All Articles in april, 2026

Obesity represents a significant public health challenge on a global scale, with its prevalence increasingly linked to socio-economic factors, most notably family income. This study investigates the relationship between family income and several obesity measures specifically, the Body Shape and Size Index (BSSI), Body Mass Index (BMI), Body Surface Area (BSA), Ponderal Index (PI), Weight/Body Mass (BM), and Height within a sample of 9,906 respondents from Pakistan. Utilizing descriptive statistics and p - values, the analysis aims to provide a comprehensive understanding of how variations in income affect these obesity indicators, ultimately informing potential public health interventions. The findings reveal a complex, variable association between family income levels and obesity measures that differs by the specific obesity index examined. For BSSI, individuals in the lowest income bracket demonstrated higher values (indicating greater adiposity), while for BMI and weight, higher income brackets showed elevated values. These mixed findings suggest that the direction of association depends critically on which obesity measure is analysed. The study reveals that lower-income families are more likely to face barriers in accessing nutritious food, engaging in physical activity, and achieving favourable health outcomes. This situation is often exacerbated by economic constraints that drive families toward caloric-dense, nutrient-poor food choices. The implications of this research are far-reaching, emphasizing the need for targeted public health strategies to address obesity, particularly among economically disadvantaged populations. The study advocates for policies that enhance food security, improve access to health-promoting resources, and create supportive environments for physical activity. Through a nuanced exploration of these relationships, the research aims to contribute valuable insights to the field of public health, promoting equity in health outcomes and addressing the root causes of obesity in Pakistan.

Background: Obesity is one of the most pressing global health challenges, with over one billion people now living with the condition worldwide. In Southeast Asia, nearly 40% of the population is projected to be overweight or obese by 2035, with Thailand reporting prevalence exceeding 42%. Intensive Lifestyle Modification (ILM) combined with Meal Replacement (MR) has emerged as a promising strategy for achieving sustainable weight loss, supported by landmark trials including the Diabetes Prevention Program, Look AHEAD, and DiRECT.Objective: To illustrate the clinical effectiveness of ILM combined with MR through detailed case presentations documenting anthropometric outcomes at baseline, 8 weeks, and 52 weeks, contextualized within international obesity management guidelines and comparative research across diverse populations. We hypothesized that selected participants undergoing the ILM+MR intervention would demonstrate clinically significant weight loss (≥5% of initial body weight) sustained through 52 weeks, with concurrent improvements in waist circumference indicating reduced central adiposity.Methods: Twelve participants (9 female, 3 male) from the ILM+MR arm of a previously published retrospective cohort study (n = 702) were selected based on complete longitudinal data and representativeness. The intervention comprised structured nutritional counseling, soy-based MR (220 kcal per serving, twice daily for 8 weeks), behavioral modification with group therapy, and physical activity guidance aligned with the 2013 AHA/ACC/TOS guidelines. Body weight and waist circumference were measured at baseline, 8 weeks, and 52 weeks.Results: Mean total weight loss was 38.2 kg (35.3% of initial body weight), with mean waist circumference reduction of 13.0 inches (33.0 cm) over 52 weeks. All 12 participants achieved clinically significant weight loss (>5%), substantially exceeding the 5–10% threshold recommended by international guidelines. Weight loss occurred in two phases: a rapid intensive phase (mean 14.0 kg during weeks 0–8) followed by continued loss during maintenance (mean 24.2 kg during weeks 8–52). All participants completed the 52-week follow-up.Conclusion: This case series demonstrates the potential for substantial, sustained weight loss through ILM+MR intervention, supporting findings from the larger Thai cohort study and international research including the DiRECT trial and systematic meta-analyses. These results reaffirm the foundational role of comprehensive lifestyle programs and highlight their relevance as scalable, culturally adaptable interventions for obesity management across diverse populations.

The prevailing dogma regarding urinary tract sterility has been fundamentally challenged by advances in culture-independent molecular techniques. The urinary microbiome, also known as the urobiome, is defined as a complex ecosystem comprising bacteria, fungi, and viruses. This microbiome plays a pivotal role in maintaining urological health. Emerging evidence suggests a potential link between urinary microbial dysbiosis and the pathogenesis of Urologic Chronic Pelvic Pain Syndrome (UCPPS), a clinical umbrella term that explicitly encompasses two major phenotypes: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS).This review examines the paradigm shift in understanding urinary tract microbiology, characterizes the urobiome in health and disease, and explores the therapeutic implications of microbiome-targeted interventions for UCPPS management.

Background: Burch colposuspension is a mesh-free retropubic urethropexy for female stress urinary incontinence (SUI). Amidst increasing scrutiny of synthetic materials, re-evaluating its long-term efficacy and urodynamic profile is essential. Objective: To review contemporary evidence regarding the urodynamic mechanisms, clinical efficacy, and safety profile of the Burch procedure. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, and Google Scholar for studies published up to 2025. We included randomized controlled trials, meta-analyses, and long-term cohort studies focusing on Burch colposuspension compared to midurethral slings and autologous slings. Results: Open colposuspension achieves objective cure rates of 68.9%–88% in the first year, with approximately 70% maintaining continence at five years. Long-term studies (mean 13.1 years) show comparable efficacy to midurethral slings (83% vs. 85%). The procedure restores continence by enhancing pressure transmission to the proximal urethra without altering intrinsic sphincter function. While autologous fascial slings offer higher stress-specific success (66% vs. 49%), they carry significantly higher risks of voiding dysfunction requiring reoperation (6.1% vs. 0%). Common complications of Burch include de novo overactive bladder (3%–4.1%) and a higher risk of posterior compartment prolapse (3.3%) compared to slings. Conclusions: Burch colposuspension remains a gold-standard, mesh-free intervention for women with urethral hypermobility, especially those undergoing concurrent abdominal surgery. It provides a durable, safe alternative to synthetic slings with a lower risk of obstructive voiding dysfunction, though patients should be counseled regarding potential long-term pelvic organ prolapse.

Background: Renal malakoplakia is a rare chronic granulomatous inflammatory disorder characterized by defective macrophage function. It typically occurs in immunocompromised patients with recurrent urinary tract infections. We present a case of renal malakoplakia in a diabetic patient who progressed to nephrectomy despite initial conservative management.Case presentation: A 57-year-old female patient with a medical history of insulin-dependent type 2 diabetes mellitus was admitted to the hospital with symptoms including fever, left flank pain, and dysuria. A physical examination revealed a tender left lumbar mass. Laboratory investigations revealed a leukocytosis (16,500/mm³), elevated C-reactive protein (142 mg/L), and preserved renal function. A urine culture revealed the presence of multidrug-resistant Escherichia coli (>106CFU/mL). A subsequent Computed Tomography (CT) scan revealed an enlarged left kidney with a 9 × 6 cm multiloculated subcapsular collection, causing significant parenchymal compression, along with two non-obstructive inferior pole calculi. The initial management strategy encompassed ultrasound-guided percutaneous drainage and targeted antibiotic therapy, with the latter being contingent upon bacterial sensitivities. Notwithstanding the patient’s positive clinical recovery, Technetium-99m Dimercaptosuccinic Acid ((99m)Tc-DMSA) renal scintigraphy performed four weeks after the episode revealed a non-functional left kidney, exhibiting a 15% differential function. Following a multidisciplinary discussion, a total left nephrectomy was performed. A histopathological examination revealed extensive replacement of renal parenchyma by polymorphous inflammatory infiltrate with pathognomonic Michaelis-Gutmann bodies. These bodies are spherical, basophilic, perinuclear inclusions that demonstrate strong positivity for Periodic Acid-Schiff and Perls stains. The postoperative course was complicated by self-limited lymphorrhage. At the 3-month follow-up, the patient reported complete resolution of symptoms and remains under nephrological surveillance.Conclusion: This case underscores the diagnostic challenges posed by renal malakoplakia, a condition that can present with a wide spectrum of mimics, including infectious and neoplastic processes. Early diagnosis and prolonged antibiotic therapy with agents capable of intracellular penetration may preserve renal function; however, nephrectomy remains necessary when irreversible parenchymal damage has occurred. Diabetes mellitus has been identified as a significant risk factor for malakoplakia development through impaired leukocyte function. 

Bladder cancer is among the most costly malignancies to treat, primarily due to the high rate of recurrence for Non-Muscle-Invasive Bladder Cancer (NMIBC) and the subsequent necessity for lifelong cystoscopic surveillance. Although cystoscopy is widely regarded as the gold standard, it is an invasive procedure that can be costly and is associated with patient discomfort and anxiety. In recent years, a novel generation of urinary biomarkers (comprising genomic, epigenomic, and proteomic assays) has emerged, exhibiting diagnostic capabilities that increasingly challenge the prevailing role of cystoscopy in surveillance protocols. This mini-review examines the landscape of FDA-approved and emerging urinary biomarkers, compares their diagnostic accuracy, evaluates the first randomized controlled trials supporting biomarker-guided surveillance, and proposes a risk-stratified algorithm for the future integration of urinary biomarkers into clinical practice.

Background: Paratesticular liposarcoma is a rare entity, with dedifferentiated liposarcoma (DDLPS) representing the most aggressive subtype. Late recurrences with unusual patterns of spread have been documented but remain poorly characterized.Case presentation: We report a case of a 68-year-old male with a 10-year recurrence of paratesticular DDLPS following right orchiectomy. The patient initially underwent resection of a 5×4×4.5 cm paratesticular mass in 2015, with histopathology confirming DDLPS and negative distal spermatic cord margins. After loss to follow-up, he presented in 2026 with extensive regional recurrence involving bilateral pubic soft tissues, abdominal wall musculature, and right external iliac lymphadenopathy. Biopsy confirmed recurrent DDLPS with Mouse double minute 2 homolog (MDM2) positivity. Given the multi-site infiltrative nature and muscle involvement, the multidisciplinary team recommended neoadjuvant chemotherapy with ifosfamide and doxorubicin before consideration of surgical resection.Conclusion: This case illustrates the propensity for late regional recurrence in paratesticular DDLPS and highlights the unusual pattern of spread along anatomic pathways, including the abdominal wall and inguinal region. The case underscores the importance of long-term surveillance, aggressive initial surgical margins, and multidisciplinary management in this rare malignancy.

Background: Bladder exstrophy is a rare congenital abnormality that is usually managed with multiple surgical interventions. Long-term consequences include recurrent urinary tract infections, bladder stones, fistulae, and metaplastic changes with malignant potential.Case Presentation: We present a case of a 21-year-old male with a history of failed childhood surgeries for bladder exstrophy who presented with a vesicocutaneous fistula and a 7 cm bladder stone. He underwent an open cystolithotomy with bladder augmentation and creation of a Benchekroun continent valve. However, the patient developed recurrent fistulae due to poor tissue quality. Histopathological examination confirmed early squamous metaplasia in the bladder mucosa. After discussion in a multidisciplinary meeting, the patient underwent a radical cystectomy with ileal conduit urinary diversion using the Bricker technique. He is doing well at 3 months with no evidence of any complication.Conclusion: This case illustrates the difficulties encountered in managing adult patients with bladder exstrophy and failed reconstructions. The presence of squamous metaplasia, poor bladder tissue, and recurrent complications all contributed to the decision for radical cystectomy. It is important to recognize these changes and address them appropriately in a timely manner to prevent further complications and possible malignant changes.