted medical approaches targeted at adhesion and invasion blockage thus requiring experimental verification for future application

Background: Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive, and universally fatal neurodegenerative disorder caused by the accumulation of misfolded prion proteins. Early-stage diagnosis is often delayed due to its initially non-specific presentation and broad differential diagnosis. Case Presentation: We describe a 75-year-old male who presented with new-onset dizziness and a pressure-like headache. Neurological examination revealed subtle left-sided ataxia, mild anomic aphasia, and possible left-leg neglect. Initial investigations, including non-contrast cranial CT and carotid angiography, were unremarkable. Cognitive screening using the Montreal Cognitive Assessment (MoCA) scored 17/30. Persistent neurological deficits prompted further evaluation, including lumbar puncture, electroencephalography, and magnetic resonance imaging of the brain. CSF analysis showed a mildly elevated white cell count and was positive for 14-3-3 protein. Although RT-QuIC testing was uninterpretable due to CSF blood contamination, markedly elevated total tau (>1765 pg/mL) with normal phosphorylated tau (pTau181) supported a diagnosis of prion disease. MRI demonstrated asymmetric cortical diffusion restriction and characteristic cortical ribboning. EEG revealed a diffuse encephalopathic pattern without periodic discharges. With the rapid evolution of cognitive dysfunction, cerebellar ataxia, and extrapyramidal signs, the clinical, radiological, and biochemical findings fulfilled diagnostic criteria for probable sporadic CJD. Conclusion: This case underscores the importance of a multimodal diagnostic approach in suspected CJD. In the absence of definitive RT-QuIC results or characteristic EEG changes, early recognition of MRI patterns and CSF biomarkers remains pivotal for timely diagnosis, appropriate counseling, and care planning.

Background: Type 2 diabetes mellitus (T2DM) is associated with low-grade inflammatory response, which was reported to contribute to insulin resistance. Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, is widely used for glycemic control and has been suggested to exert anti-inflammatory effects. Aims: to investigate the impact of sitagliptin on inflammatory biomarkers, glycemic control, and body measurements in patients with T2DM. Materials and methods: The current prospective interventional study included 45 patients with T2DM who received sitagliptin (100 mg/day) for six months. Inflammatory biomarkers (TNF-α, IL-6, CRP, IL-10, and adiponectin) were measured using ELISA at pre- and post-treatment. Additional metabolic parameters, including fasting plasma glucose (FPG), HbA1c, and lipid profile (LDL-C, HDL-C, and triglycerides), were quantified on the Cobas® 4000, the clinical chemistry analyzer. Blood pressure and body mass index (BMI) were also recorded at both times. Comparative analysis was performed to assess biomarker changes. Results: Sitagliptin treatment significantly reduced HbA1c (8.26% to 5.39%, p 0.001) and FPG (164.86 to 127.88 mg/dL, p 0.001). LDL-C and triglycerides also decreased significantly, while HDL-C showed a non-significant increase. TNF-α and CRP reduced inflammatory markers significantly after treatment (p 0.001), whereas IL-6, IL-10, and adiponectin showed no significant changes. Regression analysis identified HbA1c (β = -0.75), FPG (β = -0.76), LDL-C (β = -0.36), triglycerides (β = -0.27), TNF-α (β = -0.46), and CRP (β = -0.42) as significant predictors of treatment response, while no significant associations for BMI, HDL-C, IL-6, IL-10, or adiponectin. Conclusion: Our findings suggest that sitagliptin provide beneficial effects on glycemic control, lipid regulation, and related inflammatory responses, particularly through reductions in TNF-α and CRP, while its impact on other inflammatory markers remains limited.

Restoring the continuity of the anatomical layers and the musculoskeletal soft tissues is fundamental in the reconstructive phases of all surgical proceduresSynthetic surgical meshes are commonly used augments in general surgery to fill flat gaps, but can also be used in other surgical fields, including orthopedics. We evaluated the evidence in modern international literature on the use of polyethylene surgical meshes in the different fields of orthopedic surgery, including hip and knee arthroplasty, trauma surgery, shoulder surgery, and orthopedic oncology. Polyethylene surgical meshes have been used to replace or reinforce musculoskeletal soft tissues. Flat mashes can be used to reinforce flat surfaces, like the cut articular capsules or torn rotator cuffs. Folded meshes provide good longitudinal resistance, allowing the reinforcement or reconstruction of tendons and ligaments in the lower and upper limbs. Also, orthopedic oncology could benefit from using meshes to replace resected soft tissues and provide attachment sites for remaining tendons and ligaments. In conclusion, surgical meshes represent a reliable and adaptable reconstructive approach for several soft tissue lesions in orthopedics surgery. Alone or in combination with other augments, polypropylene surgical meshes should be considered when facing wide soft tissue gaps around the musculoskeletal system.