Scripta Medica

Evaluation of a Newly Developed LC-MS/MS Vitamin D Assay

2025-11-20T14:20:08+01:00

Background/Aim: Globally, deficiency of vitamin D is highly prevalent. Besides the known consequences of vitamin D deficiency to bone health, there is now strong evidence that links low vitamin D status to an increase in the risk for diabetes, cancer, cardiovascular disease and autoimmune diseases. It is therefore important to have a highly accurate, reproducible and cost-effective test that is highly predictive of vitamin D status and of diagnostic value. This study was undertaken to validate newly developed high throughput LC-MS/MS 25-hydroxy vitamin D (25(OH)D) assay against current gold standard assays measured at two independent reference laboratories.

Methods: The initial study (n = 40) and follow up study (n = 40) recruited healthy adult men and women volunteers (18 to 55 years old). Vitamin D (25(OH)D) was measured using a targeted LC−MS/MS method.

Results: Unexpectedly, data were not consistent with the values for 25(OH)D obtained from the two independent reference laboratories (as evidenced by correlation coefficients and Bland Altman analyses), although the results between the two reference laboratories were in agreement and highly correlated.

Conclusion: These findings highlight the continued efforts and needs for harmonisation of results and standardisation of analytical methods for 25(OH)D for diagnostic accuracy.

BHLHE22 Expression as a Potential Diagnostic and Prognostic Biomarker in Cervical Cancer

2025-10-31T14:01:59+01:00

Background/Aim: Cervical cancer is a prevalent and deadly form of gynaecological malignancy, particularly among developing countries. BHLHE22 is a transcription factor that functions as a transcriptional inhibitor and is significant in cancer-related regulatory mechanisms. In cervical cancer, epigenetic alterations transpire, notably in the BHLHE22 gene, which influences gene and protein expression. The objective of this research was to examine the protein and gene expression of BHLHE22 in tissue from cervix cancer in comparison to those found in normal cervix, to investigate its association with various clinical profiles and prognoses and to assess the association of BHLHE22 gene expression with tumour-infiltrating immune cells.

Methods: This research employed a cross-sectional analytical study and retrospective cohort analyses. The expression of BHLHE22 protein in tissue from cervix cancer and normal cervix was analysed using immunohistochemistry (IHC) examinations. The level of BHLHE22 gene expression, clinical profiles and prognosis were collected from the GTEx and TCGA studies. The association of BHLHE22 expression and tumour-infiltrating immune cells has been investigated using the Pearson correlation test or Spearman’s rank correlation test from the TIMER database.

Results: BHLHE22 protein and mRNA expression in cervical cancer decreased considerably compared to the normal cervix, with protein expression reduced by 1.5-fold and mRNA expression reduced by 3.6-fold, respectively. High levels of BHLHE22 expression were determined to be linked with favourable disease-specific survival. Furthermore, BHLHE22 expression positively correlated with tumour-infiltrating immune cells with antitumour immunity.

Conclusion: BHLHE22 expression as a biomarker for early detection a prognostic biomarker for disease-specific survival and a modulator of the immune microenvironment in cervical cancer might be suggested.

Effects of Heart Cryoextract on Myocardial Antioxidant Capacity in Rats With Adrenaline-Induced Acute Myocardial Dystrophy

2025-11-20T14:22:59+01:00

Background/Aim. In a healthy heart reactive oxygen species (ROS) are by-products of normal metabolism and perform important signalling functions (sometimes referred to as “redox signalling” or oxidative eustress). Aim of this study was to investigate the cardioprotective mechanisms of porcine heart cryoextract, specifically its effect on the regulation of antioxidant defence in cardiomyocytes in an adrenaline‐induced myocardial dystrophy model.

Methods. Eighty‐four male rats were divided into four groups: intact control (I), myocardial dystrophy without treatment (II), dystrophy + cryoextract (III) (50 μg peptides per 100 g body weight daily for 14 days) and dystrophy + amiodarone (IV) (10 mg/kg daily for 14 days). Myocardial dystrophy was induced by subcutaneous injection of 0.18 % adrenaline solution (5 mg/kg). On days 2, 7 and 14, superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx) activities and reduced glutathione (G-SH) content were measured in plasma and cardiac tissue using spectrophotometric and fluorometric assays.

Results. On day 2, myocardial dystrophy caused significant decreases in SOD activity (–69.2 %), catalase (–54.4 %), GPx (–40.1 %) and G-SH content (–46.7 %) compared to intact controls (p < 0.001). Cryoextract treatment promoted early restoration of SOD activity (up to 54.6 %), catalase (up to +30.8 %), GPx (+6.7 %) and G-SH (+37.5 %) by day 2 (p < 0.01). By day 14, the cryoextract group’s enzyme activities and G-SH levels approached those of intact animals and exceeded the effect of amiodarone on GPx and G-SH (p < 0.05).

Conclusions. Porcine heart cryoextract exerts a pronounced cardioprotective effect in an adrenaline‐induced myocardial dystrophy model by restoring the activity of key endogenous antioxidant enzymes and reduced glutathione levels. It surpasses amiodarone in the speed and extent of GPx and G-SH normalisation, supporting its further investigation as a biotherapeutic agent for correcting oxidative stress in cardiomyopathies.

Assessment of Β-Sitosterol in Capsicum Annuum Grossum: A Phytochemical Approach

2025-11-20T14:26:29+01:00

Capsicum annuum Grossum Senise, a widely cultivated sweet pepper in Iraq contains a diverse array of bioactive compounds such as polyphenols, carotenoids and capsinoids, known for their beneficial effects on health. Among these, phytosterols structurally analogous to mammalian cholesterol are essential components of cellular structures of plants, where β-sitosterol predominates among sterol components. These sterols are primarily concentrated in lipid-dense botanical sources like nuts, seeds and legumes, exhibiting a wide range of pharmacological effects in experimental research. These include anxiolytic, pain relief, immune regulation, pathogen inhibition, tumour suppression, inflammation reduction, oxidative stress mitigation, as well as benefits for lipid metabolism, liver health and glucose control. This study focuses on the extraction, isolation, purification and quantitative analysis of β-sitosterol from Iraqi Capsicum annuum Grossum. The chloroform fraction exhibited a high β-sitosterol concentration (0.492 mg/mL dry weight), suggesting efficient biosynthesis of this secondary metabolite, possibly due to favourable biochemical and environmental factors. Advanced chromatographic and spectroscopic techniques were employed to ensure accurate quantification and structural characterisation. The findings underscore the potential of Iraqi-grown Capsicum annuum Grossum as a valuable source of β-sitosterol, supporting its use in nutraceutical and pharmaceutical applications. Further research is warranted to explore its mechanistic pathways and therapeutic efficacy in clinical settings.

The Stromal Derived Factor-1 (SDF-1) Secretion Attracts Stem Cells and Accelerates the Skin Wound Healing Against the Background of Its Closure With Dermal Fibroblasts Associated With Polylactide Film

2025-10-31T14:02:00+01:00

Background/Aim. Chronic skin wounds are a huge clinical problem, leading to the need for prolonged treatment and significant health care expenses. Regenerative engineering using tissue technologies and cellular constructs offers promising alternatives for treatment. The aim of this research was to evaluate the levels of stromal-derived factor-1 (SDF-1) expression and the presence of CD34+ mesenchymal stem cells (MSC) in regenerating skin wounds treated with polylactide films combined with dermal allofibroblasts.

Methods. Forty-seven white mature male mice line C57/B1 were allocated into two groups – control and experimental. In the experimental group, a standard skin wound was created and treated with polylactide films with allofibroblasts. Biopsies were taken at various time points for histological and immunohistochemical analysis of SDF-1 and CD34 expressions. Cellular indices were determined by counting positive cells per 100 cells under a microscope. Statistical analysis was performed using nonparametric tests.

Results. SDF-1 expression peaked on day 7 and then declined, disappearing by day 15, while the number of MSCs followed a similar trend. Delayed and prolonged SDF-1 expression and the presence of MSCs were observed in control wounds. Enhanced epithelialisation and granulation tissue formation were observed in the experimental group, indicating accelerated wound healing.

Conclusion. Transplantation of polylactide films with dermal allofibroblasts promotes early and active secretion of SDF-1, which promotes MSC recruitment and accelerates skin wound regeneration.

Comparison of MMP1 Gene Expression and Collagen Percentage in Response to Polydioxanone, Poly-L-Lactic Acid and Polycaprolactone Thread Implantation in Ageing Rat Skin

2025-10-31T14:02:01+01:00

Background/Aim: Photoageing causes collagen degradation, leading to sagging skin, increased wrinkles and rough surfaces as signs of skin ageing. UV-B radiation increases reactive oxygen species (ROS) production, affecting the mitogen-activated protein kinase (MAPK) pathways, resulting in the expression of the MMP1 gene, which can induce collagen fibre degradation. This study aimed to compare the MMP1 gene expression and collagen percentage in response to polydioxanone (PDO), poly-L-lactic acid (PLLA) and polycaprolactone (PCL) thread implantation in ageing rat skin.

Methods: The study involved female Wistar rats, divided into six groups: young rats without UV-B exposure, old rats without UV-B exposure, ageing model rats exposed to UV-B and ageing model rats implanted with PDO, PLLA and PCL threads. UV-B exposure was given 3 times per week for 4 weeks with a total dose of 840 mJ/cm². Parameters assessed included MMP1 gene expression and skin collagen percentage.

Results: Data analysis showed that the ageing model skin organ had higher MMP1 gene expression (p < 0.05) and lower collagen percentage (p < 0.05) compared to young rats without UV-B exposure. MMP1 gene expression in the three thread implantation groups was equivalent to other groups (p > 0.05). Collagen percentage was equivalent in the three thread treatment groups (p > 0.05), higher (p < 0.05) than an ageing model, but did not differ (p > 0.05) from young rats without UV-B exposure.

Conclusions: The study concludes that the implantation of the three types of threads, PDO, PLLA and PCL, does not reduce MMP1 gene expression but has an equivalent ability to increase collagen percentage in ageing rat models.

Psychological Aspects of Rheumatoid Arthritis: The Role of Depression in Pain Management

2025-10-31T14:02:01+01:00

Background/Aim: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints, leading to stiffness, swelling and persistent pain. Pain in these patients is not only a physical symptom but also a complex experience shaped by biological, psychological and social influences. Depression and anxiety frequently occur alongside the disease, further contributing to greater pain perception, reduced functional ability and diminished quality of life. Aim of this study was to highlight the impact of depression on functional status and pain intensity in female patients with rheumatoid arthritis.

Methods: A descriptive analytical study involving 50 female patients diagnosed with RA according to ACR/EULAR criteria followed patients during inpatient rehabilitation at the Institute for Physical Medicine, Rehabilitation and Orthopaedic Surgery "Dr Miroslav Zotović" was performed. The study examined the relationship between pain (VAS), functionality (HAQ), depression (BDI) and personality disorders (MMPI).

Results: The average age of participants was 63.8 years. The most common comorbidities were hypertension (64 %) and hypothyroidism (30 %). Of the total 50 patients, 23 (46 %) were smokers. The mean VAS pain scale value was 6.59, while the HAQ questionnaire average value was 0.811. Depression was identified in 17 patients (12 mild, 4 moderate and 1 severe depression). Patients with depression had higher pain intensity and poorer function.

Conclusion: Psychosocial factors, including anxiety and depression, are important predictors of functional status and pain in RA. For effective pain management, it is important to identify, through a biopsychosocial approach, all factors that influence subjective pain perception.

Effectiveness of Exercise and Sex Interaction on Adipokines in Obese Rats

2025-10-31T14:02:01+01:00

Background/Aim: Obesity is a low-grade chronic inflammatory state that promotes a pro-inflammatory immune response. Exercise is considered to be able to prevent inflammation in obesity. The main objective was to determine the effect of the interaction between exercise and sex on inflammation and adipokine in obese rats.

Methods: This research is an experiment using a factorial design with a post-test only. The subjects of this study were 30 Sprague Dawley rats. The rats were 4 months old and weighed 120 g. The rats were given a diet high in carbohydrates and fats. The measurement of obese rats used Lee's obesity index. The obese rats were then randomly divided into six groups to be given exercise interventions. The intervention provided consisted of aerobic exercise and anaerobic exercise. The primary outcome is adiponectin, leptin, dipeptidyl peptidase-4 (DPP4), tumour necrosis factor alpha (TNF-α) and adipose tissue hypertrophy.

Results: The study found that increased serum adiponectin levels were influenced by exercise (p < 0.05) and the interaction between exercise and gender (p < 0.05). Decreased serum leptin levels were influenced by gender (p < 0.05) and exercise (p < 0.05). Decreased serum DPP4 levels were influenced by exercise (p < 0.05). Decreased TNF-α expression was influenced by gender (p < 0.05) and the interaction between gender and exercise (p < 0.05). Decreased adipose cell size was influenced by gender (p < 0.05).

Conclusion: This study found that aerobic exercise, anaerobic exercise and the interaction between sex and exercise significantly increased serum adiponectin and decreased TNF-α expression.

Bovine Amnion–Alginate Sponge (BAAS) as A Modern Wound Dressing: Pilot Study of Functional Groups, Basic Fibroblast Growth Factor, and Interleukin-6 Level

2025-11-04T03:43:28+01:00

Background/Aim: Chronic wounds are a significant health burden, impacting millions globally and incurring high healthcare costs. Bovine amnion membrane (BAM) offers anti-inflammatory, antimicrobial properties and bioactive growth factors, making it a promising candidate for wound healing applications. At the same time, alginate enhances the stabilisation and delivery of growth factors. This study aimed to characterise a bovine–amnion–alginate sponge (BAAS) by analysing its functional groups and evaluating the interleukin-6 (IL-6) and basic fibroblast growth factor (bFGF) levels in different ratios.

Methods: A laboratory-based experimental study with a randomized, post-test-only design was conducted. BAAS at ratios of 25 %: 75 %, 50 %: 50 % and 75 %: 25 % were crosslinked with CaCl₂. The Fourier transform infrared spectroscopy (FTIR) was used to assess functional groups and provide insights into the molecular composition of the samples. Meanwhile, the biomolecules of IL-6 and bFGF levels were quantified using enzyme-linked immunosorbent assay (ELISA).

Results: Chemical functional group analysis using FTIR confirmed ionic bonding between Ca²⁺ ions and carboxylate groups, glycosidic stability and enhanced hydrophilicity in BAM-rich formulations. IL-6 levels were , pg/mL, while bFGF levels were for BAM-alginate ratios of 25 %: 75 %, 50 %: 50 % and 75 %: 25 %, respectively. No IL-6 or bFGF was detected in the pure alginate control.

Conclusion: BAAS formulations demonstrate the interplay between functional groups identified in FTIR spectra and cytokine/growth factor modulation observed in ELISA as evidence that its composition can be tailored to address specific phases of wound healing.

Central Retinal Artery Doppler Indices Change in Hypertensive Adults: A Case-Control Study

2025-10-31T14:02:02+01:00

Background/Aim: Hypertension had significant microvascular complication involving the ocular circulation. Colour Doppler imaging (CDI) using various flow indices can be used to assess the blood flow properties of the central retinal artery (CRA) in hypertensive adults. Aim of study was to evaluate the differences in CRA Doppler indices between normotensive and hypertensive individuals.

Methods: This case-control study design was undertaken in the Ultrasound unit at Al-Kindy teaching hospital for 3 months (January 2025 to March 2025), including 60 healthy controls and 60 young hypertensive patients on treatment. For each patient, two sets of data were gathered: demographic data including (age, gender and the body mass index BMI) and measurements of the Doppler indices of the CRA including the pulsatility index (PI), resistive index (RI), flow velocities: peak systolic velocity (PSV), end diastolic velocity (EDV) and arterial diameter (D). Doppler indices were compared and analysed between the cases and controls.

Results: Hypertensive patients show a not significantly decreased PSV and EDV in comparison with the control group (p = 0.122 and 0.05, respectively). However significant increases in RI and PI were detected in hypertensive group (p < 0.001 and 0.003, respectively). The hypertensive patients show a significantly decreased luminal diameter of the CRA in comparison to the control group (p < 0.001). For RI, the AUC was 0.837, 95 % confidence interval (CI) = 0.755 - 0.918, p < 0.001. The sensitivity and specificity of RI at cutoff = 0.635 were 88.3 % and 70 %, respectively.

Conclusion: There is a significant difference in Doppler indices of the CRA in hypertensive patients compared with the non-hypertensive patients. Among them, RI exhibited the highest diagnostic accuracy.

Exploring the Association Between ABO Blood Groups and Blood Glucose Levels in Known Cases of Type 2 Diabetes Mellitus

2025-10-31T14:02:02+01:00

Background/Aim: ABO blood types have long been linked to diverse predispositions to a number of diseases, including diabetes mellitus. Blood group B and type 2 diabetes are significantly positively correlated, while blood group O and DM have a negative correlation, according to several studies. This study focused a step further to evaluate whether blood type affects HbA₁c, postprandial blood glucose (PPBG) and fasting blood glucose (FBG) levels in individuals with type 2 diabetes.

Methods: A cross-sectional study was conducted on 90 patients with type 2 diabetes, aged 18 to 75 years, from the medicine department of RUHS Hospital in Jaipur, in May 2023. Detailed information regarding a number of important study variables, such as blood groups, HbA₁c levels, PPBG and FBG, were gathered through extensive laboratory tests. The gathered information was carefully examined utilising statistical methods in order to derive conclusions.

Results: Chi-square test revealed that blood groups and all blood sugar level variables in type 2 diabetic patients are independent attributes (p > 0.05) and no association exists between them.

Conclusion: The study concludes that type 2 diabetes, once developed, blood groups do not affect the severity and status of the disease, although they may have an initial contribution to susceptibility.

Impact of Maternal Endocrine Health on Foetal Development and Pregnancy Outcomes

2025-11-20T14:32:46+01:00

Maternal endocrine health is an essential predictor of favourable pregnancy outcomes, regulating both foetal development and maternal well-being. Pregnancy relates to significant hormonal changes that promote maternal-foetal connection and foetal growth. Maternal endocrine disturbances, whether caused by pre-existing illnesses or pregnancy-induced problems, can harm both the foetus and the mother. This review delves into the physiology and adaptations of the maternal endocrine system, concentrating on major organs such as the thyroid, pancreas, adrenal glands and placenta. The pathogenesis of gestational diabetes and thyroid dysfunctions and their effects on mother and foetal health. During pregnancy, it impairs foetal neurodevelopment, growth and congenital malformations, often caused by hormonal imbalances and disruptors. Polycystic ovary syndrome (PCOS), though not a gestational disorder, is a major preconception risk factor for infertility, gestational diabetes and adverse perinatal outcomes. These endocrine perturbations collectively contribute to an elevated risk of obstetric complications, including preterm birth, stillbirth and neonatal morbidity. These endocrine perturbations lead to an elevated risk of obstetric complications, including preterm birth, stillbirth and neonatal morbidity. Furthermore, environmental and epigenetic factors are evaluated in mother-foetus health due to their potential transgenerational consequences. Future research directions include combining personalized medicine, omics technologies and artificial intelligence to improve maternal-foetal outcomes. Improved diagnosis accuracy, treatment efficacy and preventative care will also contribute to the achievement of numerous Sustainable Development Goals, such as improving health and well-being, eliminating health-care disparities and supporting maternal-foetal health innovation. This study highlights the critical need to increase global efforts to promote maternal-foetal endocrine research and treatment.

The Therapeutic and Nutritive Potential of the Edible Fixed Oils

2025-11-17T10:56:43+01:00

Edible oils have been extensively consumed foods derived from different vegetables and animal parts. Approximately 96 % composed of triacyl glycerides, consisting of a variety of fatty acids, phospholipids, phytosterols, tocopherols, antioxidants and waxes. It accounted for a large portion of Indian household food expenditure and long been known for their medicinal and nutritional benefits. Data on therapeutic activity of edible oil were collected and compiled from scientific databases like Google Scholar and PubMed. This review intended to include the healthcare benefits as well as the nutritional value of the oils. It provided an overview of the therapeutic value of the edible oils including anti-ageing, antioxidant, anti-inflammatory and anti-cancer properties. Additionally, edible oils might help mitigating the risk of heart disease, reduced formation of kidney stones and lower bad cholesterol levels. It examined a variety of oils such as soybean, sesame, sunflower, olive, palm, flax seed, corn and coconut oil. Furthermore, it indicated that edible oils provide humans with a significant quantity of phytochemicals, vitamin E and fatty acids which are necessary for good health. It could be stipulated that edible oils provide both energy and nutrients for growth and metabolism as well as being used for numerous therapeutic and food applications.

Literature Review: Personalised Medicine Tools for Antidepressant Management

2025-10-31T14:02:04+01:00

Antidepressants are widely used in clinical practice, including for conditions beyond major depression (MD) disorders. However, clinicians still lack reliable tools to match patients with the right drug. Many individuals either fail to respond to the first prescribed agent or discontinue treatment due to side effects. This review focuses on two promising solutions: therapeutic drug monitoring (TDM) and pharmacogenetic testing. TDM measures the actual drug concentration in blood, rather than the prescribed dose. It's important to keep in mind that some individuals exhibit rapid or slow drug metabolism, leading to side effects or no effect at all. For example, for antidepressants like escitalopram, venlafaxine and paroxetine, blood levels often explain treatment response better than dose alone. Pharmacogenetics adds another layer, showing how genetic differences, especially in CYP2C19 and CYP2D6 – can change how drugs are processed. Other gene variants, like those in ABCB1 or SLC6A4, affect how well the drug gets into the brain or how patients tolerate it. Taken together, TDM and pharmacogenetics shift antidepressant prescribing from guesswork to evidence-based decision-making. By measuring drug levels and accounting for genetic variability, clinicians can better match each patient with the right treatment: earlier and with greater confidence. This approach improves efficacy, minimises adverse effects and reduces unnecessary switching or prolonged suffering. As prescribing expands, often beyond psychiatric indications and into long-term use without follow-up – the need for precision grows. What was once an aspirational model of care is becoming a clinical streamline in modern pharmacology.

Emerging Trends in Pharmacological Strategies for Targeting Neuroinflammation in Depression

2025-10-31T14:02:04+01:00

The article discusses evolving pharmacological strategies for addressing the neuroinflammation in depression, highlighting its role in major depressive disorder. Neuroinflammation is linked to neurotransmitter imbalances, hypothalamic-pituitary- adrenal axis dysregulation and impaired neurogenesis. Key treatments explored include anti-inflammatory agents such as N-acetylcysteine, toll-like receptor (TLR) inhibitors and cytokine blockers like anti-interleukin-6 and tumour necrosis factor alpha (TNF-α) agents. Glutamate modulation, antioxidants and omega-3 fatty acids are also examined for their therapeutic efficacy. The article emphasises the need for combination therapies and novel approaches like ketamine and microbiome-targeted treatments to combat inflammation-related depression. Despite significant progress, further research is needed to fully understand the mechanisms and optimise therapeutic strategies.

Advances in Genetic Research in Systemic Lupus Erythematosus: Trend Analysis, Global Collaborations and Bibliometric Perspectives

2025-11-06T17:29:38+01:00

Systemic lupus erythematosus (SLE) is a complex autoimmune disease affecting multiple organs and systems in the body. SLE manifestations result from lymphopenia, thrombotic thrombocytopenic purpura, thrombocytopaenia, autoimmune haemolytic anaemia, myelofibrosis and leucopoenia. SLE triggers the activation of both innate and adaptive immune responses. This process is initiated by T cells activating autoreactive B cells, leading to the accumulation of immune complexes in tissues. Consequently, an autoimmune cascade occurs, which can either affect a single organ or cause widespread systemic complications. Bibliometric analysis used Vosviewer 1.6.16 and the Biblioshiny R tool to create and display bibliometric maps by obtaining relevant journals related to SLE through the SciVerse Scopus database from 1981 to 2025. The results obtained in the form of journal document types using English with keywords in the form of SLE which shows globally. The United States is the country that produces the most research related to SLE genomics and the highest publication collaboration along with contributing citations at the global first level. Lupus was the journal source that discusses the most genomic studies in SLE disease and Anhui Medical University was the most data affiliation of 131 documents. The increasing number of publications on genomics in SLE from 1981 to 2025 indicates a growing interest in researching and writing about this topic. This trend reflects the evolving understanding of SLE's genetic underpinnings and the potential for advancements in diagnosis, treatment and precision medicine.

A Sociocultural Analysis of Stigma and Humour in Psychiatry

2025-11-01T13:57:17+01:00

In psychology and psychiatry, humour has long been used as a therapeutic tool, a coping strategy and a technique for societal criticism. Although laughter is considered a sign of health, it is paradoxically often used in the context of mental illness, creating space for both healing and stigma. This paper explores a sociocultural and psychoanalytic analysis of humour directed at psychiatrists. Examines how it may be a stigmatising factor as well as a therapeutic ally. The main contribution lies in articulating how humour functions as a projective tool, a defence mechanism and a cultural critique. It highlights the prejudices, often overlooked fears and biases society has about mental illness and psychiatry. The analysis demonstrates that humour is not insignificant in the field of psychiatry. On the contrary, it is essential for understanding social representations of mental health, the patient-doctor dynamic and the emotional landscape of stigma. The paper concludes by suggesting directions for future empirical research. Both qualitative and quantitative research should explore how different humour styles - adaptive or maladaptive impact therapy, reduce stigma and build resilience in both patients and clinicians.

Non-Pharmacological Interventions for Reducing Fear of Childbirth

2025-10-31T14:02:05+01:00

Fear of childbirth (FOC) is a common psychological condition during pregnancy and can negatively impact maternal and foetal health. Non-pharmacological interventions stand out in the literature as safe and effective strategies for reducing FOC. This review comprehensively examines the effects of methods such as antenatal education programs, cognitive-behavioural therapy, mindfulness-based approaches, yoga and breathing techniques, hypnobirthing and midwife-led continuity models on FOC. The literature search was conducted using studies published in English between 2000 and 2025 in PubMed, Scopus and Web of Science databases. Findings indicate that these non-pharmacological approaches increase pregnant women's knowledge of the birth process, reduce anxiety and fear and strengthen perceived control during labour. Social support elements such as midwife-led continuity models and partner participation stand out as important factors that increase the effectiveness of interventions. Heterogeneity in the literature regarding the duration, frequency and delivery methods of interventions limits the generalisability of the results. In conclusion, nonpharmacological interventions are effective and feasible methods for the management of FOC; their integration into routine pregnancy care will improve women's birth experiences and support maternal and child health.

Unravelling a Rare Conundrum: Enigmatic Cyst Over a Clubfoot

2025-10-31T14:02:05+01:00

Acral skin has been found to have a different aetiology for epidermal cysts, also referred to as epidermal inclusion cysts, epidermoid cysts and infundibular cysts, then non-acral skin. They primarily affect hairy areas such as the face, scalp, neck and trunk. On the palms and soles, where there are no hair follicles, epidermal cysts sporadically develop. According to a number of publications, the development of epidermal cysts on acral skin differs from that on non-acral skin. Most of the epidermal cysts on the sole had parakeratosis and a localised absence of granular layer, at least on the upper part of the cyst wall, when examined under a microscope. Compact orthokeratotic material made up the majority of the cyst content of the sole's epidermal cysts. The pathophysiology of solitary epidermal cysts, specifically invagination of surface epidermis, may account for these pathological features. According to presented research, the lone epidermal cyst is regarded as a genuine traumatic epidermal inclusion cyst. On the palms and soles, epidermal cysts might be mistaken for calluses or warts. Inappropriate treatment may result from this misdiagnosis.

Bipolar Dislocation of the First Metatarsal with Associated Lisfranc Injury: A Case Report and Literature Review

2025-10-31T14:02:06+01:00

Bipolar dislocation of the first metatarsal ("floating first metatarsal") is an exceptionally rare injury resulting from high-energy trauma, characterised by simultaneous dislocation at both the tarsometatarsal (Lisfranc) and metatarsophalangeal (MTP) joints. Despite the well-documented nature of Lisfranc injuries, isolated bipolar dislocations remain extraordinarily rare, with fewer than 25 cases reported in the literature. This study presents a case of bipolar dislocation with an associated Lisfranc fracture-dislocation, highlighting diagnostic challenges, surgical management and functional outcomes. A 32-year-old woman presented after a fall from a height with a severe deformation of the forefoot and complete functional impairment. Imaging revealed: a bipolar dislocation of the first metatarsal (Lisfranc and MTP joints), a Lisfranc fracture-dislocation type B2 according to Myerson, A spiral fracture of the second metatarsal Emergency surgical treatment included: open reduction via dorsal approach; double pin fixation (M1-M2 and M2-cuneiform); ligament repair. The postoperative protocol included 6 weeks of immobilisation without weight bearing followed by progressive rehabilitation. At 12-month follow-up: AOFAS score improved from 0 to 86/100; MTP range of motion: 45° dorsiflexion (20° plantarflexion); radiographic consolidation with preserved alignment; no instability or arthritic changes observed. This case demonstrates that anatomic reduction with dual pinning fixation yields excellent functional outcomes for this rare injury pattern. Early diagnosis (aided by the identified "double discontinuity" radiological sign) and strict adherence to postoperative protocols are critical for optimal recovery. Long-term surveillance remains essential to monitor for post-traumatic sequelae.