POTENTIAL RESEARCH WASTE DUE TO PRIMARY STUDIES OVERLAP IN ORTHODONTICS SYSTEMATIC REVIEWS: A FIVE-YEAR ANALYSIS.

Surgical site infections (SSIs) are among the most common complications following colorectal surgery. This study aimed to systematically review existing evidence on the outcomes of subcutaneous negative suction drain versus no drain in adults undergoing colorectal surgeries. A systematic review and meta-analysis was conducted to compare the SSI rates between subcutaneous negative suction drain and the no-drain inadults (18 years or older) undergoing colorectal surgery. Randomized controlled trials (RCTs), prospective, or retrospective studies till 2025 reporting use of subcutaneous negative suction drain in elective and emergency colorectal surgeries were included. SSI was defined based on Center for Disease Control and Prevention (CDC) criteria. Results were expressed as Relative Risk (RR) and Confidence interval (CI) of 95%. A p value < 0.05 was considered statistically significant. Combined data from 2177 patients across 10 studies (four: RCTs, five: retrospective cohort, and one: prospective cohort) showed a significant reduction in overall SSIs by 60% (RR = 0.40; 95% CI, 0.30-0.53; p < 0.0001) in groups with a subcutaneous negative suction drain compared to those without. There was a significant reduction in superficial SSIs by 58% (RR = 0.42; 95% CI, 0.26-0.66; p = 0.0002). There was no significant reduction in deep SSIs and organ-space SSIs. The included studies were of medium to high quality. Subcutaneous negative suction drains reduce overall and superficial SSI after colorectal surgery, but do not affect deep or organ-space infection. This paper provides updated evidence demonstrating that subcutaneous negative suction drains significantly reduce overall and superficial surgical site infections after colorectal surgery, and acknowledges their limited effect on deep and organ-space infections, supporting selective use. The study protocol was registered with PROSPERO international prospective register of systematic Reviews (Registration ID: CRD420251012636).

The continual emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants drives the need to update evidence on coronavirus disease 2019 (COVID-19) severity and disease burden, and better understand the impact on prevention, treatment, and healthcare systems. This systematic review aimed to determine relative disease severity, through comparative measures of hospitalization, intensive care unit admission and mortality, between SARS-CoV-2 variants of concern emerging since Omicron was first identified. A protocol was registered a priori (PROSPERO ID: CRD42024619193). Systematic searches of MEDLINE and EMBASE databases were conducted in November 2024 and supplemented by conference searches from 2022-2024. Population, Exposure, Comparisons, Outcomes (PECO) criteria were used to screen publications for inclusion. Critical appraisal tools published in the Joanna Briggs Institute (JBI) Handbook for Evidence Synthesis were used to assess the risk of bias of the primary studies included. The outcomes associated with Omicron variants, identified by sequencing or predominance periods, included hospitalization, admission to intensive care, death, and various composite endpoints. Thirty-two studies fulfilled the eligibility criteria, most reported on relative disease severity for early Omicron BA.5 (n = 23) and XBB (n = 24) variants. Overall, COVID-19 severity appeared largely comparable across the various Omicron subvariants. Among the subset of studies that directly compared various severity outcomes to earlier SARS-CoV-2 variants (n = 7), some reported modest increases or decreases in severity. However, these differences were generally not statistically significant. Five studies stratifying outcomes by the presence of comorbid conditions noted that comorbidities were predictors of significantly worse COVID-19 disease outcomes (p = 0.000-0.027). Overall, this systematic review found the severity of COVID-19 disease to be comparable among Omicron subvariants. As SARS-CoV-2 subvariants continue to emerge, these results highlight the continuing need for vaccination against SARS-CoV-2 infection alongside early antiviral intervention to support short-term management and long-term reduction of COVID-19-associated morbidity and mortality.

Side Branch Protection in Coronary Bifurcation Stenting: A Systematic Review and Meta-Analysis of Jailed Wire Versus Jailed Balloon Technique.

Streptococcus agalactiae, or Group B Streptococcus (GBS), is a historical cause of perinatal infections and neonatal sepsis. While routine screening programs in high-income countries have led to a steady decline in neonatal complications, GBS remains a frequent colonizer of the adult gastrointestinal and urogenital tracts. Over recent decades, the incidence of invasive GBS infections in nonpregnant adults has increased substantially, leading to significant morbidity and mortality. This shifting epidemiological landscape is further complicated by the troubling emergence of multidrug-resistant lineages and hypervirulent genomic clones, such as ST283, which demonstrate severe invasive potential and unique zoonotic transmission capabilities. Because collective data on this growing threat remains fragmented, this review synthesizes global literature on invasive adult GBS, encompassing its changing epidemiology, patient risk factors, and its expanding clinical spectrum. The primary objective is to collate updated evidence to raise clinical awareness, support antimicrobial stewardship, and direct future research toward effective preventive measures and strategies.

Pregnant people have been recommended to receive influenza vaccine at any stage of pregnancy or before conception. However, a large number of pregnant people do not receive the vaccine because of safety concerns. The aim of this study was to investigate the risk of maternal influenza vaccination during the first trimester for birth defects (BDs). A literature search of PubMed, Embase, the Cochrane Library, the Web of Science and Scopus databases was performed to identify eligible observational studies published from inception to 28th April 2023. The risk estimates were analyzed by pooling odds ratio (OR) with 95% confidence intervals (CIs). Potential sources of heterogeneity were identified by subgroup and meta-regression analysis. Several categories of sensitivity analyses were performed. 31 studies involving 1,223,024 individuals were included in this study. Compared with the unvaccinated control group or those receiving influenza vaccination during second or third trimester, no increased risk of total BDs (28 studies, unadjusted OR 1.15, 95% CI 0.97-1.36; 10 studies, adjusted OR 1.03, 95% CI 0.98-1.07) or major BDs (16 studies, unadjusted OR 1.11, 95% CI 0.97-1.25; 6 studies, adjusted OR 1.03, 95% CI 0.98-1.09) was observed among those vaccinated during the first trimester. No potential risks were observed based on different vaccine type, the use of adjuvants, the assessment of BDs or control type. Results were consistent across sensitivity analyses for primary results. This study provided updated evidence that influenza vaccination in early pregnancy did not increase the risk for BDs.

Following the 2019 FDA safety communication on e-cigarette-related seizures, we conducted an updated pharmacovigilance analysis of FDA Tobacco Problem Reports using multimethod disproportionality approaches. Pharmacovigilance study of spontaneously reported adverse events. FDA Tobacco Problem Reports database, publicly available online. Reports in which the affected individual was not the product user were excluded. Cases were classified as e-cigarette exposure if the product description mentioned "electronic cigarette," while all others were grouped as other tobacco products. Reported health problems were harmonized into standardized AE categories. Disproportionality analyses were conducted using four methods: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and shrinkage-based Observed-to-Expected ratio (O/E). A signal was defined when the lower bound of the 95% confidence or credibility interval exceeded the null. A total of 1,082 reports were analyzed, of which 891 (82.3%) involved electronic cigarettes and 191 (17.7%) involved other tobacco products. Combustible tobacco products accounted for 99 cases (9.15%) of other tobacco products, while other or unknown tobacco products represented 60 cases (5.55%). Smokeless or other nicotine products were least frequently reported, accounting for 32 cases (2.96%). Reports involving electronic cigarettes were significantly more likely to have been submitted before 2020 compared with reports involving other tobacco products (80.8% vs 50.8%; OR = 4.07, 95% CI 2.93-5.67; p < 0.001). Seizures emerged as the strongest and only consistent safety signal across all disproportionality methods. Respiratory outcomes, including shortness of breath, cough, pneumonia, and respiratory failure, were more frequently reported in e-cigarette cases and showed signals in ROR and PRR analyses, but did not remain significant when assessed with Bayesian approaches. Seizures represent a pharmacovigilance signal associated with e-cigarette use. Respiratory events were reported more often among e-cigarette users but did not meet conservative Bayesian thresholds. These findings highlight the need for continued surveillance, studies, and regulatory vigilance regarding the safety of e-cigarettes.

ABSTRACT This study documents eight extant Kos Minars within Tarn Taran District, Punjab, India, and employs GIS-based spatial analysis to reconstruct an approximately 42 km stretch of the historic Old Delhi–Lahore Royal (Badshahi) Road between Fatehabad Sarai and Sarai Amanat Khan, both ASI- and UNESCO-listed sites. Kos Minars served as route markers along historic highways that facilitated administrative, military and commercial movements. GPS-based field surveys were conducted at the sites. GIS analysis of the mapped sites, using QGIS, reveals that the inter-Kos Minar (IKM) distance along this section does not correspond to the commonly cited ∼3.2 km kos but instead aligns closely with the Akbari kos of approximately 4.19 km. GIS analysis depicts the alignment of the Kos Minars overlapping with a present-day driving road, demonstrating long-term infrastructural continuity. The study also highlights key Sikh-Mughal historical intersections along this imperial highway. The GIS-generated map revealed that Guru Arjan Dev’s large sacred pond (sarovar) megaproject aligns completely with the Kos Minars and hence the Badshahi Road. The Nurdi tomb along the royal road needs preservation, being a Mughal-era structure and of notable historical significance to Sikhs. Thus, by integrating field survey data with GIS-based analysis, the study generates updated evidence and quantitative metrics, emphasizes preservation necessities and highlights the utility of advanced geospatial technologies in enhancing heritage documentation and conservation frameworks. The study contributes to Sustainable Development Goal (SDG) 11 by supporting the documentation and safeguarding of historic cultural infrastructure through geospatial analysis.

Auditory and non-auditory effects of noise on health: updated evidence and future directions.

Timeliness of children's vaccinations in 91 low-income and middle-income countries: an analysis of survey data.

Pregnancy in women with cardiovascular disease (CVD) represents a distinct clinical condition, as the physiological adaptations of pregnancy may interact with underlying cardiac pathology in variable and sometimes unpredictable ways. Consequently, maternal and foetal risk cannot be assumed a priori and requires structured, patient- and disease-specific assessment. The new ESC guidelines on cardiovascular disease and pregnancy incorporate updated evidence following the 2018 version. The contents span from models of multidisciplinary care (the Pregnancy Heart Team, PHT), pre-pregnancy counselling, and pregnancy-related risk assessment, to novel recommendations that are both shared by all pregnancies in women with CVD and specific to each distinct disease. Due to limited prospective or randomized studies largely prevented by ethical reasons, most recommendations are based on evidence level C. This document provides a concise synthesis of innovations in shared management strategies and disease-specific pathways in pregnancy of women with known CVD. It also acknowledges that not all clinical scenarios can be fully captured by guideline-based recommendations. Beyond guidelines, and primarily because approximately 50% of recommendations are Level C evidence, there is considerable decision-making margin for cardiovascular specialists to adhere recommendations. For rare unpredictable complications/events the limited available evidence does not allow recommendations to be made. Looking to the future, the expectation is that AI, which is already generating data and models of care in pregnancy, can help support widespread access to PHT, both in hospitals equipped with the necessary requirements and remotely to all healthcare facilities serving pregnant women with CVDs.

Cardiovascular-kidney-metabolic (CKM) syndrome is a multisystem condition integrating metabolic dysfunction, chronic kidney disease (CKD), and cardiovascular disease into a unified framework. CKM syndrome encompasses progressive metabolic derangements, renal injury, and cardiovascular remodeling, which interact to amplify morbidity and mortality. Lifestyle interventions (including structured weight loss, dietary modification, physical activity, and sleep optimization) form a cornerstone of prevention and management. Pharmacologic strategies targeting the renin-angiotensin-aldosterone system, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and lipid-lowering therapies provide additional multisystem benefits. In this comprehensive review, we systematically examine the most updated evidence on CKM syndrome, in terms of pathophysiology, epidemiology, clinical manifestations, diagnostic evaluation, and therapeutic strategies. We also highlight future research directions and precision medicine approaches.

Acne vulgaris (AV) poses a significant health challenge in China, adversely affecting patients' quality of life and mental health. Updated evidence on acne burden in China integrating temporal trends, China-global comparisons, change-point patterns, and future projections remains limited. This study aimed to provide an updated assessment of AVacne vulgaris burden in China, including temporal trends and future projections, and to clarify its public health implications. Using data from the 2021 Global Burden of Disease (GBD) study, estimated annual percentage changes (EAPCs) for AVacne vulgaris were calculated for China and globally, while change-point patterns were assessed using joinpoint regression. An age-period-cohort (APC) analysis was subsequently performed, followed by Bayesian age-period-cohort (BAPC) projection of China's AVacne vulgaris burden to 2050. From 1990 to 2021, the prevalence, incidence, and disability-adjusted life years (DALYs) associated with AVacne vulgaris in China exhibited sustained increases, outpacing global rates. APCAge-period-cohort analysis revealed a peak incidence at ages 10-14 years. Overall, the main burden was concentrated in adolescence. BAPCBayesian age-period-cohort projections indicated that China's AVacne vulgaris burden will continue to rise from 2022 to 2050,, with a disproportionately greater impact on females. These findings support prioritising evidence-based prevention, early recognition, and management strategies for adolescents and for females in China.

Various surgical techniques are available for facial skin and soft tissue defect repair, with flap reconstruction being the current mainstream choice. Secondary intention healing (SIH) has re-emerged as a viable option with unique advantages, yet its standardized clinical application criteria and up-to-date evidence base remain to be systematically summarized. We performed a systematic literature review of studies on SIH for facial defect repair, with predefined search strategies, inclusion and exclusion criteria across PubMed, Embase, Cochrane Library, and Web of Science from database inception to December 2025. Concurrently, we presented a case series of 3 patients who underwent SIH for facial tumor resection defects at our institution, with detailed clinical data and long-term follow-up outcomes. A total of 37 eligible clinical studies were included in the final review. The evidence confirmed that SIH achieves excellent cosmetic and functional outcomes in concave facial subunits (NEET areas), with satisfactory results in FAIR areas for appropriately sized defects. The procedure offers the advantages of no auxiliary incisions, simple operation, low cost, and the ability to monitor tumor recurrence in strictly selected cases. Our case series further validated the favorable outcomes of SIH in nasal sidewall, periocular, and cheek defects, with complete re-epithelialization within 7-10 days and no severe complications during follow-up. For properly selected small-to-medium facial skin and soft tissue defects, SIH is a straightforward, safe, well-tolerated, and cost-effective repair modality. This review and case series provide updated evidence and clinical decision-making references for the application of SIH in facial defect reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Breastfeeding plays a critical role in providing essential nutrients and antibodies that enhance the health of new-borns and infants, supporting their immune systems and overall growth and development. Healthcare professionals, universally recommend breastfeeding for the first six months of an infant's life, in conjunction with an appropriate complementary diet. However, the COVID-19 pandemic has understandably raised concerns among lactating mothers and pregnant women regarding the risks of infection and vaccine safety. Therefore, it is essential to carefully evaluate the potential dangers of COVID-19 transmission within this vulnerable population especially when considering vaccination for pregnant and breastfeeding women. Encouragingly, the United States Food and Drug Administration has granted approval for the use of two COVID-19 vaccines namely, Pfizer-BioNTech COVID-19 and Moderna COVID-19 to contain the spread of the COVID-19 virus. Both vaccines have been approved for administration in pregnant and breastfeeding women, providing much-needed reassurance to those with concerns about vaccine safety. It is important to recognize that the benefits of vaccination for both the mother and the infant far outweigh the risks associated with COVID-19 infection. Therefore, lactating mothers should view vaccination as a vital measure to protect themselves and their infants from the virus. In addition to elaborating on the successes of safety and effectiveness, this review is unique that it also includes current and newly updated evidence published between 2020 and 2025, comprehensively discussing on several newer vaccine platforms together with recent viral variants. Furthermore, it synthesizes information on the transfer of transplacental and a breast-milk antibody that outlines a clear evidence-gap that may direct further research within pregnant and lactating populations.

HIV preexposure prophylaxis (PrEP) effectiveness depends on engagement across the PrEP care continuum. Alcohol use may influence these steps, but findings remain inconsistent. This scoping review examined studies published since March 2020 that evaluated the association between alcohol use and PrEP outcomes and identified interventions targeting PrEP users who consume alcohol. We searched two databases, conducted citation tracking, and extracted data from studies measuring the association between alcohol use and ≥ 1 step in the PrEP care continuum. We also included intervention studies targeting alcohol use among PrEP users. Findings were combined with four previous reviews to generate an updated evidence map. We identified 55 studies, including 42 quantitative studies reporting 57 associations. Most were cross-sectional, conducted in North America, and focused on men who have sex with men. Adherence was the most frequently examined outcome, followed by uptake, continuation, willingness, and awareness. Associations between alcohol use and PrEP outcomes were mixed. Six intervention studies were identified, but none demonstrated significant improvements in PrEP outcomes. The updated evidence map includes 85 quantitative studies reporting 106 associations between alcohol use and the PrEP outcomes. The association between alcohol use and the PrEP care continuum remains mixed and likely dependent on the measure or intensity of alcohol use, context, and population characteristics. Overall, this evidence suggests the need for more effective interventions and a meta-analysis to better define alcohol's role in PrEP outcomes.

Investigative interviewers play a crucial role in eliciting information from children; therefore, gathering the views and experiences of professionals helps deepen our understanding and guide areas for improvement. Twelve police officers and forensic interviewers, based in the United Kingdom and the United States, were semi-structure interviewed. A thematic analysis was used to analyse the data, leading to the identification of three main themes: challenges and limitations in interview process, strategies for enhancing interview quality and effective techniques for information gathering. Participants noted limited flexibility with respect to minors, technology-related gaps and the significance of third-party disruptions. They called for better training and interview environments with adaptations to fit to children's variable abilities, sustained rapport and supportive cues. The findings strengthen our understanding of child investigative interviews by providing updated evidence from the professionals who work directly with them. Drawing on the study's findings, hypotheses were formulated to assess the effectiveness of interview techniques, update guidelines and ultimately improve child protection through more efficient pursuit of justice.

This article highlights clinical trials on infectious diseases published in 2025 that we believe are highly relevant to internal medicine physicians who are not infectious diseases specialists. Selected studies address prevention and treatment strategies across infectious diseases. We highlight 2 studies of sexually transmitted infections (STIs): one examining the effectiveness of treating male partners to reduce recurrence of bacterial vaginosis and another study of doxycycline as postexposure prophylaxis against bacterial STI. A strategy for using methanamine hippurate to prevent recurrent urinary tract infections (UTIs) in older women is included in our review. We review the updated evidence supporting the effectiveness of COVID-19, respiratory syncytial virus, and influenza vaccines for the 2025-2026 season, and a modified messenger RNA influenza vaccine, which showed superior efficacy with an acceptable safety profile. In HIV care, a study of dual antiretroviral maintenance therapy showed that dolutegravir and lamivudine was noninferior to triple therapy at 48 weeks. A meta-analysis supporting shorter antibiotic courses for pyelonephritis and complicated UTIs provides important information for antibiotic stewardship strategies. In serious infections, dalbavancin was noninferior to standard therapy for Staphylococcus aureus bacteremia, whereas cefiderocol expanded treatment options for gram-negative bloodstream infections without clear superiority, particularly in carbapenem-resistant pathogens. Finally, a study found that elevated C-reactive protein identifies patients most likely to benefit from adjunctive corticosteroids in community-acquired pneumonia.

Accumulating evidence suggests an association between bisphenol A (BPA) exposure and decreased sperm quality. This study aimed to investigate the relationship between BPA exposure and sperm quality through a systematic review and meta-analysis, utilizing epidemiological and rodent studies. Furthermore, we systematically elucidated the potential molecular mechanism of spermatogenesis disorder after exposure to BPA. We searched and collected studies from the Web of Science, PubMed, Embase, and Cochrane Controlled Trials Centers registers up to September 24, 2025. Meta-analyses used random-effects models to calculate regression coefficients (β), standard mean differences (SMD), and 95% CI to assess the effect of BPA on sperm quality (including semen volume, total sperm count, sperm concentration, progressive motility, and sperm morphology). Sixteen studies were included, involving six epidemiological studies and 10 rodent studies. Based on epidemiological studies, the findings indicated no association between BPA exposure and sperm quality. Inversely, the rodent data demonstrated a negative correlation between BPA exposure and sperm quality (pooled SMD = -3.87, 95% CI: -4.75, -3.00, p = 0.001), including semen volume (SMD = -7.09, 95% CI: -11.26, -2.96, p = 0.001), total sperm count (SMD = -3.87, 95% CI: -5.73, -2.01, p = 0.001), sperm concentration (SMD = -3.53, 95% CI: -5.29, -1.76, p = 0.004), sperm normal morphology rate (SMD = -2.56, 95% CI: -5.02, -0.10, p = 0.001), and progressive motility (SMD = -4.99, 95% CI: -6.60, -3.38, p = 0.001). Mechanistically, BPA destroys male reproductive health through oxidative stress, hormone disorders, inflammatory response, and epigenetic regulation, and ultimately leads to decreased male fertility. In summary, there is an adverse association between BPA exposure and semen quality based on rodent evidence, but not on epidemiological evidence. It provided insight cautiously into the association between BPA exposure and sperm quality in terms of updated evidence.

Gastroesophageal reflux disease in the 21st century.