Background: Lateral patellar instability in deep knee flexion is a poorly understood and underreported condition that differs etiologically and biomechanically from the more common instability near extension. Aim: This paper presents a comprehensive review combined with clinical experience on lateral patellar instability in deep flexion, along with insights into the underlying anatomical and biomechanical characteristics. Methods: A systematic literature search was performed using the terms “patellar instability” and “knee flexion.” Inclusion criteria included original studies, book chapters, and reviews in English, whereas computational or biomechanical studies were excluded. In addition, clinical experience from cases was incorporated into the considerations and assessments. Results: Nine studies met the selection criteria consisting of three case reports, three case series, a book chapter, and two reviews. The analysis of clinical, anatomical, biomechanical, and kinematic factors in patients with lateral patellar instability in deep flexion did not reveal reliable arguments for the same etiological factors causing instability near extension. Instead, factors such as changes in the shapes of the lateral and medial condyle during knee flexion, variations in the shape of the lateral femoral condyle, terminal sulcus or false groove, short extensor muscles, contractures of soft tissues lateral to the patella, and laxity of the medial ligaments play significant roles in flexion instability. Conclusion: Lateral patellar instability in deep flexion is a rare but severely disabling condition that often begins at a younger age. The etiological factors leading to deep flexion instability differ from those causing patellar instability near extension, necessitating a clear distinction between these two types of patellofemoral instability. Accordingly, surgical treatment should address all documented etiological factors for flexion instability and involve a combination of procedures. Relevance for patients: Accurate differentiation between lateral patellar instability in deep flexion and instability near extension is essential for devising effective treatment strategies.

Background: Vaccination remains the most effective preventive measure against influenza. Current flu vaccines include split-virus, subunit, and live-attenuated vaccines. Comparing adjuvanted and non-adjuvanted subunit vaccines and split-virus formulations is essential to evaluate their immunogenicity (through geometric mean titers [GMTs] and seroprotection rates) and safety (adverse event rates). Aim: The aim of this study was to analyze the immunogenicity and safety of adjuvanted subunit vaccines, non-adjuvanted subunit vaccines, and split vaccines. Methods: A systematic search of the PubMed, Cochrane, and EMBASE databases was conducted, supplemented by manual searches. After two reviewers independently screened the articles, extracted the data, and assessed the quality, a meta-analysis was conducted with Stata 16.0 software. Results: Twenty-four studies were ultimately included in the analysis. The systematic review found that adjuvanted subunit influenza vaccines (IV), non-adjuvanted IV, and split IV all provided good protection. Based on the seroconversion rate and GMTs levels, adjuvanted subunit IV was overall superior to non-adjuvanted split IV. However, adjuvanted subunit IV had lower safety compared to non-adjuvanted IV and split IV. Non-adjuvanted IV displayed similar seroprotection rates to adjuvanted subunit IV, providing sufficient protection. Conclusion: Adjuvanted subunit IV offers better immunogenicity but has a higher incidence of adverse reactions. For individuals with impaired immune systems, it is recommended to use adjuvanted subunit IV for better protection. However, for the majority of the population, non-adjuvanted subunit IV is recommended to achieve sufficient seroprotection rates and better safety. Relevance for patients: The systematic review is helpful for guiding better vaccination strategies and improves public health outcomes.

Background: Despite the rapid development and distribution of COVID-19 vaccines, the pandemic continues to challenge global health systems. With vaccine inequity and hesitancy, especially in low-income populations and specific demographic cohorts, alternative therapeutic strategies to mitigate COVID-19 symptoms and reduce viral clearance time remain vital. Propolis, a natural bee product with immunomodulatory and antiviral properties, has demonstrated efficacy against other viral pathogens, suggesting potential as an adjunctive therapy for COVID-19. Objectives: This study protocol outlines a randomized, triple-blind, placebo-controlled clinical trial to assess the efficacy of a Greek propolis hydroalcoholic extract as an adjunct to standard care in hospitalized COVID-19 patients. The primary objectives are to evaluate the extract's impact on viral clearance time and hospitalization duration, with secondary objectives examining body temperature, cough severity, quality of life, and safety. Methods: A total of 441 severe acute respiratory syndrome coronavirus 2-positive adult patients will be enrolled and stratified by age and vaccination status. Participants will be randomly assigned to one of three arms: (i) propolis extract, (ii) placebo, or (iii) control (standard care only). Primary outcomes include time to negative reverse transcription polymerase chain reaction tests and hospital discharge. Secondary measures involve cough severity and quality-of-life assessments through Visual Analog Scale and Leicester Cough Questionnaire scores, fever duration and resolution patterns, and safety through adverse events and mortality tracking. Statistical analysis will include Kaplan-Meier survival curves, Cox regression for confounders, and analysis of variance for quality-of-life scores. Conclusion: This study aims to validate the therapeutic potential of propolis as a natural, accessible adjunctive treatment for COVID-19. Findings may provide critical evidence supporting propolis in symptom relief, viral clearance, and healthcare burden reduction in resource-limited settings. Relevance for patients: Participants in the intervention arm may experience improved clinical outcomes, such as faster recovery and symptom alleviation, while all patients will continue to receive standard care in alignment with current clinical protocols.

Background: With the advancement of technology and the increasing need for low-cost rehabilitation alternatives, video-demonstrated exercises have demonstrated potential as a viable solution for patients with limited access to in-person therapy. Post-stroke rehabilitation involves functional improvements in various areas, including structure and function, activity, and participation, as defined by the International Classification of Functioning (ICF), Disability, and Health. While in-person exercises have been widely studied, the use of audiovisual resources for promoting functional recovery is a more recent approach that requires further scientific investigation to confirm its effectiveness and benefits. The present study is a systematic review of the effects of video-demonstrated exercises in rehabilitating post-stroke individuals. Aim: This review aims to describe the functional improvements in structure and function, activity, and participation promoted by video-demonstrated exercises in post-stroke individuals. Methods: A search was conducted between October 2008 and December 2024 across three online databases: BVS, PubMed, and Web of Science. Only randomized clinical trials published in English, involving post-stroke patients and comparing video-based exercises with other physical therapy interventions, were included. Articles not available in full, duplicates, and those unrelated to the topic were excluded. Results: These studies revealed that video-based interventions provided similar functional improvements to traditional therapy, with no significant differences found between the groups. The limited number of studies and variations in intervention duration highlight the need for further research in this area. Conclusion: Guided rehabilitation programs produced comparable results to face-to-face therapy with functional improvements according ICF, Disability, and Health. Relevance for patients: Video-guided exercise rehabilitation programs have demonstrated comparable outcomes to face-to-face therapy after 3 months of therapy, with improvements in function and quality of life after stroke.

Background: Human papillomavirus (HPV) is the primary cause of cervical cancer, often through the development of cervical intraepithelial neoplasia (CIN). Persistent infection with high-risk HPV types can lead to severe dysplasia and invasive cancer. Early detection of progressive cervical carcinogenesis is crucial for improving outcomes. By targeting CIN, a pre-cancerous stage, therapeutic interventions are most effective and least invasive, offering the potential to reduce the incidence of invasive cervical cancer drastically. Early cervical carcinogenesis detection is hindered by inadequate screening coverage due to barriers, inaccurate screening methods, and patient compliance issues. Optimizing the timing, frequency, and technology availability of screening in resource-limited settings also poses significant challenges. Aim: This study evaluates the efficacy of Nematode-NOSE (N-NOSE), a novel Caenorhabditis elegans-based olfactory cancer screening tool, in detecting early cervical carcinogenesis. Methods: Urine specimens from 74 patients with cervical cancer and 245 patients with CIN were analyzed, with institutional review board approval from the National Hospital Organization Shikoku Cancer Center Hospital, Ehime, Japan. Results: We discovered that urine samples from CIN patients were successfully predicted to be positive using the N-NOSE test, with a sensitivity of 73% (180/245 patients) and 100% (9/9 patients) for CIN and pre-cancerous CIN3, respectively. Conclusion: N-NOSE demonstrates high sensitivity in detecting both early-stage CIN and invasive cervical cancer, suggesting its potential as a non-invasive, urine-based screening tool for early detection. This advancement also holds the promise of significantly improving preventive healthcare by enabling timely identification and intervention, leading to more efficient treatment modalities that effectively halt the progression of cervical carcinogenesis. Relevance for patients: The N-NOSE test offers a non-invasive, urine-based method for early detection of cervical cancer and pre-cancerous changes, enabling timely intervention and potentially enhancing patient outcomes.

Background: Antepartum hemorrhage (APH) during pregnancy has a significant impact on both mothers and neonates. Aim: This study aims to investigate maternal and neonatal outcomes by retrospectively analyzing placenta previa (PP) cases complicated by APH. Methods: This study retrospectively investigated 50 cases of singleton pregnancies in women diagnosed with PP managed at a tertiary care Hospital in Karachi, Pakistan, from January to October 2024. The participants recruited were of a gestation period ranging from 24 to 42 weeks. The participants were categorized into two groups: APH and non-APH. The study assessed various maternal clinical characteristics. Ultrasound exams were conducted using standardized methods. Perinatal outcomes for mothers and newborns were compared, including complications such as preterm delivery, placental abruption, and neonatal issues. Mann-Whitney U test, Student's t-test, Chi-square test, and binary logistic regression were employed for statistical analysis. Results: Women afflicted with APH exhibited significantly higher maternal age compared to those without APH (p=0.029). Furthermore, we discovered a notable statistical difference in the type of PP between the two groups. Specifically, complete PP was observed in 27.3% of women with APH but only in 4.3% of those without APH. The gestational age at delivery for pregnant women with APH was notably shorter compared to those without APH, leading to a considerably higher incidence of both lower birth weights and preterm deliveries when APH was present, in contrast to cases where APH was absent. Conclusion: APH has a significant association with maternal and neonatal outcomes, especially in cases of PP. Thus, timely interventions are necessary to prevent APH to mitigate further complications in mothers and newborns. Relevance for Patients: The research demonstrates why prompt diagnosis and on-time care interventions improve maternal-fetal health outcomes during APH incidents, specifically in PP patients.

Background: The recent pandemic caused by coronavirus disease 2019 (COVID-19) has resulted in increased deaths globally, and effective treatment is crucial as a form of disease management. Aims: This study was aimed to describe the epidemiological characteristics and outcomes of hospitalized COVID-19 patients who have been administered with remdesivir (RDV) at King Faisal Specialized Hospital in Saudi Arabia. Methods: Hospitalized COVID-19 adult patients who received RDV therapy (from January to December 2021) were included in this retrospective case series. Patients' demographics, medical history, presenting symptoms, and laboratory results were collected. Statistical analyses were performed using the Statistical Packages for the Social Sciences and data were presented based on their statistical variables. Results: A total of 210 patients (56.1% females, 43.9% males) with a mean ± standard deviation (SD) age of 57.43 ± 18.4 years were included in our analysis. Pneumonia was manifested in 52.4% of patients. The most common associated comorbidities were hypertension (54.76%) and diabetes (44.76%). From 180 participants that were vaccinated, 73 and 90 patients received two or three COVID-19 vaccine doses, respectively. The most frequent presenting symptoms were fever (80.1%) and cough (62.6%). About 48.1% and 10.48% of the cohort received RDV with dexamethasone or tocilizumab, respectively. Overall, 45.71% of the patients needed oxygen therapy during hospitalization, and 21 patients with pneumonia required mechanical ventilation for a mean ± SD of 15.15 ± 16.46 days with the mean ± SD length of the hospital stay which was 14.9 ± 46.29 days. Moreover, 41 patients were admitted to the intensive care unit for a mean ± SD stay of 10.5 ± 11.05 days, and 26 patients had died. Conclusion: Despite previous vaccination, a significant portion of hospitalized COVID-19 patients in our cohort required oxygen therapy and experienced longer periods of hospital stay, highlighting the seriousness of COVID-19 infection for some patients regardless of vaccination status. Relevance for patients: This study highlights RDV's role in reducing oxygen need and hospitalization duration, aiding better outcomes for COVID-19 patients.

Background: Smoking accounts for about half of bladder cancer cases in the United States; however, the etiology of up to one-third of urothelial cell carcinoma (UCC) remains poorly understood. Acrolein and arsenic are known bladder carcinogens with documented household exposures. Aim: This study aimed to (i) determine whether urinary and household exposures to acrolein and inorganic arsenic (iAs) are higher in newly diagnosed UCC patients than in those with benign urologic disease, (ii) assess whether urinary concentrations reach genotoxic thresholds, and (iii) evaluate how these exposures vary by urbanicity and area deprivation indices. Methods: Patients were recruited from the Urology Clinic at the University of Wisconsin-Madison and provided urine, drinking water, and household dust samples. Results: Acrolein exposures (as its stable metabolite 3-hydroxy-propyl-mercapturic acid) did not differ between cases and controls. Urinary arsenic concentrations were higher in cases than in controls but did not reach statistical significance (p=0.08). Unadjusted urinary iAs concentrations (reflecting urothelial exposures) ranged from 0.01 to 0.71 μM in cases and 0.02 - 0.14 μM in controls (p=0.05). No patients reached genotoxic urinary concentrations of iAs (10 μM) at a single time point. Arsenic concentrations in household dust were higher in UCC (0.42 ng/cm2) compared to control households (0.29 ng/cm2; p=0.007). Dust arsenic levels also correlated with urinary iAs across all patients (r = 0.41; p=0.004). Drinking water arsenic was associated with higher area deprivation percentiles (r = 0.30, p=0.046) and with households from more rural areas (p=0.039) but did not differ significantly between cases and controls. Conclusion: Our data suggest that indoor dust arsenic, rather than arsenic in drinking water, was a likely source of urinary arsenic exposure in this primarily non-smoking population. Relevance for patients: Simple in-home arsenic mitigation strategies, such as using high-efficiency particulate air vacuum cleaners and air filtration units, may help reduce exposure for patients diagnosed with UCC.