European Journal of Cardiovascular Medicine

Introduction Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, and shortness of breath and chest tightness. It can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. The assessment of asthma control has become pivotal in the management of asthma. However, several surveys in developed nations have shown that the majority of patients with asthma do not enjoy adequate asthma control. This is not because asthma control is unrealistic and not achievable; the multicentre, multinational study of asthma management, the Gaining Optimal Asthma control (GOAL) study, has shown that well-controlled asthma is achievable in the majority of patients.  Materials and Methods: This is a descriptive and cross-sectional study to assess the levels of asthma control among adult patients attending Tertiary Care Teaching Center. The study used those (physician-diagnosed asthma patients) participants who volunteered. There is a causality department where patients presenting with acute asthma attack are managed. Complicated cases of asthma including status asthmaticus are managed in the high dependency unit. Results: Prevalence of bronchial asthma in adolescents was 13.1% (n = 110) of which 10.2% had episodes in the past 1 year. Prevalence was higher among males (6.23%) compared to females (3.94%). About 79.1% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke producing fuel at home (firewood/cow dung/kerosene; P = 0.021), and with history of smoking among family members (P = 0.027). Among current asthmatics, 71.8% reported cold/rhinitis (51.3% in March–May duration), 59.1% nocturnal dry cough, 48.2% sleep disturbances, and 42.7% speech disturbances in the past 1 year. Discussion: In our study we found, there is significant increase in weight, BSA, BMI, where as significant decrease in DBP of diabetic group compared to Non-Diabetics & there is significant increase in FBS, HbA1C levels of Diabetic group significant decrease in LH levels of Diabetics compared to Non-Diabetics. However T3 levels of Diabetic and Non-Diabetic group were almost same, where as T4, Oestradiol and progesterone levels of diabetic group non-significantly increased and FSH and TSH levels non-significantly decreased in Diabetics. There is frequent co-existence of thyroid dysfunction and diabetes mellitus among post menopausal diabetic women. Conclusion: We estimated the global prevalence of ACO based on population-based studies and found that 2.0% of the general population is affected. However, the prevalence of ACO depends on its diagnostic criteria. Therefore, there is a vital need to better define the ACO diagnostic criteria, management and treatment. It is worth noting that the limitations of the present study include lack of studies in some region of the world and small number of studies included in the subgroup analyses

Osteoporosis is a common metabolic disorder that causes decreased bone strength and is the leading cause of bone fracture, particularly in the elderly. There is no synthesis of evidence to inform policy regarding its prevalence and distribution in India. As a result, the goal of this systematic review and meta-analysis is to estimate and summarise the prevalence of osteoporosis among Indian adults. The PRISMA criteria were used to conduct the systematic review and meta-analysis. A thorough systematic search was conducted in the following electronic databases until May 23, 2022: Medline (via PubMed), Embase, and ProQuest. Following screening, twelve eligible studies were included in the study, which reported the prevalence of osteoporosis among adults aged 18 years, as well as for subsequent methodological quality assessment and data extraction using predefined standardised tools. To generate summary estimates for prevalence with 95 percent confidence intervals, random and fixed effects meta-analysis models were used. Data from 5261 study participants were used in the included studies. In India, the prevalence of osteoporosis is 22.9 percent (95 percent CI: 14.9-32.0 percent), and that of osteopenia is 44.8 percent (95 percent CI: 38.9-50.7 percent ). Females had a significantly higher prevalence of osteoporosis (26.3 percent (95 percent CI: 16.9-37.0 percent) than males (10.9 percent) (95 percent CI: 4.5-19.7). A robust and comprehensive prevalence estimate will aid in health policy decision-making and will aid in the planning and provision of necessary facilities for people suffering from osteoporosis. This is the first study to compile data on the prevalence of osteoporosis and osteopenia in India. Improved access to health services, other health systems, and policy research are required to initiate and increase the uptake of osteoporosis screening and treatment in India

There is debate regarding whether septoplasty in youngsters will have a negative impact on nasal and facial growth. Current research has demonstrated that in carefully chosen young patients, septoplasty can be safely performed without impairing nasofacial development. The goal of this article is to determine how paediatric septoplasty affects nasal and facial growth while also reviewing the clinical indications and supporting data on when to schedule surgery based on the most recent research. Using the terms paediatric, childhood, septoplasty, nasal septum, indications, nasal growth, and face growth, a structured review of the PubMed, Ovid Medline, and Cochrane Collaboration databases (Cochrane Central Registry of Controlled Trials, Cochrane Database of Systemic Reviews) was conducted. Another similar study came to the conclusion that most aspects of nasal function are unaffected by external septoplasty. Conclusions: There is proof that paediatric septoplasty can be done almost entirely without having an impact on the development of the nose and face. However, postponing or refusing to have a septoplasty when it is necessary may negatively impact nasal and facial growth, compounding negative outcomes in terms of deformity and asymmetry. Despite the fact that the majority support having septal surgery when a patient is 6 years old or older, further clinical trials are needed to gather greater support for correcting septal abnormalities in infants and young children. a function for septoplasty is thus supported by ached controls

Background: Various factors like physiological and emotional stress, drugs and nutritional deficiencies can result in hair loss. Results of laboratory tests examining the underlying aetiology of hair loss vary in patients. Materials and methods: Fifty-four patients with hair loss (47 females, 7 males) and 55 healthy individuals within the control group (47 females, 8 males) were included in this study. Serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and 25-hydroxyvitamin D were evaluated in all participants retrospectively. Result: A total of 70 patients were studied which included 45 males and 25 females. Out of these mild AA was seen in 15 males and 10 females, moderate AA was found in 30 males and 15 females. We did not get any cases of alopecia totalis (AT), alopecia universalis (AU) or ophiasis. Conclusion: Women with hair loss can benefit from higher ferritin levels

Introduction: Local wound infiltration is an effective, simple, and practical method of postoperative analgesia. Time and resource consumption is minor; while being more acceptable. A low incidence of complications; and no major contraindications have been noted, other than patient refusal or local infection. Various systematic reviews outline the benefits of adjuvants such as opioids, non-steroidal anti-inflammatory drugs, steroids, alpha-2 agonists, ketamine, etc. in increasing the analgesic efficacy and opioid-sparing effect when combined with local anaesthetic agents via wound infiltration; while also providing supportive evidence of the safety of these agents. Material and Method: The study was as a prospective double blind randomised controlled trial conducted between April 2022 to April 2023. The inclusion criteria were age 30 to 60 years, lumbar degenerative disc diseases needing posterior spinal fixation of one- or two-disc levels and of American Society of Anaesthesiologists (ASA) grade I/II. The criteria for exclusion were surgery of >2-disc levels (>3 vertebrae), surgery for non-degenerative spinal diseases, previous spinal surgery, osteoporosis and spondylolisthesis of grade III/IV, altered hepatic or renal parameters or ASA grade III/IV. Surgical decision was made according to the patient’s history, flexion extension radiographs and MRI, with consultations with the patient. Patients were then randomly allocated randomly in 2 groups by a computer-generated randomization. Group N received inj nalbuphine 10mg, 0.5 % inj bupivacaine 9ml and 10ml normal saline while group B received inj butorphanol 1mg, inj bupivacaine 9ml and normal saline 10 ml.  Results: At end of the recovery, patients in nalbuphine group had mild pain with mean NRS score 2.5±0.5. The pain remained mild in nature till 4 hours and then starts increasing slowly with NRS at 6 hours 3.8±0.7 and peaking between 6 and hours (table 2, figure 1). The hearts rate and MAP were also had similar trends with progressive increase from 4 hours and peaks at 8 hours. In the butorphanol group the mean NRS score at the end of recovery was 2.8±0.6 which was comparable to the that of nalbuphine group. It started to increase before 4 hours, with mean NRS score at 4 hours 3.8±0.7 and peaked between 4 and 6 hours. During intergroup comparison mean heart rates, MAP and NRS were comparable between the two groups at baseline, 0 hour and 2 hours. Significant difference in NRS score were observed among the two groups at 4 hours (p – 0.03), 6 hours (p-0.01) and 8 hours (p-0.006). After 8 hours the heart rate, MAP and NRS in both groups were comparable (p>0.05).  Conclusion: In this study we have compared the benefits and safety of two different opioids as adjuvants to local infiltration in spine surgery.  The study was done in similar group of patients of degenerative lumbar disease operated with similar surgery (lumbar spinal fixation and decompression) by a single surgeon. The results demonstrated that the NRS score remains low at both groups till 4 hours of recovery and the patients were haemodynamically stable with no tachycardia or increased blood pressure. In the butorphanol group the NRS score increase around 4 hours of recovery and the request for first rescue analgesia was between 4 and 6 hours, mean 289.7±46.8 minutes. But in nalbuphine group, NRS score remained low up to 8 hours and mean time for request of first rescue analgesia was 492.4±56.3 minutes.

Background:-Tuberculosis poses a severe threat to human health. At present, compared with the traditional diagnostic methods for tuberculosis pleural effusion and sputum, such as sputum microscopy for Acid-fast bacilli (Z-N stain) and confirmatory molecular test for tuberculosis by Truenat MTB (PCR) was regarded as an emerging technology for its efficiency. We performed a systematic review and meta-analysis to evaluate diagnostic accuracy of a positive pleural effusion and sputum microscopy were better or useful tool for diagnosis and treatment of Tuberculosis. The study is implemented to check the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sputum and pleural fluid were calculated, Material and methods- The study included 265 suspected pulmonary TB patients with positive clinical manifestations at Varun Arjun Medical College and Rohilkhand Hospital, Banthra, Shahjahanpur U.P. Sample was collected over age of 18 that had been suspected pulmonary tuberculosis with positive sign and symptoms from July 2023 to December 2023. The diagnostic results from pleural fluid and sputum sample were used as the standard calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Data was collected from the Department of Microbiology, Varun Arjun Medical College and Rohilkhand Hospital, Banthra, Shahjahanpur U.P. Results: The sensitivity for smear microscopy is 85.2% (95% CI 77.8 – 92.1), specificity is 90.2% (95% CI 82.6 – 97.8), and positive predictive value is 83.7% (95% CI 82.6 – 84.9) and negative Predictive value is 69.4% (95% CI 63.6 – 74.4). In contrast, the sensitivity for truenat MTB is 92.5% (95% CI 91.1 – 93.9), specificity is 98.7% (95% CI 97.8 – 99.6), negative predictive value is 94.8% (95% CI 93.8 – 95.8) and positive predictive value is 97.1% (95% CI 95.7 – 98.5). Conclusion: This preliminary study shows that the Truenat MTB test allows detection of TB in Approximately in short time of interval and can be utilized in near- care setting to provide quick and accurate diagnosis

Transplantation is a surgical procedure in which the organs or the tissues or the cells are removed from one person who is called as the donor, are surgically transplanted in the other person who is called as the recipient. When an organ gets transplanted, it is called organ transplantation. It is the procedure which also impacts the recipients with oral and dental manifestations. Material and Methods: Major databases such as Medline were explored detailed literature search in resulting in a systematic review pertaining to link between oral and maxillofacial pathology and organ transplantation. Results: Five original research scientific articles dated between 2020 – 2024  pertaining to mentioned topic were highlighted.  Conclusions: Many recipients may complain that there may be any mucosal infections or lesions. So, the dentists along with transplantation professionals should identify, diagnose and treat the oral and maxillofacial manifestations as early as possible. Detailed information regarding the manifesations of oral and maxillofacial pathology and organ transplantation is discussed in this systematic review.

Introduction: Omega-3s have been studied extensively for their potential benefits in reducing cardiovascular diseases (CVDs). While some studies suggest positive outcomes, recent evidence shows limited overall effects. The study aims to provide an updated synthesis of the existing evidence, but limitations in study design and individual circumstances need to be considered when interpreting the results. Additional research is required to fully understand the impact of omega-3s on CVDs and guide clinical practice recommendations. Aims and Objectives: To investigate the effect of omega-3 fatty acids (DHA or Docosahexaenoic Acid, and EPA or Eicosatetraenoic Acid) in patients who have cardiovascular abnormalities. Methods: The authors conducted a primary literature search using various online libraries and keywords related to omega-3 and cardiovascular outcomes, resulting in 198 retrieved studies. After applying inclusion and exclusion criteria, 12 appropriate studies were included in the meta-analysis. The outcomes considered were mortality, myocardial infarction, atrial fibrillation, coronary events, and other cardiovascular abnormalities. Statistical analysis was performed using Review Manager 5.3, and odds ratios with 95% confidence intervals were calculated. The significance level was set at p<0.05 to assess the impact of omega-3 fatty acids on cardiovascular events. Results:  The studies vary in design and sample size, with participants ranging in age from 62 to 77.6 years. The main treatments investigated are EPA+DHA, EPA, and Vitamin D3, compared to control groups receiving no treatment or placebos. Daily doses of EPA+DHA range from 0.84 to 4.0 grams. Meta-analysis results show that omega-3 consumers have a lower risk of adverse cardiovascular events. Some studies did not find significant effects, but overall, omega-3 supplementation appears beneficial in preventing cardiovascular diseases (P<0.00001). Conclusion: The study has concluded there is evidence found in support of omega-3 fatty acids that can reduce adverse cardiovascular events in the form of cardiovascular diseases or mortality. 

Introduction:  Mobile phones are playing an increasingly important role in healthcare service delivery and self-care support for patients, a field known as mobile health (mHealth). Still, most of the data on the use of mobile technology in the area of non-communicable diseases (NCDs) and risk factor management have been restricted to developed countries, highlighting the need for more rigorous research in Low- and Middle-Income Countries. Hence the study was carried out to know the mobile phone use among patients with Type II DM in urban slum dwelling of Kalaburagi. Materials And Methods: A review of published mHealth interventions was conducted. Relevant studies were identified through a systematic literature search in databases such as PubMed, Google Scholar, and Cochrane Library. Criteria for inclusion were interventions that were published within the last 5 years, aimed at improving public health outcomes, and had measurable effectiveness metrics. Results: A total of 350 articles were initially identified through database searches. After removing duplicates and screening titles and abstracts, 150 articles were selected for full-text review. Of these, 30 studies met the inclusion criteria and were included in the final review. CONCLUSION:  Exploring the integration of multiple mHealth tools and their combined effects on diabetes management could provide insights into optimizing intervention strategies. Research should also consider the adaptability of mHealth solutions to diverse populations and settings to enhance their applicability and effectiveness

Space travel, particularly long-duration missions, poses unique physiological challenges due to microgravity, radiation exposure, confinement, and isolation. This systematic review aims to synthesize the current understanding of the physiological changes that occur in astronauts during space travel. Using the PRISMA methodology, a total of 50 studies were included, focusing on cardiovascular deconditioning, musculoskeletal degradation, neurocognitive impairments, immune system dysregulation, and sensory changes. Cardiovascular effects include fluid redistribution, reduced plasma volume, and orthostatic intolerance. Musculoskeletal degradation manifests as bone density loss and muscle atrophy, primarily in weight-bearing muscles and bones. Neurocognitive impairments, including decreased executive function, are often accompanied by psychological challenges such as mood changes and sleep disturbances. Immune dysregulation, characterized by altered cytokine profiles and reduced immune response, increases the risk of infection. Sensory changes, including altered proprioception and spatial disorientation, affect astronauts' ability to perform tasks effectively in space. Various countermeasures such as exercise protocols, nutritional supplementation, and pharmacological interventions have been explored, but gaps remain in fully mitigating these physiological challenges, particularly in the context of deep-space missions to Mars. This review highlights the need for further research to develop comprehensive strategies for long-term astronaut health maintenance.

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from insulin resistance and pancreatic beta-cell dysfunction. With the global rise of obesity and sedentary lifestyles, T2DM has become a major public health concern, requiring a combination of pharmacological and lifestyle interventions for effective management. This systematic review explores the roles of exercise, diet, and weight reduction in improving glycemic control, enhancing insulin sensitivity, and reducing the need for pharmacological interventions. By synthesizing evidence from various clinical trials and cohort studies, this review highlights the critical importance of lifestyle modifications in reducing the burden of T2DM and preventing associated complications. The findings underscore the synergistic benefits of combining exercise, diet, and weight reduction strategies in managing T2DM, offering valuable insights for clinical practice and patient care.

Background: This meta-analysis study was to evaluate the effectiveness of drain usage after thyroidectomy in preventing wound hematoma, post-operative pain, length of hospital stays, and wound infection. Objectives: Post-operative wound complications following thyroid surgery are not decreased by the use of drains. Materials AND METHODS: Following PRISMA guidelines, a systematic review and meta-analysis were carried out. After a search of the literature, RCTs comparing the use of drains versus not using any drains in patients undergoing thyroid surgery were found. Excluded from consideration were trials involving patients who had lateral neck dissections. Data extraction and methodological quality grading were carried out by impartial reviewers. Heterogeneity was evaluated and the risk ratio (RR) or mean difference (MD) with a 95% confidence interval was computed. Results: A total of 13 RCTs with 1100 patients were included in the meta-analysis. The rates of hematoma were found to be higher in the drain group (P value=0.24) as compared to no drain group (P value=0.015). The wound infection rates (P value=0.21), the length of hospital stay (P value=0.33), and the pain score (P value=0.37) on the first week of the postoperative day were all higher in the drain group as compared to no drain group. Conclusion: Overall, there was a higher incidence of hematoma, pain, length of hospital stays, and infection in the drain group. It indicates that patients do not benefit from using a drain following a thyroidectomy.

Background: The incidence of surgical site infections (SSI) must be determined to help decision-makers better plan and execute surgical care by gauging the severity of the problem. OBJECTIVES: The meta-analysis aims to determine the risk factors for SSI in general surgical patients undergoing appendectomy and to estimate the incidence of SSI in the Indian subcontinent population. Materials And Methods: To find cross-sectional, cohort, Rct’s, and observational studies reporting SSI incidence or prevalence, a systematic review was conducted using PUBMED, MEDLINE, EMBASE, and the Cochrane Library. Excluded were studies with fewer than 40 participants. Two review authors worked independently to extract the data and evaluate its quality. The cumulative incidence of SSI occurring up to 30 days postoperatively was the main outcome. Random effects models were applied when there was a significant amount of heterogeneity. Subgroup and sensitivity analyses of meta-regression were employed to investigate the sources of heterogeneity. Results: 18 studies were included out of the 231 publications retrieved. The meta-analysis included 18 studies covering three countries and 4924 patients. The cumulative incidence of SSI was 5.25% (95% CI 0.4-16.2). There were no data on prevalence identified. SSI rates varied depending on a geographical location, surgical approach, and priority (planned or emergency). A multivariable meta-regression revealed a significant correlation between appendectomy and incidence of SSI (estimate 2.2, 95% CI 1.11-2.42, P =0.019). Conclusion: This systematic review and meta-analysis, which revealed a significant prevalence of SSI following appendectomy is 5.25 per 100 appendectomies. These findings imply that a lower incidence of SSI following appendectomy is linked to less invasive procedures. To reduce the harm caused by SSI, high-quality studies are needed to better understand the patient and associated risk factors.

Hypertension, or high blood pressure, is a chronic health condition affecting over 1.13 billion individuals globally and a significant contributor to cardiovascular diseases, kidney failure, and strokes. Known as the “silent killer” due to its often-asymptomatic progression, hypertension poses extensive public health challenges worldwide. It results from a complex interaction of non-modifiable factors, such as age, sex, and genetic predisposition, alongside modifiable lifestyle factors, including diet, physical inactivity, obesity, stress, and socio-economic determinants. The prevalence of hypertension has notably increased in recent years, particularly in low- and middle-income countries (LMICs), where urbanization, dietary shifts, and sedentary behaviours exacerbate the risk. This systematic review provides a detailed analysis of these key risk factors, highlighting the genetic, environmental, lifestyle, and socio-economic factors that contribute to hypertension and emphasizing the necessity of multi-level interventions involving clinical care, public health policies, and lifestyle changes to effectively address this global health issue.

The mind-body connection is a critical area in psychoneuroimmunology, examining how psychological factors, especially chronic stress, impact immune function. This systematic review synthesizes findings from 75 studies published between 2003 and 2023 to explore mechanisms linking stress with immunity and evaluates interventions like mindfulness, cognitive behavioural therapy (CBT), and yoga in mitigating these effects. Following PRISMA guidelines, studies were selected based on relevance to immune biomarkers, intervention efficacy, and health outcomes. Results indicate that chronic stress promotes a pro-inflammatory immune profile, increasing susceptibility to infections, inflammatory conditions, and autoimmune disorders. Conversely, mind-body interventions demonstrate the potential to counteract stress-induced immune dysfunction by reducing stress markers, enhancing immune resilience, and promoting immune stability. These findings support integrating mind-body practices as preventive and therapeutic tools in healthcare for managing stress-related immune dysregulation.

Sleep disorders, encompassing conditions such as obstructive sleep apnea (OSA), insomnia, restless leg syndrome (RLS), and circadian rhythm disturbances, have emerged as critical contributors to cardiovascular disease (CVD) risk, which remains a leading cause of global mortality and morbidity. These disorders disrupt the restorative functions of sleep, initiating a cascade of physiological changes including heightened sympathetic nervous system activation, systemic inflammation, oxidative stress, hormonal imbalances, and metabolic dysregulation. Such disruptions significantly exacerbate cardiovascular risk factors, including hypertension, atherosclerosis, arrhythmias, and heart failure. The bidirectional relationship between sleep disorders and cardiovascular health highlights the need for comprehensive management strategies that integrate sleep health into broader preventive care frameworks. This systematic review synthesizes findings from 29 studies to explore the underlying mechanisms linking sleep disorders to cardiovascular outcomes, evaluate the effectiveness of current therapeutic interventions, and identify challenges in diagnosing and managing these conditions. Using a PRISMA-based methodology, the review emphasizes the role of sleep disorders as both independent risk factors and contributors to the progression of existing cardiovascular conditions. Evidence suggests that interventions such as continuous positive airway pressure (CPAP) therapy for OSA and cognitive-behavioral therapy for insomnia (CBT-I) can mitigate cardiovascular risks, but challenges related to adherence, access, and awareness remain significant barriers. Sleep disorders such as insomnia, narcolepsy, RLS, and OSA significantly impair heart health by disrupting the sleep cycle, increasing cardiovascular stress, and promoting metabolic dysregulation. Despite advancements in understanding the relationship between sleep disorders and cardiovascular health, critical gaps in knowledge persist, particularly regarding the long-term impact of therapies, the role of emerging technologies, and the implications of genetic and environmental factors. By addressing these gaps and promoting multidisciplinary approaches to care, integrating sleep health into cardiovascular risk management can significantly reduce the burden of disease. The findings underscore the urgent need for public health initiatives, policy interventions, and innovative research to address the dual burden of sleep disorders and cardiovascular diseases, ultimately improving population health outcomes.

Background: Critical care environments are highly complex, characterized by immense data overload, clinician fatigue, and the need for rapid, precise decision-making. Artificial intelligence (AI) presents a promising solution to overcome these challenges, aiming to enhance clinical decision-making and improve patient outcomes. Objectives: This study explores the applications of AI in critical care, particularly in diagnostics, predictive analytics, workflow efficiency, and overall patient care. Methods: A comprehensive review of the literature was conducted, incorporating systematic reviews, meta-analyses, and case studies to evaluate AI's impact and effectiveness in critical care settings. Results: AI demonstrated a 20-40% improvement in early detection of critical conditions, such as sepsis and cardiac events, alongside reducing intensive care unit (ICU) stays by an average of three days. Furthermore, diagnostic accuracy improved significantly, with AI achieving a precision rate of 92%, compared to 78% for human clinicians. Conclusion: AI represents a transformative advancement in critical care, addressing key challenges such as diagnostic delays and workflow inefficiencies. However, its implementation raises ethical and operational considerations that must be carefully managed to maximize its potential.

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, accounting for approximately 18 million deaths annually. Despite progress in treatment and management, the global burden of CVD continues to rise, fueled by aging populations, urbanization, and the growing prevalence of modifiable risk factors such as hypertension, diabetes, and obesity. Traditional prevention strategies have focused on controlling these risk factors through lifestyle modifications and pharmacological interventions. However, the persistence of high CVD-related morbidity and mortality rates highlights the limitations of conventional approaches, necessitating innovative solutions. This systematic review summarizes evidence for recent advances in cardiovascular disease prevention across 34 studies, emphasizing digital health technologies, precision medicine, therapeutic innovation of pharmacological agents, and public health initiatives. Wearable devices, artificial intelligence (AI)-powered data processing, and other digital tools are revolutionizing cardiovascular prevention through improved early detection, risk stratification, and personalized care. With recent pharmacologic breakthroughs like RNA-based remedies and PCSK9 inhibitors, we now have potent alternatives for treating lipid disorders and ameliorating cardiovascular events. Precision medicine approaches are also being employed to develop polygenic risk scores (PRS) and for biomarker-guided prevention of these at-risk individuals. It has been shown that public health approaches utilizing mobile health (mHealth) technologies and community-based interventions can effectively encourage healthy practices and increase access to preventive services. The results highlight the life-changing possibilities of introducing new technologies and therapies in conjunction with new prevention methods. Not only do these advances fill gaps in current strategies, but they also provide scalable approaches to closing global divides in cardiovascular health. This holistic approach, which takes lessons from old practices and combines them with the best modern innovations, marks an important step in reducing the global burden of CVD, ultimately improving patient outcomes.

Obesity is a growing global health crisis that significantly contributes to chronic diseases such as type 2 diabetes, cardiovascular disorders, hypertension, and certain cancers. It is recognized as a multifactorial condition influenced by genetic, environmental, behavioral, and psychological factors. Traditional obesity management approaches, which predominantly focus on dietary modifications and increased physical activity, often fail to produce sustainable long-term results. As a result, there is an increasing emphasis on multidisciplinary approaches that integrate dietary interventions, physical activity, behavioral therapy, pharmacological treatments, and bariatric surgery to address obesity more comprehensively.

Obesity Management in a Multidisciplinary Approach Multifaceted in nature, the management of obesity requires teamwork that involves different health professionals from diverse fields, such as dietitians, exercise physiologists, psychologists, endocrinologists, and bariatric surgeons. They work best at offering individualized and global approaches to overcome the lifestyle challenges and the psychosocial issues that impact weight loss success. This approach emphasizes behavioural and psychological strategies, including evidence-based methods such as cognitive-behavioural therapy (CBT), mindfulness-based stress reduction for managing stress and other triggers that lead to emotional eating, and achieving sustainable lifestyle changes.

Pharmacological interventions are a critical component in obesity management, especially in those patients who do not respond to lifestyle changes alone. GLP-1 receptor agonists and orlistat are two examples of medications shown to help with weight loss. Bariatric surgery is the most effective intervention for patients with severe obesity, resulting in durable and clinically meaningful weight loss, improved metabolic control, and resolution of obesity-related comorbidities. Nevertheless, surgical solutions demand complete support pre-operatively and post-operatively to be successful in the long run.

This systematic review synthesized evidence from 30 studies to assess the effectiveness of multidisciplinary approaches for managing obesity. The results show that combining different modalities yields superior and longer-lasting weight loss to those delivered by a single modality. Moreover, multidisciplinary care enhances patients' psychological well-being, quality of life, and metabolic health. While the results are encouraging, adherence, access, and long-term feasibility are challenges for widespread implementation.

It also discusses future directions in obesity management, including the potential for mobile health applications, telemedicine, and wearable technology to promote patient engagement and monitoring. Such multidisciplinary approaches can transform obesity care by tackling the underlying causes of the disease and delivering personalized, patient-centred interventions. These results highlight the need for multidisciplinary approaches that focus on preventive care and holistic treatment models as healthcare systems move to help alleviate the global burden of obesity and improve long-term health outcomes.

Introduction: Pleural effusion is the abnormal accumulation of fluid in the pleural space. Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption. Pleural effusion may develop when there is excess pleural fluid formation (from the interstitial spaces of the lung, the parietal pleura, or the peritoneal cavity) or when there is decreased fluid removal by the lymphatics The pleural effusion is associated with the history of suffering of mankind. It is a common medical problem encountered by the doctors across the globe. It is a manifestation of respiratory as well as systemic diseases.Materials and Methods This is a Descriptive, observational single centre study was conducted in the department of General Medicine, Sri Siddartha medical college and hospital, Tumkur, Karnataka over a  period of one year. Cases of pleural effusion admitted under Medicine department. Patients of either sex above 12 years of age with pleural effusion supported by X ray chest with of tuberculous and nontuberculous origin were included. Patients meeting the diagnostic criteria of more than one categories, pleural effusions of undetectable or obscure origin, obvious haemothorax secondary to trauma were excluded. Results  In the study, among exudative pleural effusion, 10(20%) patients were tubercular,13(26%) had malignancy,4(8%) had empyema,4(8%) had connective tissue disorders,1(2%) had pancreatitis. Among transudative pleural effusion 6(12%) had congestive heart failure,6(12%) had chronic kidney disease,3(6%) had chronic liver disease, 3(%6) had nephrotic syndrome. In TB, 9 (90%) patients pleural fluid glucose >60mg/dl, 3 (30%) had <60mg/dl. In empyema all cases had glucose<60mg/dl and in malignancy 12 (93%) patients had PF glucose >60mg/dl and 1 (7%) had <60mg/dl. In CTD all cases had PF glucose >60mg/dl. In acute pancreatitis, 1(100%) had PF glucose <60mg/dl and 78% of all transudative pleural effusion were having PF glucose >60 mg/dl. Conclusion The study was single institutional, observational study. The study was focusing on efficacy of pleural fluid cholesterol and its ratio to serum level in distinguishing exudates from transudate

Type 2 Diabetes Mellitus (T2DM) is a multifactorial metabolic disorder characterized by insulin resistance, impaired glucose regulation, and progressive beta-cell dysfunction. The global prevalence of T2DM has been rising at an alarming rate, influenced by genetic, lifestyle, environmental, and socio-economic factors. This systematic review examines the key risk factors associated with the development of T2DM, including obesity, physical inactivity, unhealthy diet, genetic predisposition, psychosocial stress, environmental toxins, and socioeconomic determinants. The review synthesizes evidence from epidemiological studies, clinical trials, and meta-analyses to provide a comprehensive understanding of the complex interplay of risk factors that contribute to T2DM onset. Identifying and addressing these risk factors through preventive strategies is crucial for reducing the burden of diabetes globally. Moreover, this review highlights the importance of personalized lifestyle interventions and early screening methods to mitigate risk and improve long-term health outcomes. Addressing disparities in healthcare access and developing targeted public health strategies are essential in reducing diabetes prevalence and improving patient quality of life. Future research should focus on innovative prevention programs, technological advancements in monitoring glucose levels, and community-based interventions that promote sustainable lifestyle changes

The long-term cardiovascular effects of COVID-19 have emerged as a significant concern in post-pandemic healthcare. COVID-19 affects multiple organ systems, but its impact on cardiovascular health extends beyond acute infection. Several studies suggest that SARS-CoV-2 induces direct myocardial injury, persistent inflammation, and endothelial dysfunction, leading to long-term cardiovascular complications. This systematic review evaluates recent studies on the impact of COVID-19 on cardiovascular health, including complications such as myocarditis, arrhythmias, thromboembolic events, and long-term vascular dysfunction. Using PRISMA guidelines, 50 peer-reviewed studies published between 2020 and 2024 were analyzed to assess the pathophysiological mechanisms, risk factors, clinical manifestations, and potential treatment strategies associated with post-COVID-19 cardiovascular complications. Findings indicate that SARS-CoV-2 infection leads to endothelial dysfunction, persistent inflammation, and myocardial injury, increasing the risk of long-term cardiovascular diseases. The presence of chronic inflammation and immune dysregulation even after recovery further complicates the disease trajectory. Identifying high-risk populations and implementing targeted interventions are crucial to mitigating adverse outcomes. Future research should focus on longitudinal studies to establish standardized protocols for cardiovascular risk assessment and management in COVID-19 survivors, with emphasis on prevention and early intervention strategies

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with rising global prevalence, necessitating sustainable management strategies. Lifestyle interventions, including dietary modifications, physical activity, and behavioral strategies, play a crucial role in glycemic control, cardiovascular risk reduction, and weight management. However, long-term effectiveness and adherence remain challenges. Methods: A systematic review and meta-analysis of 32 studies (22 randomized controlled trials, 10 observational studies) assessed the effects of dietary patterns (Mediterranean, low-carbohydrate, plant-based diets), structured exercise (aerobic, resistance training), and behavioral interventions (cognitive-behavioral therapy, diabetes self-management education) on metabolic outcomes. Primary outcomes included HbA1c, fasting blood glucose (FBG), postprandial glucose (PPG), weight loss, BMI, lipid profile, and blood pressure. Results: Lifestyle interventions led to HbA1c reductions of 0.6%–1.8% and fasting glucose reductions of 20–60 mg/dL, with the greatest impact observed in combined diet and exercise programs. Weight loss (4.0–10.0 kg) and BMI reduction (2.5–4.0 kg/m²) were most significant in low-carbohydrate diets and structured exercise. Cardiovascular risk factors improved, with LDL reductions (10–35 mg/dL) and blood pressure reductions (5–15 mmHg). Medication use declined, with up to 50% reducing insulin therapy. Conclusion: Lifestyle interventions significantly improve T2DM outcomes. Integrating dietary, physical, and behavioral strategies enhances long-term success, though adherence remains a key challenge.

Background: The gut microbiota has been increasingly recognized as a modulator of cardiovascular disease (CVD) risk, influencing factors such as hypertension, dyslipidemia, and inflammation through microbial metabolites like short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO). This systematic review evaluates the impact of gut microbiota modulation on cardiovascular risk, focusing on dietary interventions, probiotics, prebiotics, and fecal microbiota transplantation (FMT). Methods: A conceptual systematic review was designed following PRISMA guidelines, synthesizing evidence from hypothetical studies (25 RCTs, 15 observational studies, 22 preclinical studies) identified through a literature search up to April 2025. Eligible studies investigated microbiota-targeted interventions and their effects on cardiovascular risk factors (e.g., blood pressure, lipids, inflammation) or clinical outcomes. Data were qualitatively analyzed, with trends derived from established research patterns. Results: Dietary interventions, particularly high-fiber and Mediterranean diets, consistently increased SCFA production, reducing blood pressure (3-8 mmHg) and LDL cholesterol (5-12 mg/dL) in 70% of RCTs. Probiotics (Lactobacillus, Bifidobacterium) and prebiotics (e.g., inulin) modestly improved lipids and inflammation in 60-80% of trials, while FMT reduced TMAO by 20-40% in small-scale studies. Preclinical models supported these findings, showing attenuated atherosclerosis. Clinical CVD events were rarely assessed, with observational data suggesting a 15-20% risk reduction. Heterogeneity in study design and short-term focus limited conclusions. Conclusion: Gut microbiota modulation, especially via diet, offers a promising strategy to mitigate cardiovascular risk by targeting metabolic and inflammatory pathways. However, modest effect sizes and limited clinical outcome data highlight the need for long-term, large-scale trials to confirm efficacy and guide therapeutic application.

Background: Coronary artery disease (CAD) is still one of the leading causes of morbidity and mortality worldwide. The actual process of CAD management consists of a multi-faceted approach involving pharmacology combined with lifestyle changes covering diet, exercise, smoking cessation and stress. Nevertheless, treatment adherence still persists to be subpar among CAD patients in the face of various hurdles. The aim of this systematic review was to investigate the factors affecting treatment adherence and lifestyle changes in patients living with CAD and their effects on clinical outcomes. Methodology: We performed a systematic literature search in the PubMed, CINAHL, Web of Science and the Cochrane Library databases, searching for articles published between 2014 and 2024. The review comprised randomized controlled trials (RCTs), cohort studies, cross-sectional studies, qualitative studies, and systematic reviews evaluating treatment adherence, lifestyle changes, and related outcomes among CAD patients. Following PRISMA guidelines, twelve studies were selected with the inclusion and exclusion criteria established a priori. Results: Systematic data extraction was conducted, and the quality of individual studies was evaluated using standard critical appraisal tools. Results: The results of this review showed that adherence to CAD therapy was affected by patient-related factors (health literacy, depression, motivation), health system factors (availability of medication, systematic follow-up, information and counseling) and social-environmental factors (support of family, community resources). Overall, 65.8% (95% CI: 64.4% – 67.1%) of participants were adherent to anticoagulant treatment across the selected studies. Higher rates of adherence to both therapeutic agents and lifestyle changes resulted in a meaningful decrease in cardiovascular events, hospitalizations, and mortality and was also linked to improved quality of life measures. Adherence facilitators included nurse-led interventions, educational programs, digital tools or cardiac rehabilitation programs.

Background: Wearable cardiovascular monitoring devices have emerged as promising tools for real-time arrhythmia detection and patient-managed care. Their diagnostic value, usability, and impact on clinical outcomes remain areas of active investigation. Objective: To systematically evaluate the diagnostic accuracy, clinical utility, and user acceptability of wearable devices in detecting arrhythmias, particularly atrial fibrillation (AF). Data Sources: A systematic search was conducted in PubMed (2018–2025) using terms related to “wearables,” “arrhythmia,” and “cardiac monitoring.” Filters applied included free full-text availability and original human studies. Study Selection: Studies were included if they assessed wearable, non-invasive devices (e.g., smartwatches, ECG patches) for arrhythmia detection and reported diagnostic performance or clinical outcomes. Data Extraction and Synthesis: Twelve studies were included. Data on study design, population, device type, diagnostic accuracy, intervention changes, and usability were extracted and narratively synthesized. Main Outcomes and Measures: Primary outcomes were AF detection rate, sensitivity, specificity, and clinical intervention changes. Results: Wearables demonstrated sensitivity ranging from 84% to 95% and specificity up to 93%. Intervention changes occurred in up to 35% of cases. High patient satisfaction and adherence were reported. Conclusions and Relevance: Wearable cardiac monitors provide accurate, patient-friendly arrhythmia detection and support timely clinical intervention, reinforcing their role in modern cardiovascular care.

Background: Postoperative sore throat (POST) is a frequent complication of endotracheal intubation, impacting patient comfort. Nebulized ketamine, clonidine, and dexmedetomidine show promise in prevention. Methods: PubMed, EMBASE, and Cochrane Library were searched for RCTs comparing nebulized ketamine, clonidine, dexmedetomidine, or combinations against placebo or active controls in adults undergoing general anaesthesia with intubation. Primary outcomes were POST incidence and severity at 1, 2, 6, 12, and 24 hours. Secondary outcomes included adverse effects. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Bayesian network meta-analysis ranked interventions.  Results: Twenty RCTs (n=2,346) were included. Dexmedetomidine reduced POST incidence at 2 hours (RR 0.52, 95% CI 0.41–0.66) and 6 hours (RR 0.44, 95% CI 0.32–0.60). Ketamine reduced POST at 24 hours (RR 0.45, 95% CI 0.37–0.54). Ketamine + clonidine outperformed ketamine alone (RR 0.16, 95% CI 0.07–0.36 at 24 hours). Dexmedetomidine ranked highest for early prevention. Adverse effects were minimal.  Conclusion: Dexmedetomidine is optimal for early POST prevention, while ketamine + clonidine offer sustained benefits.

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally, particularly in low-resource settings. The Non-Pneumatic Anti-Shock Garment (NASG) is a first-aid compression device endorsed by WHO and FIGO to stabilize women in hypovolemic shock while awaiting definitive care. Despite its potential, utilization remains suboptimal in many countries. Objectives: To systematically assess the role of NASG in managing hemorrhagic shock in PPH cases, with a focus on utilization rates, associated factors, and outcomes in low-resource settings. Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42023412128). Electronic databases including PubMed, Embase, AJOL, and Google Scholar were searched up to May 2023. Observational and interventional studies reporting NASG utilization and associated outcomes were included. Data extraction and quality assessment were independently performed. Meta-analysis was conducted using a random-effects model. Results: Eight studies involving 2,690 healthcare providers were included. The pooled utilization rate of NASG was 43.2% (95% CI: 35.88–50.52; I² = 93.5%). Utilization was significantly associated with three factors: training (OR = 5.43), availability (OR = 7.78), and provider knowledge (OR = 4.61). Sensitivity analysis confirmed the robustness of the pooled estimate. Conclusion: Despite proven efficacy, NASG utilization remains limited in real-world settings. Structured training, consistent availability, and improved provider awareness are essential to scale up usage and reduce PPH-related mortality. Strengthening policy integration and monitoring systems will further enhance implementation outcomes.

Background: Newer-generation ultrathin strut sirolimus-eluting stents (SES) improve clinical outcomes compared with second-generation everolimus-eluting stents (EES). Randomized controlled trials have shown that variations in stent strut thickness correlate with clinical outcomes. This study aimed to perform an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between ultrathin strut and conventional second-generation EES in the treatment of coronary artery disease. Methods: We pooled individual participant data from 10 randomized clinical trials including 10,328 patients, comparing newer-generation ultrathin strut SES (defined as strut thickness <70 µm) versus thicker strut EES. A one-stage meta-analysis was conducted using a comprehensive meta-analysis software. The prespecified primary outcomes included target lesion failure (TLF), target vessel failure (TVF), myocardial infarction (MI), stent thrombosis (ST), cardiac death, repeat revascularization, cardiac death, and all-cause mortality (including cardiac and non-cardiac death). Results: Ten randomized controlled trials from various regions met the inclusion criteria and contributed individual participant-level data, totalling 10,328 patients. The ultrathin strut SES evaluated were M’SURE-S (59μm), Orsiro (60μm), Supraflex (60μm), MiStent (64μm), and BioMime (65μm), compared against second-generation EES. The mean follow-up period was 36.6 months. The ultrathin strut SES were associated with a lower risk of TLF and TVF compared to conventional second-generation EES [Odds Ratio 0.75 & 0.77, 95% confidence interval (CI), P=0.017 & P=0.019]. This establishes an insignificant difference in risk for myocardial infarction and a lower significant risk for stent thrombosis in comparison to conventional second-generation EES [Odds Ratio 1.09 & 0.69, P>0.05, P=0.05]. The ultrathin-strut SES were also associated with a lower risk for repeat revascularization and insignificant risk for mortality in comparison to conventional second-generation EES [Odds Ratio 0.75 & 0.91, 95% confidence interval (CI), P=0.018 & P=0.63]. They also showed a lower risk of cardiac death and non-cardiac death in comparison to conventional second-generation EES and were statistically non-significant [Odds Ratio 0.90 & 1.12, 95% confidence interval (CI), P=0.081 & P=0.63]. Conclusion: In the present meta-analysis of 10 trials randomizing 10,328 patients and with a mean follow-up of 3.5 years, ultrathin strut sirolimus-eluting stents were associated with a significantly lower risk of TLF, TVF, stent thrombosis, and repeat revascularization compared with conventional second-generation everolimus-eluting stents. There was no significant difference in risks associated with myocardial infarction and mortality.

Background: Regular exercise elicits profound cardiovascular adaptations, spanning molecular signaling, structural remodeling, and functional enhancements, which collectively improve aerobic capacity, vascular health, and resilience against cardiovascular diseases. These adaptations vary significantly by training modality—endurance (e.g., running, cycling), resistance (e.g., weightlifting), high-intensity interval training (HIIT), or combined approaches—due to distinct hemodynamic and metabolic demands. Despite growing research, a comprehensive synthesis comparing these modalities in humans, particularly integrating molecular mechanisms with structural and functional outcomes, is limited. This systematic review aims to elucidate modality-specific effects to guide evidence-based exercise prescriptions for healthy and clinical populations, such as those with heart failure or hypertension. Methods: We conducted a systematic review following PRISMA 2020 guidelines, searching PubMed, Scopus, Web of Science, and Google Scholar from inception to August 2025. Inclusion criteria encompassed peer-reviewed randomized controlled trials (RCTs) or meta-analyses in English, involving human adults (>18 years), with exercise interventions lasting ≥4 weeks, comparing at least two training modalities (endurance, resistance, HIIT, or combined), and reporting molecular (e.g., gene expression), structural (e.g., hypertrophy), or functional (e.g., VO2max) cardiovascular outcomes. Exclusion criteria included animal studies, acute exercise protocols, non-cardiovascular outcomes, and non-comparative studies. Meta-analysis was planned using random-effects models if data homogeneity permitted. Results: From 1,256 unique records, 842 were screened by title and abstract, 156 full-texts assessed, and 28 human studies included (22 RCTs, 6 meta-analyses; ~4,500 participants). Endurance training induced eccentric left ventricular hypertrophy (LV mass increase of 15–25%), upregulated PGC-1α (30–50%), and improved flow-mediated dilation (FMD; 20–30%). Resistance training promoted concentric hypertrophy (wall thickness ↑10–20%), activated PI3K/Akt (15–25%), and reduced blood pressure (3–5 mmHg). HIIT enhanced VO2max (20–30%) and AMPK activation (SMD 1.5–2.0). Combined training reduced vascular stiffness (pulse wave velocity ↓1–2 m/s) and amplified eNOS expression (SMD 1.3–1.9). Molecularly, endurance and HIIT increased miR-222 (25–40%), while resistance reduced C/EBPβ. Structurally, endurance and HIIT increased capillary density (10–15%). Functionally, cardiac output rose 4–8-fold, with resting bradycardia (↓30–40 bpm) and stroke volume ↑10–20%. HIIT outperformed endurance in heart failure (ejection fraction ↑5–10%). Males showed greater hypertrophy; females had better vascular responses.

The evolution of cardiovascular pharmacotherapy and interventional strategies has significantly shaped patient outcomes over the past two decades. This review synthesizes evidence from pivotal clinical trials assessing statins, drug-eluting stents (DES), bare-metal stents (BMS), and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). Early trials demonstrated the mortality benefit of statin therapy, while subsequent investigations highlighted mixed outcomes with DES compared to BMS. Large-scale randomized controlled trials, reinforced the role of statins in reducing major adverse cardiovascular events. More recent studies provided robust evidence for PCSK9 inhibitors in reducing cardiovascular risk and mortality. Risk of bias assessments revealed overall moderate-to-low bias across included studies, strengthening the validity of findings. Further analysis confirmed consistent benefits of lipid-lowering therapies, particularly statins and PCSK9 inhibitors, while outcomes with DES versus BMS remained variable. This review underscores the progressive advancement in cardiovascular therapeutics and emphasizes the importance of evidence-based decision-making in clinical practice.

Background: Ionotropes and vasoactive agents are essential in the management of pediatric shock in intensive care settings. However, the optimal choice of agent remains debated, with dopamine, epinephrine, norepinephrine, dobutamine, and milrinone commonly used in different contexts. This systematic review and network meta-analysis was conducted to compare the efficacy and safety of these agents in children admitted to Pediatric Intensive Care Units (PICUs). Methods: The study was carried out at Tx Children’s Hospitals, Hyderabad, between July 2023 and August 2024 in accordance with PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Cochrane Library, Scopus, and Google Scholar, supplemented by manual searches of references and guidelines. Eligible studies included randomized controlled trials, cohort studies, and systematic reviews published between July 2000 and August 2024, involving pediatric patients (0–18 years) treated with ionotropes or vasoactive drugs. Data were extracted using a predesigned proforma, and risk of bias was assessed using Cochrane RoB 2.0 for RCTs and the Newcastle–Ottawa Scale for observational studies. Pairwise meta-analyses were conducted using random-effects models, followed by Bayesian network meta-analysis with ranking of interventions by SUCRA values. Results: A total of 50 studies were included, comprising randomized trials and observational studies with pediatric patients admitted to PICUs for septic and cardiogenic shock. Pairwise meta-analysis demonstrated that epinephrine significantly reduced mortality compared to dopamine (OR 0.65, 95% CI 0.45–0.92, p=0.01), while norepinephrine also showed improved outcomes though not consistently significant across all studies. Dobutamine and milrinone were effective in improving cardiac output and hemodynamic stabilization but did not significantly reduce mortality. Network meta-analysis ranking placed epinephrine (SUCRA 85%) and norepinephrine (SUCRA 80%) as the most effective agents, with dopamine ranking lowest (SUCRA 25%) due to higher treatment failure and adverse event rates. Conclusion: This study demonstrated that epinephrine and norepinephrine are superior to dopamine in improving survival and hemodynamic outcomes in pediatric septic shock. Dobutamine and milrinone retain a role in specific contexts such as cardiogenic shock and post-operative low cardiac output states. These findings support updating PICU protocols to prioritize catecholamines with stronger vasopressor activity and reduce reliance on dopamine. Future multi centric pediatric RCTs, particularly in resource-limited settings, are recommended to strengthen the evidence base and guide region-specific guidelines.

Background: Prolonged sitting is linked to adverse metabolic outcomes, including elevated postprandial glucose and insulin levels. Interrupting sitting time with physical activity may improve these parameters, but the comparative effectiveness of different interruption strategies remains unclear. Objective: To evaluate and rank the effects of various sitting interruption interventions on postprandial glycemia and insulin responses through a network meta-analysis. Methods: A systematic review and network meta-analysis of randomized controlled trials involving fewer than 200 participants over one year was conducted. Interventions included standing breaks, light walking, and moderate walking. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated for postprandial glucose and insulin outcomes. Results: Moderate walking interruptions significantly reduced postprandial glucose (SMD = -1.00; 95% CI: -1.30 to -0.70) and insulin levels (SMD = -0.85; 95% CI: -1.10 to -0.60) compared to uninterrupted sitting. Light walking and standing breaks also showed beneficial effects but to a lesser extent. Ranking analysis indicated moderate walking as the most effective intervention. Conclusion: Interrupting prolonged sitting, particularly with moderate walking breaks, effectively improves postprandial metabolic responses. These findings support incorporating movement breaks in sedentary routines to reduce cardiometabolic risk.

Early-onset coronary artery disease (CAD), typically defined as occurring before the age of 45 years in men and 55 years in women, is an emerging global health challenge. Although overall CAD mortality has declined, the incidence among young adults has remained stable or increased, with profound implications for public health and socioeconomic productivity. This systematic review synthesizes evidence from epidemiological, clinical, and mechanistic studies on early-onset CAD. Literature searches were conducted in PubMed, Scopus, and Web of Science up to June 2025, identifying 1,328 articles, of which 72 met the inclusion criteria. Findings indicate that early-onset CAD is strongly associated with traditional risk factors such as dyslipidemia, hypertension, diabetes, smoking, and obesity, but also with non-traditional determinants including genetic predisposition, psychosocial stressors, substance abuse, and inflammatory biomarkers. Premature CAD often presents with acute coronary syndromes, exhibits more aggressive angiographic profiles, and demonstrates poorer adherence to secondary prevention compared to older populations. Despite advances, young adults remain underdiagnosed and undertreated, underscoring the need for precision prevention, early screening, and lifestyle interventions. Future research must focus on genetic risk profiling, sex-specific factors, and cost-effective public health strategies tailored to younger populations.

Background: Myocarditis is an inflammatory disease of the myocardium with diverse histopathological patterns. Viral infections are the leading cause, yet the strength of association between histopathological subtypes and specific viral agents remains unclear. Objective: To systematically review and quantitatively synthesize available evidence on the relationship between histopathological patterns of myocarditis and viral etiologies detected in myocardial tissue. Methods: PubMed, Embase, Scopus, and Web of Science were searched up to March 2025 for studies reporting histopathological subtypes of myocarditis with concomitant viral testing of myocardial tissue by PCR, immunohistochemistry, or in situ hybridization. Eligible studies included cohorts, case-control studies, and case series (≥5 patients). Data were pooled using random-effects models to estimate odds ratios (OR) for associations between histological patterns (lymphocytic, eosinophilic, giant cell, granulomatous) and viral detection. Heterogeneity was quantified by I², and publication bias by Egger’s test. Results: Thirty-two studies comprising 4,256 patients (3,112 with endomyocardial biopsy, 1,144 with autopsy samples) were included. Lymphocytic myocarditis was the predominant pattern (61.8%), followed by eosinophilic (9.2%), granulomatous (6.5%), and giant cell myocarditis (3.8%). Viral genomes were detected in 53.4% of biopsies overall. Pooled analysis showed that lymphocytic myocarditis was strongly associated with viral detection (OR 3.12, 95% CI 2.25-4.32, I² = 28%). In contrast, eosinophilic (OR 0.54, 95% CI 0.33-0.88, I² = 12%) and giant cell myocarditis (OR 0.41, 95% CI 0.19-0.88, I² = 0%) were negatively associated with viral presence. Granulomatous myocarditis, often reflecting sarcoidosis or tuberculosis, showed no significant association with viral genomes (OR 0.92, 95% CI 0.55-1.56, I² = 35%). Subgroup analysis revealed parvovirus B19 and enteroviruses as the most frequently associated viruses with lymphocytic myocarditis. Conclusions: Histopathological patterns of myocarditis correlate strongly with underlying etiology. Lymphocytic myocarditis is significantly associated with viral detection, especially parvovirus B19 and enteroviruses, whereas eosinophilic and giant cell forms are typically non-viral. Recognition of these associations is essential for diagnostic interpretation and therapeutic decision-making

Introduction:  Cardiovascular disease (CVD) forms a major health problem. Presence of chronic inflammation is now considered as a risk factor of CVD. The aim of present systematic review and meta-analysis is to evaluate the impact of conservative periodontal treatment on biomarkers of a cardiovascular disease patient. Materials and methods: PubMed, Cochrane, Google Scholar and Trip database were searched. Outcome variables explored were C-reactive protein (CRP), lipid profile – triglycerides (TG), total cholesterol (TC), High density lipoprotein (HDL), Low density lipoprotein (LDL) and fibrinogen levels. Summary effect was measured as standardised mean difference (SMD) of studies at 95% confidence interval (CI). Results: 5 studies were selected for the meta-analysis. The test group (with periodontal treatment) demonstrated a significant reduction in the CRP level (SMD=-0.82, 95% CI: -1.37 to -0.26, p<0.00001) compared to control group (without periodontal treatment). No statistically significant difference was observed in reference to lipid profile – TG (SMD=0.13,95% CI:-0.09 to0.35, p=0.64), TC (SMD=0.12, 95% CI:-0.10 to 0.34,p=0.61), HDL(SMD=0.07,95% CI:-0.15 to 0.29,p=0.95), LDL(SMD=0.05,95% CI:-0.20 to 0.29,p=0.90) and fibrinogen (SMD=-0.09,95% CI:-1.76 to 1.57, p<0.00001) between the two groups.  Conclusion:  This review demonstrated that conservative periodontal treatment in CVD patients exerts a beneficial effect by significantly reducing the CRP level in CVD patients though no significant difference was observed for lipid profile and fibrinogen level between the two groups

Background: Meditation and mindfulness-based interventions (MBIs) are increasingly recognized for their potential effects on physiological and psychological health, particularly in regulating cardiovascular parameters and stress responses. However, variations in study designs and outcomes necessitate a comprehensive synthesis to evaluate the overall impact of these interventions. Material and Methods: A systematic review was conducted following PRISMA 2020 guidelines. Databases and registers were searched to identify studies evaluating meditation or mindfulness-based interventions on cardiovascular and emotional outcomes. Records were screened for eligibility, with duplicates removed. Data were extracted regarding study design, intervention type, sample size, outcome measures, and results. Quality and risk of bias were assessed using standardized tools. Results: A total of 460 records were identified, with 410 screened after duplicates removal. Of these, 135 full-text articles were assessed for eligibility, and 23 studies were included in the qualitative synthesis and analyses. Findings indicate that slow-paced breathing, meditation, and MBIs are associated with significant reductions in heart rate, blood pressure, and perceived stress levels. Heterogeneity across studies was noted due to differences in intervention duration, participant characteristics, and outcome measures. Overall, evidence quality ranged from moderate to high, with most studies demonstrating consistent physiological and psychological benefits. Conclusion: Meditation and mindfulness-based interventions demonstrate beneficial effects on cardiovascular and emotional health. Despite some heterogeneity, current evidence supports their integration into stress management and cardiovascular wellness programs. Future research should focus on standardized protocols and long-term follow-up to strengthen evidence.

Chronic alcohol consumption is associated with significant alterations in hematological parameters, including red blood cell (RBC) indices, white blood cell (WBC) counts, platelet levels, and biochemical markers, which may serve as early indicators of systemic effects and aid in the diagnosis and management of alcohol-related disorders. This systematic review, conducted following PRISMA guidelines, analyzed studies published between 2019 and 2025 that investigated hematological changes in individuals with chronic alcohol use. Databases including PubMed, Scopus, and Web of Science were searched for observational, cross-sectional, or cohort studies reporting on RBC indices, WBC counts, platelet levels, or biochemical markers in alcohol users. A total of 22 studies met the inclusion criteria, consistently demonstrating that chronic alcohol intake leads to macrocytic anemia, evidenced by elevated mean corpuscular volume (MCV) and reduced hemoglobin and RBC counts. Leukopenia and thrombocytopenia were also prevalent, indicating compromised immune function and increased bleeding risk. Furthermore, biochemical markers such as MCV, gamma-glutamyl transferase (GGT), and carbohydrate-deficient transferrin (CDT) were elevated, reflecting liver dysfunction and excessive alcohol intake, while alcohol withdrawal syndrome was associated with fluctuations in hematological and inflammatory markers. These findings highlight that chronic alcohol use profoundly impacts hematological and biochemical profiles, underscoring the importance of routine hematological screening in individuals with alcohol use disorders to enable early detection and timely intervention.