Citations

ABSTRACT. Cervical cancer is a malignancy with a well-established viral origin linked to high-risk human papillomavirus (HPV) types. Globally, there are 348,709 estimated deaths among 662,301 cervical cancer cases. India faces a disproportionately high burden, contributing to 79,906 of these deaths and accounting for over 22% of global deaths. The nation’s high mortality rate is attributable to the low rate of cervical cancer screening and HPV vaccination uptake. There is a greater impact of cervical cancer on those of lower socioeconomic status and a cultural stigma surrounding sexually transmitted infections. We recommend a comprehensive cervical cancer prevention strategy, including screening programs, culturally sensitive education for patients and providers, government-endorsed HPV vaccination, and continuing studies on diagnostics and vaccination in the Indian context.

Abstract Context Benign thyroid nodules (BTNs) are highly prevalent, and current treatment options are primarily invasive. There is a need for effective, noninvasive alternatives. Objective To systematically evaluate the efficacy of repurposed pharmacologic agents in reducing the size of BTNs. Data Sources MEDLINE, EMBASE, Cochrane databases, and Scopus were searched from inception to December 18, 2024. Study Selection We included preclinical and clinical studies evaluating repurposed drugs for BTNs in adults. Of 1499 records screened, 20 studies met inclusion criteria: 6 randomized controlled trials (RCTs), 6 prospective cohorts, 3 retrospective observational studies, 3 case reports, 1 cross-sectional study, and 1 preclinical study. Data Extraction Data were extracted independently in duplicate using a standardized form. Data Synthesis Narrative synthesis was conducted due to heterogeneity. Metformin was the most frequently evaluated agent (7 studies), with 5 studies (including 2 RCTs) reporting statistically significant reductions in dominant nodule volume. One prospective study demonstrated a reduction in the maximum nodule diameter, which was not statistically significant, and 1 RCT showed no changes in nodule size after intervention. Statins (4 studies) and somatostatin analogues (4 studies) showed mixed results. Myo-inositol with selenium, herbal formulations, and immune checkpoint inhibitors showed promise in single studies or case reports. Conclusion Metformin shows the most consistent potential for noninvasive reduction of BTN size, particularly in patients with metabolic comorbidities. However, current evidence is limited and heterogeneous. Further large-scale studies are needed to confirm efficacy and guide clinical use.

The primary purpose of this study was to examine the acute effects of a multi-ingredient preworkout supplement (MIPS) on isometric, concentric, and eccentric peak torque and electromyographic (EMG) responses of the leg extensors during a fatiguing isokinetic protocol. Thirteen male subjects (mean age ± SD = 22.9 ± 2.2 years) were assigned in crossover fashion to ingest an MIPS or placebo before an isokinetic protocol that consisted of 30 maximal, concentric and eccentric muscle actions with EMG signals recorded from the vastus lateralis, rectus femoris, and vastus medialis muscles. Immediately before (PRE) and after (POST) the isokinetic fatigue protocol, subjects were assessed for isometric peak torque. The MIPS condition resulted in greater isometric (205 ± 48 vs. 185 ± 44 N·m, p = 0.04) and concentric (121 ± 34 vs. 103 ± 27 N·m, p = 0.015) torque values versus placebo (collapsed across time). For eccentric peak torque as well as EMG amplitude and frequency values, there were no significant (p > 0.05) interactions or main effects for each condition. These findings indicated that acute ingestion of the MIPS enhanced isometric and concentric peak torque of the leg extensors, which was not explained by changes in the EMG signal.

Background/Objectives: Sodium glucose co-transporter 2 inhibitors (SGLT2is) have demonstrated a reduction in heart failure (HF) hospitalizations in HF patients and decreased recurrence of atrial fibrillation (AF), including in those who have undergone catheter ablation (CA). The effects of SGLT2i are likely due to suppression of the renin–angiotensin–aldosterone system, reduction in oxidative stress with subsequent improvement in myocardial efficiency, and attenuation of cardiac remodeling. We aim to present the effects of SGLT2i on AF recurrence in patients who have undergone CA for AF. Methods: This is a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective studies evaluating the effect of SGLT2i on AF recurrence following CA compared with non-SGLT2i. The primary outcome was the recurrence of AF by the final follow-up reported in each study. Secondary outcomes include AF recurrence by the first follow-up within 12 to 24 months and follow-up intervals (6, 12, 18, 24, and 36 to 42 months) post-ablation, multivariate risk of AF recurrence, and the effect on left atrial diameter (LAD) (less than 45 mm vs. greater than or equal to 45 mm). For risk of bias (ROB) analysis, the NIH ROB and Cochrane ROB2 tool were used. All statistical, heterogeneity, and sensitivity analyses were conducted using Cochrane Review Manager. A random-effect model was employed for all pooled statistical analyses. Results: A total of nine studies, two RCTs and seven retrospective studies, were included (N = 6874) for the primary outcome. Compared to non-SGLT2i (N = 3693), SGLT2i (N = 3181) significantly decreased AF recurrence by the final follow-up (OR = 0.62; 95% CI: 0.45–0.85; p = 0.008). For secondary outcomes, SGLT2i significantly reduced AF recurrence by the first follow-up within 12 to 24 months post-ablation (OR = 0.58; p = 0.0001) and by the different follow-up periods, 6-month (OR = 0.53; p = 0.02), 12-month (OR = 0.56; p = 0.0001), 18-month (OR = 0.55; p = 0.01), and 24-month (OR = 0.60; p = 0.12) follow-up periods. On the other hand, by 36 to 42 months, SGLT2i was associated with increased risk of AF recurrence (OR = 1.41; p = 0.004). Conclusions: We conclude that SGLT2i demonstrated a reduction in AF recurrence following CA, particularly by 12 to 18 months post-ablation.

Background: Documentation burden is a major contributor to surgeon burnout, particularly in high-volume outpatient specialties such as hand surgery. These encounters often involve multiple concurrent diagnoses, procedural planning, and longitudinal care. Ambient artificial intelligence (AI) tools, which passively transcribe and summarize clinical encounters in real time, have the potential to streamline note generation and reduce cognitive load. Methods: Following institutional rollout of a commercially available ambient AI tool in early 2025, the system was adopted across all outpatient visits in a hand surgery clinic. Observations were collected regarding workflow adaptation, documentation quality, and perceived cognitive impact. To assess note characteristics, 14 carpal tunnel syndrome visit notes (7 AI-generated and 7 surgeon-written) were compared by word count, Flesch-Kincaid readability score, and inclusion of social and medical history. Results: AI-generated histories were longer and exhibited greater linguistic complexity compared with surgeon-written notes. Surgeon-written assessments were longer, more readable, and more consistent in structure and tone. Social history was documented more frequently in AI-generated notes. All AI-generated assessment and plan sections followed a structured, problem-based format. Conclusions: Ambient AI documentation can support the creation of more structured and contextually rich clinical notes in hand surgery settings. However, successful integration requires active clinician engagement and workflow alignment to balance efficiency with clinical accuracy. These findings highlight both the promise and the practical considerations of incorporating ambient AI into surgical documentation workflows.

Immunotherapy has transformed oncology, yet kidney complications increasingly affect outcomes. This review summarizes nephrotoxicity from immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR-T) therapies, and bispecific T-cell engagers (BiTEs). ICIs remain most used, with acute interstitial nephritis (AIN) as the hallmark lesion, while glomerular diseases and electrolyte abnormalities are less common. CAR-T therapy, though highly effective in hematologic cancers, carries risks of cytokine release syndrome, tumor lysis syndrome, and acute kidney injury (AKI). BiTEs, particularly teclistamab, show higher AKI rates than CAR-T, though mechanisms remain unclear. Early recognition, tailored management, and multidisciplinary collaboration are essential to ensure safe therapy and preserve kidney function.

Polycystic kidney disease (PKD) is a genetic disorder characterized by progressive kidney cyst formation and eventual kidney failure. Emerging evidence suggests that plant-based diets may confer therapeutic benefits in patients with PKD by modulating mTOR and AMPK signaling, reducing oxidative stress and inflammation, while improving metabolic and cardiovascular profiles. These diets, which are low in animal protein and rich in antioxidants, may help lower uric acid levels and support blood pressure control, thereby potentially reducing fibrosis. However, careful planning is required to avoid nutritional deficiencies. Well-designed clinical trials are warranted to validate their role in ADPKD management.

ABSTRACT Background Obesity affects over 40% of the US population and contributes to worse outcomes in a variety of diseases and disorders. Glucagon‐like peptide‐1 receptor agonists have drawn attention for their impact on obesity. With a dense population of receptors throughout the gastrointestinal tract, it is critical to understand the way that glucagon‐like peptide‐1 receptor agonists impact gastrointestinal diseases and disorders. Aims To evaluate the expanding role of glucagon‐like peptide‐1 receptor agonists in the management of obesity and gastrointestinal disease, with a focus on therapeutic applications, impact on gastrointestinal cancers, safety profile, and implications for gastroenterology practice. Methods We conducted a narrative review of recent clinical trials, cohort studies, and guideline updates through 2025. Evidence was synthesised on efficacy, safety, and clinical implications across gastrointestinal disorders including steatotic liver disease, gastroesophageal reflux, inflammatory bowel disease, short bowel syndrome, and obesity‐associated cancers. Results Glucagon‐like peptide‐1 receptor agonists induce substantial and durable weight loss and improve obesity‐related gastrointestinal outcomes. They are approved for steatotic liver disease, with demonstrated histologic and biochemical benefits. Evidence suggests a reduced incidence of several gastrointestinal cancers. The most common adverse events include nausea, vomiting, diarrhoea, constipation, and delayed gastric emptying, which may affect peri‐endoscopic management. Discontinuation rates remain substantial but can be mitigated by careful titration and specialist oversight. Conclusions Glucagon‐like peptide‐1 receptor agonists are a critical therapy for obesity and several related gastrointestinal conditions. Gastroenterologists are uniquely positioned to optimize their use, manage adverse events, coordinate multidisciplinary care, and ensure safe and effective integration into practice.