Vein of Galen malformations (VOGMs) are congenital arteriovenous shunts that typically present in neonates and infants. Symptomatic neonates have a poor prognosis and face high mortality without dedicated neonatal intensive care and pediatric neurointervention in specialized centers. The authors present the case of a 47-year-old Puerto Rican female with a history of chronically compensated heart failure, progressive cognitive decline, and new-onset seizures. On presentation, the patient had a Glasgow Coma Scale score of 6, and CT imaging revealed intraventricular hemorrhage, extensive parenchymal calcifications, and hydrocephalus. An external ventricular drain was urgently placed, and further workup at the authors' institution, including CT angiography and digital subtraction angiography, led to the diagnosis of a choroidal VOGM. The patient's family opted for withdrawal of care without pursuing further neurosurgical intervention. The presentation of a choroidal VOGM at this advanced age is exceptionally rare. This case highlights the importance of understanding the presentations and consequences of this life-threatening condition, as well as considering endovascular or microsurgical intervention. Specifically, workup for cerebrovascular abnormalities should be strongly considered in patients with neurodegenerative presentations at atypical ages without a clear cause, as early diagnosis and management can significantly impact patient outcomes. https://thejns.org/doi/10.3171/CASE25684.
Ectopic pregnancy is considered the most common cause of pregnancy-related deaths in the first trimester. Methotrexate is recognized as an effective drug for the treatment of ectopic pregnancy. The aim of this study was to determine the associated and predictive factors for success in medical treatment among patients with ectopic pregnancy (EP). After collection of Demographic information, serum β-hCG levels and ultrasound findings were evaluated and compared between two groups: those with successful medical treatment and those without. The mean β-hCG level have not significant difference between the two groups (P=0.806). The frequency of previous IUD use in the successful treatment group was 8%, while there were no cases in the failure group; however, this difference was not statistically significant (P=0.547). The frequency of prior EP, the observed frequency of hematoma and the frequency of tubal ring observation, which also showed no significant difference (respectively P=0.9, P=0.9 and P=0.111). Logistic regression analysis revealed that none of the investigated variables were significant predictors of treatment success. However, the presence of a tubal ring (OR: 6.500, 95% CI: 0.799-52.897, p = 0.080) and increased endometrial thickness (OR: 1.317, 95% CI: 0.971-1.786, p = 0.077) showed borderline significance. Commonly considered factors, such as gestational age, β-hCG levels, patient age, parity, and gravidity, did not significantly influence treatment success. The study highlights a high success rate for single-dose methotrexate therapy and the potential utility of tubal ring and endometrial thickness as clinical indicators, warranting further investigation. The results of this study indicate that single-dose methotrexate treatment for tubal ectopic pregnancy leads to a high success rate. Given the sample size of this study, none of the variables had a significant impact on treatment success or predictive power.
Post-modern medicine signifies a paradigm shift in healthcare by integrating the strengths of both modern biomedical science and traditional medical systems. This article explores the potential of a holistic approach that combines evidence-based practices with time-tested methodologies rooted in historical medical traditions. Emphasis is placed on prevention, diagnosis, and treatment to achieve a more comprehensive and personalized understanding of health and disease. By examining the unique contributions of each system, this integrative perspective aims to enhance patient outcomes in both human and veterinary medicine. Post-modern medicine signifies a paradigm shift in healthcare by integrating the strengths of both modern biomedical science and traditional medical systems. This article explores the potential of a holistic approach that combines evidence-based practices with time-tested methodologies rooted in historical medical traditions. Emphasis is placed on prevention, diagnosis, and treatment to achieve a more comprehensive and personalized understanding of health and disease. By examining the unique contributions of each system, this integrative perspective aims to enhance patient outcomes in both human and veterinary medicine.
Quadrigeminal cavernomas are rare midbrain cavernous malformations with potential for recurrent hemorrhage, aqueductal compression, hydrocephalus, brainstem dysfunction, and death. Surgical management is complicated when a developmental venous anomaly (DVA) is associated with the lesion, as injury to this venous drainage can result in brainstem infarction. Therefore, treatment must balance definitive lesion control with meticulous preservation of the DVA. A 26-year-old man presented with an episode of acute headache and was found on magnetic resonance imaging to have a right dorsolateral quadrigeminal cavernoma (9.4 × 9.5 mm), with associated hemorrhage, triventricular hydrocephalus, and a DVA draining into the vein of Galen complex. Endoscopic third ventriculostomy was initially performed to temporize hydrocephalus, and he was discharged without deficit. Five months later, he re-presented with recurrent headache. Repeat imaging demonstrated interval lesion enlargement, rehemorrhage, and recurrent hydrocephalus. An external ventricular drain was placed. Given the patient's young age, recurrent hemorrhage, lesion growth, and ongoing obstructive hydrocephalus, definitive microsurgical resection under neuromonitoring was recommended. A subtemporal approach through the supratrochlear corridor using the lateral mesencephalic safe entry zone was selected to optimize access while preserving the vein of Labbe. Gross-total resection was achieved without neurological deficit, with preservation of the DVA and restoration of aqueductal patency. Quadrigeminal cavernomas with associated DVA require individualized operative planning because the DVA commonly drains into the deep venous system or the vein of Galen complex. In selected patients, the subtemporal supratrochlear route provides effective access for safe resection and minimizes neurological morbidity.
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, typically classified as either ulcerative colitis (UC) or Crohn's disease (CD). The treatment approaches for both UC and CD have changed substantially over the last 10 years, going from step-up to top-down approaches and culminating in treat-to-target algorithms. In addition to the evolution of treatment strategies for IBD, disease endpoints have also changed from symptom-based outcomes to more objective measures, including endoscopy, with histology and transmural healing currently under investigation. In this narrative review, we describe recent advances in the treatment of patients with IBD, with a focus on vedolizumab, the first and only anti-lymphocyte trafficking agent approved as a gut-selective biologic for induction and maintenance therapy in IBD. Furthermore, with the approval of more biologic agents, there remains a need to determine the sequence in which biologics should be used, both individually and in combination. Substantial progress has been made in the last decade, and even though biomarkers and algorithmic trials have been largely disappointing, other avenues, such as clinical decision support tools, prognostic tools, and new approaches incorporating computational biology, have the potential to more effectively curate a tailored approach to IBD therapy in the coming years. A decade of progress: how vedolizumab has changed research and medical care for people with inflammatory bowel disease Inflammatory bowel disease, also known as IBD, is a life-long illness caused by inflammation of the gut. This means that the gut becomes swollen and irritated. For reasons we don’t understand, the immune system makes gut inflammation worse over time. In 2014, a medication called vedolizumab was approved for IBD. Vedolizumab works by preventing certain immune cells from reaching the gut, which can help reduce inflammation. This review describes improvements in IBD treatment over the last 10 years, with a focus on vedolizumab. Studies have shown that a person’s symptoms don’t always tell doctors if their IBD is getting better or worse. Instead, experts say that treatments should aim to heal the gut, not just reduce symptoms of IBD. Many studies using vedolizumab have looked at gut healing in people with IBD. Also, many new medications for IBD have become available in the last decade. However, doctors need better guidance on when to use each medication, in what order, and whether they can be used together. Research has looked at how well these medications, including vedolizumab, work and how safe they are. This information can help doctors create better step-by-step treatment plans for people with IBD. Looking to the future, doctors hope to choose medications based on what will work best for each person. This is called precision medicine. To support this, researchers have created a tool that can help doctors predict how well someone will respond to vedolizumab by using details about their medical history. Overall, our understanding of IBD and how to treat it has changed a lot in the last 10 years. Vedolizumab will continue to play an important role in IBD research and patient care.
Aims. For a study on the timeline of gout from the Corpus Hippocraticum to the Renaissance, encompassing some 26 authors, we have focussed on a Latin manuscript - "De podagra" - of the Middle Ages (posthumous edition dated to the 7th-8th century AD) of Rufus of Ephesus (98-117 AD), during the reign of Trajan. A multipurpose study has been devised to 1) translate into English and Italian the Medieval Latin treatise of the 7th-8th century AD of Rufus of Ephesus on "De podagra"; 2) define the role of Rufus in the historical timeline of gout from the Corpus Hippocraticum to the Renaissance ; 3) analyze causes, clinical presentations and therapy of acute attacks and chronic gout; and 4) identify the plant-based remedies described therein. Neither an English nor an Italian translation of "De podagra", nor the identification of the plants described therein, has been attempted before. Methods. Plants were identified taking into account methods used for studies on Dioscorides and Galen. Results. The findings highlight the originality of Rufus of Ephesus's clinical approach to therapy and the vast knowledge of diseases treated by plants. Conclusion. Rufus of Ephesus, the third most famous figure in medicine after Hippocrates and Galen, celebrated for his studies in obstetrics, gynecology, pediatrics, and neurology, a gouty physician, left a personal mark in the history of gout by making full use of his clinical skills that had been maximized by the severe apprenticeship in anatomy and in the Corpus Hippocraticum.
Anatomical terminology is often assumed to be structurally precise and historically stable. However, the anterior thoracic region demonstrates significant semantic transformation across time. In classical Latin, pectus referred broadly to the chest without sexual specification. In modern English, the term "breast" predominantly denotes the female mammary gland. This study investigates how a structurally stable anatomical region underwent progressive linguistic gendering. A qualitative historical-anatomical analysis was conducted integrating: (1) philological examination of classical Latin and Greek texts, including the Aeneid; (2) review of medical writings attributed to Hippocrates and Galen to assess early structural differentiation between thorax and mammary gland; (3) comparative analysis of medieval to 19th-century anatomical atlases to evaluate visual and terminological separation of thoracic and mammary structures; and (4) conceptual review of contemporary clinical framing in thoracic trauma and breast reconstruction. No human subjects were involved. Classical terminology (pectus, stēthos) denoted the anterior thorax without inherent sexual coding, while mastos specified mammary tissue. Renaissance dissection reinforced structural separation between thoracic wall and glandular appendage. Despite increasing anatomical precision, vernacular English progressively narrowed "breast" toward female mammary meaning. Modern anatomical standards maintain structural neutrality, but linguistic asymmetry persists in clinical and cultural discourse. The thorax has remained anatomically stable, whereas its linguistic representation has undergone gender-specific specialization. The transition from pectus to "breast" illustrates how anatomical regions may acquire cultural coding independent of structural change.
The revival of psychedelic medicalization is often narrated as a story of scientific legitimacy and neurotherapeutic promise, yet the unusual sensitivity of psychedelics to environmental conditions has encouraged research on music, therapy, setting, and other contextual factors. Treating setting and context as the building blocks of felt atmospheres, this article examines how regulation actively shapes atmospheres of consumption for substances that alter affective and sensory perception. Debates over drug-centric versus therapy-centered models are situated within the broader issue of how law shapes contexts and settings of psychedelic consumption. Policy developments in the United States and Australia show how emerging legal pathways have variably defined personnel, setting, access, substance, and the permitted forms of "holding space" or providing support or therapy. We introduce the concept of regulatory atmospheres to describe the diffuse and sometimes invisible ways in which policy shapes the contextual conditions of psychedelic use. Although policy rarely addresses atmospheres directly, we argue that it powerfully conditions them, which the case of psychedelic drug policy makes particularly clear. Alongside emerging legal pathways, the persistent shadow cast by prohibition over underground and traditional contexts reveals how some ontologies of risk and efficacy are privileged over others.
The sub-occipital transtentorial approach for pineal and pineal region tumours is reported as realized in Lyon. The approach described by C. Lapras is still performed today with a large skin flap and a large bone flap, which is sawn flush with the superior longitudinal sinus and the transverse sinus.The large bone flap allows elevation and separation of the hemisphere, avoiding its compression against the internal edge of the parietal bone.Opening the tentorium allows broad visualization of the pineal region space and of the venous arch formed by the basilar veins and the Galen vein.Protecting the occipital lobe with a rubber blade and cottonoids prevents compression of the calcarine scissure and has helped to reduce the incidence of the homonymous lateral hemianopia, which was the main criticism of this approach. In recent years, endoscopy assistance at the end of surgery has helped increase the rate of complete tumour removal by detecting pieces of tumour that were left in place.In Lyon, it was realized in more than 300 procedures.
Availability of trustworthy information has a critical role during public health emergency events. Science communication and trust in information sources, health experts and governments significantly influence public adherence to preventive measures and vaccine uptake. To investigate these effects on vaccine confidence in Southeast Asia, a region with diverse governance structures, trust levels and health literacy, this study examines trust in science and authority across six countries. Between January and June 2023, we conducted online surveys in Singapore, Philippines, Indonesia, Thailand, Malaysia and Vietnam with a total of 6611 respondents to measure their attitudes and trust towards science, vaccines, the government's management of COVID-19 and international health institutions. Our analyses explored the relationship between population trust in science, authorities and vaccine confidence. We found generally high trust in science and authority, along with strong confidence in vaccines. Trust in science increased by 0.98 (95% CI 0.93 to 1.03) for every unit increase in trust in government. Trust in information from medical staff and scientists was highest, while information from politicians and social media was least trusted. We found a positive association between the three indices across some, but not all countries. The perception of scientific support for the vaccine rollout was positively associated with vaccine confidence in nearly all contexts, with effect sizes ranging from 0.55 (in Thailand and Indonesia) to 1.07 (in Singapore). Our findings indicate that to enhance resilience against future public health emergencies and improve adherence to directives for non-urgent health concerns, health authorities should focus on communicating scientific support behind health guidelines and build trust in science and authority in the long term.
We observed that some late-term fetal prenatal magnetic resonance imaging (MRI) scans revealed normal brain structures but exhibited diffuse hyperintense signals on T2-weighted imaging (T2WI) in the cerebral white matter (white matter hyperintense signal [WMHS]). Currently, the pathological basis of this phenomenon remains unclear, and few studies have systematically investigated its impact on fetal and postnatal brain development. We aimed to compare the differences in apparent diffusion coefficient (ADC) values across distinct brain regions between fetuses with WMHS and age-matched control fetuses, to explore the potential etiology of WMHS by combining these findings with morphological changes in cerebral veins, and to conduct a comprehensive evaluation combined with clinical follow-up. We retrospectively analyzed fetal imaging data from MRI examinations performed at our hospital between January 2014 and May 2024. A total of 87 late-term fetuses (gestational age [GA]: 29-40 weeks) were identified with diffuse hyperintense signals on T2WI in the cerebral parenchyma; age-matched normal fetuses with the same sample size were enrolled as the control group. We compared differences in ADC values across distinct brain regions among fetuses with WMHS and simultaneously analyzed morphological differences in the deep cerebral veins between the two groups, combined with postnatal clinical follow-up, to explore the impact of WMHS on brain development and its clinical significance in late-term fetuses. (1) ADC values in the majority of brain regions of fetuses in the WMHS group were higher than those in the control group, with the greatest difference observed in the F2 region. (2) Compared with the control group, fetuses in the WMHS group exhibited significantly increased lumen areas of the vein of Galen (VOG) and straight sinus (SS), with a p-value of < 0.05 considered statistically significant. (3) Successful follow-up was achieved in 45 control infants and 36 WMHS cases. All control fetuses showed normal neurodevelopmental outcomes, while 33 infants in the WMHS group had normal and 3 had adverse outcomes, including cerebral palsy, developmental delay, and autism. In late-term fetuses with WMHS, elevated ADC values in specific brain regions and concurrent deep cerebral venous dilation indicate underlying intracranial abnormalities. In addition, our follow-up results indicate that these combined changes may be associated with adverse neurodevelopmental outcomes in some infants.
Despite autosomal inheritance, females are disproportionately impacted by von Willebrand disease (VWD) due to heavy menstrual bleeding (HMB). HMB remains the most frequently reported and severe bleeding symptom in females with VWD. Nevertheless, interventional studies of VWD prophylaxis frequently fail to include or report menstrual-related outcomes. This study evaluated the inclusion of menstrual and female-specific outcomes in clinical interventional trials of VWD prophylaxis. US (Clinicaltrials.gov), Canadian (https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/health-canada-clinical-trials-database.html), and European (clinicaltrialsregister.eu) databases were searched for VWD interventional studies open to females with VWD aged >12 years between 2014 and 2024. Two reviewers assessed all studies, excluding those not focused on prophylaxis or duplicates. Inclusion criteria, outcomes, and publications were reviewed for menstrual-related data. Initially, 42 interventional studies were identified; following exclusions, 10 studies remained. Only 2 of 10 (20%) studies incorporated menstrual inclusion criteria. Furthermore, 4 of 10 studies specifically excluded treated menstrual bleeding in their bleed eligibility criteria. Annualized bleeding rates were collected in 8 of 10 (80%) studies but menstrual outcomes in only 4 of 10 (40%). Most studies with results posted (n = 7) reported age (7/7) and sex (6/7) of participants; however, lack of overlapping data limited identification of females of menstrual age. Overall, identified females of menstrual age comprised 65 of 185 participants (35%) recruited. Clinical trials in VWD frequently use outcomes adapted from hemophilia studies (eg, annualized bleeding rates) rather than tailoring to the needs of females with VWD. Until we address this issue, we will lack clarity on optimal treatment, including the role of prophylaxis for the management of HMB in females with VWD.
Ketamine rapidly reduces suicidal ideation in major depressive disorder (MDD), but its effects are transient. Preclinical and clinical studies suggest that ketamine's antidepressant and antisuicidal effects may be partly mediated by mu-opioid receptor (MOR) modulation. The authors investigated the efficacy and safety of low-dose sublingual buprenorphine, a partial MOR agonist, as a follow-on treatment to prolong the effects of intravenous ketamine. This was a randomized, double-blind, placebo-controlled trial conducted at a single outpatient center in the United States. Adults with MDD and a total score ≥6 on the Scale for Suicide Ideation (SSI) were randomly assigned in a 1:1 ratio to receive either sublingual buprenorphine (0.2 to 0.8 mg/day) or a matched placebo for 4 weeks, beginning 48 hours after a single open-label intravenous ketamine infusion (0.5 mg/kg over 40 minutes). The primary outcome was the change in SSI total score, assessed weekly from day 1 through day 31. From November 2020 to March 2025, 50 participants (68% female) received ketamine, of whom 45 completed at least 1 week of follow-on treatment. Both groups showed significant reductions in SSI total scores, with greater improvement in the buprenorphine group (mean change, -11.6, SD=5.8; N=23) than the placebo group (mean change, -6.3, SD=7; N=22) (Glass delta=0.76, 95% CI=0.11, 1.39). Mixed-effects modeling showed a significant time-by-treatment interaction (p<0.001). Depression scores did not differ significantly between groups. No serious treatment-related adverse events occurred. This randomized controlled trial provides the first evidence that a pharmacological intervention, buprenorphine, significantly sustains and enhances the antisuicidal effects of ketamine in MDD. These findings offer a potentially scalable and safe therapeutic option for a population at risk of suicide.
Heavy menstrual bleeding (HMB) is a common problem existing in nearly 30% of women worldwide. An underlying bleeding disorder has been identified as a cause of HMB in a significant proportion of women seeking gynecological care for HMB. In practice, however, there is a significant underdiagnosis of bleeding disorders in these patients, highlighting a need for improvement in awareness and detection. To present a comprehensive review of the literature on HMB and bleeding disorders and to increase awareness of their interrelation. In addition, to propose a standardized diagnostic approach to help identify which women with HMB may have an underlying bleeding disorder and require further hemostatic evaluation. A literature review was performed using PubMed to identify relevant primary research and review articles on the topic of HMB and bleeding disorders in English. This was supplemented by manual reference searches and review of relevant guidelines in English and Dutch. A significant proportion (10% to as much as 62%) of women with HMB have an underlying bleeding disorder, yet many such disorders go unrecognized. Various screening instruments, particularly the validated PBAC, Philipp tool or self-BAT, can help distinguish between HMB with or without a suspected bleeding disorder, and indicate who needs additional hemostatic evaluation. An underlying bleeding disorder is far more frequent in HMB than currently appreciated. Gynecologists should be aware of this and be familiar with screening instruments and a diagnostic workflow for bleeding disorders. Multidisciplinary collaboration between gynecology and hematology is crucial for accurately diagnosing and managing potential bleeding disorders in women with HMB.
Myelofibrosis is a chronic myeloproliferative disorder primarily affecting older adults, and allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative treatment option. However, HSCT for myelofibrosis presents significant challenges, including high nonrelapse mortality (NRM) and an increased risk of graft failure. In this 20-year retrospective study, we evaluated outcomes for 32 myelofibrosis patients who underwent HSCT at our institution, with particular focus on a two-step transplant approach designed to optimize T-cell dosing by separating the lymphoid and myeloid graft components, with cyclophosphamide administered after the lymphoid infusion and before infusion of CD34-selected stem cells. Eighteen patients underwent transplantation using the two-step approach and demonstrated favorable outcomes, with 1-year and 5-year overall survival (OS) rates of 83% and 68%, respectively. NRM was reduced, with rates of 17% at 1 year and 23% at 5 years. Engraftment was robust, with median neutrophil and platelet recovery at 12 and 19 days, respectively, and a low graft failure rate of 5.9% despite the predominant use of reduced-intensity conditioning and haploidentical donors, compared with 17.5% graft failure among patients receiving a traditional one-step transplant. Across the entire cohort, OS was 66% at 1 year and 54% at 5 years, respectively, with NRM rates of 34% and 42% at 5 years, respectively. The cumulative incidence of grade 2-4 acute graft-versus-host disease (GVHD) and chronic GVHD was 17% each. These findings suggest that the two-step transplant platform is a viable and effective strategy for improving HSCT outcomes in myelofibrosis, providing lower NRM and favorable engraftment profiles. Further studies are warranted to validate these results and refine HSCT protocols to reduce transplant-related mortality and improve long-term survival in patients with myelofibrosis.
The ERBB4 gene encodes a tyrosine kinase receptor for neuregulins and EGF family members, and plays a crucial role in various neurobiological processes. At present, the phenotypic manifestations of genetic variants that disrupt ERBB4 gene function (null variants) are not well established. A search for new patients with null variants in ERBB4 was initiated through an international data-sharing collaboration via GeneMatcher, and by searching the databases Decipher and ClinVar. Diagnosis had been performed using chromosomal microarray analysis, whole-exome sequencing, or whole-genome sequencing. Twenty-four new patients from 13 unrelated families with null variants in ERBB4 were identified. Genetic findings included single- or multiple-exon deletions in eight families, a reciprocal translocation disrupting ERBB4 in one family, and sequence variants in four. Variants arose de novo in four probands, were inherited in eight, and had an unknown inheritance pattern in one. Co-segregation of variants with clinical manifestations was observed within families. The predominant clinical features included neurodevelopmental disorders (intellectual disability, neurodevelopmental delay, autism spectrum disorder, and attention deficit hyperactivity disorder), speech delay, challenging behaviors, hypotonia, psychiatric conditions and seizures. This study represents the largest case series of patients with neurological disorders and null variants in the ERBB4 gene. Our findings support haploinsufficiency as the most plausible pathophysiological mechanism underlying ERBB4-related disorders and broaden the spectrum of associated phenotypes. Autism spectrum disorders and psychiatric manifestations have emerged as frequent, previously underrecognized features. Penetrance appears to be high but incomplete, and expressivity is highly variable, with a tendency toward intrafamilial phenotypic conservation.
Variants in GBA1 are important genetic risk factors for synucleinopathies, including Parkinson's disease (PD). Although several GBA1 variants are established risk or severity modifiers, the role of the p.E427K variant remains unclear. The aim was to determine whether the GBA1 p.E427K variant is associated with risk of synucleinopathies. We performed a meta-analysis of case-control studies reporting the frequency of GBA1 p.E427K (p.E388K) in PD and related synucleinopathies. Data were obtained from published studies, open-access resources, and large cohorts, including in-house datasets. Odds ratios (OR) were calculated for each cohort and pooled using a random-effects model. Across 67,221 patients and 123,832 controls, GBA1 p.E427K was associated with increased disease risk (pooled OR = 1.94, 95% confidence interval 1.33-2.84, P = 0.0007). Enzymatic data showed reduced glucocerebrosidase activity in carriers. The GBA1 p.E427K variant is a risk factor for synucleinopathies and should be considered in genetic studies and clinical trials. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Global Developmental Delay (GDD) affects cognitive, language, motor, and adaptive functions in children under five years and is often a precursor to long-term neurodevelopmental disorders including intellectual disability and autism spectrum disorder. Early intervention can improve developmental outcomes, yet evidence regarding its effectiveness, especially in low-resource and diverse clinical settings, remains fragmented. To synthesize available evidence on the effectiveness of early intervention programs for children aged 0-6 years with GDD, and to identify intervention types, outcomes, and gaps in current research. A systematic review following PRISMA 2020 guidelines was conducted. PubMed, Web of Science, Scopus, and ClinicalTrials.gov were searched up to October 14, 2025, using predefined search terms. Eligible studies included children aged 0-6 years diagnosed with GDD or nonspecific developmental delay and involved an early intervention program assessing developmental outcomes. Data extraction and quality appraisal were performed using Joanna Briggs Institute (JBI) tools. Narrative synthesis was used due to heterogeneity across studies. Six studies involving a total of 689 participants were included. Interventions varied widely, including multidisciplinary rehabilitation, parent-mediated programs, community-based approaches, and combined medical-therapeutic methods. All studies reported improvements in at least one developmental domain (motor, language, cognitive, or social), with greater gains observed when interventions were initiated early (6 months) and sustained over longer durations. Parent-mediated and community-based models were feasible and effective in low-resource settings. However, no randomized controlled trials were identified, and most studies showed moderate to high risk of bias. Certainty of evidence was rated low to very low using GRADE. Early intervention programs demonstrate consistent benefits for children with GDD across settings, particularly when initiated early and involving caregivers. However, the current evidence base is limited by methodological weaknesses and lack of standardized outcome measures. High-quality randomized trials and long-term follow-up studies are urgently needed to inform best practices and policy implementation.
Trauma, an external assault's corporeal aftermath, manifests as wounds or injuries, breaching or not breaching the skin, wrought by environmental forces upon the human, and is considered One of the world's foremost public health challenges intertwines complex societal, environmental, and medical issues. In order to evaluate the severity of trauma, it seems necessary to have a quantitative scale that can be measured. Therefore, the aim of this study is to look into the predictive power of two scoring indices, The Injury Severity Score (ISS) and MGAP, in patients with multiple traumas. This research is a cross-sectional type and was conducted on trauma patients, aged 18 and over, with at least two traumas, hospitalized for over 24 hours in Taleghani Hospital in Mashhad in the period of one year from October 2020 to October 2021. For ISS, the Abbreviated Injury Scale (AIS) scores for affected organs in six body areas were determined, and the three highest AIS scores were calculated. For the MGAP score, data on injury mechanism, age, Glasgow Coma Scale (GCS), and systolic blood pressure were extracted. A chi-square test was conducted to ascertain the correlations between categorical variables and the status of survival. Additionally, Positive Triage Accuracy was measured and compared for ISS and MGAP. In this research, 699 cases were investigated. Among the patients, 567 (81%) were male and 132 (19%) were female. Also (92%) 641 patients were discharged alive and (8%) 58 patients died. Among the 114 patients admitted to the ICU, 45 (39%) died. Cases mislabeled as medium or low risk that experienced death happened in 7 cases (of 598 available records; 1.17%) based on the ISS risk stratification system with 98.18% Positive Triage Accuracy and 44 cases (of 698 available records; 6.30%), based on the MGAP risk stratification system with 32.75% positive triage accuracy. The findings show the robust predictive power of ISS, with a low mislabeling rate and high triage accuracy. Conversely, the MGAP system demonstrated a higher mislabeling rate, suggesting that its application may yield incorrect results in certain situations and settings. This shows the need for cautious consideration when applying the MGAP risk stratification system, as its performance may not be universally applicable across all scenarios.
Endometriosis is a prevalent medical condition that significantly affect the quality of life in a substantial proportion of women, affecting their fertility and manifesting with many symptoms like gastrointestinal symptoms. The present study aimed to evaluate the impact of laparoscopic surgery for endometriosis on general and sexual quality of life, and gastrointestinal symptoms in patients diagnosed with deep infiltrating endometriosis (DIE). This prospective cohort study was conducted on 129 women diagnosed with DIE-associated infertility and referred to Yas Infertility Center in Tehran , from 2022 to 2023. Demographic data and the presence and severity of gastrointestinal symptoms were recorded. These symptoms were reassessed one month following endometriosis surgery. Participants were also asked to complete the SF-36 Quality of Life Questionnaire and Female Sexual Function Index (FSFI) questionnaires before the surgical procedure and one month later. Data were analyzed using SPSS version 24. This study of 129 patients (mean age 34.82±5.83 years, BMI 25.64±3.77 kg/m²) revealed near-universal ovarian involvement (99.2%) and adhesions (99.2%), primarily affecting rectosigmoid (24.1%) and cervix (29.5%). Pre-intervention, 98.4% reported abdominal pain (47.3% severe), 37.9% bloating, and 24.8% constipation. Post-intervention showed dramatic improvements: pain-free cases rose to 90.7%, bloating reduced to 9.3%, and constipation to 6.2% (all P0.0001). The FSFI score increased (57.6±28.8 to 65.2±27.4, P0.0001), and SF-36 pain scores halved (6.8±1.2 to 2.7±0.9, P0.0001), though vitality and emotional well-being remained unchanged. Surgical complications included hemoglobin drop (17.8%) and intestinal injury (6.2%). The findings of this study indicate that laparoscopic treatment of DIE not only alleviates gastrointestinal symptoms but also significantly enhances the quality of life and sexual function in affected women.