Faculdade de Medicina de São José do Rio Preto

Resumo As mulheres portadoras de doença renal crônica apresentam menor probabilidade de engravidar e são mais propensas a complicações gestacionais quando comparadas a pacientes com função renal normal, sendo, portanto, consideradas gestantes de alto risco materno e fetal. Ao longo dos anos, verificou-se aumento da incidência de gestações em pacientes em diálise e melhora do desfecho materno e fetal. Acredita-se que a otimização do atendimento obstétrico e neonatal, o ajuste do tratamento dialítico (em especial, o aumento do número de horas e da frequência semanal das sessões de diálise) e o uso de agentes estimuladores da eritropoiese têm proporcionado melhor controle metabólico, volêmico, pressórico, eletrolítico e da anemia. Este artigo de revisão tem o objetivo de analisar os desfechos gestacionais em pacientes com doença renal crônica em diálise e revisar a condução médica nefrológica nesse cenário. Pelo crescente interesse pelo tema, as recomendações clínicas para a prática assistencial têm ganhado em consistência tanto no manejo medicamentoso quanto no manuseio dialítico, aspectos que tratamos na presente revisão.

Agricultural activities that alter natural habitats are among the main causes of the current decline in anuran species. In recent decades, the global expansion of sugarcane cultivation has raised concerns about its environmental consequences. In these areas, water bodies that anurans use as breeding sites face chemical contamination and changes to the surrounding landscape due to human activities. In this study, we evaluate the species richness of anurans in a region of the Brazilian Cerrado savanna dominated by sugarcane production, and we identify how environmental variables influence species occurrence patterns. We recorded a total of 31 species in the study area. Dendropsophus nanus preferred larger water bodies with greater depth and more vegetation along the edges. Scinax fuscovarius, Scinax fuscomarginatus, and Boana albopunctata were associated with sites that had higher pH levels. S. fuscomarginatus, B. albopunctata, Physalaemus nattereri, and Boana raniceps tended to occur in areas with a higher percentage of natural vegetation and higher temperatures. Additionally, Dendropsophus minutus and Physalamus cuvieri were more abundant in water bodies with internal vegetation and higher nitrogen levels, while Leptodactylus fuscus was associated with areas with more dissolved oxygen and phosphorus. Our findings highlight the complexity of anuran species’ responses to anthropogenic impacts and underscore the need for systematic monitoring of water bodies near farmland, especially around crops like sugarcane.

Objectives: In recent years, there has been an increase in suicide rates in Brazil. From 2015 to 2019 we had a 34% increase in self-inflicted deaths. Are there some subgroups at greater risk of suicide, such as the old people with Alzheimer’s disease? Methods: The data were obtained by consulting the systems of the Brazilian Institute of Geography and Statistics (IBGE) of the Brazilian Ministry of Health (DataSUS). Population data were measured and compared in the years 2010 and 2022, using the last two censuses. Results: Between 2010 and 2022, the number of registered deaths of patients with Alzheimer’s increased by 21.93%. Similarly, there was a 100.37% increase in suicides among the elderly population in the same period, compared to a 37.78% increase in the general population. Conclusions: It is not possible to conclude that the increase in suicide among the elderly is directly linked to Alzheimer’s disease. However, further studies are needed to determine if there is a correlation.

Objectives: The increase in suicidal behavior in patients treated with promising new drugs for Alzheimer’s disease is a dilemma that deserves to be understood. The correlations between suicide and neurodegenerative disorders have been debated for decades in the context of ethics, considering that many people with cognitive decline have opted for euthanasia. The academic community is invited to pay greater attention to issues other than ethics that can improve the quality of life of people with dementia. Methods: We sought to read the review articles on Pubmed on the topic over the last two decades to identify possible factors that are correlating suicide with Alzheimer’s Disease. The data were grouped and presented to demonstrate possible studies that should be carried out to clarify the topic better. Results: Depression and the presence of the E4 allele of Apolipoprotein E were the main correlation factors between Alzheimer’s disease and suicide. Conclusions: Targeted studies are needed to understand better the occurrence of depression in Alzheimer’s disease, as well as the role of the E4 allele in mood disorders and suicidal behavior.

Objectives Total knee arthroplasty (TKA) is the treatment of choice for severe knee osteoarthritis. While many studies compare mobile- and fixed-bearing designs, data on patellar position between these systems remains insufficient. This study aimed to measure and compare patellar position in mobile- and fixed-bearing TKA systems. Methods This prospective randomized study assessed 160 TKA patients, with 79 receiving a mobile-bearing tibial insert and 81 receiving a fixed-bearing system, between 2007 and 2009. The mean ages were 72 and 70 years, with a mean follow-up of 7.4 years (range 5-11 years). Both groups were comparable pre- and post-operatively using the International Knee Society (IKS) score. Patellar tilt and translation were measured using the technique described by Gomes et al. Results There were no significant differences between the two groups in the Knee Society knee scores (94 vs 92; p=0.45), pain score (45.8 vs 45.8; p=0.97), function scores (83.2 vs 83.9; p=0.78), or maximum knee flexion (116 vs 112; p=0.07) at the 7-year follow-up. Patellar translation and tilt were also not statistically different between the mobile-bearing and fixed-bearing TKAs. However, a significant difference was found in the subgroup with patellar translation greater than 5mm (OR=2.3; p=0.048) in favor of the mobile-bearing design, although this had no impact on clinical outcomes. Conclusion No advantages were found for mobile-bearing TKA regarding pain, function, maximum knee flexion, or radiographic outcomes, such as patellar tilt or translation. Longer-term follow-up is required to determine any potential benefits of mobile-bearing over fixed-bearing TKA.

Background Liver diseases often occur with hepatic encephalopathy (HE), whose pathophysiology may involve increased intracranial pressure (ICP). Tools for monitoring ICP and its pulse morphology can be useful for assessing HE. The use of a non-invasive and sensitive procedure would be extremely useful in managing these cases. Objective To evaluate the feasibility and performance of a new, non-invasive method of monitoring ICP, as an alternative to invasive methods, and to correlate the clinical diagnosis of HE with the morphological findings of ICP. Methods This is a cross-sectional analytical study, conducted in a tertiary hospital and pioneer in the application of Brain4Care® BWS equipment. The ICP pulse morphology is parallel to the arterial one, where there are three frequent peaks: percussion peak (P1), due to plasma extravasated by the choroid plexus; tidal wave (P2), due to the degree of intracranial compliance to the reflection of P1, and dicrotic notch (P3), due to the closure of the aortic valve. Normality indicates P1>P2>P3. These peaks determine intracranial compliance through their relationship with cerebral blood volume, where P2/P1 ratio >1 suggests a pathological morphology, with a sustained increase in ICP and decreased compliance. Another way to evaluate this would be by a change in the time-to-peak (TTP). These data were compared between patients with and without clinical signs indicative of HE. The study was approved by the Institution’s Research Ethics Committee (number 5.493.775). Results A total of 40 liver disease patients were evaluated, of which, at the time of collection, 20 did not have a clinical picture of HE (59.5±9.3 years; 70.0% male) and 20 had a clinical picture of HE (59.6±11.9 years; 65.0% male). The groups are demographically, clinically and laboratory similar; and statistically significant differences were identified in the morphological patterns of ICP between the groups evaluated, as well as trends in the parameters. The difference in the P2/P1 ratio was not significant (Mann Whitney: two-tailed P=0.2978); however, TTP proved to be a parameter with a statistically significant difference between the groups (Mann Whitney: two-tailed P=0.0282; median difference = 0.04). Analysis using the C statistic, using the ROC curve, suggested P2/P1=1.31 (AUROC: 0.5975) and TTP=0.22 (AUROC: 0.7013) as optimal cutoff points, where the presence of HE in liver disease patients would be associated with obtaining parameters below these thresholds. Conclusion The brain4care® BWS system proved to be feasible for use in liver disease patients with or without clinical signs of hepatic encephalopathy and was able to differentiate them. Pathophysiological explanations, however, still require better causality explanation and understanding of the intracerebral hydrodynamic picture in hepatic encephalopathy. Given the low sample power found, new studies need better clinical heterogeneity and longer-term follow-up for definitive conclusions. Keywords: Hepatic encephalopathy; intracranial pressure; liver diseases; brain4care

Background/Objectives: Patient safety is a critical component of healthcare quality, yet there remains a significant gap in understanding how patient safety knowledge progresses among nursing students throughout their educational journey. This scoping review aims to map and analyze the existing literature on the development of patient safety knowledge in undergraduate nursing education. Methods: This study will follow the Joanna Briggs Institute methodology for scoping reviews and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Scoping Reviews) guidelines. A comprehensive search strategy will be employed across multiple databases, including CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Education Resources Information Center), PubMed, Embase, SCOPUS, and Web of Science. The review will include studies published from 2019 to 2024 in English, Portuguese, and Spanish. Two independent reviewers will conduct study selection and data extraction. The data will be synthesized narratively, with quantitative data summarized using descriptive statistics and qualitative data analyzed thematically. Results: The review is expected to identify key patterns in the progression of patient safety knowledge among nursing students, including critical periods for knowledge acquisition, challenges in translating theoretical knowledge into practice, and effective educational strategies. The findings will be presented in both tabular and narrative forms, providing a comprehensive overview of the current state of patient safety education in nursing programs. Conclusions: The anticipated outcomes of this review have significant implications for nursing education, healthcare policy, and clinical practice. For educators, the findings will inform curriculum development and the design of targeted interventions to enhance patient safety competencies. From a policy perspective, the results could support the standardization of patient safety education across nursing programs. In clinical practice, the study may emphasize the importance of continuous professional development in patient safety. This scoping review aims to fill a critical gap in the literature by providing a comprehensive understanding of how patient safety knowledge progresses among nursing students. The findings are expected to contribute significantly to the advancement of nursing education and patient safety, ultimately fostering a culture of safety that benefits both healthcare providers and recipients.

Objective To analyze the sociodemographic and occupational influences on health professionals’ quality of life. Method This descriptive-exploratory, cross-sectional, analytical, and quantitative study addressed 94 health workers, including nursing technicians, nurses, and physical therapists working in Intensive Care Units in a town in the extreme south of Brazil in 2023. The student’s t-test and Spearman correlation were used. Results A significant positive correlation was found between being a woman and the psychological domain and between income and the social and environmental domain while working hours were inversely related to general QoL. Additionally, workload negatively impacted the physical, psychological, and general QOL, furniture negatively influenced the psychological domain, and equipment was negatively associated with the physical and psychological domain. Conclusion The characteristics of the work environment interfere with several areas of quality of life. Descriptors: Quality of Life; Health Personnel; Intensive Care Units; Working Conditions; Work.

Objective To analyze the sociodemographic and occupational influences on health professionals’ quality of life. Method This descriptive-exploratory, cross-sectional, analytical, and quantitative study addressed 94 health workers, including nursing technicians, nurses, and physical therapists working in Intensive Care Units in a town in the extreme south of Brazil in 2023. The student’s t-test and Spearman correlation were used. Results A significant positive correlation was found between being a woman and the psychological domain and between income and the social and environmental domain while working hours were inversely related to general QoL. Additionally, workload negatively impacted the physical, psychological, and general QOL, furniture negatively influenced the psychological domain, and equipment was negatively associated with the physical and psychological domain. Conclusion The characteristics of the work environment interfere with several areas of quality of life. Descriptors: Quality of Life; Health Personnel; Intensive Care Units; Working Conditions; Work.

PURPOSE Mounting data suggest that lower doses of anti-PD(L)1 agents can be as efficacious as label-approved doses at a fraction of its cost. We compare the outcomes of patients treated with low-dose (LD) and with conventional-dose (CD) anti-PD(L)1 agents. METHODS This observational study evaluates the outcomes of patients with solid malignancies treated with anti-PD(L)1 agents (LD or CD) at Hospital de Base, Brazil. Patients were classified as receiving LD if the dose administered in the first cycle was below the label-approved dose. Efficacy outcomes, including best clinical overall response rate (cORR), clinical progression-free survival (cPFS), and overall survival (OS), were evaluated. RESULTS From January 2020 to May 2023, 71 patients were included: 49 (69%) with LD and 22 (31%) with CD agents. The most frequent tumor sites were the lung (41% LD, 22.9% CD) and skin (melanoma; 24.6% LD, 50% CD). Most of the patients were treated with pembrolizumab (65% LD and 72% CD). The mean dose of pembrolizumab was 95.3 mg (1.5 mg/kg) in LD and 168.7 mg (2.12 mg/kg) in CD groups, once a day, q21d (every 21 days). After a median follow-up of 10.9 months, there were no significant differences between LD versus CD in cORR (38.1% v 35.2%, P = .31), cPFS (5.3 m v 7 m, P = .36), and OS (12.8 m v not reached, P = .17). A subgroup analysis with patients receiving pembrolizumab was performed, and similar results were obtained. CONCLUSION Our study found no differences in cORR, cPFS, and OS between patients treated with LD and CD anti-PD(L)1. LD anti-PD(L)1 could be an alternative to promote accessibility, which warrants further investigation in randomized trials.

Purpose. To report a rare case of Rosai-Dorfman-Destombes (RDD) disease in a teenage girl exhibiting mild fever, night chills, vertigo, and progressive bilateral vision and hearing loss. Method. Case report of a 15-year-old girl who underwent extensive ophthalmic multimodal imaging and a comprehensive workup evaluation. Results. Multiple choroid lesion masses in both eyes associated with systemic multifocal lymphadenopathy, involvement of the paranasal sinuses, and unusual intracranial manifestations well-shown by magnetic resonance imaging (MRI) and whole-body PET-scan. The PET-Scan and MRI imaging showed dural-based intracranial lesions, choroid-plexus signaling, and meningeal spread, as well as a focus on the paranasal sinuses, which helped determine the best biopsy location for a definitive diagnosis through immunohistochemistry. Conclusions. Here we describe a rare condition of RDD disease with bilateral visual and hearing loss associated with bilateral multiple choroid masses and neurological symptoms in an adolescent female patient. A definitive diagnosis relied on histological assessment, emphasizing the importance of interdisciplinary evaluation. RDD should be considered in the differential diagnosis of choroidal metastasis, tuberculosis, and other lymphoproliferative diseases.

Background Heat stress has deleterious effects on physiological and performance traits in livestock. Within this context, using tropically adapted cattle breeds in pure herds or terminal crossbreeding schemes to explore heterosis is attractive for increasing animal production in warmer climate regions. This study aimed to identify biological processes, pathways, and potential biomarkers related to thermotolerance in Caracu, a tropically adapted beef cattle breed, by proteomic analysis of blood plasma. To achieve this goal, 61 bulls had their thermotolerance evaluated through a heat tolerance index. A subset of 14 extreme animals, including the seven most thermotolerant (HIGH group) and the seven least thermotolerant (LOW group), had their blood plasma samples used for proteomic analysis by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). The differentially regulated proteins detected between HIGH and LOW groups were used to perform functional enrichment analysis and a protein-protein interaction network analysis. Results A total of 217 proteins were detected only in the HIGH thermotolerant group and 51 only in the LOW thermotolerant group. In addition, 81 and 87 proteins had significantly higher and lower abundancies in the HIGH group, respectively. Regarding proteins with the highest absolute log-fold change values, we highlighted those encoded by DUSP5, IGFALS, ROCK2, RTN4, IRAG1, and NNT genes based on their functions. The functional enrichment analysis detected several biological processes, molecular functions, and pathways related to cellular responses to stress, immune system, complement system, and hemostasis in both HIGH and LOW groups, in addition to terms and pathways related to lipids and calcium only in the HIGH group. Protein-protein interaction (PPI) network revealed as important nodes many proteins with roles in response to stress, hemostasis, immune system, inflammation, and homeostasis. Additionally, proteins with high absolute log-fold change values and proteins detected as essential nodes by PPI analysis highlighted herein are potential biomarkers for thermotolerance, such as ADRA1A, APOA1, APOB, APOC3, C4BPA, CAT, CFB, CFH, CLU, CXADR, DNAJB1, DNAJC13, DUSP5, FGA, FGB, FGG, HBA, HBB, HP, HSPD1, IGFALS, IRAG1, KNG1, NNT, OSGIN1, PROC, PROS1, ROCK2, RTN4, RYR1, TGFB2, VLDLR, VTN, and VWF. Conclusions Identifying potential biomarkers, molecular mechanisms and pathways that act in response to heat stress in tropically adapted beef cattle contributes to developing strategies to improve performance and welfare traits in livestock under tropical climates.

Purpose: Malignant ureteral obstruction is generally associated with a poor disease prognosis; therefore, managing these cases is challenging. We describe our experience in treating malignant ureteral obstruction with urinary diversion and the impact of these procedures on the indication for new antineoplastic therapy and survival. Materials and Methods: We retrospectively reviewed the data of patients with advanced cancer associated with malignant ureteral obstruction who underwent urinary diversion at three tertiary institutions between January 2013 and July 2022. Results: This study included 420 patients (mean age, 58.7 years (range, 18–90 years) with a mean follow-up of 20.3 months. Cervical (36.2%) and bladder cancers (18.6%) were the most prevalent primary neo-plastic sites. The mean creatinine values measured before diversion, 30 days after surgery, and most recently were 3.45, 1.84, and 2.59 mg/dL, respectively. In total, 300 patients (71.4%) received antineoplastic treatment, 195 received palliative treatment, and 105 received curative treatment. After an average of 251.87 postoperative days, 265 (64%) patients died. The mean overall survival was 610.76 days. Patients with prostate and cervical neoplasms had the most prolonged overall survival (573.13 and 549.28 days, respectively), whereas patients with bladder and colorectal cancer had the worst overall survival (480.25 and 370.53 days, respectively). Conclusions: Urinary diversion improves kidney function and opens a therapeutic window for a new line of antineoplastic therapy that provides a cure or increases patient survival.

During the recent yellow fever (YF) epidemics in Brazil, human cases were attributed to spillover infections via sylvatic mosquito transmission. Despite YF virus (YFV) transmission in major urban centers with insufficient vaccination coverage and abundant populations of the domestic vector, Aedes aegypti, there was no evidence of human-amplified transmission. Furthermore, the historic absence of YF in Asia, despite abundant Ae. aegypti and an immunologically naive human population, is unexplained. We tested the hypothesis that pre-existing, heterologous flavivirus immunity, specifically from dengue (DENV) and Zika (ZIKV) viruses, limits YFV viremia and transmission by Ae. aegypti. We infected cynomolgus macaques with DENV or ZIKV, then challenged them 6–9 months later with YFV. We then measured viremia and disease and allowed Ae. aegypti mosquitoes to feed during peak macaque viremia. Although prior heterologous immunity had variable effects on disease, DENV and ZIKV immunity consistently suppressed YFV viremia. Despite no statistical difference due to a small sample size, the suppression in viremia led to a significant reduction in Ae. aegypti infection and a lack of transmission potential. These results support the hypothesis that, in DENV- and ZIKV-endemic regions such as South America and Asia, human flavivirus immunity suppresses YFV human amplification potential, reducing the risk of urban outbreaks.

Background: Nursing students face unique challenges during their university education, making them vulnerable to mental health problems. Psychological resilience has been identified as a protective factor against these issues. However, previous reviews have identified gaps in the literature on resilience and mental health among nursing students. Objectives: This scoping review aims to identify and map studies on psychological resilience and mental health in undergraduate nursing students, synthesize current evidence on their relationship, identify interventions for enhancing resilience, and highlight gaps in the existing literature. Eligibility criteria: Studies published between January 2019 and April 2024 in English, Portuguese, and Spanish addressing resilience and mental health in undergraduate nursing students will be included. Primary studies, secondary studies, clinical guidelines, and grey literature will be considered. Sources of evidence: Searches will be conducted in multiple databases including EMBASE, ERIC, PubMed, Science Direct, Web of Science, DOAJ, ELSEVIER, EMERALD, and WILEY ONLINE LIBRARY. Grey literature sources will also be searched. Charting methods: Data will be extracted using a standardized form and synthesized narratively. Thematic analysis will be conducted using MAXQDA software ((Verbi GmbH, 24 version, 2023). Quantitative summaries, visual mapping, subgroup analyses, and trend analyses will be performed where appropriate. Results: As this is a protocol, results are not yet available. The review will present a comprehensive map of the current literature on psychological resilience and mental health in nursing students, including identified interventions and research gaps. Conclusions: This scoping review will provide valuable insights to guide curriculum development, support services, and policy-making in nursing education. The findings may support actions to strengthen resilience and prevent mental health problems among future nursing professionals.

Since its emergence in 2019, coronavirus disease (COVID-19) has spread worldwide and consumed public health resources. However, the world still has to address the burdens of other infectious diseases that continue to thrive. Countries in the tropics and neotropics, including Brazil, are affected by annual, cyclic dengue epidemics. Little is known about the impact of subsequent infections between DENV and SARS-CoV-2. Our study was performed on 400 serum samples collected from laboratory-confirmed COVID-19 patients between January and June 2021, months historically known for DENV outbreaks in Brazil. The samples were tested by serology and molecular assays for the presence of DENV and other arboviruses. While no DENV PCR results were detected, 6% were DENV IgM-positive, and 0.25% were DENV NS1-positive according to ELISA. IgM antibodies were isolated by chromatography, and 62.5% of the samples were positive for neutralizing antibodies (FRNT80) against DENV IgM, suggesting a recent infection. We also observed increased IL-10, TNF-α, and IL-1β levels in patients with overlapping SARS-CoV-2/DENV infections. Intriguingly, diabetes was the only relevant comorbidity (p=0.046). High rates of hospitalization (94.9%) and mortality (50%) were found, with a significant increase in invasive mechanical ventilatory support (86.96%) in SARS-CoV-2/DENV- infected patients, suggesting an impact on patient clinical outcomes. When analyzing previous exposure to DENV, secondary dengue patients infected with SARS-CoV-2 more frequently presented with dyspnea and respiratory distress, longer hospital and intensive care unit (ICU) stays (4 and 20.29 days, respectively) and a higher mortality rate (60%). However, a greater proportion of patients with primary DENV infection had fever and cough than patients with secondary dengue (87.50% vs. 33.33%, p=0.027 for fever). Our data demonstrate that differentiating between the two diseases is a great concern for tropical countries and should be explored to improve patient management.

Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review.

Down syndrome (DS) is a common chromosomal disorder with distinct phenotypes and skin markers. This study reports 39 DS patients, aged 1–44 months, who presented from birth with rough, brownish skin in the dimples of their knees and/or elbows. Dermoscopy revealed hyperkeratosis with brownish scales, and biopsies in six cases showed papillomatosis and mild hyperkeratosis. In the cases followed, the condition resolved spontaneously. Hyperkeratosis in the skin dimples on the knees and elbows seems to be a congenital and perhaps characteristic finding in patients with DS.

Irisin-based interventions have gained attention for their potential to modulate the adenosine monophosphate (AMP)-activated protein kinase (AMPK) pathway in various diseases. Physiologically, irisin is a myokine released during physical exercise that exerts anti-inflammatory effects and is a metabolic and cardiometabolic enhancer. On the other hand, AMPK is crucial for maintaining energy balance and metabolic homeostasis. Therefore, individuals presenting low blood levels of irisin and AMPK dysregulation are more predisposed to metabolic disorders and cardiovascular health inflammatory conditions since regulating energy balance and metabolic homeostasis are crucial for preventing or treating these disorders. In light of those mentioned above and considering that no review has addressed the intricate relationships between irisin and AMPK regulation in the realm of metabolic disorders, cardiovascular health, and inflammatory conditions, we comprehensively reviewed studies involving irisin's effects on AMPK signaling in different models and interventions. Our systematic analysis involved in vitro studies, animal models, and their relevant clinical implications of irisin targeting AMPK due to the absence of relevant clinical trials. The outcomes and limitations of the included studies were extensively highlighted. Objectively, irisin improved metabolic disorders by enhancing β-cell function and insulin secretion in diabetes, mitigating myocardial injury in cardiovascular conditions, and reducing inflammation and oxidative stress in various injury models by targeting AMPK. However, the lack of clinical trials limits the generalizability of these findings to human subjects. Future research should focus on translating these findings into clinical applications and exploring the broader implications of irisin-based interventions in human health.