Articles

A basic component of complementary and alternative medicine, bloodletting is also referred to as blood cupping (CP) or cupping therapy (CPT) and blood-letting puncture (CP), which refers to a superficial needle prick in the skin. In East Asia, BL or CPT is a non-medical treatment that is referred to as traditional therapy. Insulin-resistant iron overload syndrome, ischemic stroke, hemochromatosis, iron, external rheumatism, psoriasis, metabolic syndrome, and mental pain in patients with migraine porphyria cutanea-tarda, diabetes, fever, infections, and bronchopneumonia are among the various diseases for which BL is currently used. By using mechanical pressure under vacuum to influence local soft tissue microcirculation, BL improves capillary vascular permeability, increases regional blood circulation flow, stimulates the immune system for feedback control, and improves metabolism. The effectiveness of BLT in various therapies varies depending on the conditions and diseases. The results of laboratory assays indicated the effectiveness of BLT in diseases, and the meta-analysis’s showed that it is an assessment, controlling, and less side effect method than other medical methods. The various types of articles in therapy by the association of BL, titled, studied: for instance, may be helpful as a complementary therapy for acute stroke and eye drops, while BLT may boost lead absorption by lowering iron serum.

Bacteriolysis of peptidoglycan (PGN) cell wall destruction on cleavage, hydrolysis, and decomposition by copper nitrate and zinc sulfide solutions has been investigated on the ground of the results obtained from halo antibacterial susceptibility tests in metal sulfate solutions against Staphylococcus epidermidis, in which from halo-antibacterial susceptibility tests of metallic ion concentration of 100 mM/L against Staphylococcus epidermidis, the order of bacterial effect for the metal nitrate solutions is as follows, Cu2+>Zn2+ >Ag+>Pb2+>Al3+, and the other, in the metal sulfate solutions, the antibacterial effect order is found to be Zn2+>Cu2+>Ag+>Al3+. Cu(Ⅱ)-, Zn(Ⅱ)-ions induced bacteriolytic destructions for PGN cell wall on cleavage, hydrolysis, and decomposition within Cu(NO3)2 and ZnSO4 solutions have been elucidated that Cu(Ⅱ) and Zn(Ⅱ) ions can inhibit PGN biosynthesis Transpeptidase (TP)/Tranｓ-glycosylase (TG) and PGN elongation, PGN cleavage occurs by copper ions- and zinc ions-containing autolysins amidase; AmiE, Rv3717, AmiA, PGN cell wall is hydrolyzed by copper-, and zinc-containing enzymes; PGRPs, MurA, LytA, LytM=Endopeptidase, Hydrolase LytB, and PGN decomposition by copper-, zinc-containing PGN inhibitive elongation occurs. Thus, Cu(Ⅱ) and Zn(Ⅱ) within Cu(NO3)2 and ZnSO4 solutions inhibit PGN biosynthesis and activate bacterial PGN autolysins against Staphylococcus epidermidis.

Ureteral double-J stents are a commonly used device in urological practice to allow urinary drainage, avoid ureteral obstruction processes, and protect the upper urinary tract after surgical procedures. However, long indwelling time may give rise to numerous complications, such as infection, migration, and fragmentation of the stent, especially encrustation. Encrustation of stents is a well-known complication that has been closely related to the time active of the stent and can cause significant morbidity if not timely addressed. In severe cases, abundant mineral deposition can result in the development of large calculi encasing the stent and rarely progress to staghorn stones. These cases may pose challenges in terms of the extraction of the stent and may result in complex endourological intervention. The encrustation likelihood is substantially higher if stents are left forgotten or remain in place longer than the advised period. Most patients with heavily encrusted stents have symptoms including flank pain, urinary tract infection, hematuria, or obstructive uropathy, but can present without any symptoms, and this can delay the diagnosis.

Psoas abscess is a rare but potentially life-threatening condition with non-specific clinical manifestations. The condition may be primary or secondary, depending on whether it has an underlying cause. The condition may be diagnosed with the help of imaging studies, especially contrast-enhanced computed tomography (CT).A 55-year-old female patient with a history of treated hypertension presented with a 15-day history of fever and left-sided low back pain. Her laboratory parameters showed a high leukocyte count of 22,000 cells/mm³ and elevated levels of C-reactive protein (367 mg/L). Her renal functions were within normal limits, and the urine culture was negative. Contrast-enhanced CT revealed a large left-sided intra-abdominal fluid collection extending from the diaphragm to the left iliac fossa, measuring 66 x 305 mm with air bubbles. The collection also showed a left-sided intramuscular psoas collection of 66 x 50 x 131 mm. The patient received intravenous broad-spectrum antibiotics (third-generation cephalosporin, aminoglycoside, and metronidazole). The patient underwent mini-lumbotomy, and nearly 1 liter of pus was drained. The patient’s postoperative course was satisfactory with complete resolution of symptoms. The histopathological examination showed non-specific changes.Psoas abscess should be suspected in patients with febrile low back pain and inflammatory syndrome. Contrast-enhanced CT scans are essential for diagnosis and assessment of the extent of disease. In complicated cases with large abscess formation, early surgical drainage along with appropriate antibiotics will provide the best outcome.This case highlights the importance of early diagnosis and adapted management for successfully navigating the complexities associated with this condition.

Renal dysfunction after allogeneic hematopoietic stem cell transplantation (allo-HSCT) often results from common causes like drug toxicity, infection, or transplant-associated thrombotic microangiopathy (TA-TMA). However, renal graft-versus-host disease (GVHD) may be ignored. We discuss a 49-year-old man who experienced worsening kidney function despite being in hematologic remission and having negative results for infections and autoimmune diseases. A renal biopsy showed chronic tubulointerstitial injury consistent with renal GVHD, along with existing TMA. Treatment with eculizumab did not lead to improvement, likely indicating significant chronic damage. This case highlights the need to maintain clinical suspicion and to perform timely renal biopsies in cases of unexplained kidney dysfunction after transplant.

Acriptega, a combination of Dolutegravir, Lamivudine, and Tenofovir, is a cornerstone of modern antiretroviral therapy due to its efficacy and tolerability. However, treatment failures persist despite this optimization, raising questions about barriers to successful treatment. Through the analysis of two clinical cases, this study explores the biological and behavioral factors contributing to these failures following a switch to this molecule.The first case is a 69-year-old female patient, diagnosed with HIV in 2002 following pulmonary tuberculosis, who was regularly monitored with an undetectable viral load and a CD4 count > 500 cells/mm³ until the Acriptega transition and the onset of tumor symptoms in 2024. The second case is a 62-year-old female patient, diagnosed with HIV in 2009 following cerebral toxoplasmosis. She was regularly monitored with good treatment adherence and an undetectable viral load. After switching her triple therapy, she developed gastroenteritis, which led to the discovery of her treatment failure.    This case study highlights that failure after switching to Acriptega is linked to the absence of prior resistance testing (genotyping). A safe switchover requires a rigorous assessment of the patient’s virological history to prevent the emergence of cross-resistance. Close monitoring via genotyping is essential.

Intravaginal erosion of synthetic mesh after laparoscopic promontofixation(sacrocolpopexy) is an uncommon but clinically relevant late complication. When mesh becomes exposed within the bladder, it may function as a persistent foreign body, encouraging chronic inflammation, bacterial colonization, recurrent lower urinary tract symptoms, and progressive encrustation that can culminate in bladder stone formation. We report a 60-year-old woman with a history of laparoscopic promontofixation using standard polypropylene mesh performed approximately five years earlier. She presented with progressive urinary symptoms. Bladder ultrasound demonstrated an intravesical calculus, and diagnostic cystoscopy confirmed a bladder stone developing on exposed intravesical mesh fibers, consistent with intravesical mesh erosion. Endoscopic management was performed with cystolithotripsy followed by section/resection and removal of the exposed intravesical mesh to eliminate the lithogenic nidus, with a favorable outcome. In women with prior promontofixation presenting with bladder stones, recurrent urinary tract infections, hematuria, or persistent irritative urinary symptoms, intravesical mesh erosion must be considered. Cystoscopy is essential for diagnosis because imaging may identify the stone but not the underlying foreign-body etiology, and definitive treatment requires both stone clearance and elimination of intravesical foreign material to prevent recurrence.

Iatrogenic ureteral injury is an uncommon but potentially severe complication of abdominopelvic surgery. When not identified intraoperatively, it may present days to weeks later with flank pain, fever, urinary tract infection, and imaging evidence of obstruction. Early recognition and timely urinary diversion are essential to prevent sepsis and preserve renal function.A 65-year-old patient underwent elective resection of an abdominal mass; pathology confirmed schwannoma. On postoperative day 15, the patient developed left flank pain and fever. Laboratory tests showed leukocytosis (WBC 15,000/mm³) and elevated C-reactive protein (150 mg/L); urine culture grew Escherichia coli. Contrast-enhanced CT demonstrated left hydronephrosis without stones, suggesting postoperative ureteral obstruction. Retrograde double-J stenting was attempted but failed. Urgent percutaneous nephrostomy achieved decompression with clinical improvement under targeted antibiotics. Definitive exploration revealed a 1 cm stricture of the lumbar ureter, managed by segmental resection and tension-free spatulated termino-terminal ureteroureterostomy over an internal stent. Postoperative recovery was uncomplicated; the stent was removed after 3 weeks. Follow-up ultrasound showed no persistent pelvicalyceal dilatation.Delayed ureteral obstruction should be suspected in postoperative patients presenting with flank pain, fever, and hydronephrosis. When retrograde stenting fails in the setting of infection, percutaneous nephrostomy provides rapid decompression and source control, allowing delayed definitive reconstruction. For short-segment proximal or mid-ureter strictures, ureteroureterostomy remains a reliable option when performed according to reconstructive principles.

Background: WHO grade II Low-grade gliomas (LGGs) need multi-disciplinary treatment from different specialties, directed by new molecular classifications and prognostic markers. Yet regional practice patterns and obstacles are not reported, especially in MENA countries.Method: A cross-sectional survey of physicians from MENA countries (including neurosurgeons, radiation oncologists, and medical oncologists) was conducted. An electronic anonymous survey, including clinical scenarios and evidence-based treatment choices, was distributed at professional conferences. The feedback included responses regarding surgical interventions, adjuvant treatment preferences, and barriers to adoption of IDH-mutant inhibitors.Results: 137 physicians (37.23% neurosurgery, 32.85% radiation oncology, 29.93% medical oncology). Most had 6–15 years of experience (56.21%) and worked in government (51.82%) or academic hospitals (25.55%). Maximal safe resection (MSR), if applicable, was preferred over biopsy (89.05% vs. 10.95%). For residual Astrocytoma, concurrent radiotherapy (RT) with temozolomide (TMZ) (42.34%) was the preferred adjuvant, while 44.53% prefer observation after gross total resection (GTR). For residual Oligodendroglioma, RT followed by PCV (45.99%) was preferred, with 59.85% offered observation post-GTR. Most (96.35%) agreed that resection extent impacts outcomes, while 72.99% objected to extending TMZ beyond six cycles. High-risk stratification varied: 46.72% used age ≥40 years, and 88.32% prioritized residual tumor volume. Although 64.96% supported IDH-mutant inhibitors, 58.39% cited limited availability as a barrier, followed by cost (40.88%) and insufficient long-term data (31.39%). Specialty-specific differences emerged: radiation oncologists tend more to provide adjuvant radiotherapy in the context of persistent seizure post-operatively (χ² = 20.50, p < 0.05), and medical/radiation oncologists more often used age ≥40 for high-risk stratification (χ² = 10.10, p = 0.038).Conclusion: There is a wide variation in the WHO grade II LGGs management among physicians in MENA Countries. These data highlight the importance of locally derived guidelines, the increased availability of molecularly directed therapies, and ongoing collaboration between multiple disciplines to ensure optimal patient outcomes.Key points:•    Maximal safe resection (89.05%) is the dominant surgical approach for WHO grade II LGGs, taking into consideration the location and extent of infiltration, among specialists in MENA Countries, reflecting global consensus on resection extent impacting outcomes (96.35% agreement).•    Adjuvant therapy preferences vary: concurrent RT+TMZ for astrocytomas (42.34%) and sequential RT+PCV for oligodendrogliomas (45.99%), with 59.85% observing post-GTR in oligodendrogliomas.•    IDH-mutant inhibitors (e.g., Vorasidenib) are supported by 64.96% of oncologists, but limited availability (58.39%) and cost (40.88%) hinder adoption.Importance of the study: This multicenter survey is the first to evaluate real-world management trends and barriers for WHO grade II low-grade gliomas (LGGs) among physicians in MENA Countries. While all specialists align with international guidelines in surgical strategies (e.g., maximal safe resection), significant heterogeneity exists in adjuvant therapy choices, particularly for astrocytomas versus oligodendrogliomas. Crucially, we identify systemic barriers—such as limited access to molecular therapies (IDH inhibitors) and cost constraints—that disproportionately affect WHO grade II LGGs care in the MENA Countries. Our findings underscore the urgent need for regionally adapted guidelines and multidisciplinary collaboration to standardize practices aligned with international guidelines. By highlighting disparities in resource availability and specialty-specific decision-making (e.g., radiation oncologists prioritizing post-resection seizures, p < 0.05), this study provides a roadmap for optimizing WHO grade II LGGs management in resource-limited settings and advocates for the inclusion of Arab populations in global trials of novel agents like Vorasidenib.

The dynamics of the glucose-insulin regulatory system are highly nonlinear and must be understood to be controlled effectively. Bifurcation analysis and multiobjective nonlinear model predictive control (MNLMPC) are performed on a glucose-insulin dynamic model. MATCONT was used for the bifurcation analysis, and for the MNLMPC calculations, the optimization language PYOMO is used in conjunction with the solvers IPOPT and BARON. The bifurcation analysis revealed a Hopf bifurcation point and a limit point. A Hopf bifurcation point is a tipping point where a system that was behaving steadily suddenly starts to oscillate or cycle on its own, like a machine that begins to vibrate instead of staying still. A limit point is a tipping point at which pushing a system a little further suddenly causes it to jump to a completely different state, rather than changing smoothly. MNLMC converged on the Utopia solution. The Hopf bifurcation point, which leads to an unwanted limit cycle, is eliminated by an activation factor. A limit cycle is a repeating pattern of behavior that a system naturally settles into over time, like a steady heartbeat or a clock that keeps ticking. The limit point (which causes multiple steady-state solutions from a singular point enables the Multiobjective nonlinear model predictive control calculations to converge to the Utopia point (the best possible solution) in the model. A Utopia solution in multi-objective nonlinear model predictive control is an ideal operating point at which all goals are simultaneously perfectly optimized.