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Background Multidrug-resistant (MDR) Escherichia coli ( E.coli ) is a growing public health concern, largely driven by the overexpression of efflux pumps such as AcrAB-tolC . These efflux systems contribute to resistance against multiple antibiotic classes, including fluoroquinolones, β-lactams, and aminoglycosides. Despite the well-documented role of efflux pumps in resistance, inconsistencies in reported expression levels and regulatory mechanisms complicate the development of targeted therapies. This systematic review and meta-analysis aim to consolidate available evidence on acrAB-tolC expression patterns and evaluate the impact of efflux pump inhibitors (EPIs) on antibiotic susceptibility. Methods A systematic search was conducted in PubMed, Scopus, Google Scholar, and EBSCO to identify relevant studies examining acrAB expression in E.coli under antibiotic exposure conditions. Inclusion criteria encompassed experimental studies utilizing qPCR, RNA-seq, or microarray techniques to quantify acrAB expression, as well as research assessing the efficacy of EPIs in restoring antibiotic susceptibility. Data synthesis was performed using a random-effects meta-analysis model, and heterogeneity was assessed using the I² statistic. Results A total of 10 studies were included in the final meta-analysis. Pooled analysis demonstrated a significant increase in acrAB expression (SMD: 3.5, 95% CI: 2.1–4.9) in MDR E.coli isolates compared to susceptible strains. Efflux inhibition resulted in a ≥ 4-fold reduction in minimum inhibitory concentrations (MICs) for fluoroquinolones and β-lactams across multiple studies. Risk ratio analysis showed that EPIs significantly restored antibiotic susceptibility (RR: 4.2, 95% CI: 3.0–5.8). However, substantial heterogeneity was noted among studies due to methodological variations. Conclusion These findings confirm that acrAB-tolC overexpression is a major contributor to antibiotic resistance in E.coli and that efflux inhibition is a viable strategy for restoring antibiotic susceptibility. However, clinical translation remains a challenge due to toxicity concerns and pharmacokinetic limitations of current EPIs. Future research should focus on developing safer efflux inhibitors, optimizing combination therapies, and standardizing efflux pump expression assays to facilitate their integration into antimicrobial treatment strategies.

Background Mucocutaneous leishmaniasis (MCL) is a severe form of leishmaniasis causing chronic and destructive lesions. Accurate diagnosis is crucial for effective treatment. Traditional methods, such as the Montenegro skin test is delayed hypersensitivity test. Polymerase chain reaction (PCR) has emerged as a superior diagnostic tool for detecting Leishmania DNA, offering higher sensitivity and specificity. Methodology This meta-analysis adhered to PRISMA guidelines and included studies focusing exclusively on the diagnostic accuracy of PCR for MCL. A comprehensive literature search was conducted across multiple databases. Inclusion criteria mandated studies with relevant diagnostic accuracy metrics, while those mixing other forms of leishmaniasis or lacking a control group were excluded. Quality was assessed using the STARD checklist, and ensuring a low risk of bias assessed through QUADAS-2 tool. Results Eight studies were included, showing PCR sensitivity ranging from 50% to 97.1% and consistently high specificity, often reaching 100%. The studies demonstrated a low risk of bias and applicability concerns, supporting the robustness of the findings. Heterogeneity was substantial, necessitating a random-effects model for pooled estimates. Interpretations This analysis confirms PCR's high specificity for MCL diagnosis, despite variable sensitivity. Compared to previous meta-analyses, this study's focus on MCL exclusively provides a more targeted evaluation. Future research should aim to standardize PCR protocols and explore non-invasive sampling techniques to enhance diagnostic accuracy and patient comfort, ultimately improving clinical outcomes for MCL patients.

Introduction: Tirzepatide is a new molecule capable of controlling blood glucose levels by combining the dual agonism of glucose-dependent insulinotropic polypeptide (GIP) and glucose-like peptide-1 (GLP-1) receptors. The Food and Drug Administration approved tirzepatide subcutaneous injections as monotherapy or combination therapy, with diet and physical exercise. Its influence on sexual behavior as an adverse effect is not well known. Aims: The purpose of this report was to present a case study of an obese female patient who received tirzepatide treatment for sexual dysfunction. Methods: We performed an extensive clinical evaluation, which included the Female Sexual Function Index (FSFI). Metabolic, hormonal, immunologic, and hematologic etiology of sexual dysfunction was ruled out by laboratory examination. The patient was managed by a multimodal approach, with lifestyle modification, pelvic floor strengthening exercises, pharmacologic management with bupropion sustained release 150 to 400 mg per day and topical lubricants, and psychosexual therapy as needed. FSFI scores were longitudinally followed to assess treatment response. Results: A 36-year-old woman with obesity class III developed sexual dysfunction after using tirzepatide, a healthy lifestyle with a carb cycle diet, greater physical activity, and exercise for losing weight. All physical, psychological, and hormonal parameters were normal. During treatment, the patient started to complain of decreasing sexual drive, genital dryness, and failure to catch orgasm; female sexual function index (FSFI) = 12.7. Symptoms decreased after stopping the tirzepetide (FSFI = 28.7) and reappeared after retaking the injection (FSFI = 14.7). After 1 month of sexual treatment and support, FSFI = 24. Conclusion: The drug’s impact on hormones and neurological pathways may contribute to decreased sexual desire, through the specific process is unknown. Adjuvant sexual education and therapy support has an imperative role in the plan of management in cases on going in the journey of reducing their weight and complaining of sexual performance affection.

Background and Aims Acne is a frequently diagnosed skin condition that causes pilosebaceous apparatus clogs and/or inflammatory responses in the majority of teenagers. It is a multifactorial disease that can develop due to various factors. We aimed to evaluate lipid profiles and hormonal levels in patients with acne and correlate them to acne severity. We also aim to explore the alteration of lipid profiles and hormonal levels and their effect on the occurrence of acne. Methods A case‐control study was performed on 100 individuals with acne vulgaris and 100 healthy controls. The biochemical analysis included; lipid profiles such as triglycerides (TG), total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C), and high‐density lipoprotein cholesterol (HDL‐C), and hormonal levels such as estradiol (E), total testosterone (TT), and free testosterone (FT) were measured for both patients and controls. Results Comparison between patients with acne and controls disclosed that; TC, TG, LDL‐C, and HDL‐C levels were significantly higher in patients, especially when compared to controls (p ≤ 0.05); also, the same results were found in hormonal levels results (p ≤ 0.05). Conclusion These altered lipid profiles and androgen levels should be considered in the pathophysiology of acne and taken into consideration when treating patients with acne.

A significant disparity was observed between AV individuals and healthy individuals in various biochemical parameters such as total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and TG (p ≤ 0.05). Clinical and laboratory characteristics of both patients and controls Variables Acne patients N = 70 Healthy controls N = 70 P-Value Age (mean ± SD) 25.62 ± 1.7 26.53 ± 2.6 0.130 Male (N/%) 30 (42.8%) 34 (48.5%) 0.721 Female (N/%) 40 (57.2%) 36 (51.5%) 0.124 BMI (N/%) - Underweight < 18.5 8 (11.4%) 18 (25.7%) 0.0001* - Normal 18.5–24.9 36 (51.4%) 42 (60.0%) 0.132 - Obese 30-34.9 26 (37.2%) 10 (14.3%) 0.0001* - Extremely obese 35< --- --- --- Waist Circumference (N/%) - ≥ 102 cm in men 28 (93.3%) 9 (26.47%) 0.02 - ≥ 88 cm in women 37 (92.5%) 5 (13.88%) 0.01 Blood Pressure (N/%) - ≥ 130 mmHg Systolic BP (mmHg) 43 (61.42) 5 (7.14) 0.03 - ≥ 85 mmHg Diastolic BP (mmHg) 57 (81.42) 8 (11.4) 0.01 Duration of disease (years) - < 5 19 (27.14%) NA NA - ≥ 5 51 (72.85%) NA NA Acne vulgaris severity - Mild 25 (35.7%) NA NA - Moderate 19 (27.1%) NA NA - Severe 26 (37.2%) NA NA Fasting glucose mmoL/L 93.25 ± 1.7 90.15 ± 2.1 0.510 Fasting insulin mlu/L 15.4 ± 7.5 11.78 ± 5.6 0.0005** Insulin resistance (HOMA-IR) 92.5 ± 7.2 52.6 ± 5.2 0.0001* TG mg/dL (mean ± SD) 164.2 ± 22.5 57.4 ± 21.4 0.01** TC mg/dL (mean ± SD) 225.4 ± 22.1 172.2 ± 20.2 0.02** LDL mg/dL (mean ± SD) 128.1 ± 10.2 84.2 ± 11.5 0.03** HDL mg/dL (mean ± SD) 59.1 ± 3.1 41.4 ± 1.2 0.045** Estradiol pg/ml (mean ± SD) 86.2 ± 11.2 29.1 ± 12.1 0.02** Free testosterone ng/dl (mean ± SD) 16.8 ± 11.2 2.3 ± 11.3 0.01** Total testosterone ng/dl (mean ± SD) 388.2 ± 22.2 234.2 ± 11.2 0.02** Metabolic syndrome (N/%) - Fulfilling criteria 58 (82.8%) 3 (4.2%) 0.02 - Not Fulfilling criteria 12 (17.2%) 67 (95.8%) 0.01 N: number, %: percentage, SD: standard deviation, **: mild significant differences P ≤ 0.05, BMI: Body mass index, TG: triglycerides, TC: total cholesterol, LDL: low-density lipoprotein, HDL: high-density lipoprotein and NA: not applied AV group demonstrated significantly higher levels of fasting insulin and IR (p ≤ 0.05).

BackgroundAlthough cervical cancer is potentially preventable, lack of knowledge and poor attitude among healthcare professionals toward cervical cancer screening and Human Papilloma Virus (HPV) vaccination can result in underutilization of these preventive strategies. Then, the objective of this study was to assess the knowledge, attitude, and practice of cervical cancer and its prevention through Pap test screening and HPV vaccination among obstetricians and gynecologists (Ob-Gyns).MethodsA cross-sectional study was conducted on 250 Egyptian attendees of a national Ob-Gyns professional conference. Data collection was performed using a pre-designed self-administered questionnaire, which tested participants’ knowledge, attitude, and practices related to cervical cancer, Pap test screening, and HPV vaccination.ResultsThe study included 41.2% Ob-Gyns specialists and 37.6% of consultants from secondary and tertiary care hospitals or centers. About 45% of participants had poor-to-fair knowledge, 57% had negative-to-fair positive attitudes toward cervical cancer screening and HPV vaccination, and 44% had ever-performed Pap test, while 45% of participants had ever-prescribed the HPV vaccine to their patients. Physicians' knowledge and attitude were significantly associated with their age, professional level, work experience, and place of work. Although performing cervical cancer screening was significantly more common among older, more experienced, and highly professional participants, HPV vaccine prescription was associated with young, less experienced participants at lower educational and professional levels.ConclusionOb-Gyns had poor-to-fair knowledge, Attitude, and practices related to cervical cancer, Pap test screening, and HPV vaccination.

Background MicroRNAs (miRNAs) are small RNA molecules that play a regulatory role in various biological processes by acting as intracellular mediators. They hold great potential as therapeutic agents for targeting human disease pathways; however, there is still much to be uncovered about their mechanism of gene regulation. Alopecia areata (AA) is a commonly occurring inflammatory condition characterized by the infiltration of T cells that specifically target the anagen‐stage hair follicle. The limited understanding of its precise cellular mechanism may be the reason behind the scarcity of effective treatments for AA. Aim The significance and function of hsa‐miR‐193a‐5p as a genetic marker for AA and its potential influence on the advancement of the disease. Subjects and methods A case‐control study comprised 77 individuals diagnosed with AA who were matched with 75 healthy controls. In order to measure the expression of miR‐200c‐3p in both groups, the real‐time PCR technique was utilized. The prediction of suitable genes for hsa‐miR‐193a‐5p, as well as the identification of pathways and gene‐gene interactions, were carried out using bioinformatic tools. Results The levels of hsa‐miR‐193a‐5p expression were notably elevated in AA patients in comparison to healthy controls. Our prediction suggests that the involvement of hsa‐miR‐193a‐5p in the development of AA is significant due to its influence on the inositol phosphorylation pathway and the Phosphatidylinositol signaling system, achieved through its direct impact on the IPPK gene. Conclusion For the first time, our study demonstrates the significant over‐expression of a new miRNA, hsa‐miR‐193a‐5p, in the blood of AA patients compared to controls, and highlights its impact on the IPPK gene and the inositol phosphorylation and Phosphatidylinositol signaling pathways, suggesting a potential therapeutic role for hsa‐miR‐193a‐5p in AA.

Background The chin is an essential element of the facial unit and influences how people perceive facial aesthetic appeal. Hyaluronic acid (HA) gel injections are tried‐and‐true therapies for regenerative therapies with a record of success in efficacy and safety. Aims To determine the best type of concentration of HA and way of injection for deep and superficial planes of chin. Materials and Methods VYC‐20L and VYC‐25L (Juvederm Voluma XC® Juvéderm Volux®; Allergan plc) are 20‐ and 25‐mg/mL HA gels with lidocaine, respectively, were injected with cannulas and needles on the bone, respectively. Results Chin reinforced respecting the measures with good contouring. No serious complications. Patient was satisfied with results. Discussion We advise using VYC 20L superficially above the muscle or with a cannula for injection, and we recommend using VYC 25L in the supraperiosteal plane.

Background Macrophage scavenger receptor 1 gene (MSR1), is responsible for producing macrophage scavenger receptors. MSR1 is primarily located on the surfaces of various macrophage types and is known to exert a range of effects on the human body. These effects include influencing innate and adaptive immunological reactions, as well as contributing to the development of conditions such as atherosclerosis, dyslipidemia, liver and lung disease, and cancer. The unregulated assimilation of lipoproteins by MSR1 leads to the creation of macrophages rich in cholesterol that manifest as foam‐like cells, ultimately contributing to dyslipidemia. This occurrence highlights the significance of MSR1 as a key player in the pathophysiology of dyslipidemia. Aim In this study, we aimed to estimate variation in lipid profile in acne vulgaris (AV) patients. Also, we aimed to investigate the role of MSR1 in lipid profile variation. Subjects and methods A case‐control study consisting of 100 patients with AV and 104 healthy controls. Lipid profiles were assessed using normalized enzymatic processes and genotype analyses were performed by a polymerase chain reaction and standard Sanger sequencing. Predictions of variant effects were performed using in silico tools. Result Our results indicated that the levels of lipid profile were higher in patients with AV than in healthy patients. The two haplotypes that were most prevalent in the patients were TCAC (16.5%) and CAGG (15.47%), whereas the two haplotypes that were more prevalent in the controls were TAAC (16.43%) and CCAC (15.62%). IVS5.59 C > A and rs433235 A > G are in linkage disequilibrium. Additionally, rs433235 A > G has a significant linkage disequilibrium with rs3747531 C > G. In silico analysis, tools indicated that the rs433235 A > G variant was disease‐causing. Conclusion Patients diagnosed with TCAC and CAGG exhibited a higher prevalence compared to healthy patients with TAAC and CCAC. The linkage disequilibrium between rs433235 A > G and IVS5.59 C > A has been established. Furthermore, there appears to be significant linkage disequilibrium between rs3747531 C > G and rs433235 A > G. These findings support the notion that genetic variations may play a critical role in the pathogenesis of these conditions.

Background Acne vulgaris (AV) is a chronic inflammatory skin condition affecting the pilosebaceous unit, commonly presenting as comedones, papules, pustules, or nodules on the face, upper limbs, torso, and back, with comedones formation being the primary pathology leading to disfiguring inflammation, hyperpigmentation, scarring, and psychological impact. Aim The purpose of this study was to investigate the significance of two genetic variants in the promoter region of the tumor necrosis factor‐alpha (TNF‐α) gene and their association with insulin resistance (IR) in acne patients. To understand how these variants contribute to AV and its associated IR. Subjects and methods An analytical cross‐sectional study with a case‐control design and research evaluation was carried out on 87 AV patients and 73 healthy volunteers. The medical histories of both groups were obtained, as well as the severity and duration of inflammation among acne sufferers, as well as demographic data. Biochemical analysis was performed on both sets of participants, including fasting blood glucose levels, insulin levels while fasting, IR, and serum TNF‐α. PCR‐RFLP analysis identified −863 G > A (rs1800630) and −308 G > A (rs1800629) variations, and real‐time PCR analysis evaluated TNF‐α gene expression in both patients and healthy people. Results Acne patients exhibited significantly higher levels of IR, fasting glucose, fasting insulin, serum TNF‐α, and TNF‐α folding change, when compared to healthy controls. The co‐dominant model for −863 G > A and −308 G > A variants exhibited significant variations between the two groups. Severe acne patients who had the A/A genotype for −308 variants exhibited higher levels of IR, serum TNF‐α, and TNF‐α folding change. Highly significant positive linear correlation between IR, serum TNF‐α, and TNF‐α folding change in severe AV. Conclusion There is a correlation between AV, especially severe acne, and the −863 G > A and −308 G > A polymorphism, which influences TNF‐α gene expression and serum TNF‐α levels.