Background: Levothyroxine (LT4) therapy is highly effective for biochemical correction of hypothyroidism, yet many patients report persistent symptoms and reduced health-related quality of life (HRQoL) despite achieving target thyroid-stimulating hormone (TSH) levels. Whether alternative management strategies meaningfully improve HRQoL remains clinically important. Aim: To systematically review and qualitatively synthesize evidence on the relationship between hypothyroidism management approaches and patient quality of life. Methods: A systematic review was performed following PRISMA principles. Eligible studies were primary clinical studies evaluating adults with hypothyroidism or subclinical hypothyroidism in which HRQoL was measured and related to a management approach, treatment strategy, formulation, or biochemical response. Nine studies met eligibility and were synthesized qualitatively due to heterogeneity in populations, interventions, comparators, and HRQoL instruments. Results: Evidence from large randomized trials in older adults with subclinical hypothyroidism showed no clinically meaningful HRQoL benefit from LT4 compared with placebo or usual care. In primary hypothyroidism, switching from LT4 tablets to liquid LT4 was consistently associated with improved patient-reported QoL in selected cohorts, often without major changes in thyroid biochemistry. Trials of LT4/LT3 combination therapy generally did not demonstrate consistent HRQoL superiority over LT4 alone, although some studies reported patient preference or selective domain improvements. Observational studies and surveys repeatedly documented impaired HRQoL among LT4-treated patients compared with controls, and HRQoL was frequently weakly correlated or not correlated with TSH/FT4 within the reference range. Conclusion: Quality of life in treated hypothyroidism is influenced by more than biochemical normalization alone. LT4 treatment in older adults with subclinical hypothyroidism does not appear to improve HRQoL, while liquid LT4 may improve HRQoL in selected, dissatisfied, or absorption-challenged patients. Combination therapy remains an inconsistent strategy for HRQoL improvement. Future research should prioritize patient-centered outcomes, identify phenotypes of persistent symptoms, and test targeted management pathways using validated thyroid-specific HRQoL instruments.

Bulbar ulcer bleeding remains a frequent cause of upper gastrointestinal hemorrhage, although its incidence has decreased with the use of proton pump inhibitors and the eradication of Helicobacter pylori. The aim of this study was to evaluate the correlation between bulbar ulcer topography and clinical severity. This was a prospective analytical study conducted over a 28-month period, from April 2020 to August 2022, including patients admitted on an emergency basis for upper gastrointestinal bleeding secondary to a bulbar ulcer. The use of non-steroidal anti-inflammatory drugs and tobacco consumption were the main identified risk factors. A marked male predominance was observed, and anterior localization of the bulbar ulcer was significantly associated with an increased risk of hemodynamic instability.

This quasi-experimental pre–post interventional study evaluated the effect of a structured health education program on patients’ knowledge and practice related to warfarin therapy in River Nile State, Sudan, during 2024–2025. Adult outpatients receiving warfarin for at least one month were enrolled using consecutive sampling and assessed before and after the intervention. A total of 150 participants completed both assessments. Data were collected using a structured interviewer-administered questionnaire covering key knowledge domains (indications, adherence, drug and food interactions, adverse effects, missed-dose management, and monitoring requirements) and self-reported practice behaviors. The intervention consisted of standardized face-to-face educational sessions supported by printed materials. Changes in knowledge and practice scores were analyzed using appropriate paired statistical tests. At baseline, most participants demonstrated poor warfarin-related knowledge despite high self- reported adherence. Following the educational intervention, there was a marked improvement across nearly all knowledge domains, with the mean knowledge score more than doubling and the majority of participants transitioning to a good knowledge category. Improvements were particularly notable in awareness of drug and food interactions, recognition of warning signs, and appropriate management of missed doses. Self-reported adherence remained high before and after the intervention, suggesting a ceiling effect. Overall, the study demonstrates that a brief, structured educational intervention is a feasible and effective approach to substantially improving warfarin-related knowledge in a low-resource outpatient setting, highlighting the importance of integrating patient education into routine anticoagulation care to enhance medication safety.

Background: Dermatoglyphics, the study of unique, immutable epidermal ridge patterns, emerges from the same embryological ectoderm as the nervous system during early gestation. This shared origin posits it as a potential phenotypic marker for neurodevelopmental anomalies like autism spectrum disorder (ASD). Most studies are from Western populations, with a paucity of gender-stratified data from South Asia. Objectives: This study aimed to conduct a gender-wise comparative analysis of digital dermatoglyphic patterns between autistic and neurotypical children in Northern Bangladesh, to identify potential pattern deviations associated with ASD. Methods: This cross-sectional analytical study enrolled 100 Bangladeshi children aged 5–15 years: 50 diagnosed with ASD (38 male, 12 female) and 50 age-matched neurotypical controls (26 male, 24 female). Bilateral fingerprints were acquired using a ZKT ECO biometric scanner and classified into Arch (A), Ulnar Loop (UL), Radial Loop (RL), and Whorl (W) patterns using DigiDoctors software (v1.0.1). Statistical analysis was performed using SPSS v23.0, employing Chi-square and Fisher’s exact tests where appropriate. A p-value <0.05 was considered significant. Results: Significant inter-group differences were observed (p<0.001). The autistic group exhibited a higher frequency of: Arch (12.6% vs. 4.4%; OR=3.15, 95% CI: 1.89-5.25), Whorl (36.4% vs. 32.4%), and Radial Loop (3.6% vs. 1.2%). Ulnar Loops were significantly lower in the autistic group (47.4% vs. 61.6%). Gender-stratified analysis revealed autistic males had significantly higher frequencies of Arch, Whorl, and Radial Loop compared to neurotypical males. Autistic females showed a pronounced increase in Arch pattern (16.67% vs. 2.92%; p<0.001) but lower frequencies of Whorl and Radial Loop. Radial Loops were absent in autistic females. Conclusion: This study provides the first gender-stratified dermatoglyphic profile of autistic children in Bangladesh, revealing distinct pattern deviations that differ between males and females. The findings support the hypothesis of altered ectodermal development in ASD and suggest dermatoglyphics could serve as a low-cost, non-invasive adjunctive tool in multidisciplinary ASD assessment, particularly in resource-limited settings. Further large-scale, familial, and genetic correlational studies are warranted.