Introduction: Subclinical hypothyroidism (SH), or hyperthyrotropinemia, is an asymptomatic condition defined by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine (FT4) levels. It can be detected in newborns or children, but there is no consensus regarding treatment criteria since FT4 levels often remain normal. [MOU1.1] Materials and methods: We included 116 participants, including infants and children up to 3 years old with subclinical hypothyroidism, born to mothers with autoimmune thyroiditis and those with Down Syndrome. Kaplan-Meier survival analysis determined the median time for TSH normalisation. Cox Proportional Hazards Re-gression was used to explore associated prognostic factors. Results: During the study, 98% of the 116 patients with subclinical hypothyroidism experienced normalisation of their TSH levels, with a median time of 4.0 weeks. Patients who were born term at birth, appropriate for gestational age (AGA), and birth weight of ≥2.5 kg; median (95 % CI):[4 (3.3,4.6)],[4 (3.3,4.6)] [4 (3.3,4.6)] and had a median time of TSH normalisation earlier compared to patients who were born preterm; [12 (0.0,27.1)], small for gestational age (SGA); [8 (4.7,11.2)] and birth weight of < 2.5kg; [8 (1.1,14.8)]. Preterm gestation was identified as a significant predictor for TSH level normalisation with an adjusted HR(95%CI): 0.389(0.2, 0.75), (p=0.005) from multiple Cox regression analysis. [MOU2.1]Conclusion: This study shows that premature patients have a 61.1% lower chance of reaching normal TSH levels, underscoring the signifi-cant challenges they encounter in achieving hormonal balance.

Immunoglobulin G4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is a rare condition with symptoms often mimicking malignancy, infection, or other autoimmune diseases. This case report describes the unique case of a 62-year-old male initially diagnosed with IgG4-SC, followed by subsequent diagnosis of cholangiocarcinoma. Biliary tract cancer in the setting of IgG4 related disease has been previously described; however, this patient course is novel as it encompasses the spectrum of challenges in IgG4-SC management, including diagnostic uncertainty, risk of infection with immunosuppressive agents, and development of malignancy diagnosed shortly following IgG4-SC diagnosis. We review the literature of management, outcomes, and malignancy risk and furthermore, highlight a promising recent therapy in treatment of IgG4 related disease, inebilizumab.

Objective: Parkinson’s disease (PD) affects approximately 2% of individuals over the age of 60. With more than two billion Muslims observing Ramadan, individuals with PD encounter specific challenges, such as deteriorating motor skills, sleep disturbances, and an increased risk of falls during fasting. Methods: Our study focused on 75 patients with idiopathic PD divided into two groups: the Ramadan Regime group, which consisted of 50 patients whose medication was adjusted to twice daily at Suhoor and Iftar, and the Nontreatment group, which included 25 patients who abstained from medication for religious reasons. Both groups were instructed to wear a Parkinson’s KinetiGraph (PKG) wrist device. Results: The study findings revealed that motor function worsened in the Nontreatment group (p<0.001) but improved in the Ramadan Regime group (p=0.007). Daytime sleepiness also significantly increased in the Nontreatment group (p<0.001). Conclusion Overall, the findings suggest that the Ramadan regime significantly enhances patient health and quality of life.

Cost-Effectiveness of Mobile Application Use in Managing Type 2 Diabetes Mellitus: A Systematic Review Introduction Type 2 diabetes mellitus (T2DM) is a debilitating condition that imposes a significant economic burden on its management. This study aims to systematically review the published evidence on the cost-effectiveness of mobile health (mHealth) application interventions for T2DM. Methods A search strategy was conducted using electronic bibliographic databases, including PubMed, Web of Science and Scopus for published studies. The inclusion criteria included original articles that reporting cost-effectiveness evaluation studies on mHealth application interventions directed at patients diagnosed or at risk of T2DM, English-language articles and published in the year 2016 to 2020. Results A total of 6 eligible studies were selected. The cost savings per person for treating T2DM ranged from USD 1,346 to USD 3,781 per year. The major contributor to cost savings was reduced complication management resulting from good glycaemic control. The direct impacts of the intervention include reduced hospitalisation and fewer unplanned clinic visits, while diabetes- related mortality was indirectly reduced usingmHealth. Conclusions The mHealth intervention was cost-effective in managing patients with T2DM. Implementation can be extended to other disease management areas to not only reduce total healthcare expenditure but also improve patients’ quality of life.

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours commonly found in the gastrointestinal tract, particularly in the stomach, but they can mimic gynaecological tumours. We report the case of a 56 -year-old postmenopausal woman who presented with a right adnexal pelvic mass. Computed tomography (CT) revealed a large, lobulated pelvic mass with liver lesions. Pan - endoscopy showed normal findings, and her tumour markers were within normal limits. Based on these findings, the gynaecological oncology team proceeded with a laparotomy and tumour debulking, diagnosing the pelvic mass as likely ovarian in origin. Intraoperatively, the mass was found to originate from the stomach and extend posteriorly to the transverse colon. An en -bloc resection with primary anastomosis was performed and histopathology confirmed a high -risk GIST. The patient made a good post -operative recovery and was scheduled for adjuvant chemotherapy at her follow -up visit. This case highlights the importance of considering GIST as a differential diagnosis in postmenopausal women presenting with an abdominopelvic mass that may mimic an ovarian tumour

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours commonly found in the gastrointestinal tract, particularly in the stomach, but they can mimic gynaecological tumours. We report the case of a 56 -year-old postmenopausal woman who presented with a right adnexal pelvic mass. Computed tomography (CT) revealed a large, lobulated pelvic mass with liver lesions. Pan - endoscopy showed normal findings, and her tumour markers were within normal limits. Based on these findings, the gynaecological oncology team proceeded with a laparotomy and tumour debulking, diagnosing the pelvic mass as likely ovarian in origin. Intraoperatively, the mass was found to originate from the stomach and extend posteriorly to the transverse colon. An en -bloc resection with primary anastomosis was performed and histopathology confirmed a high -risk GIST. The patient made a good post -operative recovery and was scheduled for adjuvant chemotherapy at her follow -up visit. This case highlights the importance of considering GIST as a differential diagnosis in postmenopausal women presenting with an abdominopelvic mass that may mimic an ovarian tumour

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. Materials and Methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT’s future use, despite pending guidelines support. Conclusions This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.

Background/Aims: We explored the mechanisms underlying the improvement of postoperative ileus (POI) following probiotic pretreatment. We assessed intestinal permeability, inflammation, tight junction (TJ) protein expression in the gut epithelium, and plasma interleukin (IL)-17 levels in a guinea pig model of POI. Methods: Guinea pigs were divided into control, POI, and probiotic groups. The POI and probiotic groups underwent surgery, but the probiotic group received probiotics before the procedure.The ileum and proximal colon were harvested. Intestinal permeability was measured via horseradish peroxidase permeability. Inflammation was evaluated via leukocyte count in the intestinal wall muscle layer, and calprotectin expression in each intestinal wall layer was analyzed immunohistochemically. TJ proteins were analyzed using immunohistochemical staining, and plasma IL-17 levels were measured using an enzyme-linked immunosorbent assay. Results: The POI group exhibited increased intestinal permeability and inflammation, whereas probiotic pretreatment reduced the extent of these POI-induced changes. Probiotics restored the expression of TJ proteins occludin and zonula occludens-1 in the proximal colon, which were increased in the POI group. Calprotectin expression significantly increased in the muscle layer of the POI group and was downregulated in the probiotic group; however, no distinct differences were observed between the mucosal and submucosal layers. Plasma IL-17 levels did not significantly differ among the groups. Conclusions Probiotic pretreatment may relieve POI by reducing intestinal permeability and inflammation and TJ protein expression in the gut epithelium. These findings suggest a potential therapeutic approach for POI management.

Background/Aims: We explored the mechanisms underlying the improvement of postoperative ileus (POI) following probiotic pretreatment. We assessed intestinal permeability, inflammation, tight junction (TJ) protein expression in the gut epithelium, and plasma interleukin (IL)-17 levels in a guinea pig model of POI. Methods: Guinea pigs were divided into control, POI, and probiotic groups. The POI and probiotic groups underwent surgery, but the probiotic group received probiotics before the procedure.The ileum and proximal colon were harvested. Intestinal permeability was measured via horseradish peroxidase permeability. Inflammation was evaluated via leukocyte count in the intestinal wall muscle layer, and calprotectin expression in each intestinal wall layer was analyzed immunohistochemically. TJ proteins were analyzed using immunohistochemical staining, and plasma IL-17 levels were measured using an enzyme-linked immunosorbent assay. Results: The POI group exhibited increased intestinal permeability and inflammation, whereas probiotic pretreatment reduced the extent of these POI-induced changes. Probiotics restored the expression of TJ proteins occludin and zonula occludens-1 in the proximal colon, which were increased in the POI group. Calprotectin expression significantly increased in the muscle layer of the POI group and was downregulated in the probiotic group; however, no distinct differences were observed between the mucosal and submucosal layers. Plasma IL-17 levels did not significantly differ among the groups. Conclusions Probiotic pretreatment may relieve POI by reducing intestinal permeability and inflammation and TJ protein expression in the gut epithelium. These findings suggest a potential therapeutic approach for POI management.