Peroxisome biogenesis disorders (PBDs) are a genetically heterogeneous group of metabolic diseases caused by impaired peroxisome assembly and function. PBDs exhibit striking clinical variability, ranging from lethal neonatal forms (e.g., Zellweger spectrum disorders) to milder childhood-onset presentations such as rhizomelic chondrodysplasia punctata. While elevated levels of very-long-chain fatty acids (VLCFAs) remain a key diagnostic feature, the existence of unusual cases with normal plasma VLCFA levels highlight the limitations of relying solely on this biochemical marker for diagnosis. Genetic variations in PEX6, an important peroxisome biogenesis factor, contribute significantly to this phenotypic diversity, with missense variants often associated with less severe disease compared to truncating mutations. Recent studies further implicate dysregulated pexophagy—a targeted autophagic degradation of peroxisomes—in the underlying disease mechanisms. This review underscores the necessity for a multifaceted diagnostic approach that, thorough clinical assessment, detailed biochemical evaluation, and advanced molecular genetic testing, seeks to improve diagnostic accuracy and patient care, particularly in pediatric populations. Advancements in identifying novel biomarkers and targeted therapies offer promise for tailored interventions, underscoring the importance of precision medicine in optimizing outcomes for pediatric PBD patients.

Background: We aim to analyze the additive value of repeated transthoracic echocardiography (TTE) within a 1-week interval after a baseline TTE to diagnose infective endocarditis (IE) in patients admitted with Staphylococcus aureus bacteremia (SAB). Methods: We prospectively enrolled consecutive patients with SAB who were referred for TTE and transesophageal echocardiography (TEE) to exclude IE between January 2017 to December 2019. All patients underwent a second TTE within 5 to 7 days. We excluded patients with poor echo windows, previous IE, valve repair/replacement, and those with cardiac devices or a dialysis catheter in place. Results: A total of 105 patients were enrolled, of which 40 (38.1%) were female. The mean age was 52 ± 14 years.Sixty-four patients (61%) had a defined source of infection, and 36 (34.3%) were intravenous drug users. The majority (n = 74, 70.5%), had methicillin-sensitive S. aureus. Sixteen patients (15.2%) were diagnosed with definite IE based on TEE findings as follows: eight tricuspid valve IE, four mitral valve IE, three aortic valve IE, and one with double valve IE (mitral and tricuspid). The mortality rate was 7.6% (two patients with definite IE and six without IE). Vegetations were not detected in one patient on the first TTE, compared to TEE and the second TTE. The baseline TTE had a sensitivity of 93.8%, specificity of 87.6% and accuracy of 88.6% in identifying echocardiographic evidence of IE. The addition of second TTE findings increased the sensitivity to 100%, specificity to 95.5%, and diagnostic accuracy to 96.2% in comparison to TEE for the detection of IE. Conclusions A repeat TTE within 5 to 7 days of an initial study significantly enhances diagnostic accuracy for detecting IE in patients with SAB and may help reduce the need for TEE in selected low-risk cases.

Background:Female fish farmers in coastal Bangladesh face significant reproductive health(RH)challenges due to occupational,nutritional,and sociocultural factors.However,their health burdens have been largely overlooked in labor and health policies.Objectives:This study aims to investigate the prevalence,severity,determinants,and emotional and relationship consequences of RH morbidities among female fish farmers in Shyamnagar,Satkhira,Bangladesh.Methods:A cross-sectional survey with structured questionnaires was conducted among 297 female fish farmers.Data were supplemented by rural appraisal activities.Descriptive statistics,chi-square tests,Poisson regression,and Structural Equation Modeling were used for analysis.Results:The study found that 59.60％(177/297)of participants suffered from moderate to severe uterine issues,remarkably menstrual irregularities(92.65％,164/177),backache(59.32％,105/177),pelvic and fatigue pain(42.37％,75/177),anemia(28.24％,50/177),with the"21-30"year age group bearing a higher physiological burden with greater relational and emotional disruptions than"31-40"year age group,and"41-50"year age group women.High exposure to occupational chemicals(81.82％,243/297)and lack of personal protective equipment(93.94％,279/297)were key contributors.Access to formal healthcare is limited due to financial hardships(85.86％,255/297),social stigma(51.52％,153/297),and inadequate health services(46.47％,138/297).Structural Equation Modeling results also revealed significant associations among RH morbidities,emotional distress,social isolation,and diminishing well-being.Conclusion:The study highlights the urgent need for integrated health policies addressing reproductive care,occupational safety,and mental health support for female fish farmers in coastal Bangladesh.Addressing these issues will improve their health,well-being,and resilience.

Background:Female fish farmers in coastal Bangladesh face significant reproductive health(RH)challenges due to occupational,nutritional,and sociocultural factors.However,their health burdens have been largely overlooked in labor and health policies.Objectives:This study aims to investigate the prevalence,severity,determinants,and emotional and relationship consequences of RH morbidities among female fish farmers in Shyamnagar,Satkhira,Bangladesh.Methods:A cross-sectional survey with structured questionnaires was conducted among 297 female fish farmers.Data were supplemented by rural appraisal activities.Descriptive statistics,chi-square tests,Poisson regression,and Structural Equation Modeling were used for analysis.Results:The study found that 59.60％(177/297)of participants suffered from moderate to severe uterine issues,remarkably menstrual irregularities(92.65％,164/177),backache(59.32％,105/177),pelvic and fatigue pain(42.37％,75/177),anemia(28.24％,50/177),with the"21-30"year age group bearing a higher physiological burden with greater relational and emotional disruptions than"31-40"year age group,and"41-50"year age group women.High exposure to occupational chemicals(81.82％,243/297)and lack of personal protective equipment(93.94％,279/297)were key contributors.Access to formal healthcare is limited due to financial hardships(85.86％,255/297),social stigma(51.52％,153/297),and inadequate health services(46.47％,138/297).Structural Equation Modeling results also revealed significant associations among RH morbidities,emotional distress,social isolation,and diminishing well-being.Conclusion:The study highlights the urgent need for integrated health policies addressing reproductive care,occupational safety,and mental health support for female fish farmers in coastal Bangladesh.Addressing these issues will improve their health,well-being,and resilience.

Patients with congenital insensitivity to pain and anhidrosis (CIPA) exhibit an inability to perceive pain, recurrent fractures, self-mutilation, and impaired thermoregulation, which lead to severe complications and high morbidity. Children with CIPA often sustain multiple unnoticed fractures that may be mistaken for child abuse because of the presence of fractures at different stages of healing. If unrecognized or inadequately managed, these injuries can cause permanent damage. We report the case of a 9-year-old boy who presented with recurrent fractures, chronic osteomyelitis, heterotrophic ossification, and gangrene. This case underscores the need for heightened awareness among healthcare providers regarding the clinical manifestations and management challenges of CIPA. It also emphasizes the importance of early diagnosis, meticulous follow-up, and a multidisciplinary approach to optimize outcomes and prevent severe complications in affected children.

Obesity is an escalating health problem that has been increasingly associated with surgical complications. In general, open surgical techniques worsen these complications, because they are more tissue-destructive and associated with a relatively long recovery period. Minimally invasive techniques, such as endoscopic spine surgery, appear to be good substitutes, because they reduce tissue iatrogenic injury and hasten recovery. However, the effect of obesity on the performance of endoscopic spine surgery remains uncertain. This metaanalysis was designed to evaluate the safety and efficacy of endoscopic spine surgery in patients with obesity compared with those without obesity. This study adhered to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. We conducted a thorough search using PubMed, Scopus, and Virtual Health Library. Methodological quality was assessed using the MINORS (Methodological Index for Non-randomized Studies) criteria. Mean differences (MD) and standardized mean differences with 95% confidence intervals (CI) were calculated. Statistical analyses were conducted using Review manager ver. 5.4.1. Seven studies involving 659 participants were analyzed. The obese and nonobese groups had no significant differences in operative time (MD, 9.86 minutes; 95% CI, −4.93 to 24.65); Visual Analog Scale (VAS) scores for back pain at 3 months (MD, 0.26; 95% CI, −0.11 to 0.63), 6 months (MD, 0.26; 95% CI, −0.05 to 0.56), and 12 months (MD, −0.54; 95% CI, −1.70 to 0.62); VAS leg pain scores at 3 months (MD, 0.17; 95% CI, −0.06 to 0.41), 6 months (MD, 0.23; 95% CI, −0.13 to 0.59), and 12 months (MD, 0.18; 95% CI, −0.10 to 0.45); Oswestry Disability Index scores at 3 months (MD, 1.02; 95% CI, −0.14 to 2.18) and 12 months (MD, 0.10; 95% CI, −1.14 to 1.33); and reherniation rate (odds ratio, 1.35; 95% CI, 0.73 to 2.49). Endoscopic surgery demonstrated no significant differences in outcomes between obese and nonobese patients and was safe and effective for this patient population.

The August 2024 floods in Bangladesh have precipitated a major public health crisis, significantly elevating the risk of waterborne and vector-borne diseases and exacerbating existing health vulnerabilities. This disaster has impacted over 5 million people, causing widespread environmental disruption, population displacement, and strained healthcare resources. The flooding of latrines, sewage systems, and agricultural land has led to the contamination of drinking water sources, increasing the risk of cholera, enterotoxigenic Escherichia coli diarrhoea, shigellosis, and hepatitis. Additionally, stagnant floodwaters have created breeding grounds for mosquitoes, thereby increasing the threat of malaria and dengue fever. The disruption of healthcare services has further compounded the crisis, delaying emergency responses and impeding access to care. The psychological impact on affected communities is profound, with mental health issues such as anxiety, depression, and post-traumatic stress disorder emerging as significant concerns. This perspective provides an analysis of these public health threats, supported by data on the impact of floods and a discussion of the underlying risk factors. This underscores the need for immediate and long-term public health interventions, including restoring clean water access, enhancing disease surveillance, repairing healthcare infrastructure, and addressing mental health needs. The response to this disaster must be rapid and comprehensive, with lessons learned to inform preparedness efforts to better manage similar events in the future.

Background and Objectives: There are limited national data on the trends and outcomes of patients hospitalized with acute myocardial infarction (AMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the impact of early COVID-19 pandemic on the trends and outcomes of AMI using the National Inpatient Sample (NIS) database. Methods: The NIS database was queried from January 2019 to December 2020 to identify adult (age ≥18 years) AMI hospitalizations and were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) based on International Classification of Diseases, Tenth Revision, Clinical Modification codes. In addition, the in-hospital mortality, revascularization, and resource utilization of AMI hospitalizations early in the COVID-19 pandemic (2020) were compared to those in the prepandemic period (2019) using multivariate logistic and linear regression analysis. Results: Amongst 1,709,480 AMI hospitalizations, 209,450 STEMI and 677,355 NSTEMI occurred in 2019 while 196,230 STEMI and 626,445 NSTEMI hospitalizations occurred in 2020. Compared with those in 2019, the AMI hospitalizations in 2020 had higher odds of inhospital mortality (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], [1.23–1.32];p<0.01) and lower odds of percutaneous coronary intervention (aOR, 0.95 [0.92–0.99];p=0.02), and coronary artery bypass graft (aOR, 0.90 [0.85–0.97]; p<0.01). Conclusions We found a significant decline in AMI hospitalizations and use of revascularization, with higher in-hospital mortality, during the early COVID-19 pandemic period (2020) compared with the pre-pandemic period (2019). Further research into the factors associated with increased mortality could help with preparedness in future pandemics.

The August 2024 floods in Bangladesh have precipitated a major public health crisis, significantly elevating the risk of waterborne and vector-borne diseases and exacerbating existing health vulnerabilities. This disaster has impacted over 5 million people, causing widespread environmental disruption, population displacement, and strained healthcare resources. The flooding of latrines, sewage systems, and agricultural land has led to the contamination of drinking water sources, increasing the risk of cholera, enterotoxigenic Escherichia coli diarrhoea, shigellosis, and hepatitis. Additionally, stagnant floodwaters have created breeding grounds for mosquitoes, thereby increasing the threat of malaria and dengue fever. The disruption of healthcare services has further compounded the crisis, delaying emergency responses and impeding access to care. The psychological impact on affected communities is profound, with mental health issues such as anxiety, depression, and post-traumatic stress disorder emerging as significant concerns. This perspective provides an analysis of these public health threats, supported by data on the impact of floods and a discussion of the underlying risk factors. This underscores the need for immediate and long-term public health interventions, including restoring clean water access, enhancing disease surveillance, repairing healthcare infrastructure, and addressing mental health needs. The response to this disaster must be rapid and comprehensive, with lessons learned to inform preparedness efforts to better manage similar events in the future.

Background and Objectives: There are limited national data on the trends and outcomes of patients hospitalized with acute myocardial infarction (AMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the impact of early COVID-19 pandemic on the trends and outcomes of AMI using the National Inpatient Sample (NIS) database. Methods: The NIS database was queried from January 2019 to December 2020 to identify adult (age ≥18 years) AMI hospitalizations and were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) based on International Classification of Diseases, Tenth Revision, Clinical Modification codes. In addition, the in-hospital mortality, revascularization, and resource utilization of AMI hospitalizations early in the COVID-19 pandemic (2020) were compared to those in the prepandemic period (2019) using multivariate logistic and linear regression analysis. Results: Amongst 1,709,480 AMI hospitalizations, 209,450 STEMI and 677,355 NSTEMI occurred in 2019 while 196,230 STEMI and 626,445 NSTEMI hospitalizations occurred in 2020. Compared with those in 2019, the AMI hospitalizations in 2020 had higher odds of inhospital mortality (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], [1.23–1.32];p<0.01) and lower odds of percutaneous coronary intervention (aOR, 0.95 [0.92–0.99];p=0.02), and coronary artery bypass graft (aOR, 0.90 [0.85–0.97]; p<0.01). Conclusions We found a significant decline in AMI hospitalizations and use of revascularization, with higher in-hospital mortality, during the early COVID-19 pandemic period (2020) compared with the pre-pandemic period (2019). Further research into the factors associated with increased mortality could help with preparedness in future pandemics.