Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients’ management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits.

Complete atrioventricular (AV) block is a severe conduction abnormality caused by intrinsic cardiac disease, ischemia, electrolyte imbalances, or drug interactions. Elderly patients on multiple medications are particularly vulnerable to polypharmacy-related interactions. This case report describes an 82-year-old female presenting to the emergency department with fatigue, syncope, and disorientation. Her medical history included atrial fibrillation, hypertension, and heart failure, with a medication regimen of digoxin 0.25 mg given daily 5 days out of 7, metoprolol 50 mg twice daily, lisinopril 10 mg daily, furosemide 40 mg daily, and spironolactone 50 mg daily. Clinical examination revealed bradycardia and a holosystolic murmur in the mitral valve area, while the electrocardiogram showed complete AV block at a ventricular rate of 35 bpm. Laboratory results indicated mild hyperkalemia (4.9 mmol/L). Suspecting a digoxin–beta-blocker interaction, antiarrhythmic therapy was discontinued. Within three days, the AV block resolved, transitioning to atrial fibrillation with a high ventricular rate. Bisoprolol was introduced for rate control, and hemodynamic stability was achieved. The patient was discharged with a revised medication regimen and showed no recurrence of AV block. This case emphasizes the importance of recognizing drug interactions as a reversible cause of AV block and using drug interaction checkers to manage polypharmacy, especially in elderly patients with multiple comorbidities. It also highlights the rare and paradoxical combination of atrial flutter and complete AV block.

Background: Phytotherapeutic agents, including Momordica charantia, have been proposed as complementary strategies to enhance metabolic control in type 2 diabetes mellitus patients on oral antidiabetic drugs. Methods: This was a real-world, longitudinal, comparative cohort study with treatment escalation, conducted in patients with type 2 diabetes mellitus receiving metformin therapy. All patients were initially prescribed add-on dapagliflozin at 10 mg/day and re-evaluated after 6 months. Based on glycemic response at 6 months, patients were stratified into two groups: 70 patients with persistent inadequate glycemic control received adjunctive supplementation with a standardized Momordica charantia extract for 3 months (intervention group), while 85 patients who achieved glycemic targets continued dual antidiabetic therapy alone (control group). Anthropometric, hemodynamic, and metabolic parameters were assessed at baseline, 6 months, and 9 months from baseline. Results: Between-group analyses revealed divergent glycemic trajectories during the 6–9 month interval. In the intervention group, HbA1c decreased from 7.82 ± 0.58% at baseline to 6.93 ± 0.30% at 6 months and to 6.34 ± 0.42% at 9 months, while in the control group, glycemic parameters showed only modest additional changes after 6 months. The reduction in HbA1c and fasting plasma glucose between 6 and 9 months was significantly greater in patients receiving Momordica charantia compared with controls (p < 0.001). Fasting plasma glucose declined from 138.4 ± 17.5 mg/dL at baseline to 122.3 ± 13.1 mg/dL at 6 months and to 113.3 ± 12.2 mg/dL at 9 months in the intervention group. Dapagliflozin therapy was associated with significant improvements in body weight, BMI, and blood pressure at 6 months in both groups, whereas adjunctive Momordica charantia supplementation did not produce significant additional effects on anthropometric or hemodynamic parameters. Conclusions: Adjunctive Momordica charantia supplementation was associated with additional improvements in glycemic control compared with continuation of dual antidiabetic therapy alone, with the most pronounced effects observed for HbA1c and fasting plasma glucose. These findings support a potential adjunctive role for phytotherapeutic supplementation in patients with suboptimal glycemic control receiving contemporary standard therapy.

A psoriasis vulgaris flare is characterized by a rapid intensification of symptoms, which is often triggered by various factors that can worsen the condition. The risk factors for these exacerbations are numerous and include obesity, antihypertensive drugs, and psychological stress. Moreover, links have been documented between type II diabetes, hypertension, and psoriasis vulgaris. The present case report describes a 52-year-old female patient who presented at the clinic with disseminated erythematous-squamous plaques and patches covered by thick, white-pearly, easily detachable scales, along with stress, fatigue, anxiety, severe pruritus, irritability, insomnia, and decreased self-esteem. Her past medical regimen included various conventional topical options, including calcipotriol combined with betamethasone, clobetasol, betamethasone combined with salicylic acid, and betamethasone combined with gentamicin, yet the condition remained refractory, with periodic flare-ups. The integrated and personalized therapeutic approach aimed to target both the dermatological issues and the associated systemic and psychological factors contributing to the condition. The therapeutic strategy implemented in this case combined psychological counseling sessions, a very low-calorie ketogenic diet, oral supplementation with anti-inflammatory and antioxidant vitamins and minerals, topical treatments utilizing urea and Dead Sea-mineral-based formulations, and rosemary extract-based scalp care, without requiring additional conventional treatment. This comprehensive approach led to significant improvement, ultimately achieving complete remission of the patient’s psoriasis. The associated comorbidities were well controlled with the specified medication, without any further complications. Thus, the importance of alternative options was emphasized, particularly in the context of an incurable disease, along with the need for continued research to improve the ongoing therapeutic management of psoriasis vulgaris. Such approaches are essential to reducing the risk of flare-ups and to achieving better management of associated risk factors.

Background: Central serous chorioretinopathy (CSCR) is a retinal condition characterized by the accumulation of subretinal fluid, often linked to elevated levels of endogenous corticosteroids and stress-related hormones, which can lead to visual disturbances. This connection may explain the association of CSCR with high stress levels and the use of corticosteroid medications. Although many cases resolve spontaneously, persistent or severe instances may require intervention. Case Description: Our report presents a case of acute CSCR in a 33-year-old male who developed the condition following corticosteroid treatment for acute parotiditis and left submandibular lymphadenopathy. Initial presentation was 6 weeks after corticosteroid treatment was initiated. Diagnostic evaluation with optical coherence tomography (OCT) and fluorescein angiography confirmed the presence of subretinal fluid at the retinal pigment epithelium–Bruch’s membrane complex. Micropulse laser therapy (MPLT) was applied to address the leakage points, leading to significant fluid reduction at a two-week follow-up. By six weeks, the complete resolution of subretinal fluid was documented, with substantial visual recovery. Conclusions: This case confirms MPLT as an effective treatment for CSCR, particularly when conservative management is insufficient. Unlike traditional photocoagulation, MPLT offers a safer alternative, minimizing the risk of retinal damage, such as permanent scotomas. Clinical Significance: This case underscores the importance of carefully monitoring patients undergoing corticosteroid therapy for potential ocular complications and highlights the role of MPLT as a safe and effective option for managing persistent CSCR, protecting the surrounding retinal tissue from damage while achieving significant therapeutic outcomes.

Background/Objectives: Venous thromboembolism (VTE), whose most severe manifestation is pulmonary embolism (PE), is the third most common acute cardiovascular disorder, and many of its risk factors≠—obesity, physical inactivity, smoking, and unfavorable dietary patterns—are modifiable. No validated instrument is currently available to assess knowledge, attitudes, and practices (KAP) regarding PE among adults in Romania, and the burden of self-reported thromboembolic risk factors in community settings has not been described with standardized measures. This protocol describes the development and psychometric validation of the PE-KAP-RO questionnaire, an integrated assessment tool comprising three scored KAP scales, three embedded validated lifestyle instruments, and an exploratory, unweighted VTE risk-factor burden index. No participants had been enrolled and no data had been collected at the time of submission; all procedures are therefore described as planned. Methods: The study comprises two phases. Phase 1 (development) includes qualitative concept elicitation with members of the target population, guideline- and theory-anchored item generation, expert content validation quantified by the content validity index, and pilot testing with cognitive debriefing (n ≈ 30). Phase 2 is a cross-sectional field validation in at least 450 adults (≥18 years) from Western Romania—with recruitment continuing toward 600 where feasible—through combined in-person (quota-guided) and online sampling that includes healthcare professionals, with test–retest re-administration in a subsample of at least 60 participants after 14 ± 4 days. Physical activity, diet, and nicotine dependence will be measured with the IPAQ-SF, MEDAS, and FTND. Sample size is justified separately for each analysis (precision of proportions, correlation and regression power, events per variable, split-sample factor analysis, item response theory calibration, and reliability estimation). Measurement properties will be evaluated against pre-specified acceptance criteria: item difficulty 0.20–0.80 (a screening range interpreted together with discrimination) and corrected item–total correlations ≥ 0.30; internal consistency (KR-20/Cronbach’s alpha and McDonald’s omega) 0.70–0.95; test–retest ICC ≥ 0.70 and item-level weighted kappa ≥ 0.60; structural validity by split-sample exploratory and confirmatory factor analysis (CFI/TLI ≥ 0.90, RMSEA ≤ 0.08, SRMR ≤ 0.08); item response theory calibration with formal model comparison and differential item functioning screening; construct validity requiring confirmation of ≥75% of a priori hypotheses; floor/ceiling effects < 15%; and measurement invariance across sex, age group, and administration mode. Expected Results: The study will deliver a validated Romanian-language instrument, a structured characterization of PE-related knowledge, attitudes, and preventive practices, and the distribution of self-reported risk factors in the study sample. Conclusions: PE-KAP-RO is intended as a standardized assessment tool for PE-related knowledge, attitudes, and practices; the risk-factor burden index is descriptive and does not estimate VTE probability; any future predictive tool would require a separate cohort followed for incident VTE. Reporting follows the STROBE recommendations and COSMIN-based methodology; the protocol is presented prior to participant enrollment.