Structural brain findings associated with clinical profiles but not diagnosis in unmedicated adults with obsessive-compulsive disorder: the Global OCD study.

Large Language Models for the Differentiation of Benign and Malignant Liver Nodules based on Multimodal Prompts in Liver US Cases.

Oocyte donation (OD) is an established ART involving an oocyte donor and recipient with a rising number of treatments. Previous meta-analyses highlight increased risks of hypertensive complications compared to naturally conceived (NC) and IVF/ICSI pregnancies, including pregnancy-induced hypertension (PIH) and preeclampsia (PE), but limitations exist due to study quality and heterogeneity. The DONOR (DONation of Oocytes in Reproduction) individual participant data (IPD) meta-analysis aims to generate clinically relevant and robust evidence regarding the development of hypertensive complications in OD pregnancies compared to autologous pregnancies. IPD meta-analyses offer an advantage over current meta-analyses, as bias is reduced by using IPD of original studies, allowing reliability checks, correction for confounders, and examining causes of heterogeneity by subgroup analyses. Furthermore, using IPD increases statistical power and generalizability of results. A literature search was conducted using PubMed, EMBASE, and Cochrane up to March 2024, with a last update performed in February 2025. We included observational studies that compared a cohort of women pregnant after OD beyond 20 weeks of gestation with an autologous pregnancy cohort (NC or IVF/ICSI), and reported on hypertensive pregnancy complications. Risk of bias was assessed using the ROBINS-I tool. Authors of eligible articles were invited to share IPD. The DONOR IPD meta-analyses were executed using both a one- and two-stage approach, adjusted for maternal age, parity, and multiple gestation. Furthermore, sensitivity, meta-regression and subgroup analysis were performed. IPD was requested for 48 cohorts, and provided from 16 cohorts with data of 2747 OD, 4699 IVF/ICSI, and 33 323 NC pregnancies. The one- and two-stage approach comparing OD to autologous pregnancies showed adjusted ORs of respectively 2.62 (95% CI 2.22-3.10) and 2.85 (95% CI 2.30-3.54; I2 44%; moderate certainty) for hypertensive complications in total, 2.15 (95% CI 1.73-2.68) and 1.49 (95% CI 0.80-2.80; I2 74%; low certainty) for PIH, and 2.28 (95% CI 1.88-2.78) and 2.39 (95% CI 1.94-2.94; I2 0%; high certainty) for PE. When the autologous group was split into NC and IVF/ICSI pregnancies, higher risks for hypertensive complications, including PIH and PE, persisted in the OD group. The results of the IPD meta-analyses for HELLP syndrome show a higher risk in OD pregnancy, though with a broad 95% CI. Sensitivity meta-analyses for risk of bias showed comparable results. Subgroup analyses indicated increased risks for hypertensive complications in OD pregnancy, regardless of maternal age, BMI, multiple pregnancy, parity, ethnicity, medical history, and number of transferred embryos. A potential lower risk for hypertensive complications was found when acetylsalicylic acid or heparin is used during OD pregnancy compared to both autologous and NC pregnancy. The DONOR IPD meta-analysis provided a unique opportunity to assess the risk for hypertensive complications in OD compared to autologous pregnancy. The results must increase alertness of health care professionals who are involved in OD health care towards the risk profile of these pregnancies, as the DONOR IPD meta-analysis results in the best evidence-based statement for international guidelines in obstetrics to date. Possibly, preventive treatment with low-dose acetylsalicylic acid is successful in lowering the risk for hypertensive complications, though more evidence is needed to confirm this effect, alongside the underlying pathological mechanism. CRD42021267908.

The annual prevalence of lumbar disc herniation (LDH) in western industrialized countries averages between1% and 2.5% but shows aclear age dependency with apeak between the ages of30 and50 years. The medical history and physical examination are the most important parts of the examination, with attention being paid to so-called red flags that trigger further imaging. Most LDH can be successfully treated conservatively and tend to regress over time. It is not imaging but clinical symptoms that determine whether surgery is indicated. Patients with severe motor deficits (Medical Research Council, MRC < 2) benefit most from early surgical intervention within the first48-72 h. Approximately 1-1.5% of patients develop acute conus/cauda symptoms, representing an absolute spinal surgical emergency. After confirmation of the diagnosis, surgical decompression should be performed without delay; decompression after more than 48 h is associated with poorer functional outcomes. Minimally invasive endoscopic discectomy shows identical results to conventional surgical techniques for LDH in terms of pain relief, functional improvement, safety and recurrence rate.

Gestational trophoblastic neoplasia (GTN) encompasses a spectrum of pregnancy-related disorders and poses significant clinical challenges. Understanding its prevalence, clinical characteristics, and associated risk factors is essential for timely diagnosis and management. This study aimed to evaluate the prevalence, clinical and biochemical features, and associated factors of GTN patients admitted to a tertiary referral center in northwestern Iran. A cross-sectional, descriptive-analytical study was conducted on all women diagnosed with GTN at Imam Reza Hospital, Kermanshah, between 2017 and 2022. Data were collected retrospectively from both electronic and paper-based medical records using a standardized checklist. Variables included demographics, obstetric and medical history, clinical signs, biochemical markers (β-hCG), treatment modalities, and metastatic status. Descriptive statistics were analyzed using SPSS v26. Among 30,133 deliveries during the study period, 382 GTN cases were identified, yielding a prevalence of 1.27%. Complete mole was the most frequent subtype (56.8%), followed by partial mole (37.7%). Vaginal bleeding (85.6%) and uterine enlargement (74.6%) were the most common clinical presentations. Blood group A was the most prevalent (47.4%), and 15.4% of patients had a history of consanguineous marriage. Uterine evacuation was the primary treatment (85.3%), with chemotherapy and hysterectomy used as indicated. Metastatic disease was observed in 7.6% of patients, predominantly affecting the lungs. GTN represents a notable health concern in this region, with complete mole being the most common form. Age, educational level, blood group, and prior molar pregnancy were identified as relevant factors. Early recognition based on clinical and biochemical markers, alongside structured follow-up, is crucial to optimizing outcomes. These findings underscore the importance of awareness, education, and comprehensive care strategies for high-risk populations.

Exploratory analysis of the associations of the brain age gap with cognitive function and amyloid-β accumulation: participants selection based on metabolic and physiological blood markers.

Preferred medications (trospium and beta-3 agonists) for overactive bladder (OAB) treatment require additional steps for insurance approval despite favorable safety profiles. The objective of this study was to test the hypothesis that preferred OAB medications will have significantly higher administrative burden and delay of care compared with the administrative nonpreferred (other anticholinergic) OAB medications. This single-center mixed methods study included a retrospective chart review of adult women initiating anticholinergic or beta-3 agonist therapy for OAB between July 12, 2022 and May 21, 2024 and a prospective observational study of clinical staff from June 18, 2024 to July 19, 2024. Retrospectively, demographics, medical history, information on OAB medication approval, and the frequency of OAB medication approval tasks were collected. Prospectively, time spent by clinic staff performing OAB medication approval tasks was recorded. A total of 200 participants were included in the retrospective cohort and 13 participants in the prospective cohort. Most patients were prescribed a preferred (n=193) versus nonpreferred (n=7) OAB medication with no significant differences in baseline demographics. Prescription of preferred medications required a significantly higher mean number of messages compared with nonpreferred (3±7 vs. 0±0, P <0.001) and had a significantly longer time to medication approval (17±36 vs. 0±0 days; P <0.001). Mean minutes per task were 94±24 per prior authorization, 67±37 per appeal, and 2±2 per staff message. On the basis of our modeling, each prescription for a preferred OAB medication requires an additional 38 minutes of administrative time. Preferred medications had significantly higher associated administrative burden and delay of care compared with nonpreferred OAB medications. These findings highlight the need for expanded coverage of preferred medications and streamlined approval processes.

Dry mouth is a disruptive symptom in patients with life-limiting illnesses. It has one of the highest symptom burdens in palliative care and a significant impact on quality of life. Nonetheless, dry mouth remains an underacknowledged and undertreated symptom with limited evidence-based interventions. To examine the quality and content of guidelines for the treatment of dry mouth in patients with life-limiting illnesses. A systematic review of clinical practice guidelines was conducted (preregistered in PROSPERO in 2023). PRISMA reporting guidelines were followed. The search strategy involved 4 scientific databases and 9 guideline databases, targeted searches and stakeholder outreach for 183 countries/regions. Quality and content were analysed using the AGREE II instrument and directed content analysis, respectively. Seventy-two clinical practice guidelines from 42 countries across 6 continents were included. Only two guidelines were recommended for use based on the AGREE II quality appraisal. Four main themes emerged from the content analysis: (1) Assessment of dry mouth by medical history, oral examination and measuring instruments (n = 32, n = 36 and n = 19 guidelines respectively); (2) Oral care (n = 68); (3) Management by treating causes (n = 40), saliva substitutes (n = 66) and stimulants (n = 62), diet (n = 45), and medication (n = 40); and (4) Patient and family involvement (n = 43). Despite differences in quality and comprehensiveness of guidelines for treatment of dry mouth in palliative care, many care practices are shared worldwide. This review highlights the need for methodologically robust guidelines with a strong evidence base that specifically focus on dry mouth.

Erythroderma is arare dermatological reaction pattern characterized by generalized erythema with scaling and systemic symptoms. It represents the maximal manifestation of various inflammatory, infectious, or malignant diseases and requires rapid diagnostic evaluation and initiation of therapy. In adults, inflammatory dermatoses as well as drug reactions represent the most common underlying causes. Malignant disorders, most notably cutaneous T‑cell lymphomas, must be considered in the differential diagnosis. Diagnostic evaluation is based on medical history, clinical examination, and additional laboratory and histopathological investigations. In unclear cases, repeated skin biopsies are needed. In most cases, hospital admission is warranted to enable definitive diagnosis and treatment. Early identification of the underlying cause and therapy are crucial for prognosis and clinical outcome.

To investigate the relationship between injury factors, nonsteroidal anti-inflammatory medication (NSAID) use, and concussion outcomes. Prospective cohort. Adolescents (N = 118) ≤14 days of concussion seen at a sports medicine center between November 2020 and May 2025. Participants who reported ibuprofen and/or naproxen use were assigned to the "NSAID use" group, all others were assigned to the "No NSAID use" group. Symptom severity, medical history, and medication use information were collected. The development of persisting symptoms after concussion (symptoms > 28 days, [PSaC]) was monitored via time to symptom resolution. We enrolled 118 participants with concussion (15.4 ± 1.7 years, 54% female, 8.4 ± 3.1 days postinjury): 29 (25%) reported taking NSAIDs (n = 24 ibuprofen, n = 3 naproxen, n = 2 ibuprofen/naproxen) before their evaluation. Those who reported NSAID use were evaluated sooner (7.4 ± 2.8 vs 8.7 ± 3.2 days postinjury; P = 0.05), weighed less (57.2 ± 11.0 vs 63.5 ± 17.0 kg; P = 0.06), and had more severe symptoms (59.9 ± 32.6 vs 39.3 ± 22.2; P < 0.001). More participants who reported NSAID use sustained a sport-related concussion (93% vs 73%; P = 0.02), and fewer participants who reported NSAID use started physical activity before evaluation (17% vs 39%; P = 0.03). Severe symptoms were associated with NSAID use (OR = 1.03; 95% confidence interval [CI], 1.01-1.05). Non-sport-related injuries (OR = 0.27; 95% CI, 0.08-0.91) and higher symptom severity (OR = 1.02; 95% CI = 1.00, 1.04) were associated with greater odds of PSaC, but NSAID use was not (OR = 0.62; 95% CI, 0.19-1.97). In adolescents, NSAID use was associated with more severe symptoms but not PSaC. To optimize clinical guidance, future research should further evaluate the role of NSAIDs in concussion recovery.

Aim: To examine the characteristics, treatment patterns, and physicians' assessments of outcomes for patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or dermatomyositis/polymyositis (DM/PM) who received Acthar Gel. Materials & methods: This survey-based medical chart review study asked rheumatologists who met specific inclusion criteria to abstract data from patient records covering the period from April 2022 to November 2024. Eligible patients were adults ≥18years diagnosed with RA, SLE, or DM/PM, treated with Acthar Gel for ≤24months. An online questionnaire screened and identified contributing physicians and collected anonymized patient data (baseline demographic, medical history, concomitant medications, Acthar Gel treatment history, and physicians' assessment of health status, symptom severity, treatment outcomes with Acthar Gel). Results: The study population comprised 73 patients with RA (average age 50years; 49 [67%] female; 44 [60%] White/non-Hispanic), 56 with SLE (average age 42years; 47 [84%] female; 28 [50%] African-American), and 104 with DM/PM (average age 52years; 69 [66%] female; 62 [60%] White/non-Hispanic). Patients had received Acthar Gel for an average of 9 (RA) or 8months (SLE, DM/PM), with most receiving treatment at the time of the study. Per physicians' assessment, health status improved in 68 (93%) patients with RA, 50 (89%) patients with SLE, and 100 (96%) patients with DM/PM after starting treatment with Acthar Gel. The most common treatment goals achieved in patients with improved overall health status were improved overall symptoms, pain, physical function, and corticosteroid use in the RA cohort; overall symptoms, pain, corticosteroid use, and fatigue in the SLE cohort; and overall symptoms, strength, physical function, and corticosteroid use in the DM/PM cohort. Conclusion: These findings support the use of Acthar Gel as a potential treatment option for appropriate patients with RA, SLE, or DM/PM.

Clinical and Dermoscopic Characteristics of Facial Hyperpigmentation Disorders in Skin of Color.

This study aimed to examine the association between pulmonary function and serum biomarkers among Egyptian workers occupationally exposed to ultrafine calcium carbonate (CaCO 3 ) particles, which can penetrate biological membranes and accumulate in the lungs. A cross-sectional study was conducted on 80 nonsmoking males: 40 CaCO 3 -exposed workers and 40 matched controls. Participants underwent medical and occupational history taking, clinical examination, spirometry, and serum biomarker measurement (Clara cell protein 16 [CC16], matrix metalloproteinase-9 [MMP-9], and tissue inhibitor of metalloproteinase-1 [TIMP-1]). Exposed workers demonstrated a significantly higher prevalence of respiratory symptoms along with significantly reduced pulmonary function indices. They also showed decreased CC16 and elevated MMP-9 and TIMP-1 levels. Biomarkers correlated with lung function decline and exposure duration. Chronic CaCO 3 exposure was associated with increased respiratory risk, necessitating protective workplace measures.

Immunity to varicellazoster virus among health care workers in transplantation units.

Music is the combination of harmony of melody and rhythm. Music listening have been associated with decrease of physiological arousal, heart rate, blood pressure and reduction of cortisol levels. Pharmacological and non-pharmacological measures have been advocated to minimize the development of stress related diseases. Relaxation techniques and listening to music can prevent cardiovascular complications. Music can affect central and autonomic nervous system as well as endocrine system. This experimental study was conducted in the Department of Physiology, Chittagong Medical College, Chattagram, Bangladesh from January 2020 to December 2021. Total 60 subjects of first year MBBS, with equal number of male and female, studying in Chittagong Medical College, Chattagram, were included by stratified random sampling method according to inclusion and exclusion criteria. A questionnaire along with general information about previous diseases, medical and family history were filled up by the subjects. Stress biomarkers- systolic and diastolic blood pressure, perceived stress scale (PSS) score and serum cortisol were recorded before and after 15 minutes of music intervention for 15 days. Result was compiled and compared after data collection by using SPSS 25.0. Paired 't' tests were done to compare differences between pre and post-intervention values of different outcome parameters. P value <0.05 was considered as statistically significant. Stress biomarkers- systolic and diastolic blood pressure, perceived stress scale (PSS) score and serum cortisol were significantly reduced after 15 days music intervention. This study concludes that regular listening to slow music causes significant reduction of stress and improvement of cardiorespiratory endurance and quality of life.

All-cause mortality risk associated with leisure activities in China: A cohort study.

Introduction: Aortic diseases, such as acute thoracic aortic dissection type A (ATAAD), are life-threatening conditions that require prompt diagnosis and treatment. This condition exhibits high mortality, particularly due to its unpredictable nature and clinical variability. Although it primarily affects elderly men, female patients often present with atypical symptoms, complicating diagnosis and treatment approaches. This study presents a clinical case of a female patient under 60 years of age diagnosed with ATAAD. Aim: Presentation of a case with a female patient highlighting the importance of early diagnosis, multidisciplinary care, and a holistic approach. Case Presentation: A 58-year-old woman with a medical history of rheumatoid arthritis, hypertension, and dyslipidemia presented with sharp chest pain and was urgently transferred to a University Hospital. Her clinical condition included hypoxia and severe hypotension. Investigations revealed elevated troponin levels, and the diagnosis of aortic dissection was confirmed via computed tomography and echocardiography. The patient underwent immediate surgical operation. Postoperatively, she had bleeding and she was hemodynamically unstable, which were successfully managed. Gradually, her condition stabilized, and she began a rehabilitation program. The multidisciplinary team provided psychological support to the patient and educated her about her new health condition. The patient was hospitalized for 50 days, 30 of which were in the Cardiothoracic Intensive Care Unit, and then transferred to a rehabilitation center.

Hand, foot and mouth disease (HFMD) is a common viral disease caused by a group of enteroviruses within the Picornaviridae family, specifically Coxsackie A16 (Cox A16) and Enterovirus 71 (EV71). Symptoms of HFMD include fever, mouth ulcers and skin rash. It is usually mild and self-limiting but some people may have a serious illness that requires hospitalization due to neurological complications and severe organ impairment, which can result in long-term morbidity and mortality. In rare cases, it can even lead to death. There is no specific treatment for severe cases of HFMD. Objective of the study was to evaluate the Clinico-etiological features and immediate outcome of HFMD. This cross-sectional observational study was conducted at the Outpatient department of Paediatrics and department of Dermatology and Venereology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The sample included 87 children with clinically diagnosed HFMD aged between 1 month and 12 years. Written parental consent was obtained after primary selection and a detailed medical history and physical examination were performed on each participant. All information collected was recorded in a semi-structured questionnaire and the data was analyzed with SPSS version 22.0. The chi-square test was used as a statistical test and a p-value 0.05 was considered significant. The 87 HFMD patients had a Mean age 2.40±2.0 years, with 69.0% male and 31.0% female. The male to female ratio was 2.2:1. Most patients were from urban areas, followed by 2.3% from rural areas. 92.0% of the children were from middle-income families. According to the clinical information, 100% of patients had fever, rash and oral ulcers. High grade fever (≥101.30°F) had in 66.7% and low grade fever (<101.30°F) had in 33.3%. Rash was noted in 100.0% of patients on the hand, 90.8% on the feet, 82.8% on the knee and 79.3% on the buttocks. The rash was painful in 74.7% of cases and itchy in 73.6% of cases. Painful oral ulcers occurred in 80.5% of cases and painless oral ulcers in 19.5% of cases. This study found that Coxsackie virus A6 (Cox A 6) was the most important etiologic agent in 87 clinically diagnosed HFMD patients. Of the 87 patients, 78(89.7%) were RT-PCR positive, including Cox A 6 [75(86.2%)], Cox A 16 [1 (1.1%)], other enterovirus 2[2nd (3.0%)] and only 9(10.3%) patients RT-PCR negative. The immediate outcome was fever resolved within 5 days in most patients (58.6%) and within 5-7 days in 23.0%. The rash resolved within 7 days in 68.8% of cases (completely resolved in 24.1% of cases, 24.1% resolved but hyper-pigmented areas, 14.9% hypo-pigmented areas and 5.7% had mild lesions). Oral ulcerations resolved within 5 to 7 days in 51.8% of cases, followed by 24.1% within 5 days. No complications were found in the examined patients. The prognosis was usually good.

Concussion is a high-profile and important brain injury, yet the on-pitch assessment of concussion in football (soccer) remains challenging due to the absence of a standardized, evidence-based assessment protocol that can be completed within a time-restrained on-pitch football-match environment. The objective of this study was to develop a football-specific, standardized on-pitch concussion assessment protocol informed by research evidence and expert opinion using an international consensus process and steering committee deliberation, which included medical experts from each of the 6 football confederations. Nominated global medical representatives with experience in the on-pitch assessment of concussion in football (≥5 assessments within previous year) from Fédération Internationale de Football Association (FIFA)-member associations completed a 2-round Delphi questionnaire to score all identified assessment items that have been used to assess an athlete with a suspected concussion within an on- or off-pitch environment (in any sport) along with expert recommendations. Consensus (≥80% agreement) was required for assessment items to be included in a football-specific on-pitch concussion assessment protocol. Results demonstrated that from 101 identified assessment items, 41 achieved greater than or equal to 80% agreement for inclusion in round 1, and 6 additional items achieved greater than or equal to 80% agreement in round 2. Four items (scoring 75%-79%) were added after steering committee review. Twelve items were merged to avoid duplication of items that assess the same issue. This resulted in the final Football-Specific Standardized On-Pitch Concussion Assessment Protocol (FOCUS) comprising 45 items categorized into 11 domains as follows: player medical history, mechanism of injury, visible signs, level of consciousness, cervical spine assessment, symptoms, orientation, balance, proprioception, oculomotor function, and activity-based assessment, with each structured for rapid on-pitch evaluation. FOCUS provided a standardized, evidence-informed protocol for the on-pitch assessment of a suspected concussion during football match play, addressing a critical gap in player health and safety. Adoption of FOCUS has the potential to harmonize concussion management globally; however, implementation feasibility and diagnostic accuracy require further evaluation.

Osteonecrosis of the femoral head (ONFH), femoral neck stress fracture (FNSF), and subchondral insufficiency fracture (SIF) are distinct yet clinically overlapping causes of non-arthritic hip pain. All three conditions threaten femoral head viability via distinct pathophysiologic mechanisms and may lead to fracture displacement (FNSF) and irreversible collapse (ONFH, SIF, and displaced FNSF), ultimately necessitating arthroplasty if not identified and managed early. These conditions frequently present with groin pain and unremarkable radiographs in their early stages. Imaging may be normal or show generalized bone marrow edema. MRI is the most sensitive modality for detection; however, accurate diagnosis requires the integration of specific imaging features with the synthesis of the patient's past medical history, including age, activity level, and bone quality. ONFH identified before collapse may be amenable to joint-preserving procedures, such as core decompression. FNSF requires urgent recognition and non-weight-bearing precautions to avoid displacement and vascular injury. SIF may be managed conservatively with protected weight-bearing and monitoring. Despite the expertise of experienced examiners and advanced imaging techniques, the initial diagnosis is frequently incorrect, and treatment options only become clear with timely follow-up and serial imaging. This review highlights diagnostic distinctions among ONFH, FNSF, and SIF, emphasizing clinical context, imaging-based differentiation, and appropriate management. Accurate early classification is crucial for guiding management decisions and preventing collapse of the femoral head or femoral neck displacement.