Scripta Medica je časopis sa recenzijom i otvorenim pristupom koji se objavljuje u online i štampanom obliku. On pokriva sve oblasti medicine, dentalne medicine, farmacije i zdravstvenih nauka. Scripta Medica se objavljuje kvartalno, krajem svakog kvartala. Časopis ima Međunarodni savetodavni odbor sa članovima iz celog sveta.
Faculty of Medicine, University of Banja Luka
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Infiltrative Therapy of Adipose Vital Micrografts in a Metabolic and protective Solution in Peyronie's Disease: a Case Report in a Pilot Study
Peyronie's disease (PD) or induratio penis plastica (IPP), is characterised by fibrotic plaque formation within the tunica albuginea, leading to penile curvature and pain. Current minimally invasive treatments provide limited outcomes. Aim of the research was to explore the preliminary feasibility and tolerability of intralesional injections of viable adipose-derived micrografts composed of mesenchymal stem cells (MSCs) and their exosomes, emulsified with a metabolic and protective solution of non-cross-linked hyaluronic acid, amino acid chains and sodium bicarbonate. A 52-year-old male presented with a 12-month history of penile curvature and painful erections. He underwent a single injection of adipose-derived micrografts (20-40 microns) composed of mesenchymal stem cells (MSCs) and their exosomes and emulsified with a metabolic and protective solution of non-cross-linked hyaluronic acid, amino acids branches and sodium bicarbonate for pH stabilisation directly into the plaque. Outcomes were assessed at baseline and 6 months post-treatment using goniometry, Visual Analogue Scale (VAS) for pain and International Index of Erectile Function-5 (IIEF-5). At 6 months, penile curvature decreased from 28° to 22°, a 21 % reduction. Pain resolved completely (VAS from 5 to 0) and erectile function improved (IIEF-5 from 17 to 21). No adverse events were reported. This single case report provides preliminary, hypothesis-generating observations suggesting that intralesional injection of adipose-derived micrografts combined with a metabolic and protective hyaluronic acid solution is feasible and apparently well tolerated in one patient with Peyronie’s disease. The observed numerical improvements in curvature, pain and erectile function cannot be attributed to the treatment with confidence in the absence of a control group and may reflect the natural history of the disease. This approach was investigational and not currently endorsed by EAU or AUA guidelines. Larger randomised controlled studies are required before any conclusion on efficacy can be drawn.
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Gut Microbiome and Diabetes: Emerging Perspectives in Metabolic Regulation
Diabetes mellitus Type 2 (T2DM) is one of the fastest-growing metabolic disorders in the world. It is marked by insulin resistance, high blood sugar and high cholesterol levels. Recently, its prevalence has increased significantly, making it a major health issue globally. New evidence shows that people with T2DM often have changes in their gut microbiota composition and suffer from problems in multiple organ systems. This review focused on the changes in gut microbiota related to T2DM and examines how microbial byproducts affect the disease's development. The potential for identifying at-risk individuals based on microbial patterns and the creation of specific treatments was also discussed. Lastly, it was looked into gut health strategies that aim to change the gut microbiota to prevent or slow the advancement of T2DM.
Stem Cell-Based Therapies Combined With Nano-Biomaterials for Nerve Regeneration and Repair
Nerve injuries, often resulting from trauma or degenerative diseases, pose significant challenges due to limited regenerative capacity of nervous system. Conventional treatments, including surgical nerve grafts, exhibit limitations such as donor site morbidity and limited functional recovery. Emerging regenerative strategies combining stem cell-based therapies with nano-biomaterials offer promising solutions for enhancing nerve regeneration and functional restoration. A comprehensive review of recent advancements in stem cell sources and induced pluripotent stem cells (iPSCs) was discussed. Also design, properties and applications of nano-biomaterials such as nanoparticles, nanofibers and hydrogels in nerve repair were analysed. Preclinical and clinical studies demonstrating effectiveness of these combined strategies were evaluated. The integration of stem cells with nano-biomaterials has demonstrated improved nerve regeneration outcomes, including enhanced neuronal differentiation, reduced inflammation and accelerated axonal growth. Studies indicate that biomaterial scaffolds provide structural support and biochemical cues, facilitating stem cell survival and integration into damaged neural tissues. Stem cell-based therapies combined with nano-biomaterials represent a promising approach for nerve regeneration. This combinatorial strategy offers enhanced neuroprotection, functional recovery and long-term stability in neural repair. Future research should focus on optimising scaffold properties, improving cell survival rates and translating preclinical findings into clinical applications.
Navigating the Storm: Understanding and Managing Depression During Menopause in Women
Depression has a prevalence of about 280-300 million individuals globally and is more prevalent in women than in men. Hormonal changes, vasomotor changes and psychosocial factors are linked with the high risk of depression during menopausal transition. Oestrogen also acts upon serotonergic, dopaminergic and noradrenergic processes, which are involved in mood regulation, indicating a biological association between menopause and depression. Aim of this review was to examine the mechanisms underlying menopause-related depression and summarise existing management strategies A literature review was based on published articles and clinical guidelines was conducted to investigate the relationship between menopause, hormonal changes and depression and the assessment of treatment options. Studies indicate a close relationship between menopausal transition and symptoms of depression. Factors that increase the risk of experiencing vasomotor symptoms, a negative attitude to menopause, surgical menopause and a previous history of depression are some of the risk factors. Several diagnostic tools are common, such as the Beck Depression Inventory and the Hamilton depression rating scale. There is evidence of the usefulness of menopausal hormone therapy (MHT) in the treatment of both menopausal and depressive symptoms. Adjunctive measures, such as antidepressants, phytoestrogens, B vitamins, vitamin D, magnesium and polyunsaturated fatty acids, have also been shown to have other advantages in the treatment of mood disturbances and psychosocial discomfort. Menopause-related depression is a growing issue in the population that has causes with multifactorial predictors. A combined management approach of MHT, nutritional supplements and psychosocial interventions is needed to enhance the quality of life and the psychological well-being of perimenopausal and postmenopausal women.
Intermittent Fasting as a complementary Strategy to Manage Type II Diabetes and Metabolic Health: A Review
As an alternative or supplement to traditional pharmaceutical treatments, intermittent fasting (IF) has become a viable dietary approach for the management of type 2 diabetes mellitus (T2DM). Improved insulin sensitivity and blood glucose management are the outcomes of various IF patterns, such as time-restricted eating, alternate-day fasting and the 5:2 diet, which encourage a metabolic shift from glucose to fat utilisation. Even in patients on insulin therapy, research indicates that IF may help lower fasting blood sugar, glycated haemoglobin (HbA1c) and insulin resistance with no risk of hypoglycaemia when appropriately monitored. Physiological benefits of IF include enhanced circadian rhythm alignment, increased autophagy, reduced oxidative stress and improved lipid metabolism. Comparisons with other dietary approaches, such as the Mediterranean, Palaeolithic, ketogenic and fasting-mimicking diets, indicate that IF offers flexibility and long-term sustainability for many individuals. However, consistent adherence and personalised strategies are essential for optimal results. Overall, IF presents a valuable complementary approach for managing T2DM and promoting better metabolic health.
Effects of Different Crosslinkers on the Release Profiles of Growth Factors (TGF-ß, BMP and PDGF) From Hydroxyapatite Combined With Secretomes
Background/Aim: Controlled release of growth factors is essential for bone regeneration, requiring biomaterials with high stability and osteoconductivity. Hydroxyapatite (HA) is biocompatible and osteoconductive but limited by weak mechanical strength and uncontrolled growth factor release. This study evaluated the release profiles of transforming growth factor-beta (TGF-β), bone morphogenetic protein (BMP) and platelet-derived growth factor (PDGF) from HA combined with secretome and crosslinked using polyvinyl alcohol (PVA), glutaraldehyde (GA), or aluminium hydroxide gel (Alhydrogel), aiming to identify the most effective crosslinker for controlled release and scaffold stability. Methods: In vitro tests were conducted on four groups (n = 6 each): HA + PVA 0.5 % + Secretome, HA + GA 0.1 % + Secretome, HA + Alhydrogel 0.1 % + Secretome and a non-crosslinked control. HA derived from bovine bone was sterilised using gamma radiation, then crosslinked through immersion and dry-heat treatment. Samples were incubated in PBS at 37 °C and growth factor release was analysed using ELISA on days 1, 3, 7, 10 and 14. Results: HA + PVA showed the highest TGF-β release (617.90 ± 18.66 ng/L) and the most stable BMP (0.19 ng/L) and PDGF (0.61 ng/L) profiles. HA + Alhydrogel had the highest BMP release (6.01 ± 0.50 ng/L) and stable TGF-β (7.57 ng/L), while HA + GA had the highest PDGF release (27.27 ± 1.92 ng/L). The control showed rapid but unstable release. Conclusion: HA combined with secretome and PVA offers the most stable and sustained release, supporting its use as an optimal scaffold for bone regeneration.
Antifungal Pharmacotherapy and Hepatic Safety: Mechanisms of Drug-Induced Liver Injury (DILI) and Risk Mitigation
The growing prevalence of invasive fungal infections (IFIs), especially among immunocompromised patients, has resulted in increased reliance on systemic antifungal therapies. Hepatotoxicity is still a serious clinical problem even with improvements in treatment results. This study consolidates the mechanisms, incidence rates and risk factors associated with drug-induced liver injury (DILI) across various antifungal classes, including flucytosine, azoles, polyenes, echinocandins and allylamines. Triazole antifungals, such as voriconazole, fluconazole and ketoconazole are particularly implicated because of their substantial hepatic metabolism via cytochrome P450 enzymes and potential for interactions between drugs. Direct hepatocyte damage, immune-mediated responses, mitochondrial malfunction and changes in cytokine signalling are some of the mechanisms of hepatotoxicity. Terbinafine and other echinocandins and allylamines can also be hepatotoxic, particularly when combined with polypharmacy and pre-existing liver illness. Acute liver failure and asymptomatic liver enzyme increases are examples of clinical symptoms. To maximise treatment while reducing hepatic side effects, a thorough understanding of antifungal pharmacokinetics, metabolism and patient-related risk factors is necessary.
Role of Chrononutrition in Modulating Metabolic and Cardiovascular Health
Maintaining optimal cardiovascular and metabolic health depends on aligning dietary practices with the body’s intrinsic circadian rhythms. Chrononutrition is a rapidly advancing research area that explores how the timing of food intake influences physiological health outcomes. Unlike conventional nutritional strategies that emphasise food quantity and composition, chrononutrition highlights meal timing as a critical regulator of metabolic processes, including glucose metabolism, insulin responsiveness and lipid regulation. Accumulating evidence indicates that unfavourable eating behaviours, particularly late-day or nighttime food consumption, are closely associated with metabolic impairments and an increased risk of conditions such as obesity, type 2 diabetes and cardiovascular disease. By integrating principles of nutrition with chronobiology, chrononutrition offers a promising approach for reducing the burden of chronic diseases. This review evaluates the role of chrononutrition in metabolic and cardiovascular health, with particular emphasis on time-restricted eating (TRF), consistency in meal timing and the underlying molecular mechanisms responsible for the observed health benefits. Overall, the findings suggest that dietary strategies synchronised with biological clocks may represent an effective approach for chronic disease prevention.
Phenotypic Characteristics of Patients With Irritable Bowel Syndrome: Association Between Gastrointestinal Symptoms and Psychological Factors – A Pilot Study
Background/Aim: Irritable bowel syndrome (IBS) is a heterogeneous functional gastrointestinal (GI) disorder frequently associated with psychological symptoms. Phenotypic characterisation of patients may improve understanding of the relationship between gastrointestinal and psychological dimensions. The aim of this pilot study was to describe gastrointestinal and psychological phenotypic features in IBS patients and to examine their interrelationships. Methods: The study included 20 IBS patients (8 IBS-D, 7 IBS-M, 5 IBS-C) and 9 healthy controls. Gastrointestinal symptoms were assessed using the GSRS and VSI questionnaires, while psychological status was evaluated with the PHQ-15 and HADS. Groups were compared using independent samples t-tests and correlations within the IBS group were analysed using Spearman’s correlation. Statistical analysis was performed using SPSS. Results: IBS patients demonstrated significantly more severe GI symptoms and higher somatic symptom perception compared to controls (p < 0.01). Within the IBS group, strong correlations were observed between VSI and PHQ-15 (p = 0.740, p < 0.001) and between GSRS and PHQ-15 (p = 0.605, p = 0.001). Associations between HADS and GI symptoms were weaker; the correlation with GSRS was not statistically significant (p = 0.333, p = 0.078), while the correlation with VSI reached statistical significance (p = 0.484, p = 0.008). Conclusion: Gastrointestinal symptoms in IBS patients are strongly associated with somatic symptom perception, whereas associations with general anxiety and depression are weaker. These findings support the heterogeneity of the IBS phenotype and highlight the importance of individualised assessment of gastrointestinal and psychological dimensions in clinical practice.
Exploring the Nutritional, Medicinal and Economic Significance of Morchella Esculenta: a Comprehensive Review
This overview summarises the nutritional profile, medicinal properties, economic significance and traditional uses of Morchella esculenta (Guchhi). It also highlights research gaps to guide future studies. Information from multiple sources was synthesised to explore the mushroom’s nutritional composition, bioactive compounds, pharmacological activities, ethnobotanical relevance and economic role. M esculenta provides proteins, fibre and micronutrients such as zinc, selenium and iron, which contribute to immune support, antioxidant defence and blood health. Its pharmacological potential includes antioxidant, antitumour, antimicrobial and anti-inflammatory effects, largely attributed to polysaccharides (β-glucans, galactomannan) and phenolic compounds. Traditional uses for arthritis, fatigue and gastrointestinal disorders align with modern pharmacological findings. Economically, it remains one of the world’s most valuable wild fungi, supporting rural livelihoods. M esculenta is a nutritionally and pharmacologically significant mushroom with cultural and economic value. Further toxicological studies, clinical trials and cultivation research are needed to realise its full potential.
Metabolic Syndrome in Lean vs Obese Polycystic Ovarian Syndrome (PCOS) Phenotype
Background/Aim: Polycystic ovarian syndrome (PCOS) is the most common metabolic, hormonal and endocrinological condition. Compared to lean, obese PCOS women are more likely to experience infertility, irregular menstruation, acanthosis and hirsutism. Aim of this study was to investigate the prevalence of metabolic syndrome in lean and obese PCOS patients as well as its correlation with age, body mass index (BMI) and obesity. Methods: The 450 research participants in the cross-sectional study visited the tertiary care hospital. The individuals were chosen using the updated Rotterdam criteria and then divided into lean and obese groups according to their BMI. Clinical, biochemical, anthropometric, metabolic and demographic information about the patients were assessed and compared. Results: The average age of obese patients was 29.8 ± 8.47 years, whereas the average age of lean patients was 24.8 ± 7.07 years. Obese PCOS individuals had significantly higher levels of all examined parameters, including age, height, weight, WHR, hip and waist circumferences and BMI. Obese people were significantly more likely than thin people to have clinical parameters such infertility, alopecia, hirsutism, acanthosis and irregular menstruation. When comparing biochemical parameters such total testosterone (TT), luteinising hormone (LH): follicle stimulating hormone (FSH) ratio, thyroid stimulating hormone (TSH), dehydroepiandrosterone sulphate (DHEAS), the fasting oral glucose tolerance test (OGTT) and blood pressure, there were significant differences between PCOS patients who were thin and obese. Compared to lean individuals, obese patients showed higher levels of the lipid profile (p < 0.001). Metabolic syndrome was far more common in obese PCOS patients than in lean ones. Conclusion: Study showed that both lean and obese persons might have metabolic syndrome. Consequently, all PCOS patients require monitoring for cardio-metabolic risk, irrespective of age, weight, or BMI.
Oral Health-Related Quality of Life and Satisfaction Following Implant Restoration After Sinus Floor Augmentation: A Prospective Evaluation
Background/Aim: Alveolar ridge resorption and maxillary sinus pneumatisation present significant challenges for implant rehabilitation. Although lateral window sinus floor augmentation (LWSFA) is a predictable surgical approach, patient-reported outcomes remain essential for evaluating treatment success beyond osseointegration. This study aimed to evaluate longitudinal oral health-related quality of life (OHRQoL) and satisfaction in patients undergoing implant therapy after LWSFA. Methods: This prospective longitudinal study included 39 patients with 57 posterior maxillary edentulous sites and residual bone height ≤4 mm. All patients underwent LWSFA using a mixture of allograft, synthetic bone substitute and platelet-rich fibrin. After six months of graft maturation, implants were placed, followed by definitive prosthetic restoration after a further six months. OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14) at baseline and at one week, six months and 12 months after functional loading. Patient Satisfaction Score (PSS) was measured using a visual analogue scale. Results: Mean OHIP-14 scores improved significantly from 24.28 ± 9.77 at baseline to 6.13 ± 2.82 at 12 months (p < 0.001). Most domain-specific improvements appeared to stabilise by six months. PSS increased significantly from 8.92 ± 0.81 at one week to 9.44 ± 0.55 at six months (p < 0.017), before reaching a plateau. Across all time points, female patients consistently reported significantly higher OHIP-14 scores than males (p < 0.05). Satisfaction in single-tooth cases stabilised within one week, whereas multi-unit cases required six months. Conclusion: LWSFA followed by implant-supported restoration significantly improves OHRQoL and satisfaction. Maximum satisfaction and functional comfort are typically achieved and sustained after six months of functional loading.
Hypolipidaemic Effect of an Immature Pomelo (Citrus Maxima) Extract in a Tyloxapol-Induced Hyperlipidaemia Mouse Model
B Background/Aim: Pomelo extracts are rich in bioactive flavonoids and may regulate lipid metabolism. However, studies evaluating the lipid-lowering effects of immature pomelo derived from agricultural by-products remain limited in Vietnam. This study was conducted to investigate the hypolipidaemic activity of a liquid extract obtained from immature pomelo (Citrus maxima) in a tyloxapol-induced mouse model of acute hyperlipidaemia. Methods: Sixty mice were randomly assigned to six groups: normal control, pathological control (tyloxapol-induced hyperlipidaemia), positive control (atorvastatin-treated) and three experimental groups receiving immature pomelo extract orally at doses of 5.17, 10.34 and 15.51 g/kg. Key lipid indicators, including total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), were quantified in serum samples. Data were analysed using appropriate statistical tests, including the Shapiro–Wilk test, independent t-test and Levene’s test. Results: All extract doses significantly reduced total cholesterol, triglycerides and LDL-C compared with the pathological control (p < 0.001). The lowest dose produced the greatest reduction in total cholesterol (3.420 mmol/L), while higher doses showed stronger effects on HDL-C restoration, reaching levels similar to those recorded in the normal and atorvastatin-treated groups (2.100 and 1.950 mmol/L; p > 0.05) Conclusion: The liquid extract of immature pomelo demonstrated significant hypolipidaemic activity in this experimental model.
Development of a Sprayable Thermosensitive Hydrogel Containing Rambutan (Nephelium Lappaceum L) Leaf Extract for Diabetic Wound Therapy
Background/Aim: Diabetic wounds are challenging to treat due to impaired healing processes. This study aimed to develop a sprayable thermosensitive hydrogel incorporating rambutan (Nephelium lappaceum L) leaf extract, known for its phytochemical wound healing potential. Methods: Rambutan leaves were extracted via 70 % ethanol maceration. Qualitative and quantitative analyses confirmed the presence of tannins and flavonoids. The extract was formulated into thermosensitive hydrogels (F1–F3) using sodium alginate, Poloxamer 407 and Poloxamer 188. Physical properties were evaluated and wound healing efficacy was tested on diabetic rats over 21 days using a full-thickness wound model. Results: The extract yielded 25.44 % with tannin and flavonoid contents of 2.94 % and 5.73 %, respectively. All formulations were homogeneous, pH-balanced (4.52–5.03) and met ideal criteria for spreadability, gelation, swelling and viscosity. In vivo tests showed F3 had the highest wound healing rate (81.25 %), approaching the normal control (84.00 %) and outperforming the reference drug (61.67 %). Statistical analysis indicated significant differences (p < 0.05). Conclusion: The thermosensitive hydrogel with rambutan leaf extract effectively accelerates diabetic wound healing and shows potential as a topical therapy.
Predictive Value of Protein Kinase C Delta as a Diagnostic Biomarker for Hepatocellular Carcinoma in Hepatitis C Virus-Related Cirrhosis
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QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Background/Aim: Hepatocellular carcinoma (HCC) is considered the 6th prevalent tumour and 3rd leading cause of cancer-associated mortality worldwide. Protein kinase C delta (PKCδ), released by liver cancer cells, has an effect in cell-proliferation and cancer formation, recommending PKCδ can serve as a good biomarker in HCC detection. The aim of this research was the assessment of predictive value of PKCδ as a diagnostic biomarker for HCC in hepatitis C virus (HCV)-related cirrhosis. Methods: The study involved 180 participants, who were separated into three groups, the first control group included 45 healthy volunteers, the second cirrhotic without HCC group (non-HCC group) included 45 cirrhotic patients due to HCV and the third cirrhotic with HCC group (HCC group) included 90 cases with HCC on top of HCV-related cirrhosis. All participants were subjected to clinical examination, taking of history, radiological evaluation and routine laboratory investigations involving alpha-fetoprotein (AFP) assessment. PKCδ was assessed for all participants using Enzyme-Linked Immunosorbent Assay. Results: AFP and PKCδ concentrations were greater in HCC than in non-HCC and controls. PKCδ ≥ 30.75 ng/mL showed excellent diagnostic performance for detecting HCC in HCV-related cirrhosis (AUC = 0.977, sensitivity 95.6 %, specificity 86.7 %, accuracy 92.6 %). Multivariate analysis identified PKCδ ≥ 30.75 ng/mL, AFP ≥ 9.4 ng/mL and current smoking as independent predictors of HCC. Conclusion: PKCδ has a significant diagnostic ability for hepatocellular carcinoma (HCC), with good specificity and sensitivity in HCC prediction in patients with HCV-related liver cirrhosis.
Silybin Attenuates Neurobehavioural Impairments and Secondary Brain Damage Following Traumatic Brain Injury in Mice
Background/Aim: Traumatic brain injury (TBI) is a neurodegenerative disorder resulting in temporary or permanent impairment of cognitive, physical and psychosocial functions. Presently no treatment is available to overcome TBI. Flavonoids can be utilised for treatment of TBI due to their anti-oxidant and anti-inflammatory potential. Aim of this study was to investigate the neuroprotective potential of silybin against secondary cascade of TBI. Methods: TBI induced by weight drop model of trauma has been utilised to assess the neuroprotective effect of silybin at the doses 50 mg/kg and 100 mg/kg in mice. After 30 min of injury, silybin was administered. The effect of silybin was observed on neurobehaviour (Morris’s water maze test, beam walk and beam balance), blood brain barrier permeability (BBB), brain oedema and mitochondrial dysfunction after 24 h and 21 days of drug administration. The study of interaction of silybin with N-methyl-D-aspartate receptors (NMDARs) by using PDB: 3QEL was evaluated by molecular docking. Results: Silybin significantly improved the neurological behaviours such as motor coordination and learning and memory. Silybin significantly decreased the BBB permeability, brain oedema and mitochondrial dysfunction. Molecular docking studies showed the significant interactions of silybin with target residues MET 207, THR174, TYR175, PHE 176, PRO177, GLU236,THR233, GLU106, ALA107, GLN110, ASP136, ALA135, MET134 of PDB: 3QEL. Conclusion: Silybin provides novel insights into the neuroprotective and therapeutic potential for TBI.
Green Synthesis of Silver Nanoparticles Using Euphorbia Microsphaera: Tuning Size and Stability Via Precursor Concentration
Background/Aim: The green synthesis of silver nanoparticles (AgNPs) by plant extracts provides an environmentally friendly alternative to traditional chemical methods. This study aimed to report the biosynthesis of AgNPs using Euphorbia microsphaera, a native plant of the Middle East and to investigate how different precursor concentrations affect the physicochemical properties of the synthesised nanoparticles. Methods: The methanolic extracts prepared from E microsphaera leaves were employed for the fabrication of AgNPs at varying precursor concentrations such as 1, 3 and 5 mM in silver nitrate (AgNO3). The formation of NPs was observed visually and by measurement with UV-VIS spectroscopy. Dynamic light scattering (DLS) was used to determine the hydrodynamic size, polydispersity index (PDI) and zeta potential. Morphological and elemental analyses were conducted by utilising scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDS). Results: A clear colour change from pale yellow to dark crimson pink suggested a successful biosynthesis of AgNPs. UV-Vis spectroscopic analysis showed a distinct surface plasmon resonance (SPR) peak at 452.5 nm for the 1 mM sample, indicating the formation of small, monodispersed nanoparticles. In contrast, at 5 mM, a pronounced red shift to 530.5 nm was observed, accompanied by a substantial increase in hydrodynamic size from 238.8 nm to more than 2000 nm. TEM and SEM images supported the results obtained from UV–vis, depicts a well-dispersed spherical shaped nanoparticles in size range 20–50 nm at concentration of 1 mM, whereas 5 mM showed massive agglomeration associated to the saturation of the capping agent. Conclusion: This study successfully showed the green synthesis of AgNPs by using E microsphaera. The results revealed the significant effect of precursor concentration on nanoparticle stability and 1 mM was found to be the optimal value for high stability of monodisperse nanoparticles. E microsphaera can be considered as a promising bio-resource for nanotechnology in the biomedicine area.
Distribution of CD15- and CD31-Positive Cells in the Oesophageal Mucosa of Children With Eosinophilic Oesophagitis Across Different Age and Sex Groups
Background/Aim: Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory disease of the oesophagus with a multifactorial nature. The prognosis and effectiveness of therapy for EoE largely depend on a detailed study of its pathogenetic mechanisms. To clarify the severity of the inflammatory process, along with routine histological methods, a comprehensive immunohistochemical examination of the oesophageal mucosa was performed. To verify the intensity of tissue alterations, the marker CD15 was used and to assess the state of the vascular bed and the degree of vascularisation, the endothelial marker CD31 was employed. The aim of this research was to determine the morphometric features of the inflammatory process and tissue vascularisation in EoE in children of different age and sex groups. Methods: A retrospective study included 94 children with EoE (ICD-10: K20), stratified into three age subgroups: Subgroup A (3–7 years), Subgroup B (8–12 years) and Subgroup C (13–18 years). The study utilised clinical data and morphological methods (general histology, histochemical reactions – Masson's trichrome and Periodic acid–Schiff (PAS) and immunohistochemical analysis for CD15 and CD31) for examining biopsy material from the oesophageal mucosa. Results: Distinct age- and sex-dependent patterns were identified. In male patients, peak CD15+ cell density was recorded in Subgroup A, demonstrating a significant 1.57-fold decrease toward the adolescent group (p < 0.05). Conversely, female patients demonstrated the lowest CD15+ density in Subgroup A, with a significant 1.89-fold increase in Subgroup C (p < 0.05), where female CD15+ density exceeded males by 1.94 times (p < 0.05). All assessed microvascular parameters progressively increased from Subgroup A to C in both sexes (p < 0.05). When comparing by sex in the older age cohort, the microvascular density in girls significantly exceeded that in boys by 1.18 times (p < 0.05). Conclusion: EoE in children is characterised by distinct age- and sex-dependent inflammatory and structural changes in the oesophageal mucosa. Immunohistochemical analysis revealed prominent epithelial CD15 expression reflecting the intensity of cellular alteration and CD31+ endothelial reactivity reflecting a microvascular response during the development of the disease. The results underscore the importance of comprehensive diagnostics, including detailed morphological, histological and immunohistochemical evaluation of the mucosa, which may provide valuable insights for improving diagnostic strategies and monitoring disease progression.
Geriatric Diabetes Care: Prescribing Practices and Drug Utilisation at a Teaching Hospital
Background/Aim: Diabetes is increasingly recognised as a major health concern worldwide, affecting around 537 million adults and causing approximately 6.7 million deaths annually. In India alone, 74.9 million individuals had diabetes in 2021 and this figure could rise to 124.9 million by 2045. Older adults (aged 60 and above) are particularly affected, with 14.3 % of them living with type 2 diabetes. Managing diabetes among the elderly is complicated, as they often have other health conditions and are on multiple medications, which can lead to issues such as polypharmacy and harmful drug or food interactions. Consequently, it is crucial to examine how diabetes medications are being prescribed for this age group. Methodology: A prospective cross-sectional study was conducted among geriatric patients (≥ 60 years) at a tertiary care teaching Hospital in Mullana, Ambala, Haryana, over six months from December 2024 to May 2025. Study samples were selected through systematic random sampling and each prescription was evaluated to analyse prescribing patterns, polypharmacy and drug interactions. Additionally, patient’s quality of life was assessed. Results: A total of 185 patients participated in the study, including 96 males (51.9 %) and 89 females (48.1 %), with a mean age of 66.58 ± 6.26 years. Metformin was the most commonly prescribed monotherapy, followed by glimepiride, human insulin and dapagliflozin. The most frequent combination therapy was metformin with vildagliptin (17.2 %). Hypertension (22.7 %) was the most prevalent comorbidity. Polypharmacy was observed in 80 % of patients, drug-drug interactions in 84.3 % and food-drug interactions in 29.9 %. The average quality-of-life score was 67.74 ± 13.53 %, with lower scores among those aged over 80. Conclusion: The study highlights prevalent polypharmacy, drug interactions and comorbidities among elderly diabetics, emphasising the need for rational prescribing to enhance treatment efficacy, minimise adverse effects and improve quality of life. Overall, the study underscores the importance of rational prescribing and optimised drug use in elderly diabetic patients to improve outcomes and reduce adverse effects.
Arshdeep Department of Pharmacy Practice, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India
Retinoic Acid Delivery via Ultraflexible Nanovesicular System for the Management of Posterior Segment Ocular Diseases
Background/Aim: The ongoing perusal centred on formulating and analysing ultraflexible nanovesicular system ie nano-transfersomes for carrying retinoic acid locally to the deeper, posterior regions of the optic Methods: The composition of transfersomes were refined and evaluated by different criteria such as vesicle diameter and distribution, surface charge, encapsulation capacity, surface morphology, viscosity and pH, Additional analyses included drug release behaviour in simulated tear fluid (STF), 3 month stability analysis and ocular safety test using hen’s egg test chorioallantoic membrane (HET-CAM). Results: The ideal blend (F12) showed the median of vesicle diameter 155.32 ± 4.45 nm, scaled by the light scattering process (Malvern Zetasiser, ZEM 5002, UK), The Zeta potential measured approximately -36.5mV, signifying a negative surface charge, which consequently resulted in the absence of particle aggregation. The % entrapment efficiency for the different formulations ranged from 65.45 ± 1.27 to 79.12 ± 2.23. Nano-transfersomes displayed a spherical and elastic morphology, characterised by either unilamellar or multilamellar vesicle structures. The viscosity and pH of retinoic acid loaded nano-transfersomal formulations were measured to be approximately 20.0 ± 2.1 to 48.0 ± 1.8 cP and range of 5.0 ± 0.5 to 7.0 ± 0.1, respectively. The drug release profile in STF was observed to be 98.89 ± 0.45 after 24 h. Conclusion: The drug release profile of retinoic acid loaded ultraflexible nanovesicular system indicating a sustained release pattern. According to storage stability studies, the formulation exhibited greater stability under refrigerated conditions. Research findings suggested that the nano-transfersomal formulation loaded with retinoic acid could provide prolonged release and stable nano transfersome formulation with suitable physico-chemical characteristics facilitating its easy application to the eye. Nano-transfersome might be an innovative approach for delivering retinoic acid to the eye, particularly for treating diseases affecting the posterior segment, due to its distinctive properties such as flexibility, prolonged drug release and reduced size.
Case Series of Burkholderia Pseudomallei Infections in Critically Ill Patients: Unveiling Key Challenges
Melioidosis remains a diagnostic challenge in tropical regions due to its broad clinical spectrum. This series presents seven diabetic individuals from an endemic area with diverse forms of the disease, including pulmonary, visceral, soft tissue and lymph node involvement. Laboratory confirmation was achieved through culture and nested polymerase chain reaction (PCR). Most patients improved with appropriate intravenous therapy followed by oral antibiotics; one experienced recurrence. The varied presentations often resemble other endemic infections, delaying diagnosis. Prompt clinical recognition and early use of molecular tools are vital for initiating targeted treatment and improving outcomes in vulnerable populations.
COVID-19 Vaccine Safety in Adults: A Narrative Review of Adverse Reactions in ASEAN Countries
The spread of the SARS-CoV-2 virus, known as the COVID-19 virus, which causes the coronavirus disease 2019 known as “COVID-19”, has led to a rapid response from governments around the world. In response to the significant threat it presents to global health, comprehensive strategies have been implemented to mitigate worldwide transmission and reduce mortality rate. Association of South East Asian Nations (ASEAN) countries have also taken steps to encourage people to get vaccinated. The use of vaccines from many global pharmaceutical companies has led to the collection of reports on adverse drug reactions to monitor and evaluate the use of pharmaceutical products after administrated. This study aimed to evaluate the adverse drug reactions of COVID-19 vaccines administered in ASEAN countries through a narrative review of relevant scientific literature. A narrative review was conducted using PubMed and ScienceDirect databases to identify original, open-access studies published between 2020 and 2025. Eligible articles involved adults aged 18–59 years and reported adverse events following COVID-19 vaccination in ASEAN countries. Nine studies met the inclusion criteria and were qualitatively analysed. Six vaccines were evaluated: Ad26.COV2.S (Johnson &Johnson), AZD1222 (AstraZeneca), BNT162b2 (Pfizer-BioNTech), CoronaVac (Sinovac), Sputnik V and mRNA-1273 (Moderna). The most adverse drug reactions reported included injection site pain, fever, headache, fatigue and muscle pain, respectively, based on the severity of side effects. Current evidence confirms that COVID-19 vaccines used in Southeast Asian demonstrated favourable safety and tolerability profiles among adults, consistent with global pharmacovigilance data. These findings support continued vaccination programs and highlight the importance of strengthening regional pharmacovigilance systems and harmonised AEFI reporting to sustain public confidence in immunisation efforts across ASEAN.
Gunshot wounds remain one of the most complex types of combat injuries. A gunshot wound is a dynamic system in which the initial mechanical destruction of tissue is only the starting point of a complex and multi-level process. Subsequently, the wound site steadily transforms and the volume of non-viable tissue increases, spreading beyond the wound channel area. This review examines the pathogenesis of a gunshot wound, which is a chain of cause-and-effect changes in which each link is formed as a direct consequence of previous disturbances. The pathophysiological events that contribute to the chronic wound process are identified, which cannot be interrupted by natural mechanisms.
Global Research Trends and Risk Factors for Loneliness in Older Adults
Loneliness was defined as an unpleasant feeling for a person when there is a gap between expectations of desired social connection with actual number of social relationships owned, both in terms of quantity or especially the quality. This research was systematic literature review with bibliometric analysis employs a two-phase quantitative approach. In the first phase, scientific publications were collected from two databases, there is Scopus and Web of Science (WoS). The analysis and visualization show that loneliness among older adults is an increasingly prominent topic in global research, especially since the COVID-19 pandemic. This research reveals that loneliness was closely linked to multidimensionality and was receiving attention from various fields, including neuroscience, behavioral health and geriatric care. The main themes of this research include psychological and cognitive factors, social isolation, and geriatric vulnerability. Although the topic of loneliness among the elderly is gaining high attention in global academic interest, there was still a gap in innovative research, which calls for a multidisciplinary approach, especially in the discussion of risk factors for loneliness among the elderly. Some of the potential topics for further research are the relationship of loneliness among the elderly with socioeconomic factors, technology and digitalization, elderly care, religion and culture, and the direct relationship of loneliness with biomedical risks in geriatric clinical conditions such as atrial fibrillation, cognitive impairment, osteoporosis, and fall risk. These topics will open up great opportunities for researchers to contribute to and develop the advancement of this issue.
Unveiling the Therapeutic Potential of Ipomoea Batatas Lam: A Journey From Preclinical Research to Clinical Applications
Ipomoea batatas Lam, commonly known as sweet potato, has garnered recognition for its significant therapeutic potential, which can be largely ascribed to its abundant array of bioactive secondary metabolites. Among these phytoconstituents, flavonoids, anthocyanins, carotenoids and terpenoids have been shown to possess notable pharmacological properties through preclinical investigations. Evidence from in vitro studies utilising cell culture models indicates that these compounds exhibit robust antioxidant and anticancer activities, with anthocyanins in particular being reported to inhibit the proliferation of cancer cells. Furthermore, in vivo experiments substantiate the diverse therapeutic efficacy of Ipomoea batatas, revealing its anti-obesity, hypoglycaemic, hepatoprotective and anti-arthritic properties. Advancements in the understanding of these therapeutic attributes have facilitated the progression of extracts from Ipomoea batatas to clinical evaluation with subsequent assessment of safety, toxicity, pharmacokinetics and benefit-risk ratios. The transition from preclinical research to clinical validation accentuates its relevance in the realm of metabolic health, especially in combating obesity, liver dysfunction and diabetes. The successful completion of Phase III clinical trials has resulted in the introduction of plant-based antidiabetic formulations into the market, thereby reinforcing the pharmacological significance of this plant. Nevertheless, despite these promising developments, the complex interactions between the phytoconstituents and their corresponding therapeutic effects warrant further investigation. Continued research in this domain is essential, as it promises not only to enrich the understanding of the medicinal properties of Ipomoea batatas but also to reveal innovative therapeutic applications. Such endeavours will likely establish Ipomoea batatas as an esteemed natural resource within contemporary medicine.
Antifungal Interventions and Clinical Outcomes: A Review
Fungal infections pose a significant risk to public health since they are linked to high rates of illness and death, particularly in immunocompromised individuals. Therapy is difficult because there are few antifungal drugs available and many of them are harmful. Fungi have also evolved defence mechanisms to fight these drugs. This article overlooks at antifungal drugs that are currently on the market, discusses resistance mechanisms and investigates new treatment-enhancing strategies. Combinations of antifungal drugs can increase effectiveness and reduce toxicity. New drug formulations, including nanoparticles are being studied to improve dispersion and reduce adverse effects. Furthermore, commercially marketed prescriptions may become more effective if their chemical makeup is changed. Additionally, novel drugs are being tested more rapidly and precisely using mini-host animal models. These creative methods could expedite the process and enhance patient outcomes. This study notes multiple challenges, such as patient peculiarities, intricate drug interactions and pathogen diversity, while also emphasising the advancements in antifungal therapy. Enhancing efficacy and reducing toxicity requires advancements in diagnosis, treatment and medicine. More studies on emerging fungal infections and antibiotic resistance are needed.
Pathophysiological Pathways Linking Diabetes to Cardiac Hypertrophy: From Insulin Resistance to Personalised Cardioprotection
Diabetes and cardiac hypertrophy are closely interconnected, sharing overlapping metabolic and cardiovascular pathways. This review aimed to investigate the underlying mechanisms that drive this relationship and to evaluate current diagnostic and therapeutic strategies with the goal of improving clinical outcomes. An extensive review of recent literature was undertaken to explore how factors such as insulin resistance, hyperglycaemia, inflammation, oxidative stress and lipotoxicity contribute to cardiac remodelling and functional decline. Developments in diagnostic modalities, including advanced imaging techniques and emerging biomarkers, were examined alongside both lifestyle interventions and pharmacological treatments. Diabetes is a significant contributor to the progression of cardiac hypertrophy, primarily through metabolic dysregulation and persistent low-grade inflammation. The importance of early detection—using sophisticated imaging tools and biomarker profiling—has become increasingly evident for timely and effective intervention. Therapeutic agents such as metformin, sodium glucose cotransporter-2 inhibitors (SGLT2) and glucagon like peptide-1 receptor agonist (GLP-1) have demonstrated beneficial effects in reducing cardiovascular complications in individuals with diabetes. Moreover, novel approaches, including chronotherapy and personalised medicine, are gaining traction as potential means to enhance treatment efficacy and patient outcomes. The robust association between diabetes and cardiac hypertrophy underscores the necessity for a more integrated and nuanced approach to diagnosis and management. Combining early detection with targeted pharmacotherapy and personalised care strategies offers a promising route to addressing this complex clinical challenge. Continued research is essential to refine these approaches and to optimise long-term outcomes for affected patients.
Emerging Biomaterial Strategies for Giant Cell Arteritis: Challenges and Future Outlook
Giant cell arteritis (GCA) is a common vasculitis of the big arteries that affects people as they get older and it usually results in potentially serious problems like vision loss and stroke. Steroids remain the cornerstone of GCA treatment, although long-term steroid use is associated with significant adverse effects and a high chance of recurrence. This review will look at biomaterials as a new treatment technique that could help improve GCA management through focused therapy, reduced systemic side effects and facilitated vascular restoration. A comprehensive evaluation of current breakthroughs in biomaterial-based GCA techniques was carried out, with an emphasis on nanoparticles, hydrogels and tissue-engineered scaffolds. The literature was reviewed to determine their therapeutic efficacy, biocompatibility and potential for clinical use. Biomaterials such as nanoparticles and hydrogels have showed promise in controlled drug delivery, allowing for focused treatment at sick artery sites while lowering systemic steroid exposure. Tissue-engineered scaffolds have shown promise for vascular repair and regeneration, at least more effectively than standard methods of treating an injured vessel. However, many problems exist, including maintaining long-term biocompatibility, stability and avoiding immunological responses. Although early preclinical studies have produced encouraging results, clinical translation is still in its infancy. Emerging biomaterials will be a potential area in GCA care, offering new opportunities for treatment efficacy enhancement while reducing side effects. Advanced research in the areas of biocompatibility and immune response challenges should be conducted to ease these promising tactics into clinical practice as a new hope for people suffering from this debilitating condition.
A Narrative Review on Preclinical/Clinical Trials on Aducanumab
The most widespread type of dementia, Alzheimer's disease (AD), is predicted to triple in global prevalence by 2050. AD has a substantial societal and economic impact across the world, negatively affecting both patients and their caregivers, as the disorder has few therapeutic alternatives. Aducanumab was the first monoclonal antibody approved in 2021 for the treatment of mild AD. Representing the first AD drug approval in 20 years and based on the concept of targeting amyloid-β (Aβ) as an immunisation treatment for AD, Aducanumab was demonstrated to reduce Aβ plaque formation in animal models and humans. This was used as a proxy of efficacy in AD clinical trials to slow disease progression and reduce cognitive decline in AD. Culminating from the Aβ hypothesis of AD that has dominated the focus of AD drug development since its inception, Aducanumab, for many, represents validation of the hypothesis and promise for the future. This review examines the antibody research, preclinical and clinical studies, that underpin the development of aducanumab as an AD medication. No single drug is generally likely to cure a complex, progressive and heterogeneous degenerative disorder, but it may act as a stepping stone towards greater understanding and potentially more effective treatment options. Time will ultimately tell in the case of aducanumab as to whether it is a small or large step in the correct or incorrect direction to unravel the mystery of this complex disorder and provide a worthwhile treatment.
Ubiquitously Occurring Perfluoroalkyl and Polyfluoroalkyl Substances: An Overview of Food and Environmental Contamination and Implications for Human Health
Perfluoroalkyl and polyfluoroalkyl substances (PFAS), commonly known as ‘forever chemicals’, are synthetic, anthropogenic compounds widely used in food packaging, processing equipment and nonstick surfaces. Their strong carbon–fluorine bonds make them highly persistent in the environment and within living organisms, including humans. This review focuses on the chemical structures of PFAS, their similarity to fatty acids, environmental contamination pathways, their entry into the food chain and water systems, their biological behaviour and their adverse health effects. Our observations suggest that the harmful effects of PFAS pollutants may be even more far-reaching, as they may jeopardise the function of the cardiorespiratory, neurological and reproductive systems in humans. PFAS analogues exhibit exceptionally long biological half-lives in humans with 2.7 to 5.1 years for perfluorooctanoic acid (PFOA), 3.4 to 5.7 years for perfluorooctane sulfonate (PFOS) and 2.8 to 8.5 years for perfluorohexane sulfonate (PFHxS), often persisting in blood and tissues for several years after exposure has ceased. This prolonged retention allows PFAS to accumulate over time, increasing the likelihood of chronic exposure and long-term health consequences even at low environmental concentrations. Evidence-based regulations by food and environmental regulatory agencies, along with projections of the impacts of regulatory intervention, are needed to protect public health.