Objective: The aim of the present study was to systematically review published evidence on the prognostic ability of brain natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) in patients with cardiac arrest. Methodology: This review searched PubMed, Embase, Scopus, and Cochrane databases for studies assessing mortality, survival to discharge, return of spontaneous circulation (ROSC), or neurological outcomes in cardiac arrest patients based on BNP or NT-proBNP. Search limits were from database inception to 20th March 2025. Results: Eleven studies were eligible. Meta-analysis showed a statistically significant association between high baseline BNP levels and mortality after cardiac arrest (OR: 2.47 95% CI: 1.24, 4.92 I2=90%). However, the results turned non-significant on exclusion of an outlier study (OR: 1.37 95% CI: 0.91, 2.07 I2=73%). Pooled analysis indicated that high baseline BNP levels were predictive of poor neurological outcomes (OR: 2.68 95% CI: 1.19, 6.04 I2=61%). This result was also not stable on sensitivity analysis. Association between BNP levels and ROSC and survival to discharge was conflicting. Pooled analysis also showed that NT-proBNP was not a significant predictor of mortality after cardiac arrest (OR: 1.16 95% CI: 0.95, 1.42 I2=76%), but descriptive analysis indicated that it could be a predictor of poor neurological outcomes. Conclusions: Evidence on the prognostic ability of BNP and NT-proBNP for cardiac arrest is preliminary. BNP and NT-proBNP may potentially predict poor neurological outcomes after cardiac arrest. Limited and inconsistent evidence also shows that there may be no association between baseline level of these markers and mortality. Data on ROSC and survival to discharge is scarce and conflicting and needs more studies for robust conclusions. Given the high heterogeneity and lack of stability of outcomes on sensitivity analysis, the results must be interpreted with caution.

Background & Objective: Myocardial work (MW) indices offer an afterload-adjusted assessment of left ventricular (LV) function and may improve risk stratification in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). This systematic review and meta-analysis aimed to evaluate the prognostic significance of MW indices, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), in patients with severe AS undergoing TAVR. Methodology: PubMed, Embase, Web of Science, and Scopus were searched from inception to 26 November 2025 for studies assessing prognostic value of MW indices in TAVR-treated AS patients. Data were synthesised qualitatively, and a random-effects meta-analysis was performed when at least three studies reported comparable effect estimates. Results: Five cohort studies met the inclusion criteria. Across studies, GWI consistently demonstrated strong prognostic performance. Lower post-TAVR GWI predicted mortality in multiple cohorts, with thresholds ranging from 1,095 to 1,234 mmHg% and area-under-the-curve values up to 0.71. Pooled analysis confirmed that higher GWI was associated with reduced mortality (HR 0.94; 95% CI 0.90–0.98). GCW showed modest prognostic value, whereas GWW was not independently predictive. GWE was a significant predictor in select studies, but mostly in univariate models. Conclusion: Limited evidence shows that MW indices, especially GWI, may provide meaningful prognostic information in AS patients undergoing TAVR. Further studies are needed to improve the evidence.

Patients presented with jaundice and splenomegaly are easily diagnosed as having liver diseases. Actually, some atypical cases belong to hemolytic diseases leading to secondary hemochromatosis, which is easily misdiagnosed or never diagnosed. Here, we describe an atypical case in a 27 years old man presenting with unconjugated hyperbilirubinemia and splenomegaly since early childhood, who was hospitalized to check for any possible causes related to liver diseases. However, the probable etiology related to hemolytic diseases and liver disease was ruled out by negative traditional tests, which left a mystery to us. Fortunately, next-generation sequencing is becoming a suitable choice to determine the candidate genes responsible for rare or inherited disorders. A novel de novo mutation (c.5032delA) was firstly identified through whole exome sequencing which could induce an arginine to glycine substitution at residue 1678 (p.R1678Gfs*12), causing a premature termination codon in exon 38 of ANK1. ANK1 is involved in erythrocyte cytoskeleton formation, and contributes to one of the most common causes of hereditary spherocytosis (HS). Besides, homology-modeling analysis confirmed the loss-of-function of frameshift variant of ANK1 with bioinformatics methods. This work adds new knowledge in the etiology of hereditary spherocytosis. In addition, genetic testing can open up new perspectives for atypical and unknown diseases when traditional tests cannot be met.

Objective: To determine the frequency and clinicopathological features of incidental premalignant and malignant gynecological lesions detected after hysterectomies performed for benign indications, and to identify associated risk factors. Methodology: This retrospective study reviewed 1,047 hysterectomies performed for benign conditions at a tertiary center in Ankara, Turkiye, over a ten years period (January 2006-December 2015). Demographic characteristics, preoperative assessments, surgical indications, and histopathological outcomes were analyzed. Incidental lesions were defined as pre-malignant or malignant pathologies identified postoperatively without prior clinical suspicion. Statistical analyses were performed using chi-square and t-tests. Results: Incidental pre-malignant or malignant lesions were identified in 6% (n=63) of cases, including cervical dysplasia/HSIL (0.9%), borderline ovarian tumors (1.1%), endometrial adenocarcinoma (0.5%), leiomyosarcoma (0.5%), and high-grade serous ovarian carcinoma (0.6%). Postmenopausal women had a significantly higher incidence than premenopausal women (9.2% vs. 3.8%, p<0.001). Patients with incidental findings were older than those with benign pathology (55.4 ± 11.2 vs. 52.7 ± 9.6 years, p=0.034). Larger myomas were associated with uterine sarcoma (172 ± 92 mm vs. 71 ± 39 mm, p<0.001). Ovarian malignancies were detected in 2.4% of cases without suspicious ultrasound features and in 14.8% of cases with ≥2 malignancy criteria (p=0.013). Serous tubal intraepithelial carcinoma (STIC) was identified in 0.28% (n=3). Conclusion: Incidental pre-malignant or malignant lesions were present in 6% of hysterectomies performed for benign indications. Age, menopausal status, myoma size, and suspicious imaging features were significant predictors. Preoperative evaluation may not completely exclude the possibility of occult pathology; therefore, this risk should be discussed during preoperative counseling.

Objective: To find out the influence of different dentin disinfectants—chlorhexidine (CHX), Er, Cr: YSGG laser (ECYL), and iron oxide nanoparticles (Fe₃O₄NPs)—on inhibition of Streptococcus mutans and shear bond strength (SBS) of glass ionomer cement (GIC) in primary molars. Methodology: This in vitro study was conducted at King Khalid University, approved under IRB# KKU 2025-2026-161. The study duration was three months, 15th September, 2025 - 20th December, 2025. Forty extracted primary second molars with ICDAS scores of five were selected. CAD was identified through visual inspection, surface hardness assessment, and dye staining. Teeth were randomly divided into four groups (n=10): Group-I (no disinfection), Group-II (2% CHX), Group-III (ECYL at 2.5W, 20Hz), and Group-IV (Fe₃O₄NPs). Antibacterial efficacy against S. mutans was assessed using the agar diffusion test. GIC restorations were placed and subjected to thermocycling. SBS testing was performed using a universal testing machine, and failure modes were analyzed under stereomicroscopy. Data were analyzed using one-way ANOVA and Tukey’s post hoc test (α=0.05). Results: CHX (Group-II) demonstrated the largest zone of inhibition (15.95±1.54 mm). The control group showed the smallest inhibition zone (6.24±1.13 mm). ECYL (Group-III) exhibited the highest SBS (7.33±0.34 MPa), statistically superior to all groups (p<0.05). Fe₃O₄NPs (Group-IV) displayed the lowest bond strength (4.02±0.25 MPa). Mixed failure patterns predominated across all groups. Conclusion: Er, Cr: YSGG laser demonstrated optimal performance as a cavity disinfectant, combining effective antimicrobial activity with superior bond strength preservation in primary molars.

Background & Objective: To compare the efficacy and safety of two human epidermal growth factor receptor 2 (HER2)-targeting antibody-drug conjugates (ADCs), disitamab vedotin (RC48) and trastuzumab deruxtecan (DS-8201), in patients with the HER2 altered solid tumors. Methodology: We conducted a preliminary real-world comparative study, which included a case of a patient with HER2 exon 20 insertion mutated lung adenocarcinoma and a retrospective analysis of 18 patients treated at Air Force Medical Hospital, PLA, Beijing between 2021 and 2025. Patients received either RC48 (n=12) or DS-8201 (n=6). The primary endpoints were objective response and adverse events, evaluated using RECIST 1.1 criteria and standard toxicity assessments. Results: The case patient exhibited primary resistance and severe gastrointestinal toxicity to RC48 but achieved partial remission (PR) with DS-8201. In the cohort analysis, DS-8201 demonstrated a significantly superior PR of 66.67% compared to 8.33% for RC48 (P = 0.022). The adverse event profiles differed notably: DS-8201 was primarily associated with elevated transaminases and fatigue, while RC48 more frequently caused myelosuppression and hyperbilirubinemia. Conclusion: DS-8201 demonstrates potential as one of the effective salvage therapies following RC48 failure in HER2 altered solid tumors, showing significantly better disease control and a distinct, manageable toxicity profile. These findings highlight the importance of selecting personalized ADCs based on molecular subtypes and toxicity factors and provide a basis for future, larger-scale prospective studies.

As part of the Belt and Road Initiative, the China-Pakistan Economic Corridor (CPEC) has gradually broadened the scope of its collaboration from the first energy and infrastructure projects to include human development and health. This study examines medical technology transfer and health system capacity building in Pakistan within the framework of CPEC. It details the current state of Pakistan's healthcare system, including the absence of a comprehensive healthcare infrastructure and health insurance system, the lengthy and costly training cycles for medical professionals, Pakistan's relatively insufficient investment in medical education, and the uneven distribution of healthcare resources between urban and rural areas. It proposes strengthening Sino-Pakistani medical cooperation through measures such as facilitating medical technology transfer between the two countries, prioritizing capacity building in Pakistan, and leveraging China's indirect role in promoting rule of law. This approach aims to transition the China-Pakistan Economic Corridor from “hardware export” to “joint institutional development.

Objective: To evaluate the predictive value and clinical utility of thrombelastography (TEG) combined with coagulation parameters for adverse pregnancy outcomes (APOs). Methodology: A retrospective analysis was conducted on the clinical data of 186 pregnant women admitted to the Department of Obstetrics in Affiliated Hospital of Chengde Medical College between January 2022 and June 2025. Based on pregnancy outcomes, patients were classified into the APO group and the normal pregnancy outcome group. Baseline characteristics, TEG parameters, and coagulation parameters were compared between groups. Pearson correlation analysis was performed to assess associations between TEG and coagulation parameters in the APO group. Results: No significant differences were observed between the two groups in baseline characteristics such as age, gravidity, parity, and gestational weight gain (all P > 0.05), indicating comparability. Regarding TEG parameters, the APO group showed lower R values and higher maximum amplitude (MA) and coagulation index (CI) values compared with the normal outcome group (P < 0.05, respectively). For coagulation parameters, fibrinogen (FIB) and D-dimer (D-D) levels were significantly elevated, while antithrombin III (AT-III) levels were decreased in the APO group (P < 0.05, respectively). Conclusion: The combination of TEG and coagulation parameters demonstrates higher predictive efficiency for APOs than either method alone, providing a reliable basis for the early identification of high-risk populations and guiding clinical intervention strategies.

Objective: This study aimed to compare knee flexion contracture before & after Total knee arthroplasty (TKA) post-intraoperative soft tissue release, posterior osteophytes removal & distal femoral additional cutting. Methodology: This descriptive study was conducted in the department of orthopedic & spine Hayatabad Medical Complex, Peshawar from 1st February 2023 to 30th April 2025. The required sample size was 72. The inclusion criteria included all adult patients having age > 45years & having moderate to severe (Grade-II and III) flexion contracture who were undergoing primary total knee arthroplasty (TKA) and had either osteoarthritis or rheumatoid arthritis. Patients having mild flexion deformities such as Grade-I flexion contractures, and those with hip flexion contractures due to other conditions including psoriatic arthritis, haemophilic arthritis, or post-traumatic arthritis were excluded. Results: Out of 72 patients included in our study, 41(56.9%) were women & 33(45.8%) were men. 49(68%) patients had age <65years & 23(31.9%) patients had age >65years. The mean flexion contracture in pre-op patients was 16.9 degrees & in post-op patients mean flexion contracture was 5.9 degrees at 1 month of follow up, 5.5 degree at 3 months & 5.3 degree at 6 months of follow up. Conclusion: Knee flexion contracture is one of the debilitated conditions associated with knee OA & can be corrected in Total Knee Arthroplasty with soft tissue releases, posterior osteophytes removal & capsular release in moderate flexion contracture cases while flexion contracture >30º require additional resection of distal 2-3mm of distal femur.

Background and Objective: Pediatric liver transplantation (LT) is curative therapy for end-stage liver disease. One of the most frequent pulmonary complications after LT in children is pleural effusion. With improvement in surgical techniques and postoperative intensive care, long-term survival is now more than 80%. This study was performed to assess the incidence, risk factors, and clinical significance of post-LT pleural effusion in children. Methodology: This retrospective cohort study from a single center enrolled 60 children who had undergone liver transplantation in our center from July 2021 to April 2024. Preoperative, perioperative, intraoperative, and postoperative parameters were collected and measured to determine factors related to the development of pleural effusion. Data was entered and analyzed in SPSS ver:26.0. Results: Post-liver transplant (LT) pleural effusion occurred in 36/60 pediatric patients (60%). Some important risk factors were found in those patients who had pleural effusion. These were a Pediatric End-Stage Liver Disease (PELD) score of ≥18, malnutrition, and lower preoperative fibrinogen, albumin, and hemoglobin levels. A binary logistic model was used to evaluate risk factors for post operative pleural effusion among patients with postoperative fibrinogen, albumin, protein, INR, APTT, platelets, and Hemoglobin level. Odds ratio for Serum albumin level (B) was 34.545 for developing plural effusion. Conclusion: Pleural effusion is a frequent postoperative complication in children undergoing liver transplantation and is correlated with greater morbidity, especially in those patients necessitating therapeutic drainage. Preoperative and intraoperative factors can also act as significant predictors and prognostic markers. Early recognition and treatment of these risk factors may be helpful in outcomes.