Impact of Graded Physical Exercise on Aerobic fitness, Endurance and health related functional outcomes among cancer patients: A Systematic Review.

Myomectomy for intramural fibroids prior to invitro fertilization/intracytoplasmic sperm injection cycles, a conundrum: Systematic review and meta-analysis.

Community health workers (CHWs) play an important role in delivering essential health services in low- and middle-income countries (LMICs). Training CHWs using digital approaches is on the rise. Although scoping and systematic reviews of digital training have been conducted for medical professionals in high-income countries (HICs), none have been conducted with lay professionals in LMICs, a population with different considerations. This review describes the characteristics of digital training for CHWs and identifies their impact on health services outcomes in LMICs. A scoping review approach based on Arksey and O'Malley's guiding principles was used to retrieve, review, and analyze existing literature. We searched 10 foremost databases using keywords and Medical Subject Headings terms for CHWs, LMICs, and digital learning to identify primary, peer-reviewed studies published up to and including November 26, 2024. An updated search of studies in all the databases was conducted on January 12, 2026, by the research team. No registries were searched. Articles that focused on the provision of digital or blended learning training for CHWs working in LMICs in any disease domain evaluating a learning, implementation, or clinical outcome met the eligibility criteria. Two reviewers (TAT and FA) screened the articles at the title and abstract levels and at full-text review. Study details, study designs, training attributes, technology and CHW descriptions, and outcomes were abstracted using a data-charting form. Descriptive analysis was conducted of the population, training characteristics, and reported outcomes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting scoping reviews were used. A total of 892 articles were retrieved and screened for eligibility, of which 18 original articles met the inclusion criteria. Most (n=13) were conducted in Asia. Most (n=15) used nonrandomized study designs. The most common attributes included synchronous (n=8), accessible in the community (n=14), use of smartphones (n=6), and accessible online (n=9). The majority reported learning outcomes (n=14), about half reported implementation outcomes (n=10), and only one reported clinical outcomes (n=1). The learning outcomes focused on knowledge gained and were mostly positive. The implementation outcomes included CHW's acceptability and feasibility to use the digital training approach. The clinical outcome was effectiveness. We found few evaluations of digital training for CHWs in LMICs, in spite of a proliferation of such trainings. Digital trainings had a broad range of attributes. Many evaluations had knowledge, acceptability, and feasibility outcomes. However, other learning outcomes (eg, attitudes and skills), implementation outcomes (eg, appropriateness and fidelity), and clinical outcomes were rare. Most lacked experimental designs. Although the existing evidence suggests that digital training can impact knowledge in lay health workers in LMICs, more rigorous studies with a broader range of outcomes are needed.

Liver transplantation is a life-saving procedure for patients with end-stage liver disease. Risk of post-transplantation infection remains high despite improvement in graft and patient survival. Antibacterial and antifungal prophylaxis plays an important role in reducing infection-related morbidity and mortality, but optimal timing and regimens are not well defined. The Surgical Infection Society's (SIS) Therapeutics and Guidelines Committee and individuals with content expertise convened to develop guidelines on antibacterial and antifungal prophylaxis in liver transplant to prevent surgical site infection and other infections, shorten intensive care unit length of stay, and decrease mortality. PubMed, Embase, Web of Science, and the Cochrane Database were searched using Medical Subject Heading terms including "liver transplantation," "antibiotic prophylaxis," and "antifungal prophylaxis" for studies limited to randomized controlled trials, systematic reviews, meta-analyses, cohort, and case-control studies in adult patients. Evaluation of the published evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation system, and final recommendations were developed by an iterative process. We cannot make a recommendation for or against using pre-operative (more than 1 h before incision) antibiotic agent prophylaxis in liver transplantation with available evidence. We suggest the use of broad-spectrum antibiotic agent prophylaxis in liver transplantation rather than gram-positive antibiotic agent prophylaxis alone (Grade 2B). We recommend limiting administration of antibiotic agent prophylaxis to 24 hours post-operatively after liver transplant (Grade 1B). We recommend against empiric antifungal prophylaxis for patients at low risk for invasive fungal infections (IFIs) after liver transplant; for patients at high risk for IFI, we recommend antifungal prophylaxis (Grade 1B). This guideline summarizes the current SIS recommendations on antibacterial and antifungal prophylaxis in liver transplantation.

Microgravity-related Changes in Urinary Calcium and Oxalate Excretion: A Systematic Review of Astronaut Data.

Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease worldwide, affecting over 40% of individuals with diabetes. Despite advances in glycemic control and renin-angiotensin system blockade, effective therapeutic strategies remain limited. A narrative review was synthesized from research papers using PubMed, Wiley Online Library, ScienceDirect, Cochrane Library, Springer, and other sources, published between 2000 and 2025 with logical combinations of appropriate keywords and Medical Subject Headings. Emerging evidence implicates mitochondrial dysfunction as the central pathogenic mechanism underlying DKD progression. Mitochondria govern critical cellular processes, comprising energy metabolism, reactive oxygen species homeostasis, and cell survival. In DKD, hyperglycemia-induced metabolic stress compromises mitochondrial oxidative phosphorylation, enhances reactive oxygen species production, damages mitochondrial DNA, as well as disrupts mitochondrial dynamics through aberrant fission, fusion, and mitophagy processes. These alterations occur early in the pathogenesis of disease and affect multiple renal cell types, particularly proximal tubular epithelial cells and podocytes. Recent studies have identified key molecular regulators of mitochondrial quality control, including PTEN-induced putative kinase 1/Parkin-mediated mitophagy, dynamin-related protein 1-driven fission, and peroxisome proliferator-activated receptor gamma coactivator 1-αlpha-dependent biogenesis, as potential therapeutic targets. Novel therapies targeting mitochondrial dysfunction, including sodium-glucose cotransporter 2 (SGLT2) inhibitors, mitochondria-targeted antioxidants, and metabolic modulators, have shown promise in preclinical and clinical studies. This paper synthesizes recent understanding of mitochondrial metabolism and dynamics in DKD pathogenesis and evaluates emerging mitochondria-directed therapeutic strategies. This review concludes that only SGLT2 inhibitors are the only class of drugs with robust randomized controlled trial evidence to date and other emerging therapeutic options require further clinical validation.

Digitalis glycosides may be used as additional therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HF with reduced EF (HFrEF). To assess the effect of digitalis glycosides on clinical outcomes in patients with HFmrEF or HFrEF. PubMed was searched from inception to March 1, 2026, using medical subject headings and keywords related to digitalis glycosides and HF. The review was restricted to placebo-controlled randomized clinical trials including more than 1000 patients and articles published in the English language. Data were extracted by 2 reviewers who followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Risk of bias was assessed with the Cochrane Risk of Bias tool (version 2). A fixed-effects model was used to estimate the hazard ratios (HRs) with 95% CIs. The primary end point was the composite of time to cardiovascular death or first worsening HF event. Secondary outcomes included individual components of the composite outcome and time to all-cause death. A total of 3 studies met the inclusion criteria and included 9013 patients with HFmrEF or HFrEF (weighted mean age, 64.5 [weighted SD, 11.2] years; 22% female and 78% male). The composite outcome of cardiovascular death or first worsening HF event occurred in 1852 of 4510 patients (41%) in the digitalis glycoside group vs 2037 of 4503 patients (45%) in the placebo group (HR, 0.85 [95% CI, 0.80-0.90]; P < .001). First worsening HF event occurred in 1183 (26%) patients in the digitalis glycoside group vs 1474 (33%) patients in the placebo group (HR, 0.75 [95% CI, 0.69-0.81]; P < .001). There were 1224 cardiovascular events in the digitalis glycoside group vs 1224 in the placebo group (27% of participants in each group; HR, 0.99 [95% CI, 0.92-1.07]; P = .81) and there were 1466 vs 1497, respectively, all-cause deaths (32% of participants vs 33%; HR, 0.97 [95% CI, 0.90-1.04]; P = .41). There was no statistically significant heterogeneity by trial, type of digitalis glycoside treatment, or extent of background HF therapy. Treatment with digitalis glycosides was associated with a lower risk of the composite of cardiovascular death or first worsening HF event in patients with HFmrEF or HFrEF, mainly through a lower risk of worsening HF events. There was no statistically significant interaction with important study characteristics, including the extent of HF background therapy or type of digitalis glycosides treatment. These results suggest digitalis glycosides may be used as additional medical therapy to reduce worsening HF events in patients with HFmrEF or HFrEF.

ObjectiveThis review article was conducted to summarize the published literature on the most common errors and clinical consequences, and to explore technological solutions for securing the process of preparing chemotherapeutic drugs.Data sourceThe literature used in this review was identified through searches of major medical and pharmaceutical databases including (PubMed) (Science Direct). Articles were searched using the Medical Subject Headings terms: "cytotoxic drugs", "compounding", "reconstitution errors", "oncology pharmacy", "chemotherapy preparation errors "; "automated compounding"; "dilution errors ".Summary of dataThe preparation of cytotoxic drugs has generally been centralized in the hospital pharmacy for two main reasons: to ensure the safety of staff, and to provide greater protection for patients. Errors in chemotherapy compounding have been identified, which can lead to severe outcomes, including death or permanent loss of function in patients with cancer. Such errors may occur during drug reconstitution and mixing, as well as during verification and labeling of the compounded mixture. Automated compounding systems have demonstrated the ability to prepare chemotherapy drugs effectively, delivering high-quality products with productivity comparable to that manual preparation methods.ConclusionCytotoxic drug reconstitution is a strategic link in oncology pharmacy to enhance safety, it is necessary to promote harmonized practices, develop continuing education, and integrate innovative technologies into preparation units.

Pulpotomy is a commonly used approach for treating deep caries in primary teeth. In recent years, diode lasers have been explored the use in pulpotomy. This study systematically reviewed the clinical and radiographic efficacy of diode lasers in pulpotomy and evaluated their feasibility and safety as an alternative treatment modality. This systematic review searched PubMed, Embase and the Cochrane Library for all published articles in the English language from inception to August 31, 2025. The medical subject headings (MeSH) terms and free-text keywords were used. The Cochrane collaboration risk assessment tool was used to evaluate the quality of the literature. Meta-analysis was performed using RevMan 5.4. Heterogeneity was evaluated using Cochran's Q test and the I2 statistic. The results of this study showed that comparing with other treatments, no significant differences in clinical or radiographic success rates at every follow-up period (P > 0.05). However, diode lasers significantly decreased the occurrence of pathologic widening of the periodontal space (P < 0.05). Laser wavelength did not significantly influence the outcome (P > 0.05). When using zinc oxide eugenol (ZOE) as the pulp capping material, diode lasers lowered the incidence of pathological widening of the periodontal ligament space (P < 0.05). Sensitivity analyses confirmed that most results were consistent, although some subgroup outcomes were affected when individual studies were excluded. Funnel plot examination indicated no evidence of publication bias. Compared with other methods, diode laser treatment demonstrated similar clinical and radiographic success rates and showed potential benefits in reducing the incidence of pathologic widening of periodontal space. Therefore, diode laser-assisted pulpotomy may be considered a viable alternative therapy. The study was submitted to the Open Science Framework platform[https://osf.io/rweuq/overview?view_only=fa297ad91199454581a03dedc1b3d4e0].

Parkinson's Disease (PD) is a neurodegenerative disorder characterized by the selective degeneration of dopaminergic neurons in the substantia nigra, leading to motor and non-motor symptoms. Recent research highlights the importance of the microbiome-Gut-Brain Axis (GBA) in PD pathogenesis, particularly the role of gut microbiota dysbiosis and inflammation. This review aims to explore the potential of alkaloids, a diverse group of naturally occurring compounds, in modulating gut microbiota and their implications for PD management. We evaluated studies that investigated the effects of various alkaloids on gut microbial composition, neuroinflammation, and dopaminergic neuron health using PubMed, Scopus, Web of Science, and Google Scholar databases. The search strategy combined Medical Subject Headings (MeSH) and free-text keywords. The primary search terms included: "Parkinson's disease" OR "PD", "gut-brain axis" OR "gut microbiota" OR "intestinal dysbiosis", "alkaloids" OR specific compound names (e.g., "berberine," "harmine," "galantamine," "nicotine," etc.). Evidence suggests that alkaloids such as berberine, protopine, and palmatine, matrin, etc., can restore microbial balance, reduce inflammation, and enhance neuroprotective effects, potentially mitigating both gastrointestinal and neurological symptoms associated with PD. This review underscores the need for further research, particularly human clinical trials, to validate the therapeutic efficacy and safety of alkaloids in the context of PD. By elucidating the mechanisms through which alkaloids influence the GBA, we can pave the way for innovative treatment strategies that enhance the quality of life for PD patients.

Good Teachers: A Scoping Review on What Medical Students Value in OB/Gyn Resident Educators.

UCVA ontology: Standardizing local context factors to support the analysis of unwarranted clinical variation.

Introduction: Co-ordinated hip, ankle, and stepping strategies play a crucial role in postural control, which is often impaired in patients with neurological conditions such as stroke, multiple sclerosis, Parkinson’s disease, and Diabetic Peripheral Neuropathy (DPN). Despite their widespread clinical use, the available evidence has not been systematically mapped to determine their effects on balance and gait parameters. Aim: To collate, synthesise, and report existing evidence on the effects of hip, ankle, and stepping strategy training (SST) on balance and gait parameters among individuals with neurological conditions. Materials and Methods: This scoping review followed PRISMA-ScR guidelines. The review protocol was registered on the Open Science Framework (OSF) with the registration DOI: 10.17605/OSF.IO/CAF63. Three electronic databases— PubMed, Scopus, and ScienceDirect—were searched for studies published in the English language. The search strategy included relevant keywords, Boolean operators (AND, OR, NOT), Medical Subject Headings (MeSH) terms, and filters such as publication year range, randomised clinical trials, and language. Results: Fourteen studies were included in this scoping review. Study characteristics were summarised based on the populations investigated, types of postural-strategy training employed (hip, ankle, and stepping strategies), and intervention duration. Ankle Strategy Training (AST) on unstable surfaces demonstrated significant improvements in Centre Of Pressure (COP) sway. When combined with Hip Strategy Training (HST), greater improvements were observed in proximal extremity control and limits of stability. Several studies also reported that perturbation-based training enhanced reactive balance by increasing tolerance to perturbation intensity, improving confidence during community mobility, reducing fall risk behaviours, and enhancing gait parameters. Conclusion: Postural-strategy training improves balance and gait parameters in individuals with neurological conditions. Each strategy offers distinct benefits, while multistrategy training yields greater functional improvements than single-strategy interventions.

Pharmacoepidemiology and population health studies using electronic health care records (EHRs) must define study variables through available electronic data. These variables are operationalized through phenotypes, which are a defined set of criteria used to identify specific traits or medical conditions. There is diversity across phenotype libraries (collections of code lists or algorithms) which intend to standardize these sets of criteria. This review aimed to characterize the landscape of phenotype libraries and how phenotypes are constructed, validated, managed, and reused across research settings. We conducted a systematic review of existing phenotype libraries to appraise their attributes. We systematically searched three databases (Scopus, PubMed, and Web of Science) up to November 2025 to identify studies on key characteristics of phenotype libraries. The search combined Medical Subject Headings(MeSH) terms related to "electronic health record," "phenotype algorithm," and "phenotype library". A structured hand search was performed to identify relevant web-based resources without accompanying publications to ensure comprehensive inclusion of libraries available to date. We extracted information on library size, vocabularies, phenotype construction methods, validation practices, management, and portability. Of 336 articles, 37 met eligibility criteria for full-text review, of which25 were excluded because they were not EHR-based phenotype libraries (representing single algorithms, genomic resources, or study-specific phenotypes rather than reusable libraries), leaving 10 unique libraries described across 12 articles. A structured hand search identified seven more libraries. In total, 17 phenotype libraries met the inclusion criteria, including Education and Child Health Insights from Linked Data (ECHILD) Phenotype Code List Repository, Centralized Interactive Phenomics Resource (CIPHER), Chronic Condition Data Warehouse (CCW), ClinicalCodes Library, Clinical Classifications Software Refined (CCSR), ComPLy, CALIBER (Health Data Research UK (HDR UK) Phenotype Library or CALIBER), Jigsaw Algorithm Repository (JAR), Manitoba Centre for Health Policy (MCHP) Concept Dictionary, Open CodeLists, Observational Health Data Sciences and Informatics (OHDSI) ATLAS, PheCode, Phenotype KnowledgeBase (PheKB), Phenotype Execution and Modeling Architecture (PhEMA) Workbench, PheMap, Sharing and Reusing Computable Phenotype Definitions (SharePhe), Value Set Authority Center (VSAC). Libraries varied substantially in scope, size, and phenotype representation, including rule-based algorithms, probabilistic phenotypes, and standardized code groupings. Validation practices were heterogeneous and reported only for a subset of libraries. All the libraries utilized a web-based platform and met at least the minimum requirements for library management, including phenotype definitions, metadata, and version control. We observed large variations in library construction and validation across diverse libraries built in varied EHR research settings. The transparency of phenotypes and creating computable phenotypes enhance portability and streamline the effective reuse of phenotypes for different systems.

A scoping review of adverse visual outcomes among preterm infants without, versus those with, retinopathy of prematurity.

Quantification of emergency operating theatre process performance: a systematic review of clinical studies.

To evaluate the benefits of platelet-rich plasma administration after adhesiolysis in women with intrauterine adhesions. A database search using the keywords (autologous platelet-rich plasma) AND (intrauterine adhesions) and their Medical Subject Headings terms revealed 11 studies with 1,130 participants. Endometrial thickness was reported in four studies with 274 participants. The mean difference effect estimate was 0.53 with a 95% confidence interval (CI) of 0.23, 0.82; P<0.001, and I²=0%. The menstrual pattern after the procedure showed that the odds ratio (OR) effect estimates for amenorrhea, hypomenorrhea, and normal menstruation were 6.47 (0.24, 174.08), 0.84 (0.41, 1.73), and 1.21 (0.51, 2.84), respectively, and the P-values were 0.27, 0.63, and 0.66, respectively. The number of women with adhesions after the procedure showed that the OR effect estimates for grade I, II, and III adhesions were 1.74 (0.41, 7.45), 0.76 (0.21, 2.70), and 0.31 (0.11, 0.88), respectively, and the P-values were 0.46, 0.67, and 0.03, respectively. Changes in the American Fertility Society (AFS) score after the operation were reported in three studies with 276 participants. The mean difference effect estimate was 0.87, with a 95% CI of 0.17, 1.56; P=0.01; I²=0%. The clinical pregnancy rate was reported in five studies involving 506 participants. The OR effect estimate was 1.80 with a 95% CI of 1.18, 2.75; a P-value of 0.006, and I² of 0%. Platelet-rich plasma administration after hysteroscopic adhesiolysis improved endometrial thickness (low evidence), recurrence of grade III adhesions (low evidence), AFS score of adhesions (low evidence), and clinical pregnancy rates (moderate evidence).

Asthma is a heterogeneous inflammatory disease driven by complex genetic, immunological, environmental, and neuro-immune interactions. Modern therapeutic strategies increasingly target distinct molecular mechanisms underlying specific asthma endotypes. Emerging evidence highlights the role of psychological stress in modulating the neuro-immune axis, contributing to allergic airway inflammation. Systems biology offers a powerful framework to understand the multi-cellular and cross-organ interactions between lung and brain microenvironments that drive asthma pathogenesis. To develop a molecular systems architecture of asthma using the CytoSolve® systems biology platform and process. This approach enables a multi-layered, systems-level analysis of molecular pathway interactions across thirty-one pulmonary, immune, and neuronal cell types involved in allergic-eosinophilic and non-allergic asthma phenotypes, and identifies potential therapeutic targets. A systematic bioinformatics literature review was conducted using Medical Subject Headings (MeSH) across PubMed, Medline, and Google Scholar, covering peer-reviewed publications from January 2008 to August 2025. Relevant full-length articles were curated and analyzed using the CytoSolve® platform to construct a molecular systems architecture of asthma. The relevant literature was critically analyzed to understand the link between environmental and psychological stress triggers that drive asthma pathogenesis and disease exacerbations. The systems architecture identified biomolecular interactions across thirty-one cell types spanning bronchial, immune, stromal, vascular, endocrine, and neuronal compartments, including airway epithelial cells, T-cells, eosinophils, mast cells, fibroblasts, microglia, hypothalamic and brainstem neurons, vagal sensory neurons, and autonomic airway neurons. Environmental triggers such as pollutants and infections initiate cascades that promote three core pathobiological processes: airway inflammation, hyperresponsiveness, and remodeling. Psychological comorbidities, including anxiety and depression, further amplify airway inflammation through brain-lung cross-talk, contributing to neuronal inflammation and asthma exacerbations. This system architecture generated a multilayered visual map that shows the associations between various triggers and biomolecular interactions across airway and neuronal cell types in the lung and brain microenvironment, respectively. The architecture may be utilized for target identification, discovery of single and combination therapeutics, biomarkers, and clinical strategies to treat asthma endotypes.

School-based instructional supervision (SBIS) carries a formal legislative mandate in Malaysian public secondary education, yet its intended purpose of fostering teacher professional growth is not consistently realised. Documentation requirements frequently displace developmental intent, and supervision and evaluation continue to be conflated in ways that undermine formative practice. This qualitative multiple-case study examined SBIS implementation across two purposively selected urban public secondary schools in Selangor: one participating in the Transformasi Sekolah 2025 (TS25) programme, and one under standard national provisions. Fourteen participants comprised principals, senior assistant principals, heads of department, subject panel heads, and novice, mid-career, and experienced teachers. Data were generated through semi-structured interviews, classroom observations, and document analysis. Thematic analysis used Atlas.ti Version 23; intercoder reliability was confirmed via Fleiss' Kappa (κ = 0.775, p &lt; .001), indicating substantial agreement. Seven themes addressed supervision implementation, professional growth, and systemic challenges. Findings reveal structurally divergent supervisory cultures despite shared policy frameworks: the TS25 school demonstrated a multi-tiered developmental approach embedded in Professional Learning Communities, while the non-TS25 school prioritised procedural compliance. Drawing on Glickman's Developmental Supervision Model and Knowles' Adult Learning Theory, the study proposes a PDDA (Plan-Do-Develop-Analyse) framework centred on professional growth. Three contributions are advanced: the first empirical comparison of SBIS between TS25 and non-TS25 Malaysian secondary schools; a reconceptualisation of the compliance-development tension as structural rather than individual failure; and a practice-derived framework actionable within existing policy constraints. Findings carry implications for teachers, school leaders, and policymakers seeking to move supervision beyond compliance toward dynamic, teacher-centred practice.

ABSTRACT This study investigates how Nigerian public librarians experience and negotiate colonial residues embedded in contemporary knowledge-organisation systems. Using an interpretive phenomenological approach, interviews with 18 librarians revealed four interconnected themes: the persistence of colonial structures in cataloguing and classification; the moral and institutional pressures of epistemic gatekeeping; identity tensions arising from conflicting professional and cultural expectations; and everyday acts of resistance that challenge exclusionary systems. Participants described classification work as emotionally and ethically fraught, shaped by inherited epistemic hierarchies that marginalise Indigenous worldviews. Yet they also demonstrated agency through local innovations, adjusted subject headings, and informal documentation of Indigenous concepts. The study argues that meaningful decolonisation requires institutional policy reform, recognition of librarians’ interpretive labour, and KO systems capable of representing diverse epistemologies. These findings underscore librarians’ critical role in reshaping how memory, identity, and knowledge are preserved in postcolonial contexts.