Bioactive isoquinoline alkaloids from (pursh.) Nutt acclimatized to natural conditions in Georgia.

Species of the genus have long been used in traditional medicine for the treatment of different types of diseases. In the present study, the alkaloid composition and biological activity of acclimatised to the natural conditions of Georgia were investigated. Total alkaloids were extracted from the aerial parts of the plant and fractionated using AlO and SiO columns with CH-MeOH and CHCl-MeOH solvent systems.

Chronic Cardiac Resynchronization Therapy-Defibrillator Infection Leading to Sepsis and Bilateral Septic Pulmonary Emboli: A Case Report.

Cardiac implantable electronic devices (CIEDs), including cardiac resynchronization therapy-defibrillators (CRT-Ds) and other pacemaker systems, are widely used in patients with varying degrees of heart failure to improve cardiac function and reduce the risk of sudden cardiac death. Despite their life-saving benefits, infections related to CRT-Ds present significant clinical challenges. These infections can lead to serious complications, including endocarditis, pocket infections, and device-associated bloodstream infections, often resulting in prolonged hospitalization and potentially life-threatening outcomes.

Artificial intelligence for diagnosing rare bone diseases: a global survey of healthcare professionals.

Background: Rare bone diseases (RBDs) are an important group of conditions characterized by abnormalities in bone and cartilage. Their large number, individual rarity, and heterogeneity make accurate and timely diagnosis challenging. Establishing correlations between genotype and phenotype (mainly via imaging) is critical for diagnosing RBDs.

When Being Overweight Masks the Diagnosis: Identifying Familial Hypercholesterolemia in Pediatric Patients.

Familial hypercholesterolemia (FH) is a genetic disorder leading to elevated low-density lipoprotein cholesterol (LDL-C) from early life, significantly increasing the risk of premature atherosclerotic cardiovascular disease. Despite its prevalence, FH remains underdiagnosed, particularly in pediatric populations where obesity may obscure clinical suspicion. Here, we present two Georgian siblings diagnosed with heterozygous familial hypercholesterolemia (HeFH).

Kneeling (Incomplete Knee) Presentation: A Single Case Report.

The kneeling breech presentation is extremely rare, especially among the deliveries at term; the information about the management of this type of fetal lie is poor. Here we discuss a case of a 24-year-old primipara woman, at 37 weeks of gestation, who was admitted to the hospital with a fully dilated cervix and ruptured membranes. The pelvic examination revealed an incomplete kneeling breech presentation.

A Rare Case Report of a Large Dentigerous Cyst in the Maxillary Sinus Associated With an Ectopic Maxillary Third Molar.

Ectopic eruption of permanent molars is an uncommon developmental anomaly characterized by abnormal tooth positioning, which can lead to significant complications. In rare instances, ectopic molars may be associated with dentigerous cysts, particularly within the maxillary sinus, posing challenges for diagnosis and management. This report discusses a rare case of a 58-year-old male who presented with chronic right maxillary sinusitis, intermittent facial pain, and purulent nasal and oral discharge.

A Multidisciplinary Approach to a Treatment-Resistant Anti-N-Methyl-D-Aspartate Receptor Encephalitis Patient in the ICU: A Case Report.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder characterized by complex neuropsychiatric features and the presence of immunoglobulin G (IgG) antibodies against the receptor subunit 1 (NR1) of the NMDA receptors in the central nervous system. In this case report, we present a 31-year-old female patient who was admitted to the hospital with altered mental status, hallucinations, and seizure activity. After the failure of first-line treatment with intravenous immunoglobulin/plasma exchange (IVIG/PLEX) started at the previous facility, the patient was started on a trial of rituximab, which showed clinical improvement.

Factor Analysis of the BDI-II and HAMD-21 in Patients With Irritable Bowel Syndrome.

Objective: The factorial validity of the Beck Depression Inventory-II (BDI-II) and the 21-item Hamilton Depression Rating Scale (HAMD-21) in individuals with Irritable Bowel Syndrome (IBS) has not yet been investigated. This study aimed to assess the factor structure of these instruments and analyze their interrelationships within the Georgian IBS population.

Methods: Principal component analysis was performed on data from 89 IBS patients.

International Home Dialysis Consortium: Declaration Advocating for the Promotion of Home Dialysis Globally.

The use of home dialysis (peritoneal dialysis [PD] and home hemodialysis [HHD]) is variable in high-income countries despite its known lifestyle benefits and lower costs, and is unavailable or underused in many lower-income countries, where PD could increase access to dialysis. The International Home Dialysis Consortium (IHDC) is a joint project of the ISN and the International Society for Peritoneal Dialysis (ISPD). The consortium has been established to address the challenges and barriers to and improve the adoption of home dialysis globally.

A Systematic Review of the Efficacy and Safety of Anti-amyloid Monoclonal Antibodies in Alzheimer's Disease.

Monoclonal antibody (mAb) therapies targeting amyloid-beta (Aβ) plaques have gained prominence over the past decade as potential disease-modifying treatments for Alzheimer's disease (AD), leading to major regulatory approvals and global debate. Nonetheless, the central question persists: does this emerging therapy have a justified role in the treatment protocol for AD? This systematic review evaluates the efficacy and safety of these agents across phase II and III clinical trials conducted in the past decade (2014-2024), aligning with the timeline when disease-modifying therapies gained momentum. A systematic search was performed across PubMed and the Cochrane Library to identify phase II and III randomized controlled trials (RCTs) conducted between January 2014 and December 2024.

Artificial Intelligence Software Changes Rare Disease Testing Strategy in Real Time: An International Case Series Using Face2Gene.

Genetic disorders commonly share features such as developmental delays, cognitive impairment, and behavioral challenges, yet many conditions also present unique dysmorphic features that distinguish them. Performing a thorough medical and family history and a detailed physical exam with attention to dysmorphic features is often the first step toward arriving at a genetic diagnosis. Synthesizing a differential diagnosis from the information gathered helps to guide the genetic testing strategy.

A Pathway to Healthier Aging or an Illusion? A Narrative Review on Deprescribing Protocols for the Elderly.

Polypharmacy is the concurrent use of many drugs increasingly prevalent in elderly populations worldwide, with over 50% of older adults taking more than five drugs. The rise in chronic conditions such as diabetes, hypertension, and dementia largely drives this trend. However, polypharmacy poses significant risks, including adverse drug events, falls, cognitive decline, and hospitalizations, particularly due to age-related physiological changes that alter drug metabolism and clearance.

A rare presentation of subphrenic abscess caused by in a non-immunocompromised patient: A case report.

Subphrenic abscesses are rare, yet clinically significant, and are often associated with intra-abdominal infections. The present case report describes the case of a 77-year-old male patient with an unusual presentation of a subphrenic abscess caused by without typical predisposing factors. The patient experienced a prolonged 2-year course characterized by recurrent febrile episodes and respiratory symptoms.

Awareness of the use of non-steroidal anti-inflammatory drugs: A cross-sectional study.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely utilized across the globe and are frequently used without prescription for various therapeutic purposes. Given their potential for severe adverse effects, assessing the awareness of the use of NSAIDs is crucial. The present study evaluated the awareness levels of the use of NSAID among consumers through a descriptive, cross-sectional, non-randomized study.

Impact of sodium bicarbonate locking solution on catheter-related blood stream infection in hemodialysis patients: comparative effectiveness of three locks.

Background: The primary challenge for hemodialysis (HD) patients using permanent tunneled cuffed catheters is to prevent catheter-related bloodstream infections. This study assessed the effectiveness of sodium bicarbonate in preventing catheter-related bloodstream infections and compared its efficacy to antibiotic-containing locks.

Design, Materials, And Methods: We conducted a prospective single-center, open-label, cohort study over 30 months with the aim to compare three cohorts: cohort I employed 8.

Biallelic ELOVL1 Variants Are Linked to Hypomyelinating Leukodystrophy, Movement Disorder, and Ichthyosis.

Background: Very long chain fatty acids (VLCFAs) are an integral component of myelin and the epidermal water barrier. Variants in genes encoding enzymes responsible for catalyzing the first and rate limiting step in the production of VLCFAs, elongation of VLCFAs (ELOVLs), underlie a novel group of metabolic disorders.

Objectives: The goal was to describe the clinical phenotype and disturbance in VLCFA metabolism associated with variants in the ELOV1 gene.

Smear- and Polymerase Chain Reaction (PCR)-Negative Tuberculosis: A Case Series Highlighting Diagnostic Limitations and the Role of Escalation.

Tuberculosis (TB) remains a major global health concern, and its diagnosis can be particularly challenging when microbiological tests yield negative results. We present two diagnostically complex cases, one pulmonary and one pleural, in which tuberculosis was confirmed only after extended clinical evaluation and diagnostic escalation, resulting in delays of approximately eight weeks and two weeks, respectively. The first patient, a 31-year-old asymptomatic man with recent TB exposure, underwent bronchoalveolar lavage (BAL), with smear microscopy and polymerase chain reaction (PCR) both negative; cultures remained negative after eight weeks.

Metabolic disorder-associated kidney disease and diabetic kidney disease in developing countries.

There is a paucity of literature addressing the epidemiology of metabolic disorder-associated kidney disease in developing countries, but extrapolating from the high prevalence of metabolic syndrome in low- and middle-income countries, and the known high prevalence of diabetic kidney disease in the same, the health and economic impact of metabolic disorder-associated kidney disease and diabetic kidney disease is substantial. Resource constraints in developing countries amplify the challenges in preventing, detecting, and treating metabolic disorder-associated kidney disease and diabetic kidney disease. There is diminished capacity for kidney care and hence poorer clinical outcomes including disproportionately higher rates of death and disability when compared with high-income countries.

Malaria Vaccines and Global Equity: A Scoping Review of Current Progress and Future Directions.

The journey toward a viable malaria vaccine, initiated in 1965, reached a major milestone in 2021 with the WHO's endorsement of RTS,S/AS01, a recombinant protein-based malaria vaccine. This progress continued with the 2023 approval of the R21/Matrix-M vaccine, which is more cost-effective, more potent due it is higher protein content, and easier to manufacture. Though these achievements signal hope, malaria's intricate life cycle and its prevalence in underprivileged regions make vaccine development and equitable distribution challenging.

Evaluation of Cystic Fibrosis Newborn Screening and Follow-Up Process in Georgia (2022-2023).

Cystic fibrosis (CF) is a chronic, autosomal-recessive disorder caused by mutations in the CFTR gene, leading to thickened secretions that affect multiple organ systems. This study examines the effectiveness of Georgia's national CF screening program, which was initiated in 2012 and includes the measurement of immunoreactive trypsinogen (IRT) levels at birth. An analysis of data from 2022 and 2023 revealed a decrease in follow-up attendance for sweat chloride testing among newborns with elevated IRT levels, from 59.

Differentiating Malignant and Healthy Areas in Isolated Kidney Samples Through Infrared Visualization Techniques.

Background: Because partial nephrectomy (PN) may remove malignant tissue while maintaining kidney function, it is currently the gold standard for nephrectomy. However, the blood arteries that supply the kidney are clamped at the start of the procedure. The most common method for evaluating surgical margins during PN is intraoperative frozen section (FS) evaluation.

Accessory spleens, mixed hiatal hernia, and incisional hernias: a complex case of multidisciplinary surgical management.

Background: Accessory spleens, arising from incomplete fusion during embryogenesis, are frequent developmental anomalies detected incidentally in abdominal imaging studies. Despite surgical advancements, post-laparotomy incisional hernias persist, while hiatal hernias, common in older adults, often present asymptomatically.

Case Presentation: A 55-year-old male presented with abdominal pain, chronic vomiting, and gastrointestinal bleeding.

Impact of the full-scale invasion on the mental health of the population of the country in a state of military conflict: a study of regional trends in anxiety, depression, early symptoms of acute stress disorder and post-traumatic stress disorder.

Objective: Aim: To evaluate subjective distress caused by the invasion and examine the relationship between regional residency and mental health indicators.

Patients And Methods: Materials and Methods: Descriptive statistics, a cross-sectional observational analysis. Data were collected through an online questionnaire comprising demographics, anxiety and depression assessment (HADS), and trauma impact evaluation (IES-R).

Acute Management of Neurological Events in Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS) Syndrome: A Case Report.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a rare mitochondrial disorder characterized by recurrent stroke-like episodes, seizures, and progressive neurological decline. We presented the case of an 18-year-old female, diagnosed with MELAS syndrome at age 11, who presented with acute vision loss and seizures. Neuroimaging revealed acute infarcts in the occipital and parietal lobes, consistent with MELAS syndrome-related strokes.