Metabolic syndrome (MetS) defines as a cluster of risk factors and is a global public health problem. Quality and quantity of carbohydrates (CHOs) intake plays a crucial role in the development of MetS. This study aimed to investigate the role of CHOs quantity and quality in relation to MetS.

This prospective cohort study was conducted among healthy adults aged 18-65 years in Kerdabad, Isfahan, Iran. Participants (n=1904) were selected through a census-based sampling method. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). CHOs quantity and quality were evaluated using measures such as dietary glycemic index (DGI), dietary glycemic load (DGL), and fiber intake. MetS was defined by established clinical criteria ATPΙΙΙ and assessed annually over a two-year follow-up. Anthropometric measurements, blood pressure, and fasting blood samples were collected at baseline and yearly to monitor metabolic parameters. Statistical analyses included multivariate logistic regression models adjusting for potential confounders including age, sex, energy intake, physical activity, socioeconomic factors, and BMI.

Among 1904 participants (45% male; mean age: 39.6 ± 10.2 years; mean BMI: 27.1 ± 4.9 kg/m²), in fully adjusted models, none of the dietary CHOs quantity or quality indices were significantly associated with MetS during the two-year follow-up.

quantity and quality of CHOs not significantly associated with MetS after adjusting for confounders. Although some trends indicated potential metabolic effects, these were not statistically significant. Further long-term research with more detailed dietary assessments is needed to clarify these relationships.

To describe a probable oral mucosal injury associated with the off-label sublingual administration of captopril in a medically complex patient, and to illustrate the role of structured clinical reasoning in identifying route-related adverse drug reactions, with exploratory insights into AI-assisted reasoning.

A 77-year-old patient presented with persistent burning pain and a progressive oral mucosal lesion on the floor of the mouth. Despite appropriate management of local infectious and mechanical factors, symptoms worsened over time. A consistent temporal relationship was observed between lesion exacerbation and repeated sublingual captopril use during hypertensive episodes. Structured clinical reasoning, including iterative causal analysis, supported identification of a probable route-related adverse drug reaction. Discontinuation of sublingual captopril, combined with topical corticosteroid therapy, resulted in complete resolution of the lesion. An exploratory interaction with a large language model was conducted to examine how structured clinical input may influence the coherence and clinical relevance of AI-assisted reasoning.

Sublingual administration of captopril may cause localized chemical injury to the oral mucosa, particularly in vulnerable patients with complex medical conditions. Recognition of route-specific adverse effects is essential to avoid unnecessary interventions and improve patient outcomes. This case also illustrates that AI-assisted reasoning is highly dependent on the structure and quality of clinical input, supporting its role as a complementary cognitive tool rather than an autonomous diagnostic system.

Children with heart disease face competing risks of thrombosis and bleeding. Antiplatelet agents are widely used, but clinical effectiveness and safety may vary with pharmacogenomic variants. We evaluated bleeding and thromboembolic outcomes and explored pharmacogenomic associations in a pediatric cardiac cohort.

Single-center, retrospective study of patients prescribed aspirin or clopidogrel during admissions (2011-2020). We abstracted clinical characteristics, pharmacodynamic testing, and adverse events while prescribed the antiplatelet agent through July 2021. Pharmacogenomic variants relevant to aspirin and clopidogrel metabolism/function (including CYP2C19 haplotypes and selected aspirin response loci) were called from existing genomic data. Outcomes included major bleeding and thromboembolism (TE) as well as pharmacodynamic aspirin "resistance." Analyses were exploratory.

We included 105 patients treated with aspirin with VerifyNow pharmacodynamic and pharmacogenomic variant data and 49 clopidogrel-treated patients with genetic data. Major bleeding occurred in 5% (aspirin) and 16% (clopidogrel); TE occurred in 12% and 8% of patients, respectively. On aspirin, bleeding was more frequent with renal (40% vs. 2%, p = 0.011) or hepatic dysfunction (20% vs. 0%, p = 0.048); TE was associated with younger age, lower weight, and single-ventricle physiology. On clopidogrel, bleeding was associated with older age/greater weight and renal dysfunction. No association was observed across CYP2C19 phenotypes and clopidogrel outcomes. No poor metabolizers were identified in this small cohort. Pharmacodynamic aspirin "resistance" was seen in 23% and was more common in females, with no association identified with TE. A P2RY1 variant (rs1065776-CT) was associated with the composite aspirin outcome of pharmacodynamic resistance and/or TE.

Clinically important bleeding and TE events were common in pediatric cardiac patients on antiplatelets, with organ dysfunction, age, and physiology emerging as key associations. Pharmacogenomic variants were frequent; a candidate P2RY1 signal warrants validation. Pediatric antiplatelet management and relationships with outcomes are complex, supporting the need for prospective studies integrating pharmacogenomic variant analyses with standardized pharmacodynamic testing.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Antazoline, a first-generation antihistamine with antiarrhythmic properties, has shown efficacy in the rapid conversion of recent-onset AF to sinus rhythm; however, direct comparative evidence against standard antiarrhythmic agents remains limited. This study aims to systematically evaluate the efficacy and safety of antazoline for pharmacological cardioversion of AF, in comparison with standard antiarrhythmic agents such as amiodarone and propafenone.

The methodology of this systematic review and meta-analysis adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane Library from inception to April 2025, including citation and reference screening. Statistical analyses were performed using R version 2025.05.0 + 496.

From 172 records, 5 studies comparing antazoline with propafenone (n = 5) or amiodarone (n = 3) for AF were included. For antazoline vs propafenone, conversion to sinus rhythm favored antazoline (risk ratio [RR] 1.13 [95% confidence interval (CI): 1.04-1.23], P = .017). No significant difference was observed in time to conversion (mean difference -10.98 [95% CI: -124.93-102.98], P = .436), bradycardia (RR 0.84 [95% CI: 0.35-2.03], P = .478), hypotension (RR 0.40 [95% CI: 0.14-1.12], P = .056), or other adverse events (RR 1.24 [95% CI: 0.01-247.13], P = .694). For antazoline vs amiodarone, conversion to sinus rhythm favored antazoline (RR 1.22 [95% CI: 1.08-1.36], P = .018, I2 = 0%), with no significant differences in bradycardia (RR 1.36 [95% CI: 0-1072357.09], P = .823) or hypotension (RR 1.05 [95% CI: 0.04-26.16], P = .877).

Antazoline might be more effective than propafenone and amiodarone in achieving sinus rhythm in AF, with no significant differences in safety outcomes.

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with substantial morbidity and mortality worldwide. However, its underlying mechanisms are still not completely understood. Emerging evidence suggests that pyroptosis may contribute to AF development. This study aimed to investigate the involvement of pyroptosis-related genes (PRGs) in AF and to develop a validated diagnostic model for this condition. Three AF-related datasets were obtained from the Gene Expression Omnibus. Data were processed using R packages, including GEOquery, sva for batch effect correction, and limma for normalization. Differentially expressed genes were identified and analyzed using clusterProfiler for Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment. Gene set enrichment analysis and gene set variation analysis were performed. A protein-protein interaction network was generated using STRING, immune cell infiltration was assessed with cell-type identification by estimating relative subsets of RNA transcripts, and transcriptional regulatory networks were visualized using ChIPBase and StarBase. A total of 1107 differentially expressed genes (579 upregulated and 528 down-regulated) were identified. Among these, 21 PRGs, including ATP6AP1, PKM, and SPTBN1, showed significant dysregulation in AF. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed enrichment of PRGs in inflammation- and immune-related pathways. A diagnostic model incorporating 15 genes accurately distinguished AF patients from controls (area under the curve> 0.9). Gene set variation analysis further highlighted distinct pathway enrichment between high- and low-risk AF groups, underscoring potential therapeutic targets such as the TGF-β signaling pathway. This study provides new evidence that pyroptotic cell death contributes to AF pathogenesis. The proposed diagnostic model demonstrates strong clinical utility and may guide the future development of targeted therapies aimed at preventing AF onset or protecting against its progression.

Wernicke's aphasia is a challenging communication disability to live with, characterised by fluent speech, impaired auditory comprehension and reduced self-monitoring. There is little literature addressing functional therapy approaches. For example, there is limited evidence for communication partner training (CPT) for this client group, despite research on its effectiveness more generally. It is not known how speech and language therapists (SLTs) understand and apply this limited and disparate evidence to their practice.

To explore how SLTs assess and treat people with Wernicke's aphasia (PwWA), specifically how SLTs engage with PwWA; work with the multi-disciplinary team to support PwWA; support significant others of PwWA, including through the provision of CPT.

In this qualitative interview study, SLTs were recruited through social media and professional newsletters. Interviews via videoconferencing followed a topic guide and were transcribed and analysed using Framework Analysis. Fifteen SLTs participated, with 1.5-34 years of experience, working in England and Wales across a range of inpatient and community settings.

SLTs described a range of issues when working with PwWA. Building a therapeutic alliance was considered important, but could take longer than in other types of aphasia. Informal assessment was required for many PwWA, with published language assessments deemed unsuitable by many. It was perceived that available outcome measures did not capture change. SLTs took differing views on which theoretical models they should use to guide impairment-based therapy. Treatment choices were sometimes driven by trial and error. SLTs offered CPT throughout the stroke pathway, reporting it to be clinically useful; however, there was uncertainty around which communication strategies to recommend. Many SLTs viewed working with PwWA negatively. They wanted to help but felt unsure about how to do so, and commented that the evidence base for treatment was limited. SLTs worked most closely with occupational therapists to manage Wernicke's aphasia. SLTs expressed concerns around the quality of decision-making capacity assessments completed by other members of the multidisciplinary team and access to psychological support for PwWA.

SLTs want evidence to guide their practice when working with Wernicke's aphasia. Further research is needed to inform CPT and outcome measures for PwWA. CPT should be supported by empirical research into interactions involving PwWA. There needs to be improved access to mental health support and high-quality decision-making capacity assessment for PwWA.

What is already known on this subject Impairment-based treatments for Wernicke's aphasia from varied theoretical perspectives are reported in the literature. There is little literature reporting on functional approaches and communication partner training for Wernicke's aphasia. It is not known how practising speech and language therapists (SLTs) assess and treat people with Wernicke's aphasia (PwWA). What this paper adds to existing knowledge SLTs found PwWA difficult to work with; they wanted to help but felt unsure about what to offer. SLTs are offering communication partner training for Wernicke's aphasia throughout the stroke pathway; however, they expressed differing opinions on which communication strategies to recommend. What are the potential or actual clinical implications of this work? SLTs would like more research evidence to guide them when managing Wernicke's aphasia. There is a need for assessments, treatments, outcome measures and psychological support that meet the unique needs of PwWA.

Youth with attention-deficit/hyperactivity disorder (ADHD) may experience persistent barriers to engagement in individual psychotherapy despite adequate pharmacologic treatment and evidence-based therapeutic content. Existing gamified approaches often rely on fixed protocols, specialized materials, or group-based formats to address interfering symptoms such as distractibility, low frustration tolerance, and difficulty sustaining mental effort, with mixed feasibility and clinical outcomes. This case describes a novel, individualized gamified intervention designed to address limitations of existing approaches and support ADHD treatment engagement. An otherwise healthy 11-year-old male with ADHD, combined type, was referred for outpatient psychotherapy to address difficulties with organization and emotional self-regulation while receiving methylphenidate extended-release 18 mg daily. Early sessions used established approaches, including gamified interventions, but were marked by distractibility, fidgeting, and disengagement. Treatment was reorganized into a structured, therapist-led, quest-based gamified framework delivered across 21 completed 60-minute sessions over approximately 24 weeks. ChatGPT-4o was used to assist with narrative creation and maintenance and to support integration of therapist-selected psycho-education, behavioral skills training, cognitive-behavioral strategies, mindfulness, and parent management principles into a tabletop role-playing structure. Over time, the patient demonstrated progressively improved engagement, emotional awareness, organization, and coping skills, corroborated by parent-informed improvements on the "Hyperactive/Impulsive" and "Conduct" items of the National Institute for Children's Health Quality (NICHQ) Vanderbilt Assessment Scale, third edition. This case illustrates how therapist-led gamification may function as a pragmatic delivery framework for evidence-based individual psychotherapy in youth with ADHD when engagement is a primary treatment barrier. The intervention emphasized therapist-guided skills coaching, flexibility, narrative reinforcement, and repeated practice. A large language model was used to make the intervention feasible, primarily as a preparatory narrative support tool under full therapist oversight. Further study is needed to evaluate the feasibility, acceptability, and generalizability of individualized gamified psychotherapy frameworks in outpatient ADHD treatment.

Delirium is a frequent yet often underrecognised complication in hospitalised patients, particularly in those with renal impairment. Cefepime, a broad-spectrum cephalosporin, has been increasingly associated with neurotoxicity, manifesting as confusion, hallucinations, and agitation. This case report describes a 63-year-old woman with chronic kidney disease secondary to autosomal dominant polycystic kidney disease who developed acute confusional symptoms after initiating cefepime during treatment of a urinary tract infection associated with infected renal cysts. Following clinical improvement of the underlying infection, she developed temporal disorientation and visual hallucinations within 24-48 hours of cefepime initiation, which resolved within 24 hours of drug discontinuation. The Naranjo Adverse Drug Reaction Probability Scale classified the association as "probable" (score: 6). Although alternative contributors to delirium were present, including acute infection and renal dysfunction, the temporal relationship between cefepime exposure and symptom onset, together with rapid symptom resolution after withdrawal, supported cefepime-induced neurotoxicity as the most likely diagnosis. This case reinforces the importance of considering cefepime-induced neurotoxicity in the differential diagnosis of delirium, particularly in patients with renal dysfunction. Close clinical monitoring and early recognition are essential to prevent misdiagnosis and unnecessary interventions. Further studies are needed to refine risk assessment and explore safer therapeutic alternatives.

This review addresses the high prevalence of depression and anxiety in systemic sclerosis (SSc), as well as the core biological, psychological and social mechanisms underlying such psychiatric comorbidities, The prevalence of clinically significant depression or anxiety disorders reaches 30%-50% among patients with SSc who satisfy corresponding diagnostic criteria. Established risk factors encompass multi-organ involvement (e.g., lung fibrosis, digital ulcers), chronic pain, physical disability and disease-related stigma. Three key pathophysiological mechanisms drive this comorbidity: immune dysregulation induces neuroinflammation via pro-inflammatory cytokines (IL-6, TNF-α), pathogenic autoantibodies and gut-brain axis disruption; cerebral microvascular damage and chronic hypoxia impair emotion-regulating neural circuits; tissue fibrosis and persistent stress over activate the HPA axis, forming a pathogenic cycle connecting systemic inflammation, glucocorticoid resistance and negative mood. Clinical management of SSc should extend beyond conventional antidepressants and cognitive behavioral therapy to include integrated rheumatology-psychiatry care, IL-6/JAK-targeted biologics and transcutaneous vagus nerve stimulation (tVNS), all designed to ameliorate patients' physical and psychiatric symptoms simultaneously. In conclusion, psychiatric comorbidity in SSc stems from the intricate interplay of biological, psychological and social factors. Elucidating these mechanisms facilitates the development of targeted therapeutic strategies that address both systemic SSc manifestations and associated mental health conditions, thereby enhancing patients' health-related quality of life and long-term psychiatric outcomes.

Increases in the proportion of pediatric emergency department (ED) visits due to mental illness (MI) or intentional self-harm (ISH) in early months of the COVID-19 pandemic have been documented. Less is known about hospitalizations, or trends during later months of the pandemic. This study assessed changes in MI/ISH-related ED visits and hospitalizations among enrollees in Alabama's Children's Health Insurance Program, ALL Kids, during the pandemic.

Administrative claims data from ALL Kids, were used for enrollees aged 6-17 from 2017 to 2022. The study-period was divided into pre-COVID (January 2017-March 2020), early COVID (April 2020-May 2021), and late COVID (June 2021-December 2022). Multivariate logistic regressions were employed to estimate the probabilities that ED visits and hospitalizations were MI/ISH related.

The study sample included 72,870 ED visits and 8205 hospitalizations for all causes. After adjusting for covariates, the proportion of MI/ISH-related ED visits increased from 2.5% pre-COVID to 4.1% in early COVID (p < 0.01), then declined to 2.8% in late COVID. MI/ISH-related hospitalizations rose from 26.3% pre-COVID to 31.3% in early COVID and remained elevated at 30.2% in late COVID. Increases were more pronounced among females and older enrollees.

The COVID-19 pandemic was associated with increased MI/ISH-related ED visits and hospitalizations among publicly-insured youth, with hospitalizations remaining elevated later into the pandemic. Shifts in healthcare-seeking behaviors or admission criteria during the pandemic may have impacted these findings.

Findings on pediatric mental health during the COVID-19 pandemic can inform efficient health resources allocation for future public health crises. Our findings highlight the need for ensuring adequate access to health care for youth with severe mental health conditions during public health emergencies.