The Mediterranean diet (MD) is one of the healthiest diets, high in fiber, antioxidants, and unsaturated fats. MD improves lipid profiles, reduces inflammation, controls blood pressure, decreases insulin resistance, and enhances the sensitivity to this hormone, lowering the risks of Metabolic syndrome (MS). MS is characterized by central obesity, hypertension, insulin resistance, and dyslipidemia, increasing the risk of cardiovascular disease and type II diabetes. The objective of this study was to know the effectiveness of the MD versus other treatments in patients with MS. A systematic search across multiple databases, Medline, Embase, Web of Science, Scopus, Google Scholar, and Cinahl, was conducted using keywords such as “Mediterranean diet”, “Mediterranean food”, “eat mediterranean”, “Metabolic syndrome”, and “x syndrome”. A total of 12 studies met the inclusion criteria. Mediterranean diet at different doses versus other diets or other treatments showed significant improvements in clinical parameters, including BMI (mean difference of −0.83 95% CI: −0.93 to −0.74; p < 0.00001),waist circumference (mean difference = −1.81, CI = −2.63 to −0.99, p < 0.00001) triglycerides (mean difference = −22.38, CI = −32.86 to −11.90, p < 0.00001), Glucose (mean difference = −4.28, CI = −7.64 to −0.93, p = 0.005) and, HOMA IR (mean difference = −0.72, CI = −0.78 to −0.65, p < 0.00001), and Insulin resistance (mean difference = −2.98, CI = −3.27 to −2.69, p < 0.00001), all of which improved, Although there were more outcomes, these are the most important changes for patients with metabolic syndrome. MD improves metabolic and cardiovascular health, but study heterogeneity limits the results’ generalizability. Because of that, further research is needed to standardize approaches and explore their mechanisms. MD should be part of an optimized strategy that includes education and physical activity. The strength of the evidence was very low according to the GRADE approach. Further research is needed to support the efficacy of the Mediterranean diet in patients with MS.

Temporomandibular disorders (TMD) are a heterogeneous group of conditions frequently associated with pain and functional impairment. Arthrocentesis has been proposed as a minimally invasive therapeutic option; however, its comparative effectiveness versus other treatments remains uncertain. To evaluate the effectiveness of arthrocentesis compared with other therapeutic modalities in patients with TMD, focusing on pain relief and mandibular functional outcomes. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Randomized controlled trials comparing arthrocentesis with other therapeutic interventions for TMD were included. Comparator interventions included conservative therapies (e.g., occlusal splints, physiotherapy, and pharmacological treatment), intra-articular injections, arthroscopy, and alternative arthrocentesis-based protocols. Primary outcomes were pain intensity assessed by visual analogue scale (VAS) and mandibular functional outcomes, including maximum mouth opening (MMO), maximum incisal opening (MIO), masticatory efficiency, mandibular movements, and overall joint mobility. Pooled estimates were calculated using mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE approach. Thirty-two randomized controlled trials were included in the quantitative synthesis. No statistically significant difference in pain reduction was observed between arthrocentesis and comparator interventions (MD = -0.25; 95% CI -1.09-0.59; p = 0.55), with very high heterogeneity (I² = 96%). No statistically significant differences were found for maximum incisal opening (MIO), mandibular movements, or overall joint mobility. Masticatory efficiency showed a small statistically significant improvement favoring arthrocentesis (SMD = 1.15; 95% CI 0.22-2.08), based on very low-certainty evidence. Overall, the certainty of evidence ranged from low to very low across outcomes, and heterogeneity was substantial in most analyses. Arthrocentesis may provide modest symptomatic improvement in selected patients with TMD; however, it does not demonstrate superiority over alternative therapeutic modalities for most functional outcomes. Given the substantial heterogeneity and low certainty of the available evidence, these findings should be interpreted cautiously. Further well-designed randomized controlled trials with standardized diagnostic criteria, clearly defined comparators, and longer follow-up are required to better define the role of arthrocentesis in the management of temporomandibular disorders. Current evidence does not demonstrate clear superiority of arthrocentesis over alternative therapeutic modalities for pain reduction or functional improvement in temporomandibular disorders. While arthrocentesis may be considered as a minimally invasive approach in selected patients, particularly those who do not respond to conservative management, its clinical benefits remain uncertain due to substantial heterogeneity and low certainty of evidence. Therefore, arthrocentesis should be interpreted as a potential adjunctive option within a stepwise treatment strategy rather than as a definitive or superior intervention.

Background: The radial artery (RA) is one of the terminal branches of the brachial artery, extending along the lateral forearm, crossing the anatomical snuffbox, and contributing to the palmar arches. Anatomical variations in the RA are of great clinical relevance due to their implications in procedures such as transradial catheterization, arterial cannulation, and bypass grafting. These variants may alter the course, branching pattern, or origin of the vessel, potentially increasing procedural complexity and the risk of iatrogenic injury. In critically ill patients and in surgical or interventional settings, accurate identification of RA anatomy is essential. The objective of this study was to systematically identify and describe RA variants reported in the scientific literature and to analyze their clinical relevance. Methods: A systematic search was conducted across six electronic databases: Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Latin American and Caribbean Literature in Health Sciences (LILACS), covering publications up to July 2025. Eligible studies included anatomical, radiological, and surgical investigations reporting RA variants. Study quality was evaluated using the Assessment of Quality in Anatomical Studies (AQUA) tool. Quantitative synthesis was performed using a random-effects model to estimate the pooled prevalence of RA variants and subgroup differences. Twenty-three studies met the inclusion criteria, and eleven were included in the meta-analysis, encompassing a total of 6320 participants. Results: Radial artery variants were categorized into three main types: variations in origin, course, and branching pattern. The pooled global prevalence of RA variants was 12% (95% CI: 6–18%), with substantial heterogeneity (I² = 97.7%). Higher prevalence was found in imaging-based studies (14%) compared with donor-based studies (12%). Sex-based subgroup analysis revealed a higher prevalence in females (18%; CI: 9–28%) compared with males (3%; CI: 3–4%), with moderate heterogeneity (I² = 61.3%). Regionally, European populations demonstrated a higher prevalence (20%) than Asian populations (11%), both showing high heterogeneity (I² > 98%). Notably, only one study from the Americas and none from Africa or Oceania were identified, representing a major geographical limitation in the available data. The findings of this study highlight the considerable variability in RA anatomy across populations. Such variations hold significant clinical importance, particularly in the context of transradial interventions, arterial cannulation, and reconstructive procedures where vascular integrity is critical. The high degree of heterogeneity observed may reflect differences in population genetics, sample size, and imaging or dissection methodologies. The limited representation of certain regions underscores the need for further anatomical and radiological studies to obtain a more comprehensive understanding of global RA variability. Preoperative or pre-procedural imaging using Doppler ultrasonography or computed tomography angiography is recommended to identify anomalous patterns and minimize iatrogenic complications. Conclusions: Radial artery variants are frequent and diverse. Their recognition is fundamental for the safety and success of invasive and surgical procedures in the upper limb. A standardized approach to vascular evaluation, particularly through preoperative imaging, is essential to improve procedural outcomes and reduce the risk of arterial injury in clinical practice.

Background: Cancer and its treatments frequently lead to physical and psychological symptoms that negatively affect quality of life. Massage therapy has been proposed as a complementary intervention to reduce symptom burden through its effects on stress regulation and autonomic balance. This systematic review and meta-analysis evaluated the effectiveness of massage therapy in patients with cancer. Methods: A systematic search was conducted in MEDLINE, Web of Science, Scopus, Embase, Google Scholar, and CINAHL. Search terms included “massage therapy,” “reflexology,” “massage,” and “cancer.” Randomized controlled trials comparing massage therapy with placebo or standard care and reporting quantitative outcomes were eligible. Seven studies met inclusion criteria for the meta-analysis. Results: Compared with control conditions, massage therapy was associated with significant improvements in several outcomes: Behavioral Symptoms Frequency (BSF) (MD = −12.54; 95% CI: −18.70 to −6.38; p < 0.0001), Quality of Life Questionnaire (QLQ) scores (SMD = 10.10; 95% CI: 1.21 to 19.00; p = 0.03), Spielberger State–Trait Anxiety Inventory (STAI) scores (MD = −3.97; 95% CI: −4.63 to −3.31; p = 0.0001), and Visual Analog Scale (VAS) symptom intensity (MD = −1.09; 95% CI: −2.11 to −0.07; p = 0.04). Overall certainty of evidence was limited by methodological heterogeneity and risk of bias. Conclusions: Massage therapy may provide short-term improvements in selected physical and psychological symptoms in cancer patients and may serve as a supportive complementary intervention. However, the evidence remains limited, and well-designed trials with standardized protocols are needed to strengthen the reliability of these findings.

Background: Glibenclamide remains widely used for glycemic control in type 2 diabetes mellitus (T2DM), but its comparative metabolic effects across glycemic, lipid, anthropometric, and cardiometabolic outcomes remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing glibenclamide with other antidiabetic therapies. Methods: We restricted eligibility to randomized trials in adults with T2DM. We performed random-effects meta-analyses for continuous outcomes; we assessed statistical heterogeneity using I², risk of bias using Cochrane RoB 2, and certainty of evidence using GRADE. Results: We retained 19 reports representing 18 unique randomized trials for the qualitative synthesis; after final verification of study design and population, 14 reports, each from a distinct trial, contributed data to at least one quantitative meta-analysis. RoB 2 was assessed for a principal eligible result from all 19 included reports (18 unique trials): 11 report-level results (57.9%) were at high overall risk of bias, and eight (42.1%) raised some concerns. Within the 14-report quantitative subset, 10 were at high overall risk of bias, and four raised some concerns. No significant difference was observed for HbA1c (MD −0.45%; 95% CI −1.05 to 0.16; I² = 99%) or fasting plasma glucose (MD −1.52 mmol/L; 95% CI −3.27 to 0.23; I² = 99%). Body weight was higher with glibenclamide (MD 2.41 kg; 95% CI 1.63 to 3.20; I² = 91%), and triglycerides showed a small nominal increase (MD 1.11 mg/dL; 95% CI 0.02 to 2.19; I² = 91%); both findings were supported by very low-certainty evidence and were not uniformly stable in leave-one-out analyses. Conclusions: Across randomized T2DM trials, the available evidence does not demonstrate consistent differences in most metabolic outcomes between glibenclamide and heterogeneous comparator therapies. Interpretation is limited by substantial clinical and statistical heterogeneity, high risk of bias, imprecision, and predominantly low or very low certainty of evidence. The pooled estimates should not be interpreted as evidence of therapeutic equivalence between drug classes, and comparative safety remains uncertain because hypoglycemia was reported inconsistently.