Recent Meta-analysis Research Articles

Risk of anaphylaxis on commercial flights.

Air travel has now returned to prepandemic levels, with over 10.5 billion passengers in 2024. Many of these passengers have food allergies, and there is a perception that allergic reactions are common during commercial flights. A recent systematic review and meta-analysis reported an incidence of in-flight medical events due to allergic reactions of 0.7 (95% CI 0.4-1.1) events per million passengers. For those with food allergies, the incidence of allergic reactions is around 10-100 times lower than that reported for reactions 'on the ground' - equivalent to one reaction per 3600 food-allergic passengers in any 1-year period. Reassuringly, there is no evidence that this rate had increased over the past 30 years, despite significant increases in both the prevalence of food allergy and passenger numbers. Allergic reactions during commercial flights are uncommon; however, this is very likely to be confounded by the many precautions food-allergic passengers and their families take when flying. Nonetheless, the data confirm that flying can be safe for those with food allergies. While air travel continues to present numerous challenges to those with food allergy, this can be mitigated by consistent and helpful airline policies, which address the concerns of food-allergic individuals.

Virtual reality for the management of musculoskeletal pain: an umbrella review

BackgroundMusculoskeletal pain (MSK) is a condition that affects multiple parts of the musculoskeletal system, including limbs, neck, and back, leading to deterioration in both mental and physical health and overall quality of life. Despite the available treatments, they are not considered effective enough to eradicate pain symptoms, thereby requiring new methods as a substitute. This review comprehensively summarizes virtual reality (VR) technology as an adjunct or an alternative treatment for MSK pain and aims to explore the most suitable conditions and settings of VR.MethodsPubmed, Scopus, and Cochrane databases were searched for recent systematic reviews and meta-analyses investigating VR and MSK pain. The search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and revealed 17 relevant articles. The AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) analysis was conducted to assess the quality of included studies. The Corrected Covered Area was calculated to identify the degree of overlap.ResultsThe results found significant pain reduction and mental and physical improvements in patients with MSK pain in comparison to standard therapies in treating neck, knee, and back pain. Nevertheless, the heterogeneity and inconsistencies in results among papers were recognized. The promising aspects are multimodality, namely, VR in combination with exercises, patient acceptance of VR, and the effectiveness of immersive, non-immersive, and gamified versions. These findings also revealed the need for more research on underexplored regions, standardized methodologies, and personalized approaches.ConclusionTo summarize, VR poses the potential to treat MSK pain as an adjunct, and future research is recommended to focus on improving methodological rigor and multimodal approaches.Systematic review registrationOSF (https://osf.io/uyc7z).

Impact of GLP-1 receptor agonists on upper gastrointestinal endoscopy: an updated systematic review and meta-analysis.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used to treat diabetes and obesity. Emerging evidence suggests that GLP-1 RAs may be linked to increased gastric residual content (GRC), aspiration pneumonia, and aborted esophagogastroduodenoscopy (EGD) procedures. Although a recent meta-analysis showed an increased risk of GRC and aborted EGDs with GLP-1 RA use, it could not definitively establish a link to aspiration events due to limited data. This systematic review and meta-analysis aims to update the evidence on the impact of GLP-1 RAs on EGD outcomes, evaluate the effect of concurrent colonoscopy (CLN) on GRC, and assess the influence of different GLP-1 RA agents on GRC. We conducted a systematic review of studies from PubMed, Embase, and Cochrane databases (until November 2024), as well as relevant abstracts from Digestive Disease Week (DDW) 2024 and American College of Gastroenterology (ACG) 2024 to assess the impact of GLP-1 receptor agonists (GLP-1 RAs) on EGD. The primary outcomes were the rate of GRC and the rate of aspiration pneumonia. Secondary outcomes included the incidence of aborted EGDs due to GRC, the effect of concurrent CLN on GRC, and a comparison of GRC risk among different GLP-1 RA agents. A network meta-analysis was conducted to assess differences in GRC risk across the various GLP-1 RAs. Results were expressed in odds ratios (ORs) and 95% confidence intervals (CI). Moreover, to account for possible confounders, adjusted ORs (mainly based on age, sex, body mass index [BMI], diabetes) were pooled and analyzed. Meta-analysis was conducted using a random-effects model in Stata 17. The primary analysis assessing the association between GLP-1 RA use and GRC or aspiration events included 20 retrospective studies with a total of 207,708 patients (23,366 GLP-1 RA users). GLP-1 RA use demonstrated significantly higher rates of GRC compared to non-users (OR: 5.57; 95% CI: 4.07-7.62), an association that remained statistically significant on the analysis of adjusted ORs (3.18; 95% CI: 2.75-3.67). Furthermore, rates of aborted EGDs were higher with GLP-1 RA use (OR 4.90; 95% CI: 2.94-8.18), while there was no difference in aspiration events between the two groups (OR 1.75; 95% CI: 0.64-4.77). Concurrent colonoscopy was found to reduce GRC risk among GLP-1 RA users (OR 0.27; 95% CI: 0.19-0.38). A network meta-analysis comparing semaglutide (PO/SQ), exenatide, liraglutide and dulaglutide in terms of GRC showed no significant difference across these agents (chi square 0.966, p = 0.96). This updated systematic review and meta-analysis found a significant association between GLP-1 RA use and increased GRC. While GLP-1 RA use was linked to higher rates of aborted procedures, no difference in aspiration events was observed between the two groups. Notably, our study identified a protective effect of concurrent colonoscopy on GRC among GLP-1 RA users, while no significant differences were found in GRC risk among different GLP-1 RA agents. Further prospective studies are needed to control for potential confounders and better assess the true impact of GLP-1 RA use on EGD outcomes.

The neuroimaging correlates of depression established across six large-scale datasets.

Neuroimaging data offers noninvasive insights into the structural and functional organization of the brain and is therefore commonly used to study the brain basis of depression. To date, a substantial body of literature has suggested reduced size of subcortical regions and abnormal functional connectivity in frontal and default mode networks linked to depression. However, recent meta analyses have failed to identify significant converging correlates of depression across the literature such that a conclusive mapping of the neuroimaging correlates of depression remains elusive. Here we leveraged 23,417 participants across six datasets to comprehensively establish the neuroimaging correlates of depression. We found reductions in gray matter volume/ cortical surface area associated with depression in the frontal cortex, anterior cingulate and insula, confirming prior studies showing the importance of prefrontal and default mode regions in depression. Our findings demonstrate multiple surprising results including a lack of depression correlates in subcortical brain regions, significant depression correlates in somatomotor and visual regions, and limited functional connectivity findings. Overall, these results shed new light on key brain regions involved in the pathophysiology of depression, updating our understanding of the neuroimaging correlates of depression. We anticipate that these insights will inform further research into the role of sensorimotor and visual regions in depression and into the impact of heterogeneity on functional connectivity correlates of depression.

Comment on "Postoperative functional complications and quality of life following robot-assisted prostatectomy and radiotherapy in localized prostate cancer: evidence from a systematic review and meta-analysis".

The recent meta-analysis by Liu et al. comparing postoperative functional complications and quality of life (QoL) between robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) in localized prostate cancer raises important clinical questions but is constrained by methodological and interpretative limitations. Our commentary identifies four key issues: (1) inadequate adjustment for baseline confounding factors such as age, comorbidities, and androgen deprivation therapy exposure; (2) unstandardized aggregation of patient-reported outcome measures (PROMs), impairing statistical comparability; (3) absence of modality-specific stratification within the RT group, which combines external beam and brachytherapy despite differing toxicity profiles; and (4) overinterpretation of functional outcome trends without accounting for follow-up duration and evolving surgical techniques. These issues undermine the validity of the authors' conclusions regarding RT's superiority in functional recovery. We argue that future comparative effectiveness research should employ harmonized PROM frameworks, robust causal inference methodologies, and biologically stratified cohort analyses. Our critique underscores the need for precise, individualized assessment in treatment decision-making for localized prostate cancer and supports the broader scientific imperative for methodologically sound patient-centered outcomes research in robotic and radiotherapeutic oncology.

Corticosteroids for non-operative treatment of symptomatic Markwalder grades 1 and 2 chronic subdural hematomas: A retrospective study of 35 cases

Objectives: Standard treatment for chronic subdural hematoma (cSDH) consists of burr hole drainage. Corticosteroids reduce cSDH growth by inhibiting inflammation, reducing vascular permeability, and preventing the abnormal accumulation of fluid in the subdural space. Recent two randomized trials concluded that dexamethasone resulted in fewer favorable outcomes and more adverse events than placebo. However, one recent meta-analysis showed that adjuvant corticosteroids reduce recurrence rates. We aim to provide our experience in managing cSDH with corticosteroids as a primary non-operative modality and describe a novel radiological parameter, the thickness/midline (T/M) shift ratio, to predict successful treatment and resolution. Materials and Methods: This is a single-center, retrospective study. Markwalder grading scale (MGS) was used for inclusion. Significant midline shift (MLS) (>1 cm), basal cisternal effacement, and higher MGS scores (3 and 4) (stuporous, comatose, significant neurological deficits) were operated. Only borderline cases (symptomatic, conscious, no/mild focal deficits [roughly corresponding to MGS scores 1 and 2], <1 cm MLS), were prescribed steroids. Outcome measures were symptomatic relief, residual, and recurrence rates. Results: 35 patients were analyzed. Headache was the most common symptom. All had an MGS score of 1 or 2. The mean duration of steroid treatment was 14 days. The mean thickness was 1.4 cm and the mean MLS was 6.1 mm. The mean T/M ratio was 2.2 (0.6–4.1). On follow-up (FU), all had symptomatic improvement and the mean time to improvement was 4 days. Hematomas resolved in >80% of cases on FU scans. Cases with a lesser T/M ratio (T/M ratio <2.2) had significantly better resolution rates. We observed only one recurrence and none showed clinical deterioration. Except for one case of urinary tract infection, there were no other adverse effects attributable to steroids. Conclusion: In our study, steroids were of significant benefit in improving the symptoms. Symptomatic cases with MGS scores of 1 or 2 and a lesser T/M shift ratio may improve with steroids and seem to be a reasonable alternative to surgery or middle meningeal artery embolization. Steroids should not be tried for MGS scores >2. Well-designed prospective trials including both clinical and radiological parameters need to be performed to further clarify our findings.

Questionable prospective effect of perfectionism on depression: reanalysis of a meta-analytic cross-lagged panel analysis.

A recent meta-analysis claimed increasing prospective effects between perfectionism and depressive symptoms. However, the effects were estimated while adjusting for a prior measurement of the outcome variable and it is known that such adjusted cross-lagged effects may be spurious due to correlations with residuals and regression to the mean. We reanalyzed the same meta-analytic data as in the challenged study with alternative regression models. Alternative models indicated contradictory increasing and decreasing prospective effects of perfectionism on depressive symptoms. The present divergent findings suggested that the prospective effect of perfectionism on depressive symptoms may have been spurious. Consequently, the conclusions in the challenged meta-analysis, and the vulnerability model of perfectionism and depressive symptoms in general, can be called into question. It is important for researchers to be aware of the limitations of cross-lagged panel analyses, and of correlations in general, in order not to overinterpret findings.

Debate 3: Metastasis Directed Therapy in Oligometastatic Prostate Cancer.

Debate 3: Metastasis Directed Therapy in Oligometastatic Prostate Cancer.

PCOS as A Metabolic Disease

Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder, affecting 6–20% of women of reproductive age. It has evolved from being perceived solely as a reproductive disorder to being recognized as a complex metabolic disease. Multiple factors contribute to its pathogenesis, including insulin resistance, hyperandrogenism, obesity, chronic low-grade inflammation, and genetic, epigenetic, and environmental influences. The interplay of these factors increases the risk of type 2 diabetes, cardiovascular disease, and other comorbidities, highlighting the metabolic nature of PCOS. Methods and Materials: This study involved a comprehensive literature review of recent peer-reviewed articles, meta-analyses, and clinical guidelines related to the metabolic aspects of PCOS. Emphasis was placed on pathophysiological mechanisms such as insulin resistance, obesity, dyslipidemia, NAFLD, hypertension, and the role of endocrine disruptors and epigenetic modifications. Additionally, therapeutic approaches, including lifestyle modifications, pharmacological interventions, and surgical options, were evaluated to illustrate current management strategies for PCOS as a metabolic condition. Results: The findings reinforce that insulin resistance is present in 50–70% of women with PCOS, often leading to compensatory hyperinsulinemia and elevated androgen levels. Obesity exacerbates these metabolic derangements and increases the risk of comorbidities like type 2 diabetes, cardiovascular diseases, and NAFLD. The review also highlights the impact of inflammation, dyslipidemia, and hypertension, which collectively contribute to the metabolic syndrome profile observed in PCOS patients. Evidence suggests that lifestyle interventions, anti-diabetic medications, hormonal therapies, and targeted supplements can significantly improve metabolic and reproductive outcomes. Conclusion: PCOS should be approached as a metabolic disease due to its strong association with insulin resistance, obesity, and other metabolic complications. Recognizing this helps optimize prevention and management strategies, which should combine lifestyle interventions, pharmacological treatments, and patient education. An individualized, multidisciplinary approach can reduce long-term risks and improve the quality of life for women with PCOS.

Is Acupuncture Clinically Ready for Post-Stroke Sleep Disorders? A Critical Commentary on a Recent Network Meta-Analysis [Letter

Is Acupuncture Clinically Ready for Post-Stroke Sleep Disorders? A Critical Commentary on a Recent Network Meta-Analysis [Letter

Early life antibiotics exposure: exploring the fine line between treatment and neurodevelopmental risks

Dear Editor, Antibiotic prescriptions during pregnancy and early postnatal life are common. A recent meta-analysis revealed that globally, 23% of pregnant women used antibiotics 1. In infants, the incidence of antibiotic consumption over the first 14 months of life increased from 7.5% at birth to 66.1% at 14 months 2. The first three years of life- including the prenatal period, represent a critical developmental period for the central nervous system (CNS) and gut microbiota. During this time, exposure to antibiotics can affect the structure and function of the microbiota, influencing its communication with the CNS. Numerous studies have suggested that alterations in brain-gut microbiome interactions could be possible mechanisms for disorders such as autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), Alzheimer’s disease and epilepsy. Similarly, multiple studies have examined the association between antibiotic use and these neurological conditions, although the overall body of evidence remains inconclusive. A Swedish nationwide cohort study 3 reported an increased risk of ASD and ADHD associated with antenatal and early infancy use of antibiotics, with a stronger association noted for early-life exposure. Findings from a meta-analysis 4 showed that prenatal antibiotic use was significantly associated with an increased risk of ADHD and epilepsy, but not autism or cerebral palsy. In contrast, a recent large-scale study (5) found no significant association between antibiotic use during pregnancy or early infancy and neurodevelopmental conditions such as ASD, using a sibling analysis model. The study did, however, report a modest risk for epilepsy with antibiotic use during early infancy despite controlling for confounding factors. These conflicting findings and the influence of various confounding factors warrant further investigation and a cautious interpretation of the existing literature. Antibiotic prescription during pregnancy and early infancy should be based on careful assessment of the potential risks and benefits. The overuse of antibiotics among the public may result from their over-the-counter availability; therefore, policies regulating antibiotic sales should be introduced. Training programmes for healthcare professionals should be implemented to ensure accurate diagnosis of bacterial infections and appropriate antibiotic prescription. In conclusion, while the relation between antibiotic use during prenatal and postnatal periods and neurological outcomes remains uncertain, cautious prescription practices and policy measures are essential for both maternal and child health.

Impact of Caregiver and Patient Age on Efficacy of Caregiver Interventions in Advanced Cancer: A Meta-Regression.

It has been shown that interventions to support caregivers of patients with advanced cancer improve caregiver wellbeing, but the possible additional influence of patient and caregiver age is unknown. We measured the impact of patient and caregiver age on the efficacy of caregiver interventions. We included all studies from a recent meta-analysis of randomized controlled trials of caregiver support interventions for adult caregivers of adults with advanced cancer that reported on outcomes of quality of life (QOL), anxiety, or depression. Random-effects meta regression was performed on each outcome for continuous variables of: 1) mean patient age, 2) mean caregiver age, and 3) mean age difference between mean age of patients and caregivers. Among study sets demonstrating statistically significant associations, we performed sensitivity analyses excluding influential outliers. Twenty-four studies reporting on 23 trials involving 3306 caregivers were included in this meta-regression. Interventions were associated with improved QOL, anxiety and depression. In studies with older mean patient age, interventions had a greater impact on QOL (P = 0.04). In studies with younger mean caregiver age, interventions had a greater impact on depression (P = 0.02). In studies with a larger patient-caregiver age difference, interventions had a greater impact on anxiety (P = 0.01), but this effect did not prevail on sensitivity analysis (P = 0.52). Age of patients with advanced cancer and their caregivers may influence the efficacy of caregiver support interventions, and should be taken into account when designing these interventions and interpreting their effect.

Thromboembolic Risk and Testosterone Replacement Therapy: Debunking Myths and Clarifying Evidence with Recent Systematic Reviews and Meta-Analyses

Objectives: To critically evaluate the relationship between testosterone replacement therapy (TRT) and thromboembolic events, addressing concerns raised by older studies while focusing on recent robust evidence. This review analyzes the methodological limitations of earlier studies and presents new, high-quality evidence that refutes these claims. Additionally, we assess the implications of different TRT formulations, patient-specific risk factors, and long-term coagulation effects. Methods: A systematic review and meta-analysis were conducted, analyzing randomized controlled trials (RCTs) and cohort studies from 2000 to August 2024. The search strategy included PubMed, Embase, and the Cochrane Library, using combinations of terms such as “testosterone replacement therapy,” “thromboembolism,” “cardiovascular events,” “venous thromboembolism (VTE),” “deep vein thrombosis (DVT),” and “pulmonary embolism (PE).” Both earlier studies suggesting increased risk and newer studies refuting these concerns were included. Study quality was assessed using standardized risk of bias tools. Heterogeneity across studies was evaluated using the I² statistic, with subgroup analyses based on TRT formulations, follow-up duration, and patient age. Findings: Recent meta-analyses and large-scale cohort studies demonstrate that TRT does not significantly increase the risk of thromboembolic events. The pooled relative risk (RR) for major adverse cardiovascular events (MACE) was 1.08 (95% CI: 0.89–1.31, p = 0.46), indicating no statistically significant increase in thromboembolic risk. Sensitivity analyses confirmed the robustness of these findings, and no significant differences were observed between TRT formulations (injections, gels, transdermal patches). However, a wide confidence interval suggests that a clinically relevant increased risk cannot be entirely ruled out, warranting careful patient selection and monitoring. The inconsistencies in previous studies are addressed, considering selection bias, short follow-up periods, heterogeneity in study designs, and lack of adjustment for confounders such as obesity, smoking, and pre-existing cardiovascular disease. Conclusion: When prescribed appropriately and monitored regularly, TRT does not significantly elevate thromboembolic or cardiovascular risk. Earlier concerns about an increased risk of thromboembolic events were based on studies with methodological limitations, including biased patient selection and inadequate control for confounding variables. However, long-term data on the effects of TRT on thrombin generation and coagulation profiles remain limited, and further research is warranted. Clinicians should feel confident prescribing TRT in hypogonadal men, provided that individualized patient assessments, hematocrit monitoring, and cardiovascular risk evaluations are conducted.

L2 Learning and academic self-concept: The role of dimensional comparisons

An expanding literature has explored the impact of second language (L2) self-concept on language achievement and motivation. This review adopts a psychological lens to examine L2 self-concept, beginning with an outline of prominent theoretical frameworks: situated expectancy‐value theory; Shavelson et al.’s (1976) hierarchical, multidimensional model of self-concept; and the integrated Marsh/Shavelson model (Marsh et al., 1988). Building on these foundations, we introduce Marsh’s (1986) internal/external (I/E) frame of reference model, which posits that, within domains such as mathematics or verbal subjects, achievement and academic self-concept are positively correlated, whereas achievement in one domain relates negatively to self-concept in a different domain. Originally confined to mathematics and a single verbal subject in the firstlanguage (L1), the I/E model has been extended to additional disciplines, including L2, through dimensional comparison theory (DCT; Möller & Marsh, 2013). Central to this paper is a synthesis of findings from a recent meta-analysis investigating I/E effects that incorporate measures of L2 achievement and self-concept. Results demonstrate that higher L2 achievement bolsters L2 self-concept while simultaneously diminishing self-concepts in math, physics, biology, and L1; conversely, accomplishments in those other fields exert negative influences on L2 self-concept. We conclude by discussing both theoretical insights and practical applications of self-concept research for language education generally, and L2 instruction specifically.

High risk does not guarantee high accuracy-Evaluating the prognostic accuracy of OCT biomarkers for predicting late AMD.

The translation of high-risk biomarkers into accurate predictions of late age-related macular degeneration (AMD) may be limited by biomarker prevalence, subjective identification and competing risks from concurrent biomarkers. This study evaluates the prognostic performance of key optical coherence tomography (OCT) biomarkers for progression to late AMD, with colour fundus photography (CFP) as the reference standard. This retrospective study included 78 single eyes with intermediate AMD, propensity-score matched by age and sex between converters and non-converters to late AMD. Ten OCT biomarkers empirically derived from recent meta-analysis, alongside CFP biomarkers of large drusen and pigmentary abnormality, were independently graded by three clinician-researchers. Biomarkers' associated risk (odds ratios) and prognostic performance (area under the receiver operating characteristic curve (AUC), sensitivity, specificity) were evaluated for predicting late AMD. The adjusted risk was highest for OCT-detected nascent geographic atrophy, shallow irregular retinal pigment epithelium (RPE) elevations, drusenoid pigment epithelium detachment and RPE reflective abnormality (odds ratios, 6.66 [1.32, 42.71] to 28.27 [2.44, 545.3], p < 0.05). However, CFP-detected pigmentary abnormalities demonstrated the highest individual prognostic accuracy (77.69 [68.11, 87.27]% AUC, p < 0.0001), with excellent sensitivity (92.31%) but moderate specificity (63.08%). Adding at least three OCT biomarkers was required to improve prognostic performance significantly (91.01 [84.66, 97.36]%, p < 0.0001), and at least eight additional biomarkers to yield both excellent sensitivity (94.62%) and specificity (90.77%). CFP-detected pigmentary abnormality remains a mainstay of clinical AMD prognostication, likely due to its higher prevalence and interpretability than high-risk OCT biomarkers. Integrating OCT biomarkers into clinical prognostic models is promising but complex and may require automated identification to aid efficiency.

POLYCYSTIC OVARY SYNDROME: ORIGINS AND IMPLICATIONS: Long-term health outcomes in polycystic ovary syndrome.

Cardiometabolic risk factors may cluster in women with polycystic ovary syndrome (PCOS) from early ages. This narrative review suggests that the long-term prognosis of PCOS is better than expected from these associations, provided that obesity is avoided and the disorder is properly managed. Polycystic ovary syndrome (PCOS) is a widespread condition, with reported prevalences ranging from 5 to 20% in premenopausal women worldwide. Being a chronic hyperandrogenic condition, cardiovascular risk factors cluster even in young adult women with the syndrome because its pathophysiology also involves dysfunctional adipose tissue, chronic low-grade subclinical inflammation and/or insulin resistance. Recent systematic reviews and meta-analyses of available studies suggest that middle-aged and postmenopausal women with PCOS might present with an increased risk of cardiovascular events, namely myocardial infarction and stroke, when compared with non-hyperandrogenic women from the general population. Hyperandrogenic and metabolic complaints of PCOS also have a negative impact on the mental health of this broad segment of the population. However, obesity played a major role in these associations: when comparing populations matched for weight, the cardiovascular risk of women with PCOS appears to be similar to that of women without this condition, even though postmenopausal patients retain their hyperandrogenic features. Importantly, recent results from a longitudinal prospective cohort study failed to demonstrate increased cardiovascular events during the late reproductive or early postmenopausal period of Caucasian patients with PCOS after 10 years of follow-up, even though cardiovascular risk factors were very frequent in these patients. Hence, current evidence indicates that the long-term prognosis of PCOS is somehow better than that expected from their cardiometabolic associations, which are largely driven by the association of PCOS with obesity. Nevertheless, physicians attending these women must still be aware of the potential health consequences of PCOS during their late reproductive years and beyond menopause, in order to identify and properly manage these high-risk patients.

Pruritus in Uremic Patients: Approaches to Alleviating a Common Symptom in Chronic Kidney Disease

Chronic kidney disease-associated pruritus (CKD-aP) is a distressing symptom that affects both dialysis and non-dialysis patients, significantly impairing their quality of life. Despite its multifactorial pathophysiology, no gold-standard treatment has been established. This review explores various therapeutic options and evaluates their effectiveness based on recent clinical studies and meta-analyses. Therapies targeting novel mechanisms have evolved in recent years. Difelikefalin, a κ-opioid receptor agonist, represents a breakthrough in systemic treatment, demonstrating efficacy with a favorable safety profile. Another opioid-based therapy, nalfurafine, has shown notable symptom relief in multiple clinical studies, with a low risk of abuse. Sertraline, an antidepressant, offers another alternative, although its delayed onset remains a limitation. Nonpharmacologic approaches are also evolving. Phototherapy, particularly UV-B therapy, modulates the immune response, reduces inflammation, and effectively alleviates itching in hemodialysis patients. Personalized treatment strategies are crucial, as responses vary among patients. Further research, including comparative and long-term studies, is essential to refine treatment algorithms and improve patient outcomes. By integrating new pharmacologic and nonpharmacologic options, CKD-aP management is shifting toward a more tailored and effective approach that addresses the individual needs of each patient.

Dietary Interventions for Polycystic Ovary Syndrome: A Comprehensive Review

Polycystic Ovary Syndrome (PCOS) is a complex hormonal and metabolic condition that affects a significant proportion of women in their reproductive years. This review outlines the role of dietary management as a primary therapeutic approach in PCOS, emphasizing its influence on insulin resistance, hormonal imbalance, menstrual irregularities, and fertility outcomes. Various dietary models are discussed, including low-glycemic index diets, the Mediterranean and DASH diets, ketogenic and high-protein regimens, plant-based nutrition, and intermittent fasting. The review also highlights the therapeutic potential of specific supplements such as myo-inositol and vitamin D. By integrating findings from recent clinical studies and meta-analyses, the article provides practical guidance for applying dietary strategies in clinical settings. These interventions offer safe, effective, and sustainable options for improving both metabolic and reproductive health in women with PCOS.

Quo Vadis Temporomandibular Disorders? By 2050, the Global Prevalence of TMD May Approach 44.

Currently, temporomandibular disorders (TMDs) represent a significant public health concern, affecting approximately 34% of the global population. The primary aim of this study was to determine the prevalence of TMDs in the year 2050. A secondary objective was to estimate the prevalence for the years 2030, 2075, and 2100. The methodology of a prognostic study was replicated and adapted to develop prevalence projections for TMDs, utilising the most recent meta-analysis of the global prevalence of temporomandibular disorders and analyses conducted within the R environment. Projections indicate a gradual increase in the global prevalence of TMDs over the coming decades. In 2030, the estimated prevalence is 39% (95% confidence interval: 34-44%). This figure is expected to rise to 41% [36-46%] by 2040 and reach 44% [39-49%] by 2050. The upward trend continues, with projections suggesting a prevalence of 47% [42-52%] in 2075 and 49% [44-54%] by 2100. These data highlight a steadily increasing global burden of TMDs. By the year 2050, the global prevalence of TMDs is projected to reach 44%, which, according to estimates, corresponds to approximately 4,252,160,000 individuals. By 2030, 39% of the population is projected to experience TMDs. By 2075, the global TMD prevalence is expected to rise to 47%, and, by 2100, it could increase further to 49% of the global population. Urbanisation affects TMD prevalence in a region-dependent manner; a significant decrease was observed in Asia, while, in the Americas and Europe, the association was negligible. Globally, the lack of a clear impact of urbanisation on TMD occurrence suggests the influence of environmental and cultural factors.

Analysis and Characterization of Factors Affecting the Consistency of Tl-201 Myocardial Perfusion Single-Photon Emission Computed Tomography and Coronary Angiography Results in Patients with Suspected Coronary Artery Disease

Background/Objectives: Tl-201 myocardial perfusion single-photon emission computed tomography (MPS) is a minimally invasive test for patients with suspected coronary artery disease (CAD). While its predictive and prognostic values are well established, diagnostic performance varies. A recent meta-analysis reported that the sensitivity and specificity of MPS range from 48.8 to 100% and 46.7 to 94.7%, respectively, reflecting discordance between CAG. Little is known, however, about the influence of patients’ characteristics and CAD risk factors on the diagnostic performance of MPS. This study aims to evaluate these factors in relation to MPS performance. Methods: We screened 4817 consecutive patients referred to our Nuclear Medicine Department in 2015 for Tl-201 MPS. Patients with clinically suspected ischemic heart disease who underwent CAG within 60 days post-MPS were included in the present analysis. The percentage of agreement/disagreement between the MPS-abnormal/normal and CAG-positive/negative groups was evaluated. Additionally, patient characteristics, CAD risk factors, co-morbidities, and single-photon emission computed tomography (SPECT) image-derived parameters were compared among the patients. Results: Among 635 patients with abnormal MPS, 583 had coronary stenosis. For the 52 without stenosis, causes included non-obstructive CAD (34.6%), prior infarction with scarring (32.7%), and imaging artifacts (32.7%). Significant stenosis was associated with older age, male sex, diabetes, dyslipidemia, CKD, and prior PCI, while hypertension and higher BMI were more common in insignificant CAD. Among 104 patients with normal MPS, 79 had stenosis, mainly in the LAD. Clinical risk factors were more prevalent in patients with any degree of stenosis. Conclusions: In patients with an abnormal MPS, the incorporation of visual interpretation, parameters, and CAD risk factors increases specificity and helps differentiate obstructive from non-obstructive CAD.