Selective Attenuation of Acetaminophen-induced Hepatobiliary Dysfunction by Pseudoelephantopus spicatus in Sprague-Dawley Rats

Background: Pseudoelephantopus spicatus (PS) is used in ethnomedicine for hepatic disorders; however, its effects on biochemical markers of drug-induced liver injury remain incompletely characterized. This study evaluated the effects of the ethanolic root extract of PS on serum biochemical indices in an acetaminophen-induced acute hepatotoxicity model. Methods: Sprague-Dawley rats (150-200 g) were allocated into five groups (n = 6/group). PS extract (500 and 1000 mg/kg) and silymarin (100 mg/kg) were administered orally for 10 days. On day 10, hepatotoxicity was induced by a single oral dose of acetaminophen (700 mg/kg) after a 12 h fast. Serum ALT, AST, ALP, total bilirubin, total protein, albumin, and globulin were quantified 24 h post-administration. Results: Acetaminophen produced marked elevations in ALT, AST, ALP, and total bilirubin, with reduced serum protein fractions. PS treatment did not significantly reduce ALT or AST levels. However, PS significantly decreased ALP activity at both 500 and 1000 mg/kg (p < 0.001) and reduced total bilirubin dose-dependently (p < 0.01-p < 0.001 vs. acetaminophen control). At 1000 mg/kg, PS significantly restored total protein (p < 0.001) and increased albumin and globulin levels (p < 0.05), indicating partial recovery of hepatic synthetic function. Conclusion: PS ethanolic root extract produced selective biochemical attenuation of acetaminophen-induced hepatobiliary dysfunction, significantly modulating ALP, total bilirubin, and circulating proteins without significant transaminase normalization. These findings indicate partial functional improvement rather than comprehensive hepatocellular protection. Further studies incorporating histopathology, oxidative stress, and mechanistic analyses are required to establish structural and molecular correlates

First Video-Documented Vine Snake (Thelotornis Capensis) Envenomation in a Healthy Adult: A Rare Case Report from South Africa

Vine snake (Thelotornis capensis) envenomation is rare but can cause life-threatening coagulopathy. We report the 10th documented case of envenomation: a 42-year-old male who misidentified a vine snake as a juvenile python and sustained a bite while filming snake handling. Initial laboratory investigations showed complete incoagulability within 28 minutes of the bite, with normal vital signs and minimal local symptoms. The patient later developed frank hematuria, highlighting the delayed onset of systemic bleeding typical of venom-induced consumptive coagulopathy. No specific antivenom exists for venom from the Thelotornis genus. Management was supportive, with close monitoring of coagulation parameters; blood products were planned if bleeding progressed, but were not ultimately required. The patient self-discharged against medical advice despite ongoing coagulopathy, but ultimately recovered fully without sequelae. This case reinforces the need for clinicians to be aware of delayed coagulopathy and the importance of supportive care in vine snake envenomation

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Multisystemic Narrative Review of Cardiovascular and Oncological Implications

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has surpassed viral hepatitis as the primary driver of chronic liver disease globally. While traditionally viewed through the lens of hepatic progression, its clinical trajectory is increasingly defined by extrahepatic complications. Objective: This narrative review evaluates MASLD as a manifestation of systemic metabolic failure, specifically analyzing its role in accelerating cardiovascular dysfunction and extrahepatic carcinogenesis—the two principal causes of mortality in this population. Methods: A comprehensive literature synthesis was conducted from 2020 to December 2025, using databases including PubMed, Scopus, and the Egyptian Knowledge Bank (EKB) to identify high-impact studies and international guidelines. Results: The pathophysiology involves a metabolic cascade whereby hepatic lipid accumulation and insulin resistance trigger systemic inflammatory signaling. Disrupted lipid handling and genetic determinants promote pro-atherogenic and pro-oncogenic environments. The review advocates a transition to risk-stratified approaches using noninvasive biomarkers, such as the FIB-4 index. Conclusion: Addressing the bidirectional relationship between hepatic steatosis and systemic comorbidities requires a multidisciplinary therapeutic strategy. This framework provides a basis for early intervention to reduce the burden of cardiovascular events and malignancy among patients with MASLD

Motion-Artifact ‘Pseudo–Type A Dissection’ on Ungated CTA in a Morbidly Obese Patient with Resolution on ECG-Gated CTA: A Case Report

We present a case of acute chest pain in a 48-year-old morbidly obese female with multiple comorbidities that raised suspicion for Acute Aortic Syndrome (AAS). The initial ungated PE-protocol CT angiogram (CTA) revealed a linear low-attenuation band in the ascending aorta consistent with a motion artifact-induced pseudo-flap. This finding led to two Transesophageal Echocardiograms (TEEs): the first, performed under conscious sedation, was positive; the second, performed under general anesthesia (GA) to minimize artifact, was negative. To definitively assess the findings, a confirmatory ECG-gated CTA was performed immediately after heart rate control, which was negative for both pulmonary embolism (PE) and aortic dissection. The final diagnosis was Acute Decompensated Heart Failure (ADHF), and the patient was discharged on Guideline-Directed Medical Therapy. This case illustrates that the ungated PE-protocol CTA is critically suboptimal for the ascending aorta and underscores the need to use a dedicated ECG-gated CTA when AAS is suspected, particularly in obese patients prone to motion artifacts, to prevent diagnostic error and unnecessary surgical intervention

Periprosthetic Joint Infection in Egypt: A Narrative Review of the Current Landscape and Knowledge Gaps

Background: Periprosthetic joint infection (PJI) is one of the most serious complications of total joint arthroplasty (TJA). This review synthesizes the available local evidence of PJI in Egypt to identify the current landscape and knowledge gaps in the Egyptian healthcare system. Methods: A literature review was conducted by searching PubMed, Scopus, and Google Scholar for studies on PJI in Egypt, with articles published up to January 2026. Search terms included "periprosthetic joint infection," "PJI," "Arthroplasty," and "Egypt." We included 9 primary studies for synthesis and excluded review papers. Results: This paper summarizes PJI studies from Egypt and highlights the limited existing knowledge, specific local issues, and gaps. Main findings were limited epidemiological data indicating that rates of PJI in a key study appear higher than in high-income countries, with Staphylococci as the most common organism across studies. Critical gaps exist in national epidemiological data, risk factors, patient demographics, the detailed microbiological spectrum and antimicrobial resistance patterns, as well as long-term patient outcomes, and standardized national guidelines for diagnosis and management. Conclusion: Based on this review, there is limited local evidence on many aspects of PJI in Egypt. Our proposed priorities include further research into the highlighted gaps, the establishment of a national registry, the development of multidisciplinary care models, standardized antimicrobial prescribing protocols, and the implementation of evidence-based national guidelines tailored to the Egyptian healthcare system

Mortality Trends and Disparities in Hypertensive Heart and Renal Disease: A 25-Year Analysis (1999–2023) Using the CDC WONDER Database

Background: Hypertensive heart and renal disease remain major contributors to mortality in the United States. Tracking long-term mortality patterns is essential for identifying high-risk populations and guiding public health strategies. Methods: We conducted a nationwide ecological time-trend analysis using CDC WONDER underlying cause-of-death data for Hypertensive Heart and Renal Disease (ICD-10 I13) from 1999–2023. Age-adjusted mortality rates (AAMR) for all ages were examined by sex, race/ethnicity, census region, and urbanization level. Temporal changes were assessed using joinpoint regression with annual percent change (APC) and average annual percent change (AAPC). Results: AAMR increased from 1.2 (95% CI: 1.2–1.3) per 100,000 in 1999 to 4.2 (95% CI: 4.2–4.3) in 2023. After relative stability in the early years, a marked rise began around 2011, with the South and Midwest showing the steepest increases. From 2013–2023, the AAPC was not statistically significant for females (AAPC = 6.26%; p = 0.1678) but was significant for males (AAPC = 10.67%; p = 0.000117). Males(with AAMR of 4.7 vs 3.9 in females in 2023), older adults, and Black individuals consistently exhibited the highest mortality, while American Indian or Alaska Native groups experienced the most rapid recent increases. A modest decline from 2021–2023 was observed; potential explanations include shifts in healthcare access, reporting, or coding practices. Conclusions: Rising mortality from hypertensive heart and renal disease from 1999 to 2023 highlights persistent demographic and geographic disparities requiring targeted interventions

Trends and Disparities of CVD Underlying-Cause Deaths with Pneumonia and Influenza Mentioned on the Death Certificate in the United States: A CDC WONDER Analysis.

Background: Pneumonia and influenza (P&I) may precipitate cardiovascular decompensation, yet long-term U.S. mortality patterns of P&I co-mention at death among cardiovascular disease (CVD) deaths are not well described across sociodemographic and geographic strata. Methods: Using CDC WONDER multiple-cause-of-death data, we identified deaths with CVD as the underlying cause (ICD-10 I00–I99) and P&I (J09–J18) mentioned anywhere on the death certificate. We calculated crude and age-adjusted mortality rates (AAMR, per 100,000; 2000 U.S. standard), assessed 1999–2023 trends with Joinpoint regression, selected descriptive subgroup and interstate mapping summaries used 1999–2020. Results: AAMR declined from 29.58 (1999) to 8.45 (2023) (-71.4%), with joinpoints in 2005, 2009, and 2019 and a plateau after 2019. Mortality increased with age; adults ≥85 years accounted for 47.3% of deaths and the highest crude rate (277.9 per 100,000). In 2023, AAMR was higher in males than in females (10.69 vs 6.73). Rates were higher in Black than White decedents (10.7 vs 9.5 per 100,000) and highest in rural areas, with marked interstate heterogeneity. Conclusions: AAMRs declined during 1999–2023 but plateaued after 2019, with heterogeneity by age, geography, and race/ethnicity. These descriptive co-mention patterns highlight higher-rate groups and areas that may warrant prioritization for further investigation and prevention planning; they do not establish causal pathways or quantify the impact of structural determinants

Lamellar Intraocular Ossification encasing the Optic Nerve Head: A Case Report

Intraocular ossification is a rare end-stage sequela of chronic retinal detachment, inflammation, trauma, or phthisis bulbi. It typically presents as minor localised choroidal or retinal ossification. We report an exceptionally rare case of mature lamellar intraocular bone encasing the optic nerve head.A 23-year-old male presented three days after sustaining a knife injury to the right eye. The eye had been blind with no light perception for approximately five years prior, with a history of longstanding visual impairment since childhood. Examination revealed an open globe with corneal-limbal laceration and prolapse of uveal and lenticular tissue. The open-globe injury and extensive tissue prolapse precluded posterior segment assessment and B-scan ultrasonography.  The contralateral eye demonstrated a morning glory disc anomaly with a shallow chronic retinal detachment, which was treated conservatively.During routine evisceration, a near-round 12 mm lamellar bony mass was identified encasing the optic nerve head, forming a central invagination in which the optic nerve was seated. The mass felt like bone and was non-adherent; it was removed intact. Post-operative CT imaging showed no additional intra-orbital ossification or malignancy. Histopathology demonstrated mature lamellar bone with osteoblastic rimming, marrow spaces containing adipocytes, and psammomatous calcifications, consistent with long-standing heterotopic ossification. No malignant features or organisms were identified.The postoperative course was uncomplicated, and the patient remained clinically well at six months’ follow-up. This case represents an exceptionally rare report of mature lamellar intraocular bone fully encasing the optic nerve head, highlighting the remarkable metaplastic potential of intraocular tissues in chronic retinal pathology

Cross-Cultural Application of the Beck Depression Inventory (BDI-I/II) for Assessing Adolescent Depression in Low- and Middle-Income Countries: A Critical Review of Evidence from the Last Quarter-Century

Background: The Beck Depression Inventory (BDI-I/II) versions are widely used for identifying depression among adolescents in low- and middle-income countries (LMICs). Nevertheless, their global usage depends on the questionable assumption that symptoms are expressed the same way in different cultures. Methods: This comprehensive review used narrative synthesis to explore the psychometric, conceptual, and ethical aspects of the BDI studies done on adolescents in LMICs. We purposively selected 8 case exemplars from the literature based on a pre-specified framework to illustrate key cross-cultural and methodological issues. A custom rubric was used to weight studies by methodological quality. Invariance evidence was defined as explicit reporting of multi-group confirmatory factor analysis (MGCFA) for configural, metric, or scalar invariance. Results: Although the BDI showed high internal consistency across the 8 exemplar studies (Cronbach’s α: 0.79–0.96), it revealed significant psychometric variation across cultures. Somatic items showed substantial overlap with medical comorbidities (e.g., HIV, malnutrition) in vulnerable populations, confounding diagnostic specificity. Factor structures were inconsistent, and rigorous measurement invariance testing was largely absent. Discussion: The widespread absence of scalar invariance suggests that current cross-cultural score comparisons may reflect measurement artifacts rather than true differences in depression severity. Beyond psychometrics, BDI presents ethical challenges regarding developmentally inappropriate items, particularly concerning sexuality and suicidality, that limit its validity in conservative or resource-limited contexts. Conclusion: Investigations into this issue should focus more on the use of invariance-testing frameworks, the implementation of a mixed-methods strategy, and the recognition of the need for sensitive translation and culturally appropriate assessment techniques

Boerhaave Syndrome in an Elderly Woman: A Case Report

Boerhaave syndrome is a rare emergency characterized by spontaneous esophageal perforation secondary to severe vomiting. Diagnosis is often difficult due to the nonspecific nature of the symptoms and their similarity to other emergencies. Mortality is high, and it increases if rapid diagnosis and treatment are not provided. A 76-year-old woman presented to the emergency department after an episode of syncope, hematemesis, and severe retrosternal chest pain. Initial laboratory evaluation showed leukocytosis (12.7 ×10³/µL), elevated C-reactive protein (2.66 mg/dL), and preserved renal function (creatinine 0.68 mg/dL). An initial upper gastrointestinal endoscopy showed detached esophageal mucosa with adherent clots. Contrast-enhanced chest CT scan confirmed esophageal perforation associated with esophageal wall pneumatosis and extensive pneumomediastinum—surgical management with left thoracotomy and esophageal exclusion, mediastinal drainage, and cervical esophagostomy. On postoperative day seven, the patient developed acute kidney injury (creatinine 2.36 mg/dL), metabolic acidosis (HCO₃⁻ 13.4 mmol/L), and hyperlactatemia (4.54 mmol/L), followed by hemodynamic instability and respiratory failure. The patient died 10 days after surgery. Boerhaave syndrome occurs due to a sudden increase in esophageal intraluminal pressure during vomiting. Its presentation can range from asymptomatic to shock. Diagnosis requires a high index of suspicion, imaging studies, and sometimes upper gastrointestinal endoscopy. Surgery remains the mainstay of treatment, with high mortality if diagnosis and treatment are delayed. This case highlights the importance of early recognition and multidisciplinary management in patients with severe vomiting, hematemesis, and acute chest pain. Multidisciplinary coordination is key to optimizing the prognosis