Objective: To analyze the characteristics of peak expiratory flow (PEF) and the risk factor for its decline in stroke patients. Methods: This was a case-control study. A total of 809 stroke patients hospitalized in the Department of Rehabilitation of the First Affiliated Hospital of Wenzhou Medical University from January 2020 to December 2022 were prospectively enrolled as the stroke group, and 801 age-and sex-matched healthy subjects from the hospital's Physical Examination Center during the same period served as the control group. The measured PEF was detected using an adult peak flow meter. The predicted PEF and PEF% (measured/predicted PEF×100%) were calculated based on age, sex, and height. The stroke group was further divided into a normal PEF group (PEF%≥80%) and a decreased PEF group (PEF%<80%). PEF metrics were compared within and between the stroke and control groups. A multivariate logistic regression was used to analyze risk factors for PEF decline in the stroke group. Results: The stroke group (539 males, 270 females) aged (63.2±11.9) years and the control group (498 males, 303 females) aged (63.5±12.1) years. The measured PEF in the stroke group was lower than its predicted value [(243.89±139.38) vs (390.45±94.30) L/min, P<0.001], while no significant difference was found between the measured and predicted PEF values in the control group (P>0.05). Compared with the control group, the stroke group had lower measured PEF [(243.89±139.38) vs (371.52±114.78) L/min] and PEF% [(61.80±30.79)% vs (98.14±22.48)%], but higher predicted PEF [(390.45±94.30) vs (379.21±84.78) L/min] and a higher proportion of severe PEF% decline [48.6% (393/809) vs 4.5% (36/801)] (all P<0.05). Within the stroke group, the decreased PEF group had higher proportions of smoking, alcohol drinking, atrial fibrillation, total anterior circulation infarction, higher NIHSS and mRS scores and a higher proportion of dysphagia compared with the normal PEF group (all P<0.05). The decreased PEF group had a lower proportion of partial anterior circulation infarction, Barthel index score, and independent standing (all P<0.05). Multivariate logistic regression identified smoking (OR=1.466, 95%CI: 1.014-2.118), increased NIHSS score (OR=1.072, 95%CI: 1.003-1.145), dysphagia (OR=1.691, 95%CI: 1.161-2.463), and increased mRS score (OR=2.286, 95%CI: 1.263-4.137) as risk factors for PEF decline in stroke patients. Conclusions: Stroke patients exhibit decreased measured PEF and PEF%, along with higher predicted PEF and a higher proportion of severe PEF% decline. Smoking, neurological dysfunction, impaired mobility, and dysphagia are risk factors for PEF decline in stroke patients.

Background: Medicolegal cases of sexual offenses encompass behaviours such as verbal sexual harassment, compulsion, and forced penetration. Sex related crimes are the most heinous and degrading of all the crimes. The most vulnerable demographic to this crime is still women and children. A significant public health issue is the startling increase in the incidence of sexual assault on a global scale. Objective: The current study's goal was to identify the medicolegal findings of sexual offenses victims in order to highlight the procedure's obvious flaws.Materials and Methods: The data acquired from Sir Salimullah Medical College, Hospital between January 2022 and December 2023 was prepared rigorously. Informed written consent, four copies of passport-size photos, the victim herself, the authority's requisition, and a third-person female attendant, collected information on 166 victims, including the cause, location, time, and date of the examination.Results: 61.5% of the patients were between the ages of 11 and 20. 130 cases (80.2%) out of 162 were unmarried. The majority were students (44.6%) and housewives (20.5%). Significant monthly variations were discovered by the study, with January, March, and April showing the highest values.Conclusion: Collectively, evidence is a crucial responsibility for doctors. Insufficient medical evidence frequently contributes to a low conviction rate. Because of this, it is vitally important to conduct a proper and suitable physical examination in situations of sexual offenses, and the analysis of preserved biological specimens like blood and semen frequently provides essential evidence in modern criminal investigations. The Journal of Ad-din Women's Medical College; Vol. 13 (2), July 2025; p 26-30

Peritonsillar cellulitis represents an inflammatory reaction of the tissue between the palatine tonsil capsule and pharyngeal muscles without pus collection, representing a stage in the progression from acute tonsillitis to peritonsillar abscess. Bilateral involvement is uncommon and presents diagnostic challenges as classic unilateral signs are absent. Case report: A 38-year-old female presented with five days of progressive sore throat, fever, dysphagia, and hot potato voice. Physical examination revealed bilateral peritonsillar swelling, hyperemia, and edema with T3-T3 tonsillar hypertrophy and exudate. Aspiration of both peritonsillar areas produced no pus. Laboratory studies demonstrated leukocytosis with neutrophilia. The patient was admitted and treated with intravenous third generation cephalosporin (ceftriaxone), metronidazole, glucocorticoid (methylprednisolone), and supportive care. After three days, swelling subsided, leading to discharge with plans for interval tonsillectomy. Conclusion: This case demonstrates that bilateral peritonsillar cellulitis can mimic abscess clinically but requires different management. Negative aspiration distinguishes cellulitis from abscess, guiding conservative treatment and timing of definitive surgical intervention.

Assessment of intra-abdominal injuries (IAIs) in children is challenging due to unreliable physical examination, communication barriers, and the serious consequences of missed injuries. Computed tomography (CT) is widely used for its high sensitivity, but concerns persist regarding radiation exposure and resource utilization. This systematic review and meta-analysis aimed to quantify IAI prevalence, describe organ-specific injury patterns, and evaluate intervention and mortality outcomes in children with blunt abdominal trauma assessed using CT. We searched PubMed, Web of Science, Cochrane Library, and Scopus through August 2025 for studies evaluating pediatric blunt abdominal trauma, CT-based assessment, and CT-detected IAIs. Bayesian random-effects meta-analyses were used to estimate pooled prevalence and outcomes, with additional hierarchical and meta-regression models for organ-specific injuries and study-level covariates. Certainty of evidence was assessed using the GRADE framework. Fifteen studies including 7,430 children were analyzed. The pooled posterior median prevalence of IAI was 84.5% (95% credible interval [CrI]: 62-94%), while the probability of intervention was 7.7% and mortality was 1.4%. Solid organ injuries predominated, with liver (13.1%, 95% CrI: 4.9-45.5%), bowel (11.2%, 4.2-40.9%), spleen (11.1%, 4.1-40.4%), and kidney (8.7%, 3.2-34.3%) injuries most common; adrenal (3.4%) and pancreatic (1.4%) injuries were rare. Meta-regression showed higher injury probabilities with increasing age and male predominance. Injury Severity Score-based subgroup analyses yielded substantially lower IAI probabilities (11-12%), reflecting broader trauma populations. Certainty of evidence was moderate for overall IAI prevalence and low for other outcomes due to heterogeneity and sparse events. Although CT is highly sensitive for detecting IAIs in pediatric blunt abdominal trauma, low rates of intervention and mortality support selective CT use guided by validated decision rules and observation rather than routine imaging. Future research should prioritize multicenter prospective studies, pragmatic implementation of decision tools, and development of non-ionizing imaging alternatives to optimize CT use and minimize long-term risks in children.

The Patient Journey: From Diagnosis to Therapeutic Management of Chronic Hand Eczema.

Introduction Pericardial effusion can progress to cardiac tamponade, a life-threatening condition in which clinical findings are often nonspecific and a complete Beck's triad is frequently absent. Focused cardiac ultrasound (FoCUS) provides rapid bedside recognition of tamponade physiology and can expedite definitive management. This case highlights its pragmatic value for promptly identifying tamponade in a rare endocrine etiology—severe hypothyroidism (myxedema)—particularly in resource-limited settings. Case presentation A 62-year-old man with a 6-month history of progressive lower-limb edema and exertional dyspnea deteriorated to dyspnea at rest and generalized anasarca. Examination showed myxedematous features, jugular venous distension, and muffled heart sounds. Bedside FoCUS demonstrated a massive circumferential pericardial effusion (∼28 mm in diastole) with right-atrial systolic and right-ventricular diastolic collapse, consistent with cardiac tamponade. Emergency pericardiocentesis drained 1,200 mL of serous fluid with immediate clinical improvement. Chest radiography obtained before drainage showed a “water-bottle” cardiac silhouette, and pericardial fluid studies were negative for infection and malignancy. Thyroid testing confirmed severe primary hypothyroidism (TSH 225 mIU/L; free T4 &amp;lt; 0.07 ng/dL). The patient was treated with monitored levothyroxine and had no recurrence of pericardial effusion on follow-up. Conclusions Severe hypothyroidism is an uncommon but clinically important cause of cardiac tamponade. In patients with unexplained cardiomegaly or hemodynamic compromise, early FoCUS—integrated with clinical assessment and targeted biochemical testing—can rapidly confirm tamponade physiology, accelerate lifesaving pericardiocentesis, and guide timely definitive therapy. FoCUS should be incorporated into routine emergency and critical-care workflows as an extension of the physical examination.

Background: Healthcare-associated ventriculitis (HAV) is a serious complication following neurosurgical procedures, especially in patients with external ventricular drains. Diagnosis remains challenging due to nonspecific clinical features, limited physical examination options, and the low sensitivity of microbiological methods. While cerebrospinal fluid (CSF)-derived biomarkers are linked to a higher infection rate, serum biomarkers have a low predictive value. However, they are still part of our daily routine monitoring for infections. In addition, the predefined criteria catalog (Centers for Disease Control [CDC]/Infectious Diseases Society of America [IDSA]) may be promising, but also underestimate the burden of the disease. This study aims to explore, with a matched case-control design, whether systemic markers (interleukin-6 [IL-6], C-reactive protein [CRP], and procalcitonin [PCT]) and their albumin ratios are associated with the clinical decision to initiate antibiotic therapy for HAV and how their performance compares to that of routine CSF markers. Furthermore, differences between microbiologically confirmed and unconfirmed HAV are explored. Finally, we reflect on our treatment decision with reference to the CDC and IDSA criteria. Methods: Adult neurosurgical intensive care patients with and without HAV treated between 2020 and 2023 were included. Patients with microbiologically confirmed and suspected ventriculitis (mcHAV and suspHAV) were both characterized by the initiation of targeted empirical antibiotic therapy and had positive and negative CSF cultures, respectively. Serum and CSF parameters were analyzed from day −4 to day 0 (initiation of therapy). Group comparisons, logistic regression, and area under the receiver operating characteristic curve (AUROC) analyses were performed to evaluate diagnostic accuracy. Results: Of the 1,817 screened neurosurgical Intensive Care Unit patients, 196 met the inclusion criteria, and after matching, 33 treated patients (16 mcHAV and 17 suspHAV) and 33 matched controls were included. Neither serum levels of IL-6, CRP, and PCT nor their albumin ratios differed between the mcHAV/suspHAV group and the control group and were not associated with treatment initiation. In contrast, CSF markers showed strong discriminatory ability: CSF white blood cell count (WBC) (AUROC 0.828), the CSF/blood WBC ratio (0.797), CSF glucose (0.754), and the CSF/blood glucose ratio (0.768) were significantly associated with ventriculitis. No significant correlations were detected between CSF and serum biomarkers. According to the CDC and IDSA criteria, 50% of treated patients met the definition for definitive HAV and 97% for probable HAV, whereas only 2.9% of controls were culture positive. Conclusion: In this exploratory matched case–control study, in contrast to serum infection markers, higher routine CSF markers were associated with a greater likelihood of treatment despite imperfect microbiological confirmation, highlighting the need for improved bedside techniques and innovative CSF sampling methods to reduce diagnostic uncertainty in HAV.

Challenges in the diagnostic of bilharziasis: a case report

Medicare annual wellness visits (AWVs) are vital for older adults' preventive care, which was transitioned to telehealth modalities during COVID-19. This study examined primary care providers' perceptions of telehealth-delivered AWVs and explored the factors influencing telehealth implementation using the Practical Robust Implementation and Sustainability Model (PRISM). Twenty-five primary care providers from eight clinics within an integrated health system in the Midwestern United States were interviewed. Eligibility required having conducted at least one telehealth AWV for patients aged 65 or older between March 2023 and October 2023. Semi-structured interviews lasting 30-45 min were conducted using purposeful sampling. Topics aligned with PRISM domains were addressed: program (telehealth utilization), recipient (organizational characteristics), external environment, and implementation infrastructure. Data were analyzed using NVivo software, using inductive and deductive thematic coding. Providers described telehealth AWV as flexible, convenient, and efficient. Benefits included shorter visit durations and the ability to observe patients' home environments. Challenges included difficulty conducting cognitive and mobility assessments, limitations in physical exams, and managing patients with hearing or visual impairments without caregiver support. Most providers did not perceive language as a major barrier, particularly for Spanish-speaking patients (Program domain). Providers noted that limited internet, device access, and lack of community technology support, especially in underserved areas, hindered telehealth use. They also emphasized the importance of maintaining reimbursement parity between telehealth and in-person visits (External Environment). Providers reported minimal formal training and inconsistent access to telehealth-equipped rooms, though support from colleagues and workflow adaptations helped address these limitations (Implementation Infrastructure). Staff support, particularly through pre-visit coordination, technical troubleshooting, and patient preparation, was crucial in implementing telehealth (Recipient). This study provided valuable insights into the implementation of telehealth AWVs and underscored the importance of organizational support for sustainable telehealth practices in primary care settings.

Several studies investigated risk and prognostic parameters for horses with colic; however, the consensus is still debated. The present work aimed to investigate colic outcomes and to identify risk factors in horses referred for colic. In this multicenter retrospective study, 236 clinical records of equids referred for colic at three different equine centers were reviewed. The following data were collected: history, signalment, physical examination at the time of admission, hematological and biochemical analysis, diagnosis, SIRS status and 0–6 point-scale SIRS score, colic type, treatment attempted, and outcome. Descriptive statistics were performed, and distribution of continuous variables was reported as median and percentile. A multivariable logistic regression model was applied to assess parameters associated with colic outcomes in horses (p &lt; 0.05). A total of 138/236 horses were included in the study. The univariate analysis identified as potentially associated with the outcome: sex (p = 0.046), colic type (p &lt; 0.001), treatment type (p &lt; 0.001), SIRS score (p = 0.049), age (p-value = 0.057), heart rate (p = 0.013), and respiratory rate (p = 0.017). The logistic regression model indicated that colic type (p &lt; 0.001) and age (p = 0.004) were significantly associated with a negative outcome. Equine colic risks are multifactorial; prognosis declines with age and strangulating obstructive non-strangulating colic. Poor outcomes link to cardiovascular signs like elevated heart rate, SIRS status and score, and blood lactate. Heterogeneity from diverse sites limits generalizability, but standardized protocols, binarized data, and a multicenter approach enhance robustness and representativeness while reducing local biases.

Dyslipidemia, characterized by abnormalities in lipid levels, significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD), particularly as its prevalence escalates with age, notably impacting postmenopausal women due to hormonal changes. Understanding the relationship between dyslipidemia and body composition, assessed through techniques like bioelectrical impedance analysis (BIA), is crucial for developing effective prevention and management strategies for cardiovascular disease and related metabolic disorders.This study aimed to evaluate the predictive value of body composition on dyslipidemia in postmenopausal medical workers and inform prevention strategies. A cross-sectional study included 207 postmenopausal medical workers undergoing hospital employee physical examinations between July and October 2023. Body composition was assessed using the Inbody720 analyser, and serum triglycerides, total cholesterol, and other physical examination results were recorded. The study analyzed the relationship between body composition and blood lipid levels. The prevalence of total dyslipidemia in postmenopausal healthcare workers was 46.4%. Participants with dyslipidemia exhibited significantly higher levels of uric acid, fasting blood glucose, glycosylated hemoglobin, BMI, body fat percentage, visceral fat area, body water, and minerals (p < 0.05). Conversely, skeletal muscle mass index was significantly lower in the dyslipidemia group (p = 0.000). Serum triglycerides (TG) showed a positive correlation with BMI(r = 0.377,p = 0.000), body fat percentage(r = 0.271,p = 0.000), skeletal muscle mass index(r = 0.254,p = 0.000), visceral fat area(r = 0.340,p = 0.000), total body water(r = 0.249,p = 0.000), and minerals(r = 0.231,p = 0.001) in postmenopausal medical workers. The binary logistic regression analysis revealedeach unit increase in body fat percentage, the odds of developing dyslipidemia increase by 77.1% (OR, 1.771, 95% CI,1.247-2.516). For each unit increase in total body water (TBW), the odds of developing dyslipidemia increase nearly sixfold (OR = 7.296,95% CI,2.068-25.740). Additionally, for each one-year increase in age, the odds of developing dyslipidemia increase by 5.8% (OR,1.058,95%CI,1.013-1.105). Skeletal muscle mass index, body fat percentage visceral fat area, minerals, and total body water are strongly correlated with dyslipidemia and can serve as predictors. Our study indicates that body composition is closely related to dyslipidemia. Accordingly, body composition assessment can be introduced in health check-ups for early screening, and interventions involving exercise and diet can be implemented for at-risk populations, providing comprehensive support for the prevention and control of dyslipidemia.

Increased work-related physical strain associates with higher subclinical joint inflammation in the RA at-risk phase of clinically suspect arthralgia and with progression to RA. Based on this, we hypothesized that work-related physical strain is also associated with the severity of joint inflammation at RA diagnosis. We studied this in ACPA-positive and ACPA-negative RA separately, because of differences in aetiopathology. A total of 197 ACPA-positive and 220 ACPA-negative consecutively diagnosed RA patients reported occupation. Physical strain was quantified as exposure using the International Standard Classification of Occupations 1988. Joint inflammation at diagnosis was measured with physical joint examination [swollen joint count of 44 joints (SJC44)] and with MRI of hands and forefeet (evaluating total inflammation, synovitis, tenosynovitis, osteitis and intermetatarsal bursitis). Associations between physical strain and joint inflammation were studied using negative binomial regression, yielding incidence rate ratios (IRR). In ACPA-positive RA at diagnosis, increased physical strain associated with more swollen joints (IRR 1.07, 95% CI 1.02-1.12). This was related to more swollen hand joints (IRR 1.07, 95% CI 1.01-1.13). Increased physical strain also associated with higher joint inflammation scores on MRI (IRR 1.05, 95% CI 1.01-1.09). This was particularly driven by higher osteitis scores (IRR 1.07, 95% CI 1.01-1.13). In ACPA-negative RA at diagnosis, work-related physical strain was not associated with joint inflammation at physical examination or on MRI. Physical strain is a risk factor for more severe joint inflammation at diagnosis in ACPA-positive, but not in ACPA-negative RA. This differential risk factor aggravating joint inflammation adds to the growing evidence of pathophysiological differences between the two RA entities.

Background: Feline atopic dermatitis (AD), also known as non-flea, non-food hypersensitivity dermatitis, is a chronic pruritic skin condition associated with environmental allergens such as dust mites and pollens. Although the age of onset is variable, it generally occurs before 5 years of age. Similar to dogs, pruritus is a key feature of atopic dermatitis in cats, although the distribution of pruritus and lesions is often more variable. The initial workup should include a thorough history, complete dermatologic and physical examination, and routine tests such as flea combing, skin scrapings, and fungal cultures. A diagnosis of feline AD is established once other differential diagnoses have been excluded. The feline dermatitis extent and severity index (FEDESI) and the scoring feline allergic dermatitis (SCORFAD) are commonly used in the evaluation the severity of feline AD. Treatment of feline AD typically involves a combination of anti-inflammatory medications and supportive care to control pruritus and inflammation. Long-term management should be supported by identifying trigger factors and implementing environmental control measures. This study investigated the potential benefits of vitamin C as an adjunctive treatment for feline AD, utilizing the pruritus visual analog scale (pVAS) and the FEDESI as assessment tools. Materials, Methods &amp; Results: Twenty cats with dermatological symptoms, free from infectious, parasitic, or fungal diseases, were included. After hematological and diagnostic evaluations, they were divided into 2 groups: Group 1 received methylprednisolone alone, while Group 2 received methylprednisolone combined with vitamin C (25-75 mg/kg) for 14 days. Clinical assessments, pVAS, FEDESI scores, and eosinophil counts were recorded on days 0, 7, and 14. Both groups showed clinical improvement, with reductions in pruritus and skin lesions. However, Group 2 exhibited a more rapid decrease in pVAS and FEDESI scores by day 7. Eosinophil counts also dropped more significantly in the Group 2. By day 14, clinical outcomes were similar between groups, and statistical differences were no longer significant. Discussion: Feline AD is a pruritic disease in which affected cats exhibit a hypersensitivity reaction to inhaled or contacted environmental allergens. Skin lesions may be seasonal or non-seasonal. In recurrent cases, otitis externa, miliary dermatitis, pruritis in the head and neck region, and eosinophilic granuloma complex lesions may be associated with atopy. The primary symptom is pruritus, and depending on the severity of pruritus, erosion, excoriations and alopecia may be observed in the lesions. In this study, it was observed that the clinical findings were compatible with the literature data. The primary goal of treatment is to reduce pruritus and inflammation to levels below the threshold for clinical manifestation. To achieve this, a classical multimodal approach is typically employed, incorporating both anti-inflammatory and immunosuppressive agents. Although classical treatment yields highly effective results, vitamin C may be considered as an adjunct therapy in the management of feline AD due to its roles in skin barrier support and antioxidant activity. The findings suggest that vitamin C may contribute to faster short-term relief of clinical signs in feline AD, possibly through its antioxidant, anti-inflammatory, and immunomodulatory properties. While the long-term efficacy remains uncertain, early results indicate that vitamin C can support initial treatment response when used alongside corticosteroids. In conclusion, parenteral vitamin C may serve as a supportive therapy in feline AD, helping to accelerate early clinical improvement. Further large-scale and long-term studies are necessary to confirm its role in routine treatment protocols. Keywords: atopic dermatitis, feline, vitamin C.

BackgroundHepatitis B (HBV) is a chronic viral infection that can lead to cirrhosis, liver failure, and liver cancer, and has a profound impact on the patient’s mental health. However, current depression screening mainly relies on self-filled scales and clinical experience, lacking objective and efficient prediction tools. This study aims to construct a risk prediction model for depression in hepatitis B patients based on machine learning, and explore the key features that affect the occurrence of depression, so as to optimize mental health management strategies.MethodsThis study used the NHANES database to collect demographic, dietary, physical examination, laboratory test and questionnaire data. The data were standardized and SMOTE oversampling was used to solve the problem of class imbalance. Random Forest (RF) was used for feature screening to identify the top 20 most important predictive features, and five machine learning models (Gradient Boosting, Logistic Regression, AdaBoost, MLPClassifier, LDA) were used for prediction. The model performance was evaluated by AUC (area under the curve), accuracy, recall, precision and F1-score, and ROC curves, calibration curves, and decision curve analysis (DCA) were drawn to evaluate the clinical applicability of the model.ResultsAll five machine learning models performed well in the task of predicting the risk of depression in hepatitis B patients, among which MLPClassifier (multi-layer perceptron) performed best, with an AUC of 0.935, a recall of 0.980, and an F1-score of 0.917, which was better than other models. In addition, feature analysis results showed that liver function damage (serum total bilirubin, alkaline phosphatase), electrolyte imbalance (serum potassium ions), chronic inflammation (red blood cell distribution width, lymphocyte count), and socioeconomic factors (poverty-income ratio, race) were important factors affecting the risk of depression in hepatitis B patients.ConclusionThis study constructed an efficient and objective machine learning model that can be used to predict the risk of depression in patients with hepatitis B, providing a new tool for accurate screening and individualized management. The study revealed the potential mechanisms of physiological, biochemical and socioeconomic factors in the occurrence of depression in patients with hepatitis B, and provided a reference for future mental health intervention strategies.

Staphylococcus aureus is a major pathogen responsible for both community-acquired and hospital-acquired infections. However, disseminated infections complicated by pulmonary abscesses and osteomyelitis are rare in otherwise healthy children. We report a case of a previously healthy 12-year-old boy who presented with a 7-day history of cough and a 5-day history of fever and progressive swelling of the left upper limb after self-manipulating a right forearm furuncle. Physical examination and imaging revealed multifocal pulmonary abscesses and osteomyelitis of the left humerus. Blood cultures confirmed the presence of methicillin-resistant Staphylococcus aureus (MRSA). Despite initial empirical antibiotic therapy, the patient's symptoms persisted, necessitating four surgical interventions. The first two surgeries involved debridement with antibiotic-loaded calcium sulfate implantation. Nineteen months later, due to nonunion of the proximal humerus, the patient underwent open reduction and internal fixation with autologous iliac bone grafting, followed by subsequent removal of the internal fixation two years later. This staged approach, starting with infection control followed by delayed reconstruction, led to successful bone union, with complete resolution of the pulmonary abscesses on follow-up imaging. This case highlights the potential for rapid hematogenous dissemination of Staphylococcus aureus leading to complex multi-organ involvement even in healthy pediatric patients. Prompt diagnosis, multidisciplinary management, and combined surgical and antibiotic therapy are critical for favorable outcomes. Not applicable.

Background: Pregnancy is characterized by profound hormonal, physiological, and psychosocial changes that may predispose women to psychological stress. Antenatal stress has been associated with adverse maternal and neonatal outcomes, including preterm birth, low birth weight, iron deficiency, and impaired infant development. Sociodemographic factors and maternal anemia have been increasingly recognized as important contributors to perceived stress during pregnancy. Objective: To determine the prevalence of perceived stress and its association with sociodemographic characteristics and anemic status among pregnant women. Methodology: This secondary analysis was conducted on data obtained from a prospective observational study carried out at the Gynaecology and Obstetrics Department of Khalifa Gul Nawaz Teaching Hospital, Bannu, from 15th May 2023 to 15th April 2024. A total of 430 pregnant women in any trimester were enrolled. Data collection included detailed sociodemographic and obstetric history, general physical examination, obstetric ultrasonography, hemoglobin estimation, and assessment of perceived stress using the Perceived Stress Scale-10 (PSS-10). Results: Positive perceived stress (PSS-10 ≥20) was observed in 25% of participants. Significant associations were found between perceived stress and age, body mass index, monthly income, family system, social support, physical abuse by husband, gestational trimester, previous adverse pregnancy outcomes, history of blood transfusion, and low hemoglobin levels in the current pregnancy. Perceived stress was significantly higher among anemic women compared to non-anemic women. Conclusion: Perceived stress is common among pregnant women and is significantly associated with modifiable sociodemographic and hematologic factors. Optimizing maternal nutrition, ensuring adequate social support, preventing domestic violence, and strengthening antenatal care services may help reduce stress and improve pregnancy outcomes. Keywords: Antenatal stress, Anemia, Perceived stress, Pregnancy, PSS-10.

Abstract Obesity is prevalent among patients with heart failure (HF), especially in those with preserved ejection fraction (HFpEF), and complicates diagnosis, therapy, and monitoring. It alters haemodynamics, biomarker interpretation, and drug pharmacokinetics, potentially influencing treatment response. Evidence from subgroup analyses of major HF trials suggests that renin–angiotensin system inhibitors (mainly sacubitril-valsartan), mineralocorticoid receptor antagonists, and sodium–glucose cotransporter 2 inhibitors provide consistent benefits across body mass index (BMI) categories, with no major obesity-specific safety concerns. In contrast, data on beta-blockers in obese HF patients remains limited, largely reflecting the older design of pivotal trials. Management should include careful assessment of congestion, acknowledging the limitations of physical examination, natriuretic peptides, and imaging, while implementing tailored diuretic strategies. This expert consensus provides a comprehensive and pragmatic framework for the use of guideline-directed medical therapy in patients with HF and obesity, exploring the available evidence for each drug class and addressing efficacy, patient selection, safety, and monitoring.

Current Perspectives on Pectoralis Minor Syndrome: A Narrative Review.

Background: Primary tonsillar neoplasia in dogs is rare, and among these tumors, tonsillar squamous cell carcinoma (SCC) is of particular concern because of its aggressive biological behavior, high metastatic rate, and generally poor prognosis. Reported treatment strategies for this include surgery, chemotherapy, radiation therapy, and non-steroidal anti-inflammatory drugs (NSAIDs). However, the optimal therapeutic approach remains undefined, and data regarding the efficacy of systemic chemotherapy as a single modality are limited. This report describes the clinical course and outcome of a dog with advanced tonsillar SCC managed with carboplatin in combination with adjuvant piroxicam. Case: A 14-year-old castrated male Mongrel dog was evaluated for anorexia, lethargy, and bilateral cervical masses. Physical examination and ultrasonography identified marked enlargement of the bilateral medial retropharyngeal and right submandibular lymph nodes (LNs), as well as a hypoechoic nodule in the spleen. Fine needle aspiration of both the lymph nodes and the splenic lesion revealed malignant epithelial cells. Computed tomography further demonstrated a right tonsillar mass consistent with a primary tumor, supporting a diagnosis of tonsillar SCC with concurrent lymph node and splenic metastases. The patient underwent 7 cycles of carboplatin chemotherapy (179.4-207 mg/m2, intravenous, every 3 weeks) administered concurrently with oral piroxicam (0.3 mg/kg, once, daily). Following the initial cycle, the dog exhibited rapid improvement in clinical signs, including resolution of anorexia, lethargy, and weight loss. Serial physical examination and imaging demonstrated a partial response, characterized by substantial reduction in the cumulative size of metastatic lymph nodes and complete resolution of splenic metastasis although the primary tonsillar lesion remained stable in size. After the 7th carboplatin cycle, the dog developed severe neutropenia accompanied by gastrointestinal signs, prompting discontinuation of chemotherapy at the owner’s request. Palliative management with piroxicam alone was continued, but progressive lymphadenopathy and worsening clinical symptoms ensued. The patient was transitioned to hospice care and died at home 53 days after cessation of chemotherapy, surviving 208 days from the time of diagnosis. Discussion: This case highlights several important clinical considerations in the management of canine tonsillar SCC. Although regional lymph node involvement is common, the occurrence of splenic metastasis is rare, underscoring the importance of comprehensive diagnostic staging in patients with suspected primary tonsillar tumors. While multiple treatment modalities are available, including surgery and radiation therapy, no single strategy has been shown to consistently improve long-term outcomes, particularly in cases with advanced local invasion or metastasis where local therapies are of limited benefit. In this patient, the combination of carboplatin and piroxicam achieved meaningful clinical improvement, prolonged survival, and control of metastatic lesions in the absence of surgery or radiotherapy. These findings suggest that carboplatin, when administered alongside NSAID therapy, may provide therapeutic benefit in selected cases of advanced canine tonsillar SCC. Further studies are warranted to establish the efficacy, safety, and optimal role of chemotherapy and adjunctive agents in the management of this aggressive neoplasm. Keywords: dogs, tonsillar squamous cell carcinoma, carboplatin, chemotherapy, piroxicam.

Incisional hernia (IH) is a common complication of abdominal surgery, and the optimal suture technique for midline fascial closure remains controversial. This study compared continuous barbed sutures with interrupted non-barbed sutures in patients who underwent minimally invasive colorectal cancer surgery. We retrospectively evaluated 299 patients who underwent laparoscopic or robotic radical colorectal resection between 2020 and 2023. Of these, 228 who underwent a small midline umbilical incision were included. Fascial closure was performed using either continuous barbed absorbable sutures (n = 60) or interrupted non-barbed absorbable sutures (n = 162). Propensity score matching (PSM) was performed at a 1:1 ratio, yielding 51 matched pairs for comparison. Primary outcome was IH incidence as confirmed by computed tomography or physical examination. Secondary outcomes focused on infectious complications as well as postoperative morbidity, mortality, and hospital stay. After PSM, the incidence of IH was significantly lower in the continuous barbed group than that in the interrupted non-barbed group (7.8% vs. 33.3%, P = 0.001). In non-obese patients (Body mass index < 25), barbed closure reduced the IH incidence (2.7% vs. 23.5%, P = 0.006). In obese patients, the difference was not statistically significant (21.4% vs. 52.9%, P = 0.07), likely reflecting limited power. Although ileus was more frequent in the interrupted non-barbed group (7.8% vs. 0%, P = 0.02), infectious complications were comparable between groups. Multivariable analysis identified interrupted non-barbed sutures and obesity as independent risk factors for IH. Continuous barbed fascial closure was associated with a significantly lower IH incidence after minimally invasive colorectal cancer surgery without increasing infectious complications. These findings support the effectiveness of a barbed-continuous closure strategy for midline extraction incisions.