Revista Internacional de Acupuntura

Introduction and importance: Spontaneous rectus sheath hematoma (RSH) is a rare and underdiagnosed condition that can mimic more serious causes of acute abdominal pain leading to unnecessary surgery or delay in management. It occurs due to bleeding within the rectus sheath, often caused by the rupture of epigastric vessels or rectus abdominis muscle. Case presentation: In the case presented in this study, a 47-year-old man presented with acute left upper quadrant pain and a painful abdominal mass following a severe coughing episode. Imaging confirmed a rectus sheath hematoma. Conservative management, including bed rest and pain relief, led to recovery. At follow-up, the patient was asymptomatic and advised to quit smoking. Discussion: Spontaneous rectus sheath hematoma (RSH) is a rare cause of acute abdominal pain, often triggered by coughing, sneezing, or vomiting. Risk factors include hypertension, obesity, and anticoagulant use. This case highlights a RSH in the left upper quadrant, a less common site diagnosed through ultrasound and CT. While most cases are managed conservatively, surgical intervention is necessary in complicated cases. Conclusion: Rectus sheath hematoma, though uncommon, should be considered in patients presenting with acute abdominal pain and a history of intense coughing even in absence of abdominal trauma or anticoagulant therapy.

Introduction: Pelvic organ prolapse (POP) is a major public health problem. This study aims to determine the incidence, sociodemographic profile of patients, the management and outcomes of POP in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent management of POP between 1 January 2015 and 31 December 2022 in our department. The epidemiological data, treatment, and outcomes of POP were collated and subjected to analysis. Results: During the study period, 358 cases of POP were recorded out of a total of 12 536 patients treated in the department, representing a frequency of 2.8%. The mean age of the patients was 46.14 years (range: 17–90 years). The patients were identified as married (307 cases, 85.75%), unemployed (353 cases, 98.6%) and not attending school (332 cases, 92.74%). The largest number of cases were observed in large multiparous women (60.05%, 215 patients). The average parity was 6.5 children. The vast majority of patients (269 cases, 75.14%) lived in rural areas. The most frequent motif for consultation was the sensation of mass in the vagina (146 cases, 40.78%) and vulvar swelling (138 cases, 38.55%). The most frequent genital prolapses type was middle, made of the hysterocele essentially (150 cases, 41.90%). The stage III of genital prolapses was the most frequent in 76.51% (274 cases). All patients underwent surgical treatment (100%), and the vaginal access was most used in 57.55% (206 cases) of cases. Conservative treatment was performed in the majority of patients (197 cases, 55.02%). The intraoperative complications were vesical lesions (0.56%, two cases) and ureteral and vascular lesion (0.28%, one case). Conclusion: POP is a common occurrence in our region. Surgical treatment is the most practiced and hysterectomy by vaginal surgical approach is the most practiced.

Background and aim: Diabetes mellitus (DM) is a chronic metabolic disorder and a significant global concern due to its steadily increasing prevalence. Educating youths and adolescents about such diseases is crucial for promoting healthy lifestyle choices. This study aims to evaluate the knowledge of public high school students about DM and identify areas where their understanding is lacking. Materials and methodology: In February 2023, a descriptive cross-sectional study was conducted in the Duhok province of the Kurdistan Region in Iraq. The study enrolled 392 students from a public high school, who were surveyed using a self-administered questionnaire. This questionnaire had two sections: the first collected basic demographic information of the participants, while the second included 20 items assessing various aspects of DM knowledge, such as general information, risk factors, signs and symptoms, complications, and prevention. Results: The mean age of the study participants was 16.4 years (±0.71). Among the participants, 247 (63%) were female, and 190 (48.5%) had a positive family history of DM. Unfortunately, only 53 students (13.5%) had received training programs about the disease, although the vast majority (89.3%) expressed willingness to participate in the prevention programs. For 70.2% of the participants, family and friends were the primary sources of information. The mean knowledge score was 13.9 (±3), with an average correct answer rate of 68.55%. Female students, those with a positive family history, had significantly demonstrated a better overall knowledge score with a mean knowledge score of 14.14 ± 2.96 and 14.17 ± 2.98, respectively. Also, participants using multiple sources for information, and those who had received training programs on DM, demonstrated a better overall knowledge score with a mean score of 14.21 ± 2.90 and 14.34 ± 3.31, respectively. However, it missed the significance. Conclusion: The study participants exhibited good knowledge and awareness of DM. However, there were notable gaps in their understanding of the disease’s risk factors and complications. Therefore, we recommend incorporating health education programs and lifestyle modification initiatives into the school curriculum to enhance students’ knowledge and address the identified gaps.

Introduction: Focal segmental glomerulosclerosis (FSGS) is a leading cause of nephrotic syndrome, contributing to 40% of adult and 20% of pediatric cases globally. Apolipoprotein L1 (APOL1) genetic variants, particularly G1 and G2 alleles, play a pivotal role in FSGS pathogenesis, particularly among African-Americans, where 30–40% carry these risk alleles. These variants impair APOL1 function, causing podocyte injury, proteinuria, and progressive kidney damage. Secondary triggers like infections exacerbate susceptibility. Advances in gene-editing technologies, including CRISPR, offer hope for targeted therapies in FSGS management. Objectives: This review explores the link between APOL1 variants and FSGS pathogenesis, focusing on their role in podocyte injury and assessing the utility of APOL1 genetic testing in diagnosis and treatment strategies. Methodology: A systematic literature review was conducted using Medline, PubMed, Google Scholar, and PsychINFO up to April 2024. Of 331 identified articles, 29 relevant studies were analyzed, emphasizing APOL1 variants’ role in FSGS and implications for genetic testing. Results: About 13% of African-Americans carry APOL1 risk alleles, with 30% having at least one allele. Two risk alleles increase lifetime FSGS risk to 4% and ESKD risk to 7–8%. APOL1-associated kidney damage primarily affects podocytes, accelerating glomerulosclerosis. Emerging treatments, such as inaxaplin, reduced proteinuria by 47%, with 40% achieving remission in FSGS cases linked to APOL1.

Introduction: This study investigates the association between religiosity and preoperative anxiety in liver and renal transplant patients at a tertiary care hospital in Pakistan. This study aims to explore the association between Islamic religiosity and preoperative anxiety in liver and renal transplant patients at a tertiary care hospital in Islamabad. Objectives: It seeks to assess preoperative anxiety levels in both donors and recipients, examine the relationship between religiosity and preoperative anxiety, and investigate the role of religiosity as a coping mechanism in managing preoperative anxiety. Methods: Conducted on 140 patients over 2 years using non-probability convenience sampling and validated tools, significant associations were found between anxiety levels and gender, marital status, age, education, spouse occupation, and transplant type. Results: Older adults and liver transplant recipients reported higher anxiety. Significant correlations were found between transplant type and anxiety age differences in anxiety (F(3,136) = 4.5, P < 0.05) and anesthesia anxiety (F(3,136) = 6.6, P < 0.05). Liver transplant recipients reported higher anxiety than donors. Religious coping strategies, such as seeking Allah’s guidance, were linked to lower anxiety, particularly among liver transplant recipients. Conclusion: The study found that demographic factors such as age, gender, marital status, and transplant type significantly influence anxiety levels. Older adults and liver transplant recipients experienced higher levels of anxiety. Notably, religious coping strategies, including seeking Allah’s guidance, were associated with lower anxiety, especially among liver transplant recipients. The findings suggest that religiosity may serve as a valuable coping mechanism and highlight the need for further research on spiritual interventions in transplant care.

Background: The application of artificial intelligence (AI) in cardiac imaging has rapidly evolved, offering enhanced accuracy and efficiency in the diagnosis and management of cardiovascular diseases. This bibliometric study aimed to evaluate research trends, impact, and scholarly output in this expanding field. Methods: A systematic search was conducted on 14 August 2024, using the Web of Science Core Collection database. VOSviewer, CiteSpace, and Biblioshiny were utilized for data analysis. Results: The findings revealed a significant increase in publications on AI in cardiovascular imaging, particularly from 2018 to 2023, with the United States leading in research output. England and the United States have emerged as central hubs in the global research network, highlighting their role in generating high-quality and impactful publications. The University of London was identified as the top contributing institution, while Frontiers in Cardiovascular Medicine was the most prolific journal. Keyword analysis highlighted machine learning, echocardiography, and diagnosis as the most frequently occurring terms. A time trend analysis showed a shift in research focus towards AI applications in cardiac computed tomography (CT) and magnetic resonance imaging (MRI), with recent keywords like ejection fraction, risk, and heart failure reflecting emerging areas of interest. Conclusion: Healthcare providers should consider integrating AI tools into cardiovascular imaging practice, as AI has demonstrated the potential to enhance diagnostic accuracy and improve patient outcomes. This study highlights the rising importance of AI in personalized and predictive cardiovascular care, urging healthcare providers to stay informed about these advancements to enhance clinical decision-making and patient management.

Cancer is one of the leading causes of death worldwide. In cancer therapy, anti-cancer drugs are the current treatment-of-choice for patients with metastatic cancers, but these drugs present a major drawback: they destroy healthy cells along with cancerous cells. Unfortunately, the drug discovery process for de novo drugs is costly and time-consuming. To address this global problem, our research team has established the concept of “Chemotherapy with a molecular rational basis”, which focuses on the identification of molecular targets in tumor cells, whose activation or inhibition induces apoptosis or sensitizes the tumor cells to apoptosis. Here we review the experimental and clinical evidence of pentoxifylline (PTX) in the setting of chemotherapy with a molecular rational basis. A search of the literature was conducted for articles published during the period from 2 January 2003 to 21 October 2024. Articles published in English or Spanish were included. The keywords “Pentoxifylline” OR “BL 191” OR “trental” AND “cancer” were used for in vitro, in vivo, and clinical studies. PTX is an approved, accessible, and relatively safe drug. Furthermore there is a large body of experimental and clinical evidence of the beneficial effects of PTX in cancer therapy, either alone or in combination with antitumor drugs, sometimes even more effective than traditional chemotherapy regimens. However, it is necessary to carry out larger clinical trials in cancer patients to identify the benefits, adverse effects and even pharmacological interactions of PTX with current chemotherapy regimens and thus achieve a new drug repositioning that benefits our patients.

Platelet activation is increasingly recognized as a key factor in breast cancer progression, contributing to tumor growth, metastasis, and immune modulation. Platelets interact with tumor cells to promote their survival, facilitate metastasis, and enhance the formation of a pro-inflammatory microenvironment. These interactions are mediated by adhesion molecules such as P-selectin and glycoprotein receptors on both platelets and tumor cells. Additionally, activated platelets release growth factors like vascular endothelial growth factor and platelet-derived growth factor, which promote angiogenesis and tumor vascularization, crucial steps in cancer progression. The coagulation cascade, triggered by platelet activation, further enhances tumor cell dissemination and metastasis. Elevated levels of procoagulant activity in platelets, particularly through the expression of tissue factor, lead to increased thrombin generation, facilitating the formation of fibrin-rich clots that protect circulating tumor cells from immune surveillance. Platelet-derived factors also exert immunomodulatory effects, helping cancer cells evade detection by the immune system, thereby supporting tumor growth and spread.

Introduction: Deep brain stimulation (DBS) has emerged as a promising therapeutic approach, offering targeted neuromodulation for movement disorders refractory to medical management or stereotactic surgery. However, assessing its benefits against potential risks is essential. This meta-analysis aims to evaluate the efficacy and safety of DBS in movement disorders, shedding light on its role as an alternative therapeutic option. Methods: A comprehensive search of databases after systemic review yielded studies published in English from 2000 to the present. Data selection, screening, extraction, and risk of bias assessment were performed meticulously. Statistical analysis was conducted using RevMan 2.0, with significant heterogeneity addressed through appropriate methods. Results: Our meta-analysis included 40 studies assessing the Unified Parkinson’s Disease Rating Scale Part III, revealing a significant improvement in motor symptoms (mean difference [MD]: −18.05, 95% confidence interval [CI] [−20.17, −15.93], P < 0.00001). Hoehn and Yahr Stage analysis demonstrated a reduction in disease severity (MD: −0.58, 95% CI [−1.05, −0.12], P = 0.01). Tremor severity (MD: −8.22, 95% CI [−12.30, −4.15], P < 0.0001), overall tremor (MD: −2.68, 95% CI [−4.59, −0.77], P = 0.006), gait velocity (MD: 0.13, 95% CI [0.08, 0.18], P < 0.00001), and Yale Global Tic Severity Scale score (MD: −9.75, 95% CI [−14.55, −4.96], P < 0.0001) also showed significant improvements with DBS. Conclusion: DBS demonstrates efficacy in improving motor symptoms, disease severity, tremor, gait, and tic severity in movement disorders. However, further research is needed to elucidate long-term efficacy and safety outcomes.

Aims: Insulin resistance, beta-cell dysfunction, and diabetes mellitus (DM) are the extrahepatic complications of chronic hepatitis C virus (HCV) infection. The aim of the study was to determine the effects of novel directly acting antivirals (DAAs) on insulin resistance and insulin sensitivity parameters in nondiabetic patients with chronic HCV infection. Methods: A systematic search of medical databases (Pubmed, Scopus, and Google Scholar) was conducted for studies published until July 2024. Studies investigating the effect of any DAA on insulin resistance and insulin sensitivity parameters in non-diabetic patients with chronic HCV and sustained virologic response were included. Our study assessed the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) as the primary outcome. The pooled outcomes were compared pretreatment and posttreatment with DAAs using Hedges’ g (HG) with a 95% confidence interval (CI). Results: A total of 10 studies (1309 participants) were included in the meta-analysis. Insulin resistance measured by the HOMA-IR was significantly reduced with DAA therapy (HG = 0.86, 95% CI: 0.48–1.25, P < 0.001). A similar significant reduction in fasting insulin levels was observed following DAA therapy (HG = 0.88, 95% CI: 0.51–1.25, P < 0.001). However, no significant differences were seen in Homeostasis model assessment for beta-cell function (HOMA-B) (HG = 0.12, 95% CI: −0.0 to 0.24, P = 0.06) before and after DAAs use. Conclusions: The use of DAAs in nondiabetic chronic HCV patients with a sustained virologic response also significantly reduces insulin resistance and fasting insulin levels.

Background: Basic life support (BLS) is a critical skill for saving lives during emergencies. This study aims to assess BLS awareness and knowledge among undergraduates at University, examining the impact of gender, faculty, and prior correct cardiopulmonary resuscitation (CPR) training on students’ confidence and competence. Methods: A descriptive, cross-sectional study was conducted from August to December 2023 across six faculties: medicine, nursing, engineering, sciences, commerce, and law. Using convenience sampling, a total of 1165 students participated by completing a self-administered, bilingual questionnaire. Descriptive statistics, Pearson correlation tests, t-tests, ANOVA, and multivariate logistic regression analyses were performed using SPSS software version 26, with visual representations created using R software. Results: The majority of participants were female (64.8%), with a significant portion (70%) believing that CPR training should be mandatory. Only 29.6% had received CPR training. Females scored higher on BLS knowledge than males (4.9 vs. 4.5, P < 0.05). Students from medical faculties had greater BLS knowledge compared to their non-medical peers (6.3 vs. 3.5, P < 0.05). Trained students were more confident in performing CPR (35.1% vs. 10.2% among untrained, P < 0.05). Multivariate logistic regression identified prior CPR training and medical faculty enrollment as significant predictors of higher BLS knowledge and confidence. Conclusion: Significant gaps in BLS knowledge and training exist among University undergraduates, with disparities based on gender, faculty, and prior training. The findings underscore the need for mandatory CPR training across all faculties to enhance student preparedness and competence.

Introduction: Hydatid disease, caused by Echinococcus granulosus, commonly affects the liver (80%) and lungs (15%). Muscular involvement is rare, with primary hydatid cysts in skeletal muscles comprising only 2–3% of cases. This report presents the first documented case of a primary hydatid cyst in the rectus abdominis muscle in Nepal, and the 11th case globally. Case presentation: A 38-year-old female presented with a progressively enlarging epigastric swelling and localized pain over 1 year. On examination, a firm, non-tender 5 × 5 cm mass was palpated in the left rectus abdominis muscle. Imaging, including ultrasonography and contrast-enhanced CT, showed a well-defined cystic lesion without involvement of other organs. Serology for hydatid disease was negative. The cyst was excised surgically under general anesthesia, ensuring no spillage, and the surgical site was irrigated with hypertonic saline. Histopathology revealed acellular laminated keratin, protoscolices, and inflammatory infiltrates. Postoperatively, the patient received albendazole for 4 weeks and recovered uneventfully, with no recurrence on follow-up. Discussion: Primary muscular hydatid cysts are rare, as muscle contraction and lactic acid provide an unfavorable environment for the parasite. Imaging plays a vital role, as serology often yields false negatives. Surgical excision is the gold standard treatment, supported by anthelmintic therapy to prevent recurrence. Conclusion: This case highlights a rare presentation of hydatid disease in the rectus abdominis muscle, underscoring the importance of considering atypical locations in diagnosis. Early surgical intervention and postoperative medical therapy ensure positive outcomes.

Introduction and importance: Acute flaccid paralysis is a rare neurological complication of Japanese Encephalitis infection, which may involve one or multiple limbs. Symmetric involvement of upper and lower limbs such as in this case is rarely reported. Presentation of case: We present a case of a 30-year young male from terai region of Nepal who presented with fever, altered level of consciousness, and symmetrical quadriplegia. Based on these clinical findings, cerebrospinal fluid (CSF) analysis was done which came back negative. And based on results, Polymerase Chain Reaction (PCR) for herpes simplex virus (HSV) type I and II was done which came out negatively. Other neurological conditions such as Amyotrophic Lateral Sclerosis (ALS) and spinal dystrophy were ruled out because of the presence of fever and altered mental status. He was eventually diagnosed with Japanese encephalitis based on his cerebrospinal fluid analysis and positive result for JE serology/IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA) test. Clinical discussion: The patient presented with fever, altered mental status and symmetrical flaccid paralysis of the bilateral upper and lower limb. Symmetrical involvement of the upper and the lower limbs is unusual in most cases of Japanese Encephalitis. Conclusion: This case highlights the importance of awareness on the part of the clinician about the possibilities of atypical presentation in Japanese encephalitis (JE). It also emphasizes that Japanese encephalitis should be a part of the differential in patients with atypical neurological presentation in endemic areas.

Long COVID has emerged as a significant challenge since the COVID-19 pandemic, which was declared as an outbreak in March 2020, marked by diverse symptoms and prolonged duration of disease. Defined by the WHO as symptoms persisting or emerging for at least two months post-SARS-CoV-2 infection without an alternative cause, its prevalence varies globally, with estimates of 10–20% in Europe, 7.3% in the USA, and 3.0% in the UK. The condition’s etiology remains unclear, involving factors, such as renin–angiotensin system overactivation, persistent viral reservoirs, immune dysregulation, and autoantibodies. Reactivated viruses, like EBV and HSV-6, alongside epigenetic alterations, exacerbate mitochondrial dysfunction and energy imbalance. Emerging evidence links SARS-CoV-2 to chromatin and gut microbiome changes, further influencing long-term health impacts. Diagnosis of long COVID requires detailed systemic evaluation through medical history and physical examination. Management is highly individualized, focusing mainly on the patient’s symptoms and affected systems. A multidisciplinary approach is essential, integrating diverse perspectives to address systemic manifestations, underlying mechanisms, and therapeutic strategies. Enhanced understanding of long COVID’s pathophysiology and clinical features is critical to improving patient outcomes and quality of life. With a growing number of cases expected globally, advancing research and disseminating knowledge on long COVID remain vital for developing effective diagnostic and management frameworks, ultimately supporting better care for affected individuals.

Asciminib, a groundbreaking treatment for chronic myeloid leukemia (CML), has gained FDA approval as the first STAMP inhibitor. Targeting the myristoyl pocket of the BCR-ABL1 protein, this drug offers a unique mechanism to overcome resistance to traditional tyrosine kinase inhibitors (TKIs). Clinical trials, such as the ASC4FIRST study, demonstrate asciminib’s superior efficacy compared to existing TKIs, achieving higher molecular response rates and fewer severe side effects. Its favorable safety profile, characterized by reduced vascular and pulmonary risks, supports improved patient adherence and long-term outcomes. While asciminib shows promise as a second-line or even frontline therapy, long-term data on its durability, adverse effects, and potential drug interactions are still evolving. Current research highlights its potential use in pediatric cases and in combination therapies for other leukemia types. Asciminib represents a significant advancement in CML treatment, paving the way for more targeted and tolerable cancer therapies.