Trichoblastic carcinoma (TBC) is an extremely rare cutaneous malignancy of the hair follicle, first described in the literature in 1962 as a “primary neoplasm of the hair matrix” (1). Besides its rarity, TBC shares many clinical and histologic characteristics with basal cell carcinoma (BCC), making the diagnosis of TBC difficult to make. Many authors have described TBC as a malignant transformation of a benign trichoblastoma (TB), but a universal understanding of the pathophysiological origin of TBC has not been established (2, 3). We present a case of this uncommon tumor with the hope that this report will add to the small repertoire of available research, and aid clinicians in diagnosis and management of this rare tumor.

Background: Cytomegalovirus (CMV) is a common cause of viral infection. In immunocompetent patients, CMV infection is usually mild or asymptomatic and does not require any treatment. However, in some patients systemic manifestations can occur.

Case presentation: We report the case of a 40-year-old woman with a medical history of Graves’ disease and papilloma virus infection presenting with swollen ankles associated with fever and pain in the lower limbs for several weeks. Clinical examination revealed bilateral in duration of the calf. Laboratory tests showed elevated liver enzymes and systemic inflammation. Exploration by ultrasound of lower limbs and CT scan of the abdomen demonstrated superficial venous thrombosis of the lower limbs and thrombosis of the left hepatic vein. A thorough evaluation for hypercoagulability and septic states were negative. Finally, serological conversion for CMV was demonstrated with positive IgM and IgG with negative prior testing done seven years earlier. The patient was given an anticoagulation treatment and oral contraception was discontinued. The patient improved clinically and biologically after few weeks.

Conclusion: We describe a rare case of sub-acute CMV primary infection in an immunocompetent patient complicated with multiple thromboses. This case illustrates a rare complication of a common infection in order to raise awareness of this entity.

Purpose: Adequate reliability of Body Composition (BC) assessment is a requirement before such measures can be considered valid. Many studies to date have only examined a single source of measurement error such as that from trials (test-retest). Generalizability Theory (G-theory) is a statistical technique that allows for the examination of different sources of measurement error simultaneously in a single analysis. Therefore, the aim of this study was to examine the different sources of error seen in the assessment of BC. A secondary purpose was to determine the appropriate number of facet conditions required to gain a reliable BC measure.

Methods: This measurement study included 38 participants who had been assessed on two different occasions (in the same week) and on each of four different BC field methods: Percent Body Fat (PBF) by Skinfold Technique (SF), Waist Circumference (WC), Body Mass Index (BMI) and PBF by Hand-Held Bioelectrical Impedance (HH). Two different G-theory designs were used in this research. First, a two-facet crossed p×t×m design was analyzed treating all facets as random. Then, the same design was performed treating BC method as a fixed facet. In both designs, a Generalizability Study (G-study) and Decision Study (D-study) were conducted. Three different software packages were used to ensure consistent and valid results (GENOVA, SPSS macro, and SAS GLM).

Results: The completely random design showed the largest variance component for persons (p) (57.8%). Variance components for both trials (t) and BC method (m) were negligible. However, the interaction between person and method (p×m) was substantial (38.6%). D-study results indicated reliable BC scores for measurement designs administered once using three different methods (G=.803). The mixed design, averaging over BC method, showed majority of variance due to persons (98.5%) and each of the four BC methods showed reliable scores with a single trial (G’s>.945).

Conclusion: Results from this G-theory research indicate that the equivalence reliability of commonly administered BC assessments may be inadequate. Although different BC assessments individually are reliable, for dependable BC trait generalization to the universe, a minimum of three different methods administered once may be required.

This report describes a long rectal duplication cyst found during routine dissection of an 82 year old male cadaver. The cyst was tubular, blind-ending and non-communicating. It emerged from the posterior rectal wall approximately 13cm superior to the anal verge and was 12cm in length. Long duplication cysts such as that described may cause complications such as perforation, bleeding and chronic pain. Hence duplication cysts should form part of the differential work up in a clinical setting.

Herbal medicine has long been characterized by multi-component, multi-target, and multi-pathway therapeutic actions, but its complex mechanisms remain difficult to explain using conventional single-target pharmacology. Network pharmacology provides a systems-level framework for decoding these effects by integrating herbal compound databases, disease-associated gene resources, protein–protein interaction networks, and graph-theoretical algorithms. This review summarizes the most recent advances in herbal network pharmacology, with emphasis on core databases, network topology metrics, hub-target identification, and multiscale interactome analysis. It further discusses how artificial intelligence, especially graph neural networks, knowledge graph embedding, and explainable AI, is improving herb target prediction and mechanistic interpretation. The integration of single-cell transcriptomics, spatial metabolomics, molecular docking, and transfer-learning frameworks has expanded the field from static pathway mapping toward cell-type-specific and spatially resolved systems pharmacology. Despite these advances, major limitations remain, including overreliance on in silico predictions, insufficient wet-laboratory validation, neglect of dose–response relationships, inadequate consideration of pharmacokinetics and physiological barriers, and poor reproducibility caused by extract heterogeneity. Future development should move toward quantitative, dynamic, and experimentally validated systems pharmacology, supported by standardized reporting guidelines and rigorous biophysical, omics-based, and phenotypic validation. Such advances may help transform herbal medicine into a more precise, reproducible, and internationally acceptable therapeutic resource.

Background: Alcohol Use Disorder (AUD) imposes a significant health burden on adolescents and young adults, contributing to both physical and mental health challenges. With varying impacts based on sociodemographic index (SDI) levels, this study provides a comprehensive assessment of the global and regional AUD burden, revealing critical patterns that influence public health strategies. To evaluate global trends in the burden of AUD among adolescents and young adults (aged 15-39 years) from 1990 to 2021. This study aims to assess prevalence, disability-adjusted life years (DALY), and mortality related to AUD, analyze disparities across sociodemographic categories, and identify factors associated with increased risk, focusing on the influence of socioeconomic and demographic factors on AUD. Methods: This study is a systematic analysis based on the 2021 Global Burden of Disease (GBD) dataset, encompassing individuals aged 15-39 years across 204 countries and territories over a 30-year period (1990-2021). A range of statistical approaches, including Age-Period-Cohort (APC) analysis, decomposition, frontier analysis, and predictive modeling, was employed to assess the trends in AUD burden by SDI, age, sex, and geographic location. The primary outcomes measured were age-standardized prevalence, DALY, and mortality rates for Alcohol Use Disorder among people aged 15-39 years. Results: Globally, age-standardized prevalence, DALY, and mortality rates for AUD among adolescents and young adults showed a declining trend from 1990 to 2021, with Average Annual Percent Changes (AAPC) of -0.97%, -1.03%, and -1.5%, respectively. Males consistently exhibited higher prevalence and DALY rates compared to females. High SDI regions demonstrated higher AUD burdens, while low and low-middle SDI countries showed slower reductions, with population growth being a significant factor in increasing AUD DALY in these regions. Conclusions: The findings underscore the need for targeted and context-sensitive interventions to reduce AUD burden, particularly in high-SDI regions where social and lifestyle factors increase risks, as well as in low-SDI regions facing limited resources. Tailoring prevention and intervention strategies to meet the unique socioeconomic and demographic needs of various populations could enhance the effectiveness of AUD management and public health outcomes globally.

Objective: Eyelid skin laxity is an inevitable consequence of aging, and dry eye disease has a high incidence in the middle-aged and elderly population. This study aims to explore the mechanism by which eyelid laxity affects meibomian gland function and dry eye symptoms, evaluate the impact of eyelid laxity on tear film stability, tear secretion volume and inflammatory response, and provide new clinical evidence for the diagnosis and intervention of dry eye disease. Methods: A total of 200 subjects in our hospital from January 2023 to December 2024 were selected and divided into a control group of 100 subjects without eyelid laxity symptoms and an experimental group of 100 subjects with different degrees of eyelid laxity. The experimental group was further subdivided into mild, moderate and severe laxity subgroups. Correlation analysis and multiple regression analysis were performed by measuring indicators including Tear Film Break Up Time (TBUT), Schirmer I test (SIt), Tear Meniscus Height (TMH), tear osmolarity and the level of inflammatory marker IL-6 in tears. Results: SPSS 22.0 was used for data analysis of the samples. Measurement data were expressed as mean ± standard deviation (x±s), and one-way analysis of variance was used for inter-group comparison. The conclusions were as follows: with the aggravation of eyelid laxity, the objective indicators reflecting tear film stability, tear secretion volume, tear osmolarity and local inflammatory state all showed a consistent worsening trend. The specific results were as follows: TBUT decreased significantly with the aggravation of eyelid laxity: the mild laxity group was (7.87±0.12) seconds, the moderate group was (5.96±0.35) seconds, and the severe group decreased to (3.95±0.47) seconds, all significantly lower than that of the control group [(9.72±0.69) seconds, P<0.01]. The basic tear secretion volume of the control group was (12.0±1.1) mm, while those of the mild, moderate and severe laxity groups were (8.1±0.9) mm, (5.3±1.2) mm and (4.8±0.8) mm, respectively (P<0.01). The tear osmolarity of the control group was (298.45±7.98) mOsm/L, while those of the mild, moderate and severe laxity groups were (308.12±7.94) mOsm/L, (315.21±4.98) mOsm/L and (323.33±6.09) mOsm/L, respectively, with a significant increase in osmolarity (P<0.01). The IL-6 level of the control group was (3.98±2.01) pg/ml, while those of the mild, moderate and severe laxity groups were (11.78±3.70) pg/ml, (25.17±4.08) pg/ml and (38.63±7.45) pg/ml, respectively. The IL-6 level increased significantly with the aggravation of eyelid laxity, and the difference between the control group and the severe laxity group was significant (P<0.01). Conclusion: Eyelid laxity has a significant impact on tear film stability, tear secretion volume and inflammatory level, and may be a potential factor for the aggravation of dry eye symptoms. The significant changes in tear film break-up time and tear secretion volume are closely related to eyelid laxity. Early screening and intervention for patients with eyelid laxity may help prevent the deterioration of dry eye symptoms.

Obesity is well-known as a chronic multifactorial disease with significant health impacts, showing-up metabolic disorders, cardiovascular disease, type 2 diabetes, certain cancers, weakened quality of life, and significant economic burden on health systems worldwide. Although, lifestyle change, pharmacotherapy, and surgery, which constitute a traditional therapeutic approach, and are effective but certainly limited by adherence, side effects, cost, and long-term sustainability in managing the obesity.

Background: Atrial Fibrillation (AF), the most common sustained cardiac arrhythmia, significantly increases the risk of stroke, heart failure, and mortality. Hypertension (HTN) is a leading risk factor for AF, with hypertensive heart disease being the most common underlying disorder in AF patients. Despite the global rise in AF prevalence, data on its burden and correlates among hypertensive patients in Sudan remain limited. This study aimed to assess the burden and correlates of AF among hypertensive patients attending Al Mek Nimr University Hospital in 2024.

Materials and Methods: A descriptive cross-sectional study was conducted from July to December 2024, enrolling 133 hypertensive patients. Participants were selected using a consecutive sampling technique, with a sample size calculated at a 95% confidence level and a 5% margin of error, assuming an AF prevalence of 10%. Data were collected through structured questionnaires administered via direct interviews. The questionnaire included demographic information, hypertension history, clinical symptoms, comorbidities, and medication use. AF diagnosis was confirmed through ECG and/or medical records. Data were analyzed using SPSS version 25.0, with descriptive statistics, Chi-square tests, and t-tests used to assess associations.

Results: The prevalence of AF among hypertensive patients was 19.5%, with higher rates observed in older adults (37.5% in patients > 75 years) and women (23.2%). Common symptoms of AF included easy fatigue (65.4%) and palpitations (50.0%) (P = 0.018). Additionally, 46.2% of AF patients reported a history of stroke (P = 0.002), and 42.3% reported loss of independence in performing daily activities (P = 0.039), reflecting the significant burden of AF in this population. Comorbidities such as diabetes (34.6%) and obesity (26.9%) were present among AF patients but did not show statistically significant associations. Although 65.4% of AF patients were on anticoagulants, a notable proportion (34.6%) remained untreated, likely due to recent diagnosis, acute stroke presentation, or contraindications, highlighting a gap in thromboembolic risk management. Diuretics were more commonly used in AF patients (38.5%) compared to non-AF patients (P = 0.003), while the use of RAAS inhibitors (ACEIs and ARBs) was low (10.5% and 35.3%, respectively).

Conclusion: This study highlights the high burden of AF among hypertensive patients, especially in older individuals. The strong associations with stroke and functional decline underscore the need for systematic AF screening, optimized anticoagulation, and increased use of RAAS inhibitors in this high-risk population.

Introduction: Transplant renal artery stenosis (TRAS) is the most common vascular complication following kidney transplantation. Deceased donor kidneys exhibiting severe atherosclerosis involving the renal artery, if untreated, represent one cause of TRAS.

Methods: We report herein two cases of TRAS that occurred following back bench ex vivo eversion endarterectomy (EE) prior to deceased donor kidney transplantation (DDKT).

Results: Both patients presented in the first year following DDKT with worsening hypertension and one patient experienced acute kidney injury. Duplex ultrasonography was suspicious for markedly elevated renal artery velocities in the proximal to mid-renal artery segment with evidence for distal turbulence. Subsequent arteriography through an ipsilateral femoral approach confirmed severe TRAS that was successfully treated with balloon angioplasty and stenting. Both patients experienced improvements in blood pressure control, and one patient had resolution of acute kidney injury.

Conclusion: Ex vivo EE may be performed successfully as a rescue procedure to prevent nonuse of donor kidneys with severe intrinsic atherosclerosis. However, these patients may still be at risk for developing TRAS, possibly from a localized dissection occurring secondary to an intimal flap.