Psychological stress plays a critical role in modulating women’s reproductive health through integrated neuroendocrine, immune, and microbiome-mediated pathways. Activation of the hypothalamic–pituitary–adrenal (HPA) axis leads to elevated secretion of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and cortisol, which suppress hypothalamic gonadotropin-releasing hormone (GnRH) pulsatility, thereby disrupting the hypothalamic–pituitary–gonadal (HPG) axis. This results in reduced secretion of luteinising hormone (LH) and follicle-stimulating hormone (FSH), impairing folliculogenesis, ovulation, and menstrual cyclicity. Chronic stress further induces oxidative stress, mitochondrial dysfunction, and apoptosis in ovarian cells, thereby reducing oocyte competence and diminishing ovarian reserve. Additionally, stress-induced gut microbiota dysbiosis alters the composition of key microbial taxa, including Lactobacillus, Bifidobacterium, and Clostridium, disrupting the estrobolome and impairing oestrogen metabolism. This dysregulation increases intestinal permeability and promotes systemic inflammation, as evidenced by biomarkers including interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and C-reactive protein (CRP), which adversely affect endometrial receptivity and implantation success. Emerging evidence also indicates that microbial metabolites such as short-chain fatty acids (SCFAs), tryptophan metabolites, and serotonin play a crucial role in modulating neuroendocrine signalling and reproductive outcomes. Despite growing evidence, the lack of standardised biomarkers and well-designed clinical trials limits translation into clinical practice. Future research should focus on integrative, personalised therapeutic approaches combining psychological interventions, lifestyle modifications, and microbiome-targeted therapies to improve reproductive outcomes and overall well-being.
Christopher Visak, Skylar Ketteler, Shireen Husami, Imran Shafqat
Phantosmia is the perception of an odor without an external stimulus. Gastroesophageal reflux disease (GERD) has been associated with olfactory dysfunction, but phantosmia has rarely been described. A 40-year-old woman with longstanding GERD developed intermittent perceptions of cigarette smoke during a week of worsening heartburn and bloating. Episodes were accompanied by déjà vu, nausea, and chills. A double-contrast barium esophagram demonstrated a small hiatal hernia and reflux to the thoracic inlet. She reported approximately 80% improvement after starting omeprazole, with brief recurrence during a heartburn flare, and complete resolution at later follow-up. Migraine with aura, allergic rhinitis, focal seizures, and psychiatric causes were considered as alternative explanations. The close relationship between reflux activity and olfactory symptoms, together with improvement during reflux-directed treatment, supports a plausible association between GERD and phantosmia. This single case does not establish causation, and neurologic and sinonasal etiologies should remain part of the evaluation.
Akram Alnounou, Henry Zou, Madison Laird, Christopher Visak, Sage Bilsland, Sophie Numbers, Neil Hughes
Lithium toxicity can rarely manifest as cardiac arrhythmias, often initially presenting as bradycardia. Bowel obstruction is a rare cause of acute lithium toxicity. We present a case of lithium-induced symptomatic bradycardia induced by cecal volvulus. An 84-year-old female with a history of bipolar 1 disorder on chronic lithium therapy was admitted for symptomatic bradycardia and abdominal pain. She also presented with myoclonus, polydipsia, and encephalopathy. Laboratory evaluation revealed lithium toxicity in the setting of renal impairment, and abdominal imaging findings indicated large bowel obstruction secondary to cecal volvulus. Lithium was discontinued, and the patient was managed supportively. Despite declining lithium levels, the patient’s symptomatic bradycardia persisted until surgical correction of the volvulus, after which cardiac and neurological function markedly improved. This case highlights the potential role of gastrointestinal obstruction in exacerbating lithium-induced bradycardia by impairing its clearance and inducing a vagal response triggered by abdominal distension.
Exocrine pancreatic cancer, particularly Pancreatic Ductal Adenocarcinoma, is regarded as one of the most aggressive cancers with a poor prognosis. Its bleak outlook mainly results from its silent progression, late diagnosis, and unreliable early detection methods. Globally, PC ranks among the leading causes of cancer-related deaths, and its incidence continues to increase. Because the pancreas is situated deep within the abdomen, early symptoms such as mild abdominal pain, fatigue, or weight loss are often vague. Most patients are only diagnosed after the disease has spread beyond the point where curative treatment is possible. Although surgery provides the best chance for long-term survival, only a small number of patients qualify for it at the time of initial diagnosis. Several factors increase the risk of developing PC, including chronic pancreatitis, smoking, obesity, inherited genetic mutations (like BRCA1/2), and new-onset diabetes (NOD), which has recently gained attention as a possible early warning sign. However, widespread screening for PC isn’t yet practical because the disease is relatively uncommon and there are no highly accurate, non-invasive biomarkers. The most widely used blood test, CA 19-9, often gives unreliable results, while newer molecular approaches—like circulating tumor DNA, exosomal markers, microRNAs, and metabolomic profiles—are still being refined. Recent advances in imaging technology, artificial intelligence, and targeted screening for high-risk individuals hold promise for catching pancreatic cancer earlier. As we advance, combining multi-omics biomarkers with precision imaging may finally make earlier diagnosis—and improved survival—a reality for this devastating disease.
