The efficacy of anti-thyroid drugs in conjunction with radioactive iodine therapy in the management of Graves' disease is still controversial. To compare the efficacy of pretreatment with methimazole before the administration of radioactive iodine for the treatment of Graves' disease. A systematic review and meta-analysis was conducted at a teaching/tertiary hospital in Ibadan, Nigeria. A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was performed from inception to December, 2021. Five studies with 297 participants were included. There was no difference in the risk of persistent hyperthyroidism when radioactive iodine was used in conjunction with methimazole compared with when radioactive iodine was used alone (relative risk: 1.02, 95% confidence interval, CI: 0.62-1.66; P = 0.95, I2 = 0%). Subgroup analysis based on the duration between discontinuation of methimazole and the administration of radioactive iodine showed a lower risk of persistent hyperthyroidism when methimazole was discontinued within 7 days before radioactive iodine use, although this did not reach statistical significance (risk ratio: 0.85, CI: 0.28-2.58). The use of methimazole before radioactive iodine administration was not associated with an increased risk of persistent hyperthyroidism. Concerns about medication toxicity and adverse effects should be considered when clinicians make decisions on combination therapies for the treatment of Graves' disease. CRD42020150013, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150013.

Appendicectomy has been accepted as the gold standard for the management of appendicitis over the years, but there has been an increasing evidence and trend toward the conservative approach to the management of appendicitis. The aim of this review is to search existing literature and to evaluate and compare the conservative and operative approaches to the management of appendicitis. An electronic search of published literature was conducted through Pubmed, Google Scholar, Embase, and Medline using a variety of search items to find relevant observational studies, randomized clinical trials, systematic reviews, and meta-analyses. Bibliographies of selected articles were also analyzed for publications of interest relevant to the scope of the topic. The articles that reported primary outcomes after the management of appendicitis, complications, economic implications, and duration of follow-up were reviewed in detail. The major primary outcomes show a high recurrence rate and failed treatment associated with the conservative management of appendicitis. The other outcomes obtained show that there is an increased incidence of complications associated with operative management. Economic implications and cost-effectiveness analysis show that conservative treatment may be preferred. The length of hospital stay was significantly higher in conservative approach to management; however, shorter time off activities was observed. In general, the conservative management of appendicitis is still regarded as safe, effective, and efficacious, and further research with well-constructed study design, and larger sample size is required.

Neuropsychiatric diseases account for the largest proportion of the global burden of non-communicable diseases with depression being the leading cause of disability worldwide (1) Depression and suicides occur at an alarming rate among healthcare professionals despite having adequate knowledge of mental health and relative access to psychiatrists (2). In this review, the aim was to identify the association between depression and suicidal ideation among medical students and its implication on their overall health and patient care. Also examined were the preventive strategies essential in curbing depression and suicidal ideation among medical students. Method: An electronic search was conducted on PubMed, Google Scholar, and Embase, to identify articles on depression and suicide among medical students. The prevalence of depression, the association between depression and suicidal ideation among health professionals, and the outcomes of depression on productivity and patient care were explored. Results: Many studies show an association between depression and suicidal ideation in medical students. Depression is commoner in female medical students, and it impairs learning which in turn affects patient care. Long hours of lectures, financial burdens, and insufficient sleep have been identified as risk factors for depression in medical students. Conclusion: There is a significant risk of depression and suicidal ideation among medical students worldwide. Integration of mental health services, provision of free and timely counseling services, and implementation of mental health policies are strategies that can be used for mitigating depression and promoting mental wellness.

Cardiovascular disease is a leading cause of maternal morbidity and mortality. As cardio-obstetric care evolves, digital health technologies including telehealth, wearable devices and remote monitoring are playing an increasingly critical role. These innovations have the potential to enhance cardiovascular screening, risk assessment and disease management across the perinatal continuum. This article explores the role of digital health technologies in advancing cardio-obstetrics care. It focuses on the impact of telehealth, wearable sensors and emerging digital tools on improving maternal cardiovascular outcomes and reducing disparities in care delivery. A narrative review approach was used to synthesize existing literature and clinical insights related to telecardiology, wearable monitoring and digital innovations. Emphasis was placed on applications in pregnancy and post-partum care, as well as on evaluating implementation challenges and equity concerns. Digital health tools improve access to care and facilitate early diagnosis of cardiovascular conditions. Telehealth increases care continuity and patient satisfaction, especially in underserved populations. Wearable devices equipped with photoplethysmography and electrocardiogram sensors enable intermittent, non-invasive monitoring, aiding early detection of arrhythmias and hypertensive disorders. Furthermore, novel technologies such as digital twins, natural language processing and virtual reality show potential to personalize care and support medical education. Despite these advancements, key barriers persist, including data privacy concerns, unequal access to technology and algorithmic bias. Digital health technologies are transforming cardio-obstetrics care by enabling proactive management and expanding access. However, for these tools to deliver equitable benefits, targeted efforts are needed to address privacy, infrastructure and literacy challenges. Future efforts should focus on integrating digital health into routine maternal care, promoting digital literacy, ensuring equitable technology access and improving interoperability with electronic health records. Additionally, ongoing evaluation through clinical trials in high-risk pregnancies and ethical safeguards to mitigate algorithmic bias will be essential to ensure safe, scalable and inclusive implementation of these innovations in maternal cardiovascular care.

The microvasculature (with vessels <100 μm in diameter) plays a crucial role in tissue oxygenation, perfusion and wound healing in the lower limb. While this holds clinical significance, microvasculature evaluation in the limbs is not a standard practice. Surgical interventions focus on reestablishing blood flow in larger vessels affected by the peripheral artery disease (PAD). Nevertheless, the impact of revascularization on tissue oxygenation and perfusion in severe microvascular disease (MVD) is still unknown. We present the cases of two patients who underwent surgical revascularization for peripheral blood flow with different outcomes. Patient A had PAD, while B had PAD, severe MVD and a non-healing wound. Although both showed improvements in ankle-brachial index post-op, spatial frequency domain imaging metrics (which measure microvascular oxygenation and perfusion) remained unchanged in B, indicating a potential gap in assessing the surgical efficacy in MVD using ankle brachial index and emphasizing microcirculation evaluation in optimizing wound healing outcomes.

BACKGROUND: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. METHODS: Using Optum’s de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. RESULTS: Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21–0.46]; P <0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60–1.67]; P =0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days ( P <0.001) but not the remainder of the year ( P =0.56). CONCLUSIONS: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.