ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Socio-Cultural Determinants of Access to HIV Treatment and Care Among Pregnant and Postpartum People: A Systematic Review Protocol
Get PDFIntroduction: HIV-related maternal mortality remains high in many low-resource settings despite global declines. Lifelong antiretroviral therapy (ART) improves maternal and child outcomes, yet ART initiation, retention, and adherence remain suboptimal during pregnancy and postpartum. Socioeconomic, behavioral, and structural determinants influence linkage to care and viral suppression, but evidence describing their impact across the perinatal continuum remains fragmented. This review will synthesize these determinants through an equity lens using the PROGRESS-Plus framework, and reporting will follow PRISMA-E 2012 guidelines.
Methods and Analysis: This protocol follows PRISMA-E 2012 guidelines and is registered with PROSPERO (CRD420250650979). A comprehensive search will be conducted across multiple databases for studies published from January 2012 to May 2025. Eligible designs will include quantitative, qualitative, and mixed-methods studies evaluating HIV testing, ART initiation, retention in care, and viral suppression in relation to socio-cultural, economic, behavioral, or health system factors. The PECO framework will be used (Population: pregnant/postpartum individuals with HIV ; Exposure: social/structural determinants; Comparator: not exposed; Outcomes: HIV care cascade indicators). Postpartum will be defined as up to 12 months after delivery, and adolescents aged 15–17 years will be included. Two independent reviewers will screen studies using Rayyan. Quality will be assessed using Joanna Briggs Institute tools. Random-effects meta-analysis will be conducted when feasible. Qualitative findings will undergo thematic synthesis; mixed-methods results will be integrated narratively.
Ethics and dissemination: Approval is not required as this review uses publicly available data. Findings will be submitted for publication, presented at guideline meetings, and shared at scientific conferences
Near-miss Osteomyelitis in an Immunosuppressed Crohn’s Disease Patient: Diagnostic Vigilance Sparked by a Medical Student
Get PDFCrohn\u27s disease (CD) patients on immunosuppressive therapy are at increased risk of infections, including osteomyelitis, which could be diagnostically challenging. This case highlights the importance of medical student vigilance in making a near-miss diagnosis of osteomyelitis in a CD patient.
A 56-year-old CD patient developed left shoulder pain following localized muscle injection and was initially managed as a soft-tissue abscess. The condition worsened despite 21 days of antibiotics. Investigation: Cultures were positive for methicillin-sensitive Staphylococcus aureus (MSSA). Persistent pain and new neurologic complaints prompted an MRI (T1 hypointensity, T2-STIR hyperintensity, post-contrast enhancement) at 60 days, in support of osteomyelitis without bone biopsy. Management/Outcome: The patient received 6 weeks of intravenous vancomycin (1 g every 12 hours), followed by oral antibiotics, resulting in partial relief of pain (pain score: 8/10 to 4/10) and improvement in shoulder function (Constant-Murley score: 30 to 65 at 3 months). Immunotherapy (adalimumab) was restarted after infection control.
This case highlights three practical lessons: maintaining a low threshold for advanced imaging in immunosuppressed patients with persistent pain; incorporating diagnostic time-outs to invite trainee perspectives; and seeking early infectious-disease consultation when osteomyelitis is suspected
Impact of Serum Adiponectin Level on Insulin and hs-CRP in Patients with Type 2 Diabetes: A Case-Control Study
Get PDFIntroduction: Type 2 diabetes mellitus (T2DM) is marked by insulin resistance, hyperglycemia, and systemic inflammation. Adiponectin—a hormone produced mainly by adipose tissue—enhances insulin sensitivity and exhibits anti‐inflammatory properties. This study evaluated serum adiponectin and related metabolic markers in Iraqi patients with T2DM versus healthy controls.
Methods: In a case-control design, 84 Iraqi subjects were recruited (45 patients with T2DM and 39 controls). Fasting blood samples were obtained to measure adiponectin, insulin, high-sensitivity C-reactive protein (hs-CRP), fasting serum glucose (FSG), and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) using standardized ELISA and biochemical assays. Correlations between adiponectin and anthropometric parameters were also analyzed.
Results: Controls showed significantly higher serum adiponectin and insulin levels (p < 0.05) compared to patients with T2DM. In contrast, hs-CRP, FSG, and HOMA-IR were significantly elevated in the diabetic group (p < 0.05). Moreover, adiponectin demonstrated significant negative correlations with both height and weight among controls, with their lower body weight suggesting enhanced fatty acid oxidation.
Conclusions: These findings indicate that elevated adiponectin is associated with improved insulin sensitivity and reduced inflammatory markers. The data support the potential role of adiponectin in mitigating insulin resistance, hyperglycemia, and overweight risks in T2DM, warranting further investigation into its therapeutic utility
Noonan Syndrome and Osteoporosis: A Comprehensive Case Study and Literature Review
Get PDFNoonan syndrome (NS) is a genetic disorder caused by mutations in the RAS/MAPK signaling pathway, typically characterized by unique physical features, congenital heart defects, and short stature. Osteoporosis (OP), although uncommon in NS, can significantly impact patients\u27 quality of life. We report the case of a 60s-year-old male with NS who experienced progressive osteoporosis over seven years. Dual-energy X-ray absorptiometry (DEXA) scans revealed a marked decline in bone mineral density (BMD) accompanied by multiple fractures. Despite normal vitamin D and parathyroid hormone intact levels, the patient’s BMD continued to deteriorate, leading to vertebral compression fractures that necessitated surgical intervention. This case highlights the importance of early osteoporosis screening and prompt management in NS patients to prevent severe complications. Further research is warranted to explore the mechanisms underlying bone fragility in NS and to develop targeted therapeutic strategies
Demographic Factors of Colorectal Cancer Patients with Paralytic Ileus Among Adults in the United States: A Retrospective Study for Mortality Trends
Get PDFBackground: Paralytic ileus is a serious postoperative complication among individuals with colorectal cancer (CRC). Although mortality trends for CRC and paralytic ileus have been described separately, long-term national patterns involving both conditions have not been examined.
Methods: We analyzed U.S. mortality data for adults aged ≥45 years from 1999–2023 using CDC WONDER Multiple Cause-of-Death records. CRC was identified using ICD-10 codes C18–C20, and paralytic ileus using K56.0 and K56.7. Age-adjusted mortality rates (AAMRs) were calculated and standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC). Subgroup analyses were descriptive; formal between-group slope comparisons were not performed.
Results: A total of 31,363 deaths involved both CRC and paralytic ileus. The national AAMR declined from 1.48 per 100,000 in 1999 to 1.00 in 2023 (AAPC –1.50%; 95% CI –1.73 to –1.28). A significant decline occurred through 2012 (APC =– 3.27%), followed by a nonsignificant upward trend thereafter (APC = 0.63%; p = 0.057). Declines varied by sex, age group, race/ethnicity, and region, with the largest reductions among adults ≥65 years and in the Northeast. Most deaths occurred in inpatient settings (56%).
Conclusion: Mortality involving CRC and paralytic ileus declined substantially through 2012, then plateaued. Rising mortality among adults aged 45–64 years and persistent racial and geographic disparities highlight opportunities for improved perioperative quality initiatives, ERAS implementation, and opioid-sparing strategies
Prevalence of Metabolic-Associated Steatotic Liver Disease in Patients with Type 2 Diabetes with and without HIV: Retrospective Multicenter Study
Get PDFIntroduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a frequent complication in patients with Type 2 Diabetes (T2D). This study aims to evaluate the impact of HIV status on the prevalence of MASLD in patients with T2D.
Methods: We utilized the TriNetX global federated health research network to perform a comparative analysis of two cohorts: T2D patients with HIV (Cohort 1) and T2D patients without HIV (Cohort 2). Propensity score matching controlled for confounders such as age, gender, Hemoglobin A1c, LDL, HDL, total cholesterol, triglycerides, BMI, and hypertension. The study was exempt from IRB review as it did not involve direct human subjects, per the University at Buffalo Institutional Review Board.
Results: Initial data included 168,428 patients in Cohort 1 and 9,040,558 in Cohort 2. After matching, each cohort consisted of 166,803 patients. MASLD prevalence was 7.1% in HIV-positive T2D patients and 6.7% in HIV-negative T2D patients, with a significant risk difference (RD = 0.004, 95% CI: 0.002 to 0.006, p < 0.0001). The risk ratio (RR) was 1.062 (95% CI: 1.036 to 1.089), and the odds ratio (OR) was 1.067 (95% CI: 1.039 to 1.096).
Conclusion: HIV-positive T2D patients exhibit a slightly higher risk of developing MASLD than their HIV-negative counterparts. These results underscore the need for specialized screening and management of MASLD in patients with T2D, particularly those living with HIV
Epiploic Appendagitis Following Blunt Abdominal Trauma: A Case Report with Literature Review
Get PDFEpiploic appendagitis (EA) is a rare and self-limiting cause of acute abdominal pain resulting from ischemia due to torsion or venous thrombosis of epiploic appendages. It often mimics more common conditions, such as diverticulitis or appendicitis, leading to misdiagnosis and unnecessary interventions. While EA is typically idiopathic, we present a unique case of trauma-induced EA in a 58-year-old man who developed sharp left lower quadrant pain after prolonged abdominal pressure while repairing a boat engine managed conservatively, which, to our knowledge, has not been previously reported. With the increasing availability of computed tomography (CT), EA is being diagnosed more frequently, yet clear management guidelines remain lacking
Comparative Antimicrobial Efficacy of Cetrimide, Dettol, and Lizol Against Six Different Microbial Species on Epoxy-Coated Pharmaceutical Surfaces Using Surface Challenge Method
Get PDFIntroduction: Disinfectants are vital in the pharmaceutical industry\u27s sanitization process and contamination control programs. However, many pharmaceutical companies lack systematic policies for selecting appropriate disinfectants, often relying solely on manufacturer claims, which may not always be reliable. The complexity of existing disinfectant testing methods further complicates proper evaluation, highlighting the need for practical, efficient approaches.
Methods: This study used a simple surface challenge method to mimic real-world pharmaceutical conditions to test disinfectant efficacy. Three disinfectants, 1% Cetrimide, 2.5% Dettol, and 2% Lizol, were evaluated for antimicrobial activity. The test organisms included E. coli ATCC 8739, Salmonella typhimurium ATCC 14028, Pseudomonas aeruginosa ATCC 25619, Bacillus subtilis ATCC 6633, Candida albicans ATCC 10231, and an environmental isolate (Bacillus spp.). All testing was conducted on epoxy-coated floors within pharmaceutical industry premises.
Results: All three disinfectants demonstrated excellent antimicrobial activity against the tested organisms. After a 20-minute contact time, each disinfectant achieved a ≥6-log reduction in test organisms. The comparative evaluation indicated that 1% Cetrimide exhibited superior antimicrobial effectiveness compared to 2.5% Dettol and 2% Lizol.
Conclusions: The surface challenge method offers a practical approach for assessing disinfectant efficacy under pharmaceutical conditions. Among the disinfectants tested, 1% Cetrimide provided the most effective microbial reduction, suggesting its suitability for contamination control in pharmaceutical environments
Prolonged Immunosuppressive Therapy in Immune Complex-Membranoproliferative Glomerulonephritis: A Case Report of Sustained Partial Remission Over Three Years
Get PDFThe prevalence of membranoproliferative glomerulonephritis (MPGN) is very low among primary glomerulonephritis. Once MPGN is diagnosed, it is essential to classify the type of MPGN [immune complex (IC), complement-mediated, and without complement or IC deposition]. In cases of IC-MPGN, secondary causes should be thoroughly investigated. However, there are no randomised controlled prospective trials for the optimal treatment regime for primary IC-MPGN. Here, we present a report of primary IC-MPGN that achieved partial remission after 3 years of mycophenolate mofetil treatment, even though significant fibrosis was present in the kidney biopsy. This report may support consideration of prolonged immunosuppression in selected cases with primary IC-MPGN
Malrotation with Midgut Volvulus Beyond Infancy Requiring an Extensive Ileal Resection: A Case Report
Get PDFMidgut malrotation is a congenital anomaly resulting from abnormal rotation and fixation of the midgut during embryogenesis. It can be complicated by volvulus and intestinal obstruction. It rarely presents after the first year of life, which makes it a diagnostic challenge. A 5-year-old Arab female presented to the emergency department (July 2024) with repetitive frothy vomiting and diffuse abdominal pain. Laboratory findings showed leukocytosis, metabolic acidosis (pH 7.04, 13 HCO3), and deteriorating renal and liver functions. Abdominal x-ray and ultrasound suggested intestinal obstruction (the presence of distended bowel loops) without a definitive source for the obstruction. An upper gastrointestinal study wasn\u27t done due to continuous vomiting and worsening acidosis. Resuscitation and immediate surgical exploration to identify and treat the source of obstruction were done on the same day. It revealed an intestinal malrotation with distal jejunal volvulus and borderline ischemia of the ileum. First operation included detorsion of the volvulus, excision of the gangrenous segment (a 6cm segment located 6cm proximal to the ileocecal valve) with anastomosis of the remaining gut, and appendectomy. Postoperatively, the patient improved progressively for a week, but then developed an acute abdominal distension with tenderness, necessitating a relaparotomy with a near-total resection of the ileum (150 cm) and stoma formation (double-barreled ileostomy and jejunostomy). Finally, the stoma was closed, and the patient had a jejunoileal anastomosis. The patient recovered well and was discharged on a regular, pureed diet (weight 15.6 kg, passing soft stool twice/day) after 83 days of inpatient observation.