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Pneumoparotid is a rare cause of parotid swelling. It is characterized by the presence of air in the parotid ductal system. Pneumoparotid may be suggested clinically with crepitus on parotid gland palpation. Imaging using ultrasound and/or CT is crucial in diagnosing Pneumoparotid and for excluding complications. Early recognition of pneumoparotid is crucial to prevent recurrence and unnecessary interventions. Counseling to avoid activities that increase intra‐oral pressure remains the cornerstone of management. We report a case of a 3‐year‐old male ‐ one of the youngest described in the literature‐ who presented with a 3‐day history of high‐grade fever, right‐sided neck swelling, and decreased oral intake. Examination revealed bilateral parotid swelling with crepitus. Ultrasound revealed bilateral parotid enlargement and multiple enlarged cervical lymph nodes with early cystic degeneration. Contrast‐enhanced CT confirmed the presence of air within both parotid glands, which is consistent with pneumoparotid. Key Clinical Message Pneumoparotid is a rare and often overlooked cause of parotitis in children. Recurrent episodes should prompt clinicians to consider behaviors that increase intra‐oral pressure, such as balloon‐blowing. Careful examination and proper imaging can prevent misdiagnosis and ensure effective, conservative management.

Background Tirzepatide, a dual GIP/GLP‐1 receptor agonist, offers a novel cardiometabolic strategy beyond glycemic control with important implications for heart failure care. By producing potent, sustained weight reduction and favourable changes in lipids, blood pressure, systemic inflammation and endothelial biology, tirzepatide targets central pathophysiologic drivers of obesity‐related HFpEF. Methods We conducted this review to synthesise current evidence on the mechanisms, clinical efficacy and therapeutic implications of tirzepatide for heart failure management, with emphasis on obesity‐related HFpEF, cardiorenal effects and safety considerations. Randomised clinical programmes and the SUMMIT outcomes trial have demonstrated symptomatic and functional improvements, reverse cardiac remodelling on imaging, reduced circulating markers of myocardial stress and fewer worsening heart‐failure events versus placebo, alongside signals of renal stabilisation. Results The tolerability profile aligns with the GLP‐1 class, with gastrointestinal events predominating and a low risk of clinically important hypoglycemia; biliary events may be more likely at higher doses, while pancreatitis risk has not been clearly elevated. Data in HFrEF remain limited and caution is advised given prior mixed results with incretin therapies and theoretical concerns about rapid weight loss in advanced systolic failure. Conclusion This review integrates mechanistic insights and contemporary trial evidence to clarify how dual incretin agonism may modify the trajectory of obesity‐driven heart failure, to inform multidisciplinary clinical decision making, and to highlight key unanswered questions and research priorities needed to define tirzepatide's full role in heart failure management. Integrated framework for tirzepatide in HFpEF management. Through metabolic, haemodynamic, structural and anti‐inflammatory pathways, tirzepatide modifies the disease trajectory of HFpEF, leading to improvements in symptoms, functional capacity and reduction in HF events.

Infective endocarditis (IE) is life‐threatening, and while Staphylococcus aureus commonly causes left‐sided IE, community‐associated methicillin‐resistant S. aureus (CA‐MRSA) is a rare etiology in healthy individuals. A 41‐year‐old previously healthy male presented with 10 days of recurrent fever. Transthoracic and transesophageal echocardiography confirmed severe mitral valve infective endocarditis with large vegetations and significant regurgitation. Blood cultures grew MRSA, and whole‐body imaging revealed embolization to the brain, spleen, and kidney. Despite broad‐spectrum antibiotics, he remained hemodynamically unstable and required urgent mitral valve replacement. Postoperatively, the patient showed significant clinical improvement with resolution of infection and stabilization of organ function. This case highlights the rare but aggressive nature of CA‐MRSA left‐sided IE causing rapid deterioration and multi‐organ embolization in an otherwise healthy individual without traditional risk factors, highlighting the importance of early recognition, multidisciplinary management, and timely surgery. Key Clinical Message Community‐associated MRSA can cause fulminant left‐sided infective endocarditis with rapid multi‐organ septic embolization in previously healthy individuals; prompt recognition, aggressive antimicrobial therapy, multidisciplinary care, and timely surgical valve replacement are essential to prevent permanent organ damage and improve survival.

Dandy‐Walker spectrum disorder (DWSD) is a congenital abnormality of the brain, consisting typically of partial or complete hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and enlargement of the posterior fossa. Approximately 1 in 10,000 to 30,000 live births is affected by this typically early‐onset neurological condition, which commonly presents with hydrocephalus, irritability, and poor motor coordination. Usually, the diagnosis is confirmed by anatomic features typical of computed tomography or magnetic resonance imaging (MRI). Management has been largely hydrocephalus‐oriented, usually by VP shunting and multidisciplinary follow‐up for neurological and developmental improvement in the long run. Herein is reported a case with a 5‐month‐old male presenting with DWSD, which has been documented in this paper along with his clinical presentation, imaging findings, and, most importantly, the response to the cerebrospinal fluid (CSF) diversion following the shunt. This case highlights the importance of early intervention, early comprehensive imaging, and a multidisciplinary approach, including genetic counseling, in optimizing the quality of life and managing complex developmental needs associated with DWSD.

Hypertriglyceridemia is a widely prevalent disorder of lipid metabolism that increases the risk of cardiovascular disease and pancreatitis, and it often remains difficult to control even with standard treatments. Olezarsen, an antisense oligonucleotide that targets apolipoprotein C-III (ApoC-III), offers a new and promising option for lowering triglyceride levels. A systematic search of PubMed, Scopus, Web of Science, and Cochrane was conducted through September 2025 to identify randomized controlled trials (RCTs) comparing olezarsen with placebo in adults with hypertriglyceridemia at high cardiovascular risk. Dichotomous outcomes were analysed as risk ratios (RRs) and continuous outcomes as percentage mean differences (MDs), both with 95% confidence intervals (CIs). Four RCTs (n = 1615 patients) were included. Olezarsen significantly reduced triglycerides (MD -47.71%, 95% CI -56.78 to -38.64, p < 0.0001), non-HDL-C (MD -22.11%, 95% CI -28.48 to -15.75, p < 0.0001), ApoC-III (MD -68.93%, 95% CI -77.54 to -60.31, p < 0.0001), VLDL-C (MD -48.52%, 95% CI -57.16 to -39.87, p < 0.0001), and ApoB (MD -10.67%, 95% CI -16.83 to -4.51, p = 0.0007), while increasing HDL-C (MD 35.13%, 95% CI -27.30 to -42.96, p < 0.0001). LDL-C showed no significant change. The risks of any or serious adverse events were comparable to placebo. Olezarsen was associated with fewer acute pancreatitis events (p = 0.035) but higher rates of liver enzyme elevations ≥ 3× ULN (p = 0.046). Olezarsen demonstrated consistent improvements in triglycerides and other atherogenic lipid parameters with an overall acceptable safety profile. These findings suggest that olezarsen may be a useful adjunct option for patients with persistent hypertriglyceridemia despite standard therapy. Further large-scale and long-term studies are needed to confirm its cardiovascular and safety outcomes.

Background Status epilepticus is one of the most commonly occuring emergencies among children across the world. Time is crucial in the treatment of SE, with increasing risk of long term adverse events and sequelae with delay in treatment or action of drugs. This systematic review and meta-analysis aims to compare levetiracetam, a drug known for its comparatively safer profile, with other routinely used drugs in pediatric SE like phenytoin, fosphenytoin and valproate. Methods A comprehensive literature search was conducted across four databases from 1996 till November 2024. All original studies evaluating the efficacy of levetiracetam vis-a-vis other anti-seizure medications in pediatric children in an emergency setting were included in the study. Data analysis was conducted using RevMan software, using a random-effects model. Results A total of fourteen studies, comprising a patient population of 2,473, were included for further quantitative analysis. No differences were noted between the drugs when comparing seizure termination and recurrence at 24 h. Levetiracetam notably reduced the time to cessation of seizures when compared to phenytoin or fosphenytoin (MD=-3.97, 5% CI [-6.18, -1.76], p  = 0.0004) and length of ICU stay over phenytoin (MD = 0.77, 95% CI [0.54, 1.00], p  < 0.00001). A lower risk of adverse events was noted on use of levetiracetam over fosphenytoin (RR = 0.62, 95% CI [0.40, 0.96], p  = 0.03); however risk of agitation was the least on use of phenytoin (RR = 3.90, 95% CI [1.42, 10.73], p  = 0.008). Non significant differences in mortality rates were observed. Conclusion The study concludes better immediate effects of levetiracetam such as faster cessation of seizures. Levetiracetam was also suggested to stabilize patients faster, as implied by the lesser ICU stay and lower risk of adverse events. Further studies are needed to evaluate the efficacy of levetiracetam over other anti-seizure medications.

Background Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal discomfort or pain, accompanied by alterations in bowel habits. Its exact pathophysiology remains unclear, but mental health problems are recognized as a major risk factor. Therefore, this study aimed to identify the prevalence of IBS among medical students and explore its association with various factors, including comorbid mental health issues. Methods This multicentric cross-sectional study employed an online self-administered questionnaire, distributed among medical students from 27 faculties of medicine across seven countries in the Middle East and North Africa. Universities were selected using a simple random sampling technique. Possible associates were evaluated using the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, and the Rome IV Diagnostic Questionnaire for adult IBS. Results A total of 8,275 medical students completed the questionnaire, with 40.1% diagnosed with IBS according to the Rome IV criteria. Adjusted logistic regression analysis revealed significant associates of IBS, including female gender (AOR = 1.56, p  < 0.001), enrollment in the third academic year (AOR = 1.23, p  = 0.003) or higher (AOR = 1.44, p  = 0.001), lack of regular exercise (AOR = 1.18, p  = 0.003), and living alone or on campus (AOR = 1.18, p  = 0.006). Additionally, a history of food or drug hypersensitivity (AOR = 1.49, p  < 0.001) and overweight or obesity (AOR = 1.19, p  = 0.002) were significantly associated with IBS. Medical students experiencing depression (AOR = 2.38, p  < 0.001) and anxiety (AOR = 1.91, p  < 0.001) were found to be more susceptible to developing IBS. Conclusion IBS is a prevalent health issue among medical students. Nearly 40% of them suffered from IBS. In addition to certain personal and academic factors, increased rates of depression and anxiety among medical students in the Middle East and North Africa are associated with a higher probability of developing IBS.

Background The coronavirus disease (COVID-19) pandemic has profoundly impacted mental health worldwide, exacerbating anxiety and depression, and influencing adherence to public health measures. Objectives To measure the frequency and demographic determinants of anxiety, depression, and emotional contagion among Egyptians during the pandemic from May to August 2020. Methods The study employed a cross-sectional web-based survey that specifically targeted 666 Egyptians from four different regions. A validated Arabic questionnaire was used to assess anxiety using the Generalized Anxiety Disorder-7 (GAD-7) scale, depression using the Patient Health Questionnaire-9 (PHQ-9), and emotional contagion using the Emotional Contagion Scale (ECS), along with demographic variables. Results Anxiety (GAD ≥ 5) was observed in 66.7% (95%CI, 63.1%:70.1%) of participants, with severe anxiety (14.8%). Depression (PHQ-9 ≥ 5) affected 88.2% (95%CI, 85.7%:90.7%) of the participants, with severe depression affecting 17%. Females experienced higher rates of anxiety (74.3%, 95%CI = 70.0%:78.5%) and depression (91.1%, 95%CI = 88.3%:93.9%) than males (54.7%, 95%CI = 48.5%:60.8% and 83.6%, 95%CI = 79.0%:88.2%, respectively). Younger participants (< 35 years) and unemployed/students also showed significantly higher rates of anxiety (71.4%) and depression (92.7%). The ECS had a mean score of 44.2 (SD = 7.5), with the highest scores for happiness (9.8), love (9.6), and fear (8.3). ECS was significantly higher among females, urban residents, unmarried individuals, and university graduates. Conclusion The high prevalence of anxiety and depression during the COVID-19 pandemic, particularly among women, youth, unmarried individuals, and those facing socioeconomic vulnerabilities, underscores an urgent need for culturally sensitive and targeted public mental health interventions in Egypt. Strengthening accessible support systems, integrating mental health into primary care, and addressing social determinants of distress could mitigate the long-term psychological impact of the pandemic on vulnerable groups.