Background and objectives. Heart failure poses a major challenge for healthcare systems. Although left ventricular ejection fraction (LVEF)-based classification guides current therapeutic decisions, it fails to capture the complexity of the syndrome. This narrative review aimed to analyze alternative approaches that integrate comorbidity profiles, biomarker data, and machine learning-based subgroup identification to achieve a more accurate and clinically relevant framework. We focused on adult patients with chronic heart failure and literature published between 2015 and 2025, identified primarily through PubMed, Web of Science, and other indexed scientific databases. Materials and methods. We conducted an extensive narrative review of recent literature on heart failure phenotyping strategies, focusing on comorbidity profiles, biomarker integration, and machine learning-based subgroup identification. As this is a narrative review, the selection of sources may be subject to selection bias. Results. New classification models provide more nuanced stratification of heart failure patients by identifying clinically meaningful subgroups. Comorbidity clusters can reveal distinct trajectories and therapeutic responses. In addition, phenotype-based models, often derived using unsupervised machine learning, reveal latent structures associated with prognosis and risk prediction. Conclusions. A dual-axis model – comorbidity-based subgroups crossed with biologically and clinically defined phenotypes – enhances LVEF-based classification for risk stratification and may guide individualized therapy.

Background. Parry–Romberg syndrome (PRS), or progressive hemifacial atrophy (PHA), is an uncommon disorder of unclear etiology, characterized by slowly progressive unilateral wasting of craniofacial soft tissues, musculature, bone, and cartilage. This case report presents a distinctive pediatric case of PRS with temporal association to prior paramyxovirus infection (mumps). Case report. An 11-year-old boy presented with right-sided facial hemiatrophy and intraoral changes following a documented mumps infection in 2017. Clinical examination revealed hyperpigmentation, localized alopecia, palatal hemiatrophy, soft-tissue thinning of the tongue and lips, and malocclusion on panoramic radiography. MRI demonstrated multiple T2-hyperintense lesions in the right frontotemporoparietal white matter without diffusion restriction, while skin biopsy showed epidermal atrophy with perivascular lymphocytic infiltrate. Serology confirmed prior mumps exposure, while autoimmune panels were unremarkable. No disease-specific therapy was initiated, and the patient was subsequently lost to follow-up, limiting assessment of long-term progression and treatment response. Conclusion. While the temporal relationship raises the possibility of a post-viral trigger, this single case does not establish causation between mumps infection and PRS. The absence of targeted treatment and lack of longitudinal follow-up represent important limitations. Further studies are needed to elucidate potential viral contributions to PRS pathogenesis and to guide management strategies.

Background and objectives. Combination therapy in vitiligo using narrowband UVB and topical tacrolimus, topical vitamin D3, and topical corticosteroid is more effective compared to monotherapy. This study aimed to understand the effectiveness of combination therapy between TCS and NB-UVB with TCI and NB-UVB by assessing the improvement in percentage of skin repigmentation and patients’ quality of life (QoL). Materials and methods. This is a non-randomized preliminary study with the limitation of a small sample size and short-term observation involving 40 vitiligo outpatients observed for three months. Demographics assessed include age, gender, and VASI score. The QoL was assessed using the Viti-QoL questionnaire. Statistical analysis was done using the Mann-Whitney test. Results. No significant difference was observed in age and gender between the groups. Most patients had acrofacial vitiligo. The mean VASI score in the TCI group was 0.84, while the VASI score in the TCS group was 0.5. A significant difference was observed in the improvement of QoL between TCI-NB-UVB and TCS-NB-UVB groups. A similar trend was seen in both groups with the therapy success rate between 50% and 75% repigmentation, with no significant difference reported between groups. Phototherapy, either as monotherapy or combination therapy, is effective in improving the QoL of vitiligo patients. This study adds information about the best combination options for vitiligo because related data is still limited. Conclusions. No significant difference was observed between TCI-NB-UVB and TCS-NB-UVB combination therapy in the improvement of skin repigmentation and patients’ QoL. Further research with a larger sample size and longer duration is needed to strengthen this research

Background. Coronary artery disease (CAD) is a leading cause of mortality, often associated with myocardial fibrosis and acute coronary syndromes. Coronary artery calcium (CAC) scoring and high-sensitivity cardiac troponin I (hs-TnI) are valuable markers for cardiovascular risk assessment, yet their correlation with stenosis severity remains incompletely understood. Methods. This cross-sectional study analyzed secondary data from multislice computed tomography angiography (MSCTA) and hs-TnI tests of CAD patients in Makassar from January 2021 to August 2024. Correlation analysis between CAC score, stenosis severity, and hs-TnI levels was performed using Pearson’s or Spearman’s tests, with p < 0.05 considered significant. Results. Of 424 samples, 55 met inclusion criteria (20 acute CAD, 35 chronic CAD). The median hs-TnI level was higher in acute CAD (7.55 ng/L) than chronic CAD (3.00 ng/L). In acute CAD, CAC scores were most frequently minimal (30%), whereas chronic CAD had the highest proportion in the none calcification (40%). Regarding the degree of stenosis, category 3 was the most prevalent in the acute CAD group, observed in 25% (5 samples), while in chronic CAD, the most common stenosis degree was 0 group (31.4%). A significant correlation was observed between CAC score and hs-TnI (p = 0.043, r = 0.456) and between stenosis severity and hs-TnI (p = 0.046, r = 0.450). Additionally, CAC scores strongly correlated with stenosis severity (p = 0.002, r = 0.661). Conclusion. The observed correlation between calcium score, stenosis severity, and hs-TnI levels suggests a meaningful correlation between anatomical findings and myocardial injury in coronary artery disease. These parameters may complement each other in improving cardiovascular risk assessment and clinical evaluation.

Background and objectives. Breast pathologies, ranging from benign fibroadenoma to malignant invasive ductal carcinoma, represent a spectrum of diseases affecting women. Breast cancer continues to be the leading cause of fatalities among Indian women. Imaging techniques, including ultrasound, mammography, and DWI (diffusion-weighted imaging) in MRI, are pivotal for accurate diagnosis and management. This study's main objective was to evaluate the diagnostic performance of DWI-MRI in identifying and characterizing breast lesions, correlating findings with HPE (histopathological examination). Materials and methods. Forty-six people suffering from breast anomalies participated in this prospective study, which was carried out at Saveetha Medical College and Hospital over a period of 12 months (June 2021 to May 2022). A 1.5 Tesla MRI was employed to acquire DWI and compute ADC (apparent diffusion coefficient) values. Baseline characteristics, mammographic, ultrasonographic, and MRI findings, including STIR characteristics, were documented. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of DWI. Results. In correlation with histopathological examination (HPE), DWI effectively differentiated benign and malignant breast lesions using an ADC cut-off value of 1.10 × 10⁻³ mm²/s, achieving a sensitivity of 91.43% and specificity of 90.91%. Benign lesions demonstrated significantly higher mean ADC values (1.81 ± 0.51 × 10⁻³ mm²/s) compared to malignant lesions (0.88 ± 0.13 × 10⁻³ mm²/s; p < 0.001). ROC analysis showed excellent diagnostic accuracy with an AUC of 0.966, reinforcing the utility of DWI as a reliable, non-invasive diagnostic tool for breast lesion evaluation. Conclusion. The integration of DWI-MRI with conventional imaging and HPE offers a comprehensive approach for breast lesion evaluation, emphasizing its non-invasive and highly reliable diagnostic capability.

Background. Nocturnal enuresis (NE), defined as intermittent involuntary urine leakage during sleep, affects approximately 16% of children at age 5 and 10% at age 7, with prevalence declining with age. Aim. To evaluate the urodynamic features of patients with non-monosymptomatic nocturnal enuresis (NMNE). Methods. This cross-sectional study was conducted from June 2015 to September 2020 in a surgical subspecialty hospital within a major medical city complex, including 237 patients. Eligible patients were older than seven years, diagnosed with NMNE, and had refractory enuresis, defined as persistent symptoms despite at least six months of continuous medical treatment. All patients underwent a detailed history, bladder diary review, clinical examination, lumbosacral spine X-ray, and, when indicated, MRI or cystoscopy. Invasive multi-channel urodynamic studies were performed using the MMS Solar Gold system. A dual-lumen 6 Fr transurethral catheter measured intravesical pressure and bladder filling, while a rectal balloon catheter measured abdominal pressure. Patients were positioned in a seated or semi-recumbent posture to replicate physiological voiding conditions. Recorded parameters included bladder capacity, detrusor activity, bladder compliance, sphincter behavior, urinary flow rate, post-void residual volume (PVR), and urethral pressure profiles. Data were analyzed using IBM SPSS v.26, with p < 0.05 considered statistically significant. Results. A total of 237 patients were enrolled (mean age 19.2 ± 12 years). Primary NE was observed in 168 (70.9%) and secondary NE in 69 (29.1%). Bladder overactivity was present in 201 (84.8%). Compliance was significantly higher in overactive than non-overactive bladders, while post-void residual was significantly higher in non-overactive patients. No significant differences were found for bladder capacity, urethral pressure profile, filling IV pressure, or flow rate (p > 0.05). Detrusor–sphincter dyssynergia was present in 30.8%, high post-void residual in 80.0%, high urethral pressure profile in 57.0%, and low urethral pressure profile in 12.6%. Conclusion. Urodynamic evaluation is essential for guiding the management of patients with treatment-refractory NMNE.

Introduction. Menopausal symptoms such as hot flashes, night sweats, and hormonal imbalances are common in postmenopausal women. This study compares the effects of hormone replacement therapy (HRT) and seed supplementation on hormonal levels, cancer risk markers, and menopausal symptoms. Material and methods. A randomized controlled trial was conducted from November 2021 to October 2022 at Mamata Academy of Medical Sciences, Hyderabad. A total of 150 postmenopausal women (aged 40–55 years) were randomized into three groups: Group I (control, n=50), Group II (seed supplementation, 20 g/day for 3 months, n=50), and Group III (HRT, estradiol and progestin/progesterone, n=50). Outcome measures included hormonal levels (estradiol, progesterone, FSH, LH), cancer risk markers (CA-15.3, Pap smear), menopausal symptoms (hot flashes, night sweats), and adverse events. Results. Estradiol levels increased significantly in both Group II (seed supplementation) and Group III (HRT), with Group III showing a greater increase (p<0.01). Group II showed a reduction in CA-15.3, while 14% of Group III participants had elevated CA-15.3, indicating a potential breast cancer risk (p<0.05). Pap smear abnormalities were more frequent in Group III (8%) compared to Group II (2%). Seed supplementation significantly reduced hot flashes and night sweats (p<0.01), with better symptom relief than HRT. No significant adverse events occurred in Group II, while 20% of Group III participants reported breast tenderness and bloating. Conclusion. Both HRT and seed supplementation improved hormonal levels and menopausal symptoms. However, HRT was associated with elevated cancer risk markers, while seed supplementation was effective and well tolerated, providing a safer alternative for postmenopausal women.

Background. Type 1 diabetes (T1D) is a chronic autoimmune disease that leads to the destruction of pancreatic beta cells by immune cells. Type 2 diabetes (T2D) is a heterogeneous metabolic disorder characterized by hyperglycemia due to insulin deficiency or impaired secretion. It is also considered a chronic inflammatory disease. Interleukin 4 (IL-4) plays an anti-inflammatory role and is secreted by various immune cells. Genetic variations in the IL-4 gene, particularly at position 590 C>T, have been proposed as potential risk factors for diabetes. Objective. To evaluate the concentration of interleukin-4 and investigate polymorphism in the IL-4 gene region (590 C>T) and their association with type 1 and type 2 diabetes. Methods. Blood samples were collected from 30 male patients with type 2 diabetes and 24 non-diabetic controls. IL-4 concentrations were measured using the sandwich ELISA technique. Gene polymorphisms were detected using the amplification-refractory mutation system (ARMS) analysis. Results. IL-4 concentrations were significantly decreased in T1D patients compared to controls (P = 0.022). In T2D patients, IL-4 levels were lower but not significantly different from controls (P = 0.52). Significant differences in IL-4 levels were observed between T1D and T2D groups. The TT and CT genotypes appeared to have a protective effect against T1D and T2D, whereas the CC and CT genotypes were considered potential risk factors. Conclusion. Genetic variation in the IL-4 (590 C>T) region may contribute to reduced IL-4 levels and influence susceptibility to T1D and T2D.

Background and objectives. Recent evidence has demonstrated that mildly elevated bilirubin concentrations are protective against various oxidative stress-mediated diseases, including autoimmune disorders. Based on this, the present study aimed to investigate the association between serum bilirubin levels, albumin-based inflammatory ratios, and the presence of primary antiphospholipid syndrome (APS) in women with a history of spontaneous miscarriages. Materials and methods. This cross-sectional observational study included 72 women aged 21–40 years (median age 27) with a history of spontaneous miscarriages in the first trimester. Based on clinical and laboratory findings, 47 women were diagnosed with APS, and 25 were classified as non-APS. All participants underwent a complete evaluation, including blood count, coagulation tests, glucose and lipid profiles, CRP, vitamin D, and assessments of thyroid, liver, and kidney function. Results. A total bilirubin level below 8 μmol/L was observed in 53% of APS patients, significantly higher than in non-APS women (24%, p = 0.024). Total, direct, and indirect bilirubin concentrations were significantly lower, while inflammatory markers such as fibrinogen, CRP, and CRP/albumin ratio were significantly higher in APS patients (p < 0.05). Logistic regression and ROC analysis confirmed the diagnostic value of these markers. The AUC values for total bilirubin, bilirubin/albumin ratio, fibrinogen, albumin/fibrinogen ratio, CRP, and CRP/albumin ratio demonstrated moderate diagnostic accuracy (AUC = 0.723, 0.793, 0.693, 0.828, 0.761, and 0.699, respectively). Conclusions. Serum bilirubin levels and the bilirubin/albumin ratio were negatively associated with APS in women with a history of spontaneous miscarriage. These findings suggest impaired antioxidant and anti-inflammatory defenses in APS patients. Serum bilirubin combined with albumin-based inflammatory ratios may serve as additional screening tools for APS in this population.

Background. Diabetes mellitus (DM) is a prevalent disease that, if not appropriately managed, can lead to a variety of problems, including diabetic foot. Glycated hemoglobin A1c (HbA1c), FBS, amylase, and lipase are important diabetic management indicators now employed as diagnostic tests. Objective. This study aimed to evaluate the value of amylase and lipase as predictive markers in patients with diabetic foot. Patients and methods. This study included 50 patients who reported to Baghdad Hospital with diabetic feet between November 2023 and February 2025. All patients had their HbA1c, amylase, lipase, and FBS levels tested. Means, independent t-tests, and the F-test were used in the statistical analysis. Results. The study evaluated 50 patients aged 35–75, revealing significant differences (p = 0.001). These findings underscore the potential of amylase and lipase as crucial prognostic markers in diabetic foot patients. People with diabetic feet had a high percentage of HbA1c and FBS and a substantial drop in amylase and lipase measures, with a difference value of (p = 0.001). Conclusion. The study's findings highlight the importance of HbA1c, amylase, and lipase as significant prognostic factors in diabetic foot patients. Levels exceeding 8 were associated with a poor prognosis and prolonged hospitalization, emphasizing the critical role of diabetes management in preventing and treating diabetic complications.