Introduction: In resource-poor settings, mother-infant dyads are commonly exposed to environmental factors increasing the risk of infectious diseases and possibly influencing the cytokine profile of human milk (HM). Hormones in HM have been proposed to influence appetite-regulation and possibly growth in exclusively breastfed infants. Objective: To compare cytokines and appetite-regulating hormone (ARH) concentrations in HM of mothers from four contrasting populations and investigate associations with infant growth. Method: HM samples from 825 mothers participating in the Mothers, Infants and Lactation Quality Study from Bangladesh (BD), Brazil (BR), Denmark (DK) and The Gambia (GM) were collected between 1–3.5 months postpartum and analysed for tumour-necrosis factor-α, interferon (IFN)-γ, interleukin (IL)-1β, IL-4, IL-6, IL-8, IL-10, IL-33, and insulin, leptin and adiponectin. Infant growth was measured twice between 1–5.99 months postpartum. Analysis of covariance was used to compare geometric means of HM markers between the four sites and associations between HM markers and infant growth were investigated using linear regression analysis. Results: Differences in geometric means of all HM cytokines and ARHs were found among the four study sites after adjustment for possible explanatory variables. Lowest levels of most HM cytokines were found in BD, whereas highest levels of IFN-γ, IL-4, IL-10 and IL-33 were found in DK. In GM, cytokines and ARHs were inversely associated with weight-for-age and weight-for-length Z-scores. Conclusion: We showed significant differences in HM composition of cytokines and ARHs among the four countries. Highest levels of T helper cell type 2 cytokines, which is typically related to increased risk of atopic diseases, were found in DK. The results may reflect the influence of different environmental exposures in the four sites on HM composition, which may be associated with infant growth in GM.

Background: Robotic-assisted surgery (RAS) is increasingly used for colorectal cancer (CRC), but its clinical and oncologic advantages over conventional laparoscopy (LS) remain uncertain. Prior meta-analyses (e.g., Huang et al., Front Oncol 13;1273378, 2023; Zou et al., BMC Surg 25;86, 2025) have included overlapping RCTs but vary in methodology, scope, and analytical transparency. This review aims to provide an updated, independently re-analyzed synthesis of RCTs published from 2015 to 2025, with full PRISMA compliance, explicit analytic reproducibility, and expanded evaluation of bias and evidence certainty. Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. The protocol was retrospectively registered in PROSPERO (Registration ID: CRD420251237158 ). PubMed, Embase, and Cochrane CENTRAL were searched (January 1, 2015–January 31, 2025). Full reproducible search strings, PICOS criteria, and inclusion/exclusion rules were predefined. Only RCTs comparing RAS vs. LS for malignant colorectal disease were included. Data extraction was performed independently by two reviewers. Meta-analyses used DerSimonian–Laird random-effects models; standardized procedures were applied for converting medians/IQRs into means/SDs and for continuity corrections in zero-event trials. Risk of bias was assessed using Cochrane RoB 2.0, and evidence certainty was graded using GRADE. Results: A total of 12 RCTs encompassing 3,107 patients met the inclusion criteria. RAS resulted in significantly lower conversion-to-open rates (OR 0.42; 95% CI 0.28–0.63; I²=18%) compared with LS. Operative time was consistently longer with RAS (MD + 23.8 min; 95% CI 14.2–33.4; I²=67%). Overall postoperative complications (Clavien–Dindo ≥ II) were comparable (OR 0.91; 95% CI 0.76–1.13; I²=22%). Length of stay showed a small but significant reduction with RAS (MD − 0.8 days; 95% CI − 1.3 to − 0.2; I²=49%). Pathologic outcomes showed lower circumferential resection margin (CRM) positivity with RAS (OR 0.59; 95% CI 0.41–0.85). Lymph node retrieval was slightly higher with RAS (MD + 0.71 nodes; 95% CI 0.25–1.18). Distal margins and TME completeness were equivalent. No RCT reported mature long-term oncologic outcomes; evidence remains limited to short-term surrogates. Conclusions: In contemporary RCTs, RAS provides fewer conversions and slightly better pathologic surrogates, while maintaining similar morbidity compared to LS. The main trade-off remains longer operative time and higher resource use. True oncologic equivalence cannot be confirmed until long-term RCT data mature. Advanced imaging (e.g., SOMATOM Force CT), age-specific MIS evidence, and the emergence of endoluminal robotic systems are likely to shape future refinements in technique and patient selection.

Background: Hypertension is a major contributor to cardiovascular and renal disease worldwide, particularly in low-resource settings such as Yemen. Objective: To identify demographic, clinical, and lifestyle-related factors associated with hypertension among heart disease (HD) and kidney disease (KD) patients in Sana'a. Methods: A cross-sectional study was conducted on 300 patients (200 men, 100 women; aged 35–70 years) between March and August 2024. Data on age, sex, weight, smoking, Qat chewing, diabetes, and antihypertensive medication adherence were collected. Blood pressure was measured using a standardized sphygmomanometer. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Hypertension was significantly associated with age (OR: 1.08; 95% CI: 1.02–1.11), obesity (OR: 2.42; 95% CI: 1.23–4.75), smoking (OR: 1.88; 95% CI: 1.05–3.35), type 2 diabetes (OR: 2.87; 95% CI: 1.56–4.55), and irregular medication use (OR: 3.21; 95% CI: 1.45–7.11). All participants reported Qat chewing (100%). Conclusion: Age, obesity, smoking, diabetes, and poor medication adherence are major predictors of hypertension in Yemeni HD and KD patients. The universal irregularity in medication use highlights systemic healthcare gaps. Strategies to improve adherence, promote lifestyle modification, and strengthen healthcare systems are urgently needed.

Background: Post-streptococcal glomerulonephritis (PSGN) is a common cause of acute nephritic syndrome in children. Rarely, it may result in life-threatening complications, including acute pulmonary edema and critical hyperkalemia. Case Presentation: We report a 10-year-old Yemeni girl (25 kg) presenting with severe respiratory distress, irritability, and generalized pitting edema. Laboratory tests confirmed PSGN with markedly reduced complement C3 (42.2 mg/dL) and nephritic urine sediment containing numerous red blood cells and casts. The patient developed critical hyperkalemia (7.0 mmol/L) and acute pulmonary edema, requiring urgent intubation and mechanical ventilation using pressure-controlled mandatory ventilation (P-CMV). Management: Aggressive fluid mobilization and electrolyte stabilization were initiated. High-dose intravenous furosemide (4 mg/kg/day), renal-dose dopamine (5 μg/kg/min), and potassium-lowering interventions were applied. Morphine sedation (0.1 mg/kg/dose) was administered every 4 hours during the first 24 hours, then every 8 hours for 12 additional hours, followed by withdrawal prior to extubation. Morphine effectively controlled irritability and optimized patient–ventilator synchronization. The patient produced 1700 mL urine in 17 hours, demonstrating a strong diuretic response. Conclusion: Early recognition of severe extra-renal complications in PSGN is critical. Intensive supportive care—including mechanical ventilation, meticulous fluid and electrolyte management, and appropriate sedation—is essential for survival in cases of acute pulmonary edema and critical hyperkalemia.

Background: Open abdomen (OA) management remains a life-saving strategy in trauma, intra-abdominal sepsis, and abdominal compartment syndrome. Failure to achieve definitive fascial closure (DFC) during the index hospitalization is strongly associated with long-term morbidity, particularly incisional hernia and entero-atmospheric fistula (EAF). While early closure has been associated with higher primary closure rates, its impact on durable, patient-centered outcomes has not been consistently evaluated. Objective: To determine whether early (≤ 7 days) versus delayed definitive fascial closure after open abdomen management is associated with differences in long-term morbidity and clinically relevant secondary outcomes. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to January 2026. Comparative studies involving adult patients undergoing OA management were included. Primary outcomes were long-term incisional hernia and EAF/ECF. Random-effects meta-analysis was performed, with predefined subgroup and sensitivity analyses. Results: Nine studies encompassing 1,842 patients were included. Early closure was associated with a significantly lower risk of incisional hernia (18.6% vs 34.9%; RR 0.56, 95% CI 0.44–0.71) and EAF (6.2% vs 11.8%; RR 0.53, 95% CI 0.35–0.81). Early closure also increased the likelihood of primary fascial closure (RR 1.42, 95% CI 1.25–1.61) without increasing short-term mortality. Conclusion: Definitive fascial closure within ≤ 7 days after open abdomen management is associated with substantially improved long-term abdominal wall outcomes without compromising survival. Early closure should be considered a key therapeutic target in contemporary OA management.

Background: Post-streptococcal glomerulonephritis (PSGN) is a common cause of acute nephritic syndrome in children. Rarely, it may result in life-threatening complications, including acute pulmonary edema and critical hyperkalemia. Case Presentation: We report a 10-year-old Yemeni girl (25 kg) presenting with severe respiratory distress, irritability, and generalized pitting edema. Laboratory tests confirmed PSGN with markedly reduced complement C3 (42.2 mg/dL) and nephritic urine sediment containing numerous red blood cells and casts. The patient developed critical hyperkalemia (7.0 mmol/L) and acute pulmonary edema, requiring urgent intubation and mechanical ventilation using pressure-controlled mandatory ventilation (P-CMV). Management: Aggressive fluid mobilization and electrolyte stabilization were initiated. High-dose intravenous furosemide (4 mg/kg/day) and low-dose dopamine (per local institutional protocols) were applied. Despite critical hyperkalemia, standard protocols (calcium, insulin-glucose) were unavailable; thus, potassium-lowering relied on continuous salbutamol and rapid diuresis. Appropriate adjunctive sedation was utilized briefly to facilitate mechanical ventilation. The patient produced 1700 mL urine in 17 hours, demonstrating a strong diuretic response. Continuous cardiac monitoring was maintained throughout the acute phase to mitigate arrhythmic complications. Conclusion: Early recognition of severe extra-renal complications in PSGN is critical. Intensive supportive care—including mechanical ventilation, meticulous fluid and electrolyte management, and appropriate sedation—is essential for survival in cases of acute pulmonary edema and critical hyperkalemia.