Medical principles and practice : international journal of the Kuwait University, Health Science Centre最新文献

{"title":"Lactate, Carbohydrate Restriction, and Cancer Metabolism.","authors":"Yunus A Luqmani","doi":"10.1159/mpp/adpag001","DOIUrl":"10.1159/mpp/adpag001","url":null,"abstract":"<p><p>Carbohydrate restriction has been proposed as an adjunctive strategy in cancer, largely because many tumours show high glucose uptake. Clinical evidence for benefit remains limited, mixed, and often overstated. Lactate is now recognised as more than a metabolic by-product: it influences redox balance, tumour-stromal signalling, immune suppression, angiogenesis, epigenetic regulation, and metastatic behaviour. This review considers carbohydrate-restrictive diets from a lactate-centred perspective. The stronger mechanistic argument is not simple glucose deprivation, but the possibility that lower carbohydrate availability may reduce glucose-to-lactate flux and disrupt lactate-dependent tumour ecosystems in selected contexts. It discusses where this idea is biologically plausible, where claims run beyond the data, and how dietary approaches compare with direct lactate-targeted strategies. To ground the clinical discussion, registered interventional trials of caloric and/or carbohydrate manipulation in cancer were reviewed; they show an active but early-stage field dominated by small, heterogeneous studies and few direct lactate-related endpoints. Future trials should use biomarker-guided tumour selection, direct measures of tumour lactate flux, immune and microenvironmental endpoints, and explicit safeguards for weight, muscle mass, treatment tolerance, and quality of life. At present, carbohydrate restriction should remain investigational and be tested only in well-designed clinical studies with clear nutritional safeguards.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Fetuin-A and Lipid-Based Phenotyping as Markers of Cardiometabolic Risk in Subclinical Hypothyroidism.","authors":"Al Anoud N Abdallah, Ola M Al-Sanabra","doi":"10.1159/000553492","DOIUrl":"10.1159/000553492","url":null,"abstract":"<p><strong>Objective: </strong>The aims of the study were to evaluate fetuin-A (FA) as an integrative biomarker for cardiometabolic risk in subclinical hypothyroidism (SCH) and to investigate lipid-based metabolic heterogeneity.</p><p><strong>Subject and methods: </strong>In this cross-sectional study, 192 participants (105 SCH, 87 controls) were evaluated for thyroid function, metabolic parameters, lipid profiles, FA, and high-sensitivity C-reactive protein (hs-CRP). Lipid phenotyping was performed using principal component analysis (PCA) and latent profile analysis (LPA). A composite cardiovascular disease risk index (CVDRI) incorporating FA and the atherogenic index of plasma (AIP) was calculated. Correlation, regression, and receiver operating characteristic (ROC) analysis were conducted.</p><p><strong>Results: </strong>SCH patients exhibited significantly elevated thyroid-stimulating hormone (TSH), insulin resistance, dyslipidemia, hs-CRP, and FA compared to controls (p < 0.0001). FA showed strong correlations with TSH, lipid parameters, insulin resistance, and CVDRI (ρ = 0.60-0.77, p < 0.001). PCA and LPA identified three distinct SCH phenotypes, each showing progressively adverse metabolic and inflammatory profiles. ROC analysis showed excellent discriminatory performance for FA and CVDRI (AUCs >95%), whereas lipid-derived indices distinguished high-risk phenotypes.</p><p><strong>Conclusion: </strong>FA is a promising integrative biomarker linking thyroid dysfunction with cardiometabolic risk in SCH. Lipid-based phenotyping highlights disease heterogeneity and supports the use of composite biomarker strategies for early risk stratification and personalized management.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Pathological Characteristics of Men with Infertility at a Single Center: A Retrospective Descriptive Study.","authors":"Salah Al-Waheeb, Naser Al Azmi, Elizabet Angelaki, Sandro C Esteves","doi":"10.1159/000553475","DOIUrl":"10.1159/000553475","url":null,"abstract":"<p><strong>Objective: </strong>The aims of the study were to describe testicular histopathological patterns in infertile men undergoing microdissection testicular sperm extraction (mTESE) and to examine their relationship with age and clinical presentation.</p><p><strong>Materials and methods: </strong>This retrospective cross-sectional study included 62 infertile men who underwent mTESE at a tertiary care center between July 2019 and August 2025. Clinical presentation, age at biopsy, and histopathological diagnosis were extracted from medical records. Patients were grouped by clinical presentation and by predefined age bands (21-30, 31-35, 36-40, 41-50, and >50 years). Histopathological categories were Sertoli cell-only syndrome (SCO), hypospermatogenesis, late maturation arrest, full maturation, and complete atrophy; one case recorded as tubular atrophy was grouped with complete atrophy for analysis. Associations were assessed using descriptive statistics, chi-square tests, and the Kruskal-Wallis test.</p><p><strong>Results: </strong>Non-obstructive azoospermia was the most common presentation (49/62, 79.0%). SCO was the most frequent histopathological pattern (28/62, 45.2%), followed by hypospermatogenesis (14/62, 22.6%), full maturation (8/62, 12.9%), late maturation arrest (7/62, 11.3%), and complete atrophy/tubular atrophy (5/62, 8.1%). Histopathological distribution differed significantly across age groups (chi-square p = 0.0003), and age differed significantly across histopathological patterns (Kruskal-Wallis, p = 0.0127). SCO predominated in men aged 21-30 years (13/20, 65.0%) and 31-35 years (9/14, 64.3%), whereas complete atrophy/tubular atrophy occurred only in men older than 40 years. Clinical presentation was also associated with histopathological pattern (chi-square p < 0.001).</p><p><strong>Conclusion: </strong>In this single-center cohort, testicular histopathology varied significantly with age and clinical presentation. These findings support age-stratified counseling while emphasizing that the retrospective design and small subgroup sizes limit causal inference.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Psychosocial and Sleep Assessments for Long-Term Cardiovascular Risk Stratification after First Myocardial Infarction in Rural India.","authors":"Mukkirla Bhargava Sai, Bebeto Rai, Debarshi Dey, Sai Kiran Javvaji, V Ramnath Iyer, Naga Sai Visweswar Kambhampati, Sai Sathish Ramamurthy, Gautam Rege, Nisha Haloi, Kalathur Mohan Ganesh, Malleswara D","doi":"10.1159/000553362","DOIUrl":"10.1159/000553362","url":null,"abstract":"<p><strong>Objectives: </strong>The risk of myocardial infarction (MI) evolves beyond the acute phase, and in-hospital tools, such as the Global Registry of Acute Coronary Events (GRACE) score, may not fully capture long-term vulnerability. We evaluated whether simple longitudinal clinical and patient-reported measures improved the prediction of major adverse cardiovascular events (MACEs).</p><p><strong>Subjects and methods: </strong>In this prospective cohort study, 351 patients with first MI were enrolled at a rural tertiary center in South India, of whom 319 formed the analytic cohort. MACE was defined as cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent coronary revascularization, as ascertained through hospital records and structured follow-up. Baseline clinical, biochemical, echocardiographic, and interviewer-administered Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and sleep variables were collected during hospitalization and follow-up (1, 6, and 12 months). Cox models were developed in stages, with the GRACE score as a baseline anchor and follow-up variables incorporated using the last available observations. Model performance was assessed using Harrell's concordance index (C-index), time-dependent area under the curve, and bootstrap validation methods.</p><p><strong>Results: </strong>Over a median follow-up of 5.8 years, 94 patients (29.5%) experienced MACE. The baseline model modestly improved discrimination over GRACE alone (C-index, 0.622 vs. 0.556). The extended model showed higher discrimination (apparent C-index 0.684; optimism corrected 0.660). Follow-up sleep quality, psychosocial symptoms, glycemic measures, and global longitudinal strain contributed to the model, although the estimates were imprecise.</p><p><strong>Conclusion: </strong>Longitudinal follow-up measures provided modest incremental prognostic information beyond a GRACE-based benchmark. Findings are exploratory and require external validation before clinical application.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-14"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148379567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect on Vitamin D Levels and VDR Gene Polymorphism on Clinical Outcomes in Asthma.","authors":"Gülden Deniz Aksu, Nurhan Sarıoğlu, Mustafa Çolak, Ayla Solmaz Avcıkurt, Hikmet Çoban, Adnan Adil Hişmioğulları, Fuat Erel","doi":"10.1159/000553361","DOIUrl":"10.1159/000553361","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between vitamin D receptor gene polymorphism and vitamin D levels with asthma severity, control level, and exacerbation status in asthmatic patients.</p><p><strong>Subjects and methods: </strong>Over a 6-month period, 162 patients diagnosed with asthma and 85 healthy volunteers were prospectively evaluated. Blood samples were analyzed for vitamin D receptor gene polymorphism by PCR and periostin by ELISA.</p><p><strong>Results: </strong>Among the study participants, 163 were females and 84 were males. The median value of vitamin D in the patient group was significantly lower at 13.95 (3.5-33) compared to 17 (6.1-39.9) in the control group (p = 0.003). A significant positive correlation was found between Vitamin D and Asthma Control Test (ACT), eosinophil count, peak expiratory flow (PEF, %) (r: 0.18-0.25, p < 0.05). When VDR gene polymorphism Fok1 and Apa1 alleles in the patient and control groups were examined, they were found to be similar (p > 0.05). However, when VDR gene polymorphism genotypes were analyzed in terms of vitamin D levels, no significant difference was found between Apa1 genotypes (CC, CT, TT). Regression analysis of variables, which are considered to influence vitamin D levels, showed that gender and PEF are independent determinants.</p><p><strong>Conclusions: </strong>In our study, a significant relationship was found between vitamin D levels and asthma severity, asthma control level, and respiratory functions. However, no significant effect of VDR gene polymorphism was detected on the vitamin D levels and asthma.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148379527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proactive Prevention of Postpartum Hypothyroidism: The Critical Role of Community-Based Diet and Micronutrient Supervision.","authors":"Yiyun Xu, Qingzhao Xie","doi":"10.1159/000553308","DOIUrl":"10.1159/000553308","url":null,"abstract":"","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytokine Profiles in Peripheral Blood Mononuclear Cells and Neutrophils following SARS-CoV-2 Vaccination: A Study from Kuwait.","authors":"Mais A Abdulwahab, Sahar Essa, Raj Raghupathy","doi":"10.1159/000553305","DOIUrl":"10.1159/000553305","url":null,"abstract":"<p><strong>Objectives: </strong>This study characterized cytokine profiles in peripheral blood mononuclear cells (PBMC) and neutrophils following SARS-CoV-2 vaccination with Pfizer-BioNTech (mRNA-based) and AstraZeneca (adenoviral vector-based) vaccines in Kuwait.</p><p><strong>Subjects and methods: </strong>The study included 200 adult participants: 100 unvaccinated healthy controls; 18 recipients of two Pfizer-BioNTech doses; 32 recipients of two AstraZeneca doses; and 50 recipients of a third Pfizer-BioNTech dose. Blood samples were collected at 0-2 months and 3-6 months after vaccination, and cytokines were measured in mitogen-stimulated PBMC and neutrophil culture supernatants.</p><p><strong>Results: </strong>Both vaccine platforms induced measurable cytokine responses, but the cytokine patterns differed according to vaccine type, cell population, and time after vaccination. Pfizer-BioNTech vaccination was associated with an early Th2-skewed profile in PBMC, while AstraZeneca vaccination showed broader activation of Th1/Th2/Th17-associated cytokines. IL-6 and IL-10 decreased over time in several comparisons; however, these findings should be interpreted with caution because cytokine concentrations are dynamic and may vary with sampling time, cell type, and stimulation conditions. Overall, vaccine-induced cytokine profiles waned by 3-6 months after primary vaccination, whereas the third Pfizer-BioNTech dose enhanced several PBMC cytokine responses.</p><p><strong>Conclusions: </strong>These findings support the immunomodulatory effects of SARS-CoV-2 vaccines and highlight the value of booster vaccination for sustaining cellular immune responsiveness.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-16"},"PeriodicalIF":2.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Integrating Problem-Based Learning with the BOPPPS Six-Step Methodology in Endocrinology Clinical Instruction.","authors":"Ting Liu, Wanwei Guo, Bo Chen, PengCheng Chen, XiaoDan Xia, Ping Li","doi":"10.1159/000553243","DOIUrl":"10.1159/000553243","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the study were to evaluate the efficacy of the Problem-Based Learning (PBL) with the Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary (BOPPPS) PBL-BOPPPS model compared to conventional instruction in endocrinology clinical education, focusing on academic outcomes and learner satisfaction.</p><p><strong>Methods: </strong>This is a quasi-experimental study and was conducted at the Affiliated Guangdong Second Provincial General Hospital (January 2022-September 2025). A total of 285 students were enrolled (BS Cohort: PBL-BOPPPS, n = 105; TT Cohort: Conventional, n = 180).</p><p><strong>Results: </strong>The BS cohort achieved significantly higher median scores across all evaluation components, including written exam (52 vs. 47.5, p < 0.001) and total score (68 vs. 58, p < 0.001). Student satisfaction was also higher in the BS cohort (median 14 vs. 13, p < 0.001). Granular analysis revealed consistently higher satisfaction across all 10 items, with the largest differences in creativity, clinical thinking, interest, and communication skills. Correlation analyses demonstrated significant positive associations between academic performance and satisfaction (r_s = 0.433, p < 0.001), attendance and exam performance (r_s = 0.7449, p < 0.001), case-based video learning and exam performance (r_s = 0.5125, p < 0.001), and clinical thinking with creativity (r_s = 0.8604, p < 0.001).</p><p><strong>Conclusion: </strong>The PBL-BOPPPS model significantly improved academic performance and student satisfaction compared to conventional instruction in endocrinology clinical education. Its structured, interactive design enhanced both cognitive and affective learning outcomes, supporting its adoption in competency-based medical education.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13489629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Immunosuppressant Drugs in Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.","authors":"Faizah M Alotaibi, Sara M Alrowaydan, Lamia K Alshamlani, Manar A Alomar, Nora S Almutairi, Seham A Khashwayn, Kanan Alshammari, Jaffar A Al-Tawfiq","doi":"10.1159/000553094","DOIUrl":"10.1159/000553094","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to systematically evaluate the impact of immunosuppressant drugs (ISDs) use on clinical outcomes in patients with cancer treated with immune checkpoint inhibitors (ICIs).</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted. Eligible studies reporting overall survival (OS) and/or progression-free survival (PFS), among adult cancer patients receiving ICIs stratified by the use of ISDs.</p><p><strong>Results: </strong>A total of 33 studies with 34,063 patients met the inclusion criteria. Pooled analyses showed significantly worse outcomes among patients receiving ISDs during ICI therapy, with poorer OS (HR = 1.31; 95% CI: 1.10-1.56; p = 0.003) and PFS (HR = 1.39; 95% CI: 1.10-1.76; p = 0.006) compared with those who did not receive ISDs with high heterogeneity of (I2 ∼ 80-85%). In subgroup analysis, patients with non-small-cell lung cancer exhibited significantly reduced OS associated with the use of ISDs.</p><p><strong>Conclusions: </strong>The results suggest an association between ISDs use and reduced OS and PFS in patients with cancer receiving ICI treatment. These findings highlight the need for precision-based immune-related adverse events (irAEs) management strategies that balance toxicity control with preservation of therapeutic benefit.</p>","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-20"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Polarization in Coexisting Rheumatoid Arthritis and Asthma: Insights into Th2 Dominance and Unresolved Confounding.","authors":"Nedim Kaban","doi":"10.1159/000553010","DOIUrl":"10.1159/000553010","url":null,"abstract":"","PeriodicalId":520708,"journal":{"name":"Medical principles and practice : international journal of the Kuwait University, Health Science Centre","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}