Background: The risk of difficult mask ventilation (DMV) is high in patients with obesity. Therefore, we evaluated the accuracy of ultrasound-measured skin-to-hyoid bone distance (SHD) for predicting DMV in this population. Methods: This prospective observational study included adult patients with obesity scheduled for elective surgery. Preoperative airway assessment included the modified Mallampati test, thyromental distance, sternomental distance, upper lip bite test, mouth opening, neck mobility, STOP-Bang score, and the SHD measured by a handheld ultrasound probe. The mask ventilation grade was evaluated using the 4-level Han score, and grades 3 and 4 were considered as DMV. The primary outcome was the ability of SHD to predict DMV using area under the receiver operating characteristic curve (AUC) analysis. A multivariate model including the STOP-Bang score, modified Mallampati test, upper lip bite test, and SHD was also assessed. Results: Data from 326 patients were analyzed. The DMV incidence was 22/326 (6.7%). Patients with DMV were predominantly male and had higher weight, STOP-Bang score, modified Mallampati grade, upper lip bite class, and SHD than did those with easy mask ventilation. The AUC (95% CI) of the SHD for predicting DMV was 0.88 (0.84–0.92). An SHD > 1.9 cm had a positive-predictive value of 27%, while its negative-predictive value was 99% (for SHD ≤ 1.9 cm). Multivariate analysis revealed that the SHD was an independent predictor of DMV. Conclusions In patients with obesity, SHD measured by a handheld ultrasound probe is an independent predictor of DMV and can accurately predict DMV. An SHD ≤ 1.9 cm can exclude DMV with 99% accuracy.

Purpose: The present study investigates the psychological factors impacting female cancer patients receiving radiotherapy and the individuals providing care for them, within a sociocultural environment that frequently marginalizes and depends on women. This research highlights a strategy for cancer care that may enhance results for both patients and caregivers by attending to psychosocial needs. The primary objectives are to measure the levels of anxiety, depression, quality of life, and perceived stress in both patients and caregivers, as well as to determine how psychosocial counseling affects these factors. Methods: It was a single-group pre-post observational study. Before starting radiotherapy, assessment of various psychosocial factors was done in female cancer patients and their respective caregivers. Psychosocial counseling sessions were conducted at weekly intervals during radiotherapy. At the 6th week after radiotherapy, assessment of same psychosocial factors was done again in both the patients as well as their caregivers. Results: The results show that both patients and caregivers had serious psychological disorders, such as anxiety, depression, perceived stress, and decreased quality of life. Psychosocial modulation was associated with improvement in quality of life measures like overall health and emotional and physical functioning. Conclusion The findings highlight how crucial it is to include psychological support in radiotherapy regimens. Despite limitations of the study, such as its exclusive focus on female patients, the results highlight the need to provide clinical staff with psycho-oncological training. The study recommends further investigation to ascertain the long-term effects of psychological health on treatment compliance and patient survival.

In an era where male infertility poses significant challenges for many couples, intracytoplasmic sperm injection (ICSI) is becoming increasingly common. Microscopic evaluation of sperm head morphology can contribute to the development of healthier embryos. A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, and Cochrane databases. A meta-analysis was performed following the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) for randomized controlled trials. Eligible studies were selected based on the PICOS (Population, Intervention, Comparison/Comparator, Outcomes, Study type) model. The pregnancy outcomes considered after artificial reproductive technology (ART) procedures included the fertilization rate (FR), high-quality embryo rate (HQER), implantation rate (IR), and clinical pregnancy rate (CPR). This study was registered on PROSPERO (CRD42023423108). Of 105 records evaluated, three studies met the inclusion criteria. Our analysis indicated that birefringence sperm selection significantly improved HQER and IR after ART, although no significant differences were observed for FR and CPR. The use of birefringence for sperm selection in ICSI cycles may represent a straightforward strategy to improve ART outcomes, particularly for couples with abnormal sperm parameters.

Objective: Cyclophosphamide (CP), a chemotherapeutic agent, has been shown to inhibit spermatogenesis. Accordingly, the primary objective of this study was to evaluate the potential therapeutic benefits of quercetin‑loaded nanoselenium (quercetin‑loaded selenium nanoparticles [SeNPs]) in mice treated with CP. Methods: Thirty‑five adult male mice were randomly assigned to five groups (n=7 per group): control, quercetin‑loaded SeNPs (20 mg/kg, daily for 5 weeks), CP (200 mg/kg, single dose), treatment A (CP+quercetin‑loaded SeNPs), and treatment B (CP+quercetin, 20 mg/kg daily for 5 weeks). Sperm parameters, DNA fragmentation index, catalase activity, levels of glutathione (GSH), glutathione disulfide (GSSG), malondialdehyde (MDA), and reactive oxygen species (ROS) were evaluated in all groups, along with histological assessments of testicular tissue. Results: In CP‑treated mice, administration of quercetin‑loaded SeNPs (treatment A) significantly improved sperm parameters, including total count, motility, morphology, and DNA integrity. Treatment also markedly increased the numbers of spermatogonia, primary spermatocytes, spermatids, Sertoli cells, and Leydig cells in testicular tissue. Furthermore, treatment with quercetin‑loaded SeNPs resulted in a significant increase in catalase activity and GSH levels while significantly reducing GSSG, MDA, and ROS levels in CP‑induced testicular damage. Conclusion These findings suggest that quercetin‑loaded SeNPs enhance spermatogenesis in a CP‑induced mouse model by improving the antioxidant profile and testicular stereological parameters.

Purpose: The integration of video-based learning into surgical education highlights the need for high-quality instructional content, especially for complex procedures such as percutaneous nephrolithotomy (PCNL). This study aimed to systematically evaluate and compare the educational quality of YouTube videos demonstrating supine and prone PCNL techniques. Materials and Methods: A comprehensive YouTube search was conducted between January 6 and 19, 2025, using the keywords “supine PCNL,” “prone PCNL,” “supine percutaneous nephrolithotomy,” and “prone percutaneous nephrolithotomy.” Eligible videos were assessed using three validated scoring systems: Global Quality Score (GQS), the DISCERN instrument (a validated tool for assessing the quality of health information), and the JAMA (Journal of the American Medical Association) criteria, along with a novel tool, the PCNL-Edu Score (educational score). A total of 120 videos (60 supine, 60 prone) were included. Results: Supine PCNL videos demonstrated significantly higher DISCERN reliability scores (p=0.037), GQS scores (p=0.001), and PCNL-Edu Scores (p=0.018) compared to prone PCNL videos. Subgroup analyses showed no significant differences in educational quality based on video source (academic/individual) or video type (educational/surgical demonstration). In correlation analyses, video length positively correlated with PCNL-Edu Scores in both groups (prone: p=0.004, supine: p=0.001), whereas popularity metrics such as views (prone: p=0.069, supine: p=0.061) and likes (prone: p=0.183, supine: p=0.225) were not significantly associated with educational quality. Conclusions Supine PCNL videos currently offer superior instructional quality on YouTube. The PCNL-Edu Score provides a focused framework for evaluating surgical videos and underscores the need for standardized guidelines to improve video-based surgical education.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affects the respiratory system but can also involve multiple organs, including the often-overlooked ocular system. An increasing number of population-based and retrospective case series studies have reported that ocular and neuro-ophthalmic complications are temporally associated with COVID-19 infection and vaccination. Furthermore, some data suggest a modest increase in ocular adverse events (OAEs) following infection or vaccination, particularly among individuals with autoimmune or pre-existing ocular conditions. The proposed immune-mediated mechanisms include immune responses following vaccination that may contribute to demyelination through molecular mimicry, a phenomenon in which antigens share structural or functional similarities with host self-antigens. In this review, we summarize studies published between 2019 and June 2025, retrieved from PubMed and Google Scholar databases. Studies were selected based on their clinical relevance and contribution to the understanding of OAEs in the context of SARS-CoV-2 infection and COVID-19 vaccination. Thematic tables highlight the clinical spectrum of reported ocular manifestations, ranging from common conditions such as uveitis, optic neuritis, retinal vascular occlusions, and cranial nerve palsies to rarer entities, including acute macular neuroretinopathy, thyroid eye disease, and papillophlebitis. This review presents recent evidence on the proposed pathophysiological mechanisms and risk profiles of COVID-19-related OAEs, with the aim of improving awareness, promoting timely ophthalmic evaluation, and supporting surveillance and future research to clarify causality and inform preventive strategies.

Introduction: Obstructive sleep apnoea (OSA) is characterised by recurrent pharyngeal collapses that occur five or more times per hour of sleep or more and reduce or completely block airflow for at least 10 seconds. Obesity predis-poses individuals to and potentiates OSA. Materials and methods: As a pre- and post-training activity measure, 30 obese people between the ages of 25 and 45 were asked to complete the STOP-BANG questionnaire and a 6-minute walk test. After that, they engaged in aerobic activity. Results: The scores for the six-minute walk test and the stop-bang questionnaire were 0.0005 and 0.0003, respectively with a “p” value- ≤0.001 (significant). In our investigation, the effects of aerobic exercise on exercise tolerance and obstructive sleep apnoea were significantly different. Con-clusion: Aerobic exercise is a better intervention for increasing exercise tolerance and obstructive sleep apnoea in obese patients. This intervention may be a significant contributor to cardiorespiratory fitness and can be considered a useful tool for enhancing quality of life.

Abstract Hyperkalemia (serum potassium >5.0 mEq/l) is a significant complication in patients with heart failure, chronic kidney disease, and diabetes mellitus, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Both hyperkalemia and RAASi interruption are associated with increased cardiovascular events, hospitalizations, and mortality. This expert opinion document, developed between January and December 2024 through a systematic process, aims to establish guidance for hyperkalemia treatment in Indonesian patients with cardiorenal diseases receiving RAASi therapy, addressing the unique challenges within the Indonesian healthcare context. A comprehensive literature review of international guidelines and regional studies was conducted by a panel of 11 expert specialists (3 cardiologists, 6 internist-nephrologists, and 2 internist-cardiologists), who evaluated 29 statements covering diagnosis, monitoring, prevention, and treatment of hyperkalemia. Of the 29 statements, 26 reached consensus: 17 statements achieved very high agreement (≥90%) and 9 attained high agreement (≥67% – <90%). The agreed statements covered key areas, including potassium monitoring frequency, RAASi dose optimization strategies, dietary modifications, and treatment thresholds. Three statements regarding alternative therapeutic approaches did not receive agreement (<67%) due to limited local availability and cost considerations. Key recommendations include structured monitoring protocols for high-risk patients, strategies for RAASi dose optimization while managing hyperkalemia risk, and specific interventions adapted to local resources. This document provides a practical approach for managing hyperkalemia in Indonesian patients with cardiorenal diseases while maintaining optimal RAASi therapy, considering local Indonesian healthcare resources and constraints.
Hyperkalemia ; Cardio-Renal Syndrome ; Renin-Angiotensin System ; Indonesia