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Article
Medicine and Pharmacology
Ophthalmology

Takahiro Maruyama,

Tomoaki Shiba,

Tatsuhiko Kobayashi,

Seiji Takagi,

Yuichi Hori

Abstract: Objectives: To investigate the effects of the ocular blood flow in male subjects with metabolic syndrome (MetS) by using laser speckle flowgraphy (LSFG). Methods: Subjects who underwent LSFG ocular blood flow testing during physical examinations were separated into the MetS group and the control group. The groups were propensity score-matched by age with 138 male subjects compared in each group. The subjects' ocular blood flow values (mean blur rate: MBR) in the optic nerve head (ONH) and choroid were measured by LSFG. We also measured pulse waveform parameters: the blowout score (BOS), blowout time (BOT), and rising rate (RR). The ONH region was measured as a whole, a tissue, and a vascular region. Results: MBR-Choroid was significantly lower in the MetS group versus the control group. For the ONH, there was no significant difference in the MBR. Compared to the control group in all regions, the RR values in the MetS group were significantly lower. The whole, tissue-region, and vascular-region BOS values were significantly higher in the MetS group. A single regression analysis revealed that only the number of MetS components was significantly negatively correlated with MBR-Choroid among the evaluated parameters. A multiple regression analysis identified HbA1c as a factor contributing independently to the MBR-Choroid among the MetS-related factors. Conclusions: This investigation of adult males clarified that the MBR in the choroid area at the early stage of MetS is decreasing in parallel with accumulation of MetS components. The MetS component with the strongest influence to the MBR-Choroid was HbA1c.
Review
Medicine and Pharmacology
Cardiac and Cardiovascular Systems

Octavian Amaritei,

Oana Laura Mierlan,

Ciprian Dinu,

Iulia Chiscop,

Madalina Nicoleta Matei,

Cristian Gutu,

Gabriela Gurau

Abstract: Gut microbiota has increasingly been shown to exert effects beyond the gastrointestinal tract, some of which are mediated through its metabolites, such as trimethylamine N-oxide (TMAO)—a compound converted by gut bacteria from dietary choline found predominantly in animal products that is strongly associated with cardiovascular disease (CVD). However, a significant gap persists in human clinical trials assessing its potential causal role. This narrative review aims to present the current understanding of the gut microbiome, TMAO, and their relationship with CVD, while proposing future directions that may support the use of TMAO as a biomarker and guide potential interventions to reduce its harmful impact. Both animal and human studies have demonstrated a link between TMAO and CVD, with animal studies also indicating a causal effect—showing increased cardiovascular risk following TMAO administration and reduced risk when TMAO is eliminated. While direct extrapolation from animal models to humans is limited due to biological differences, these findings offer a foundation for the development of well-designed clinical trials in human populations. Although direct approaches to target TMAO—such as trimethylamine (TMA) lyase inhibitors and antisense oligonucleotide (ASO) therapy—have shown promising results in animal studies, they have yet to be investigated in human trials, leaving indirect strategies such as dietary changes and probiotics as the only currently available options.
Case Report
Medicine and Pharmacology
Dentistry and Oral Surgery

Svitlana Koval,

Viktoriia Kolesnyk,

Dariia Chepanova

Abstract: Mini-screw-assisted rapid palatal expanders (MARPE) expansion can increase maxillary skeletal width and enlarge velopharyngeal, oropharyngeal, and nasal volumes. However, techniques vary widely, especially in adults, and no consensus exists. This case series demonstrates successful adult MARPE expansion and introduces a novel 3D-printed midpalatal piezocortictomy guide. The outcomes suggest that combining MARPE with this guide results in predictable skeletal expansion while minimizing asymmetry in both expansion and suture opening. This innovation enhances precision in adult midfacial expansion and may represent a significant advancement in MARPE protocols for adult patients.
Article
Medicine and Pharmacology
Orthopedics and Sports Medicine

Hironori Kuroda,

Suguru Yokoo,

Yukimasa Okada,

Junya Kondo,

Koji Sakagami,

Takahiko Ichikawa,

Keiya Yamana,

Chuji Terada

Abstract: Background: Although adequate intraoperative imaging is routinely performed during cephalomedullary nailing for trochanteric femoral fractures, an anterior shift of the distal fragment—referred to as anterior redisplacement—is occasionally observed postoperatively. However, the incidence of this dynamic malalignment and its underlying mechanisms remain unclear. Methods: This study retrospectively reviewed data from 598 consecutive hips in 577 patients (aged ≥65 years) who underwent intramedullary nail fixation for trochanteric fractures at a single center (2012–2023). Sagittal reduction on the lateral radiographic view was classified as posterior, anatomical, or anterior according to the position of the distal fragment, and was recorded both preoperatively and postoperatively. Anterior redisplacement, the primary outcome, was defined as a change in alignment from a posterior or anatomical position postoperatively to an anterior position on any subsequent follow-up radiograph. Independent risk factors were identified by logistic regression. Results: Among the 543 hips reduced posteriorly (n = 204) or anatomically (n = 339), anterior redisplacement occurred in 73 (13.4%). The incidence of anterior redisplacement was significantly higher following anatomical than posterior reduction (19.5% vs 3.4%; p <0.001) and also higher in fractures that were anteriorly aligned preoperatively (18.0%) than in anatomical (8.5%; p <0.01) and posterior (6.2%; p <0.01) alignment. Multivariate analysis revealed two independent predictors: preoperative anterior alignment (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.24–2.81; p = 0.003) and postoperative anatomical (vs posterior) reduction (OR 6.49, 95% CI 2.92–14.44; p <0.001). Age, sex, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification, Jensen classification, nail length, and canal-filling ratio were not associated with redisplacement. No lag-screw cutout occurred during the follow-up. Conclusions: Anterior redisplacement occurred in one of seven geriatric trochanteric fractures despite apparently satisfactory fixation. An anatomical sagittal reduction—traditionally considered “ideal”—increases the risk more than sixfold, whereas a deliberate posterior-buttress is protective. Unlike patient-related risk factors, sagittal reduction is under the surgeon’s control. The study findings provide evidence that choosing a slight posterior bias can significantly improve stability.
Review
Medicine and Pharmacology
Orthopedics and Sports Medicine

Rahul Kumar,

Kyle Sporn,

Puja Ravi,

Akshay Khanna,

Nasif Zaman,

Alireza Tavakkoli

Abstract: Background: Spinal disorders frequently involve dynamic molecular cascades that unfold over multiple timescales, posing challenges for early diagnosis and intervention. Traditional sensing technologies often fail to resolve fast biochemical changes or integrate longitudinal data critical for tracking progression in spinal pathology. Neuromorphic computing, with its biologically inspired architecture and event-driven processing, offers a compelling paradigm for real-time, low-power interpretation of complex molecular signals in spinal health. Methods: This review synthesizes current approaches to neuromorphic sensing and computing as applied to spinal molecular diagnostics. We examine the role of spiking neural networks (SNNs), event-based sensory platforms, and recursive temporal attention (RTA) frameworks in modeling key molecular processes including inflammatory mediator flux, extracellular matrix remodeling, and epigenetic regulatory shifts. Hardware platforms such as Intel’s Loihi, BrainChip’s Akida, IBM’s TrueNorth, and SynSense Speck are evaluated for their utility in biomarker tracking and closed-loop spinal monitoring. Results: Neuromorphic systems demonstrate the ability to detect microsecond-scale variations in cytokine levels (e.g., IL-6, TNF-α), proteoglycan turnover, and gene expression modifiers relevant to spinal degeneration. Recursive temporal attention mechanisms improve the interpretability of multi-timescale molecular data, supporting early prediction of disc dehydration, inflammatory flares, and therapeutic response patterns. Analog-digital hybrid circuits facilitate continuous bioimpedance spectroscopy and multiplex cytokine detection with power consumption under 5 mW, enabling potential implantable use. Conclusion: Neuromorphic sensing architectures, coupled with adaptive learning algorithms, offer a promising solution for intelligent molecular diagnostics in spinal disorders. By integrating temporal molecular dynamics with event-based computation, these platforms pave the way for autonomous, personalized, and energy-efficient systems in orthopedic and neurorehabilitation applications. Future development should focus on hardware-software co-design, clinical integration, and regulatory pathways to realize scalable spinal biosensor ecosystems.
Article
Medicine and Pharmacology
Oncology and Oncogenics

Bernadeta Drymel,

Katarzyna Tomela,

Łukasz Galus,

Agnieszka Olejnik-Schmidt,

Jacek Mackiewicz,

Mariusz Kaczmarek,

Andrzej Adam Mackiewicz,

Marcin Schmidt

Abstract: The gut microbiota is recognized as one of the extrinsic factors that modulate the clinical outcomes of immune checkpoint inhibitors (ICIs) in cancer patients. However, the role of the intestinal barrier, which mutually interacts with the gut microbiota, in shaping anti-cancer immune responses has not been extensively studied so far. Therefore, the primary goal of our study was to investigate the relationship between intestinal barrier functionality and clinical outcomes of anti-PD-1 therapy in patients with advanced melanoma. Fecal samples were collected from 64 patients before and during anti-PD-1 therapy. The levels of zonulin, calprotectin, and secretory immunoglobulin A (SIgA), which reflect intestinal permeability, inflammation, and immunity, respectively, were measured in fecal samples (n = 115) using ELISA. Moreover, the composition of the immunoglobulin (Ig)-bound (n = 108) and total stool microbiota (n = 117) was determined by the V3-V4 region of 16S rRNA gene sequencing. ELISA indicated a higher baseline concentration of fecal SIgA in patients with favorable clinical outcomes than those with unfavorable ones. Moreover, high baseline concentrations of intestinal barrier state biomarkers correlated with survival outcomes. In the cases of fecal zonulin and fecal SIgA, there was a positive correlation, while in the case of fecal calprotectin, a negative correlation. Furthermore, there were differences in the microbial profiles of the Ig-bound stool microbiota between patients with favorable and unfavorable clinical outcomes and their changes during treatment. Collectively, intestinal barrier functionality was associated with clinical outcomes of anti-PD-1 therapy in advanced melanoma patients. Future studies are warranted to elucidate whether intestinal barrier modification could improve ICI efficacy and estimate the clinical value and utility of biomarkers reflecting its state.
Review
Medicine and Pharmacology
Veterinary Medicine

Rabea Lensing,

Ann Kristin Barton

Abstract: The term Equine Gastric Ulcer Syndrome (EGUS) has been used since 1999. As there are important differences, the terms Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD) have been introduced in 2015. Risk factors like die-tary management, training regimens and drug side effects, as described for NSAIDs, predispose horses to ESGD or EGGD. To date, gastroscopy remains the gold standard for a reliable diagnosis. However, there are new diagnostic approaches using less in-vasive biomarkers. The proton pump inhibitor omeprazole is currently recommended by the American College of Veterinary Internal Medicine and the European College of Equine Internal Medicine (ACVIM/ECEIM) for the treatment of both ESGD and EGGD. Omeprazole per os is much less effective in treating EGGD, so it is often combined with sucralfate, which forms a protective mucosal barrier to shield it from the gastric acid. Intramuscular application of omeprazole has been shown to increase efficacy in EGGD therapy. Alternative non-pharmacological treatments have been investigated due to the high cost of approved omeprazole, long-term adverse effects in humans and the re-striction on omeprazole use in some equestrian sports. An update on diagnosis, treat-ment and prevention of ESGD/EGGD is the focus of this review.
Review
Medicine and Pharmacology
Pathology and Pathobiology

Alessandra D'Angelo,

Anna Zenoniani,

Martina Masci,

Gitana Maria Aceto,

Adriano Piattelli,

Maria Cristina Curia

Abstract: Unlike other microbiomes, the breast microbiome remains stable across various factors, including pregnancy history, age and ethnicity. The breast is not a sterile organ, and its microbiota exhibits a distinct composition compared to other body sites. The breast microbiome is a community characterized by an abundance of Proteobacteria and Firmicutes, which represent the result of host microbial adaptation to the fatty acid environment in the tissue. The human milk microbiota (HMM) is a complex biological fluid enriched with immunomodulatory components and plays a pivotal role in shaping the neonatal gut ecosystem. Dysbiosis is strongly associated with mastitis. Risk factors for BC include genetic mutations, late menopause, obesity, estrogen metabolism and alterations in gut microbial diversity. Gut microbiota can increase estrogen bioavailability by deconjugating estrogen-glucuronide moieties in a process called estrobolome. Perturbations of this process increases circulating estrogens and risk of BC. Fusobacterium nucleatum has recently been associated with BC. It moves from the oral cavity to other body sites hematogenously. This review deals with the characteristics of the breast microbiome, with a focus on F. nucleatum, highlighting its dual role in promoting tumor growth and modulating immune responses. F. nucleatum acts both on the Wnt/β-catenin pathway by positively regulating MYC expression, and on apoptosis by inhibiting caspase 8. Furthermore, F. nucleatum binds to TIGIT and CEACAM1, inhibiting T cell cytotoxic activity and protecting tumor cells from immune cell attack. F. nucleatum also inhibits T cell function through the recruitment of myeloid suppressor cells (MDSCs). These cells express PD-L1, which further reduces T cell activation. A deeper understanding of F. nucleatum biology and its interactions with host cells and co-existing symbiotic microbiota could aid in the development of personalized anticancer therapy.
Article
Medicine and Pharmacology
Emergency Medicine

Mirjam Schäfer,

Luca Schuler,

Florian Wuethrich,

Christ Michael,

Stefan Venturini

Abstract: Background: Acute appendicitis (AA) is a common surgical emergency where timely diagnosis is eminent. Point-of-care ultrasound (POCUS) offers a fast, bedside imaging option that may reduce emergency department (ED) length of stay (LOS), though the diagnostic accuracy is highly examiner-dependent. This study evaluated the effect of POCUS performed by emergency physicians on ED LOS in patients with suspected AA at a tertiary hospital in Lucerne, Switzerland. Methods: We conducted a retrospective monocentric study including patients who presented to the ED in 2022–2023 and subsequently underwent an appendectomy for AA. Patients were divided into four subgroups based on imaging modality and examiner. Results: 252 patients met the inclusion criteria. Group distributions were as follows: Group 1 (US by ED): 107; Group 2 (US by ED + radiology or only by radiology): 59; Group 3 (US + CT): 60; Group 4 (CT only): 26. A statistically significant difference in LOS was observed among groups, particularly favouring POCUS by ED physicians (p < 0.001). In group 3, CT was performed to confirm strong US suspicion (41.7%), non-visualisation (40%), inconclusive findings (15%), or other differentials (3.3%); among cases with strong US suspicion, perforation was queried in 60%. Ultrasound experience, reflected by the weighted average, increased over time, accompanied by a rise in US-only diagnoses in the ED. Multivariable linear regression identified younger age, lower BMI, and lower CRP as significant predictors of diagnosis based on ultrasound alone (p < 0.001), R² = 0.373. Conclusions: Patients with AA diagnosed by emergency physician-performed POCUS had a significantly shorter ED LOS. Increasing ultrasound competency among emergency physicians was paralleled by a proportional increase in cases diagnosed exclusively by US in the ED. The likelihood of requiring CT imaging increased with higher patient age, BMI and CRP.
Article
Medicine and Pharmacology
Urology and Nephrology

Enrique Luna,

Álvaro Álvarez,

Jorge Alberto Rodriguez-Sabiñón,

Juan Villa,

Teresa Giraldo,

Maria Victoria Martín,

Eva Vázquez,

Noemi Fernández,

Belén Ruiz,

Guadalupe Garcia-Pino

+5 authors
Abstract: Background: Semaglutide, a GLP-1 receptor agonist, has shown promising nephroprotective effects in clinical trials, though real-world data on its long-term impact on renal function in high-risk diabetic nephropathy patients remain scarce. Methods: We conducted a multicenter, retrospective observational study involving 156 patients with type 2 diabetes and chronic kidney disease (CKD) treated with subcutaneous semaglutide between 2019 and 2023. Inclusion required an eGFR >15 mL/min/1.73 m² or albuminuria >30 mg/g and at least two years of follow-up. The primary outcome was the change in eGFR slope after semaglutide initiation. Subgroup analyses were performed based on baseline eGFR, albuminuria, and SGLT2i co-treatment. Results: In the whole study population, the median eGFR slope significantly improved from -3.29 (IQR 7.54) to -0.79 (IQR 6.01) mL/min/1.73 m²/year post-treatment (p< 0.001). Multiple linear regression showed a hazard ratio for the effect of semaglutide on the eGFR slope of 4.06 (2.43-5.68), p< 0.001. In patients with baseline eGFR 1,000 mg/g did not show a significant change (p=0.184). Semaglutide also reduced BMI (p=0.04), HbA1c (p=0.002), triglycerides (p=0.001), CRP (p=0.003), and GGT values (p=0.004). Conclusions: In real-world practice, semaglutide significantly attenuated renal function decline in high-risk diabetic patients, particularly those with advanced CKD or concurrent SGLT2i therapy. These findings support its nephroprotective role beyond glycemic control.
Article
Medicine and Pharmacology
Epidemiology and Infectious Diseases

Joseph Hickey,

Denis G. Rancourt,

Christian Linard

Abstract: Large peaks of excess all-cause mortality occurred immediately following the World Health Organization (WHO)’s March 11, 2020 COVID-19 pandemic declaration, in March-May 2020, in several jurisdictions in the Northern Hemisphere. The said large excess-mortality peaks are usually assumed to be due to a novel and virulent virus (SARS-CoV-2) that spreads by person-to-person contact, and are often referred to as resulting from the so-called first wave of infections. We tested the presumption of this viral spread paradigm using high-resolution spatial and temporal variations of all-cause mortality in Europe and the USA.We studied excess all-cause mortality for subnational regions in the USA (states and counties) and Europe (NUTS statistical regions at levels 0-3) during March-May 2020, which we call the “first-peak period”, and also during June-September 2020, which we call the “summer-peak period”.The data reveal several definitive features that are incompatible with the viral spread hypothesis (in comparison with qualified predictions of the leading spatiotemporal epidemic models): • Geographic heterogeneity of first-peak period excess mortality: There was a high degree of geographic heterogeneity in excess mortality in the USA and Europe, with a handful of geographic regions having essentially synchronous (within weeks of each other) large peaks of first-peak period excess mortality (“F-peaks”) and all other regions having low or negligible excess mortality in the said first-peak period. This includes vastly different F-peak sizes (up to a factor of 10 or more) for subnational regions on either side of an international border, such as Germany’s NUTS1 regions on its western border (small F-peaks) compared to the NUTS1 regions on the other side of the international border in the Netherlands, Belgium and France (large F-peaks), despite significant documented cross-border traffic volumes between the regions. • Temporal synchrony of first-peak period excess mortality: F-peaks for USA states and European countries were almost all positioned within three or four weeks of one another and never earlier than the week of the WHO’s pandemic declaration. For a given large-F-peak European country, the F-peaks for all subnational regions rose and fell in lockstep synchrony but showed large variation in peak height and total integrated excess mortality. A similar result was seen for the counties of large-F-peak USA states. • Large differences in first-peak period excess mortality for comparable cities with large airports in the same countries: We compare mortality results for Rome vs Milan in Italy, and Los Angeles and San Francisco vs New York City in the USA, and show that there was a dramatic difference in first-peak period excess mortality between the compared cities, despite their having similar demographics, health care systems, and international air travel traffic, including from China and East Asia.We also examined data concerning the location of death (whether in hospital, at home, in a nursing home, etc.) and socioeconomic vulnerability (poverty, minority status, crowded living conditions, etc.) at high geographic resolutions, which support an alternative hypothesis that excess mortality in jurisdictions with large F-peaks was caused by the application of dangerous medical treatments (in particular, invasive mechanical ventilation and pharmaceutical treatments) and pneumonia induced by biological stress due to treatment and lockdown measures.Exceptionally large F-peaks occurred in areas with large publicly-funded hospitals serving poor or socioeconomically frail communities, in regions where poor neighbourhoods are situated in proximity to wealthy neighbourhoods, such as the case of The Bronx in New York City, and the boroughs of Brent and Westminster in London, UK.Taken together, our study represents strong evidence that the patterns of excess mortality observed for the USA and Europe in March-May 2020 could not have been caused by a spreading respiratory virus, and instead were due to the medical and government interventions that were applied and mostly killed elderly and poor individuals.
Communication
Medicine and Pharmacology
Pharmacology and Toxicology

Luis Alejandro Roque

Abstract: Snakebite envenomation remains a severe global health burden, particularly in impoverished, rural, and tropical regions where healthcare resources are sparse. Despite over 125 years of progress in antivenom therapy, numerous obstacles persist related to efficacy, specificity, cost, and availability. Conventional antivenoms, although life-saving, are associated with significant drawbacks including species specificity and adverse immunologic reactions. This review explores the historical milestones in antivenom development, discusses current therapeutic limitations, highlights novel innovations through biotechnological approaches, and presents a list of ongoing clinical trials that aim to revolutionize the field. It emphasizes the pressing need for improved therapeutics and the critical role of translational research in mitigating the global impact of snakebite envenomation.
Concept Paper
Medicine and Pharmacology
Clinical Medicine

Valeriy Revo

Abstract: The manuscript presents some results of the author's long-term work on developing a system information theory of the origin of life and diseases. The article's purpose is to substantiate the need to use this theory concerning the problems of biology and medicine. The task of the article is to substantiate the priorities of a doctor when using the achievements of natural science, biology and clinical practice, rather than formulaic initiatives. The author has shown that diseases are phylogenetically conditioned processes of a programmatic nature. Therefore, it is necessary to train doctors of a new formation. The effectiveness of their work will be ensured by clinical experience, interdisciplinary and specialized knowledge, system models – the highest form of meaningful representation of any objects and processes. Quantum features of the organization of life can manifest themselves in specific phenomena. One of them is the quantum entanglement of a doctor, which requires the organization of appropriate monitoring.
Review
Medicine and Pharmacology
Psychiatry and Mental Health

George Ayoub

Abstract: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by difficulty with social communication, behavior, and sensory integration. With its prevalence rising worldwide in recent decades, understanding and mitigating the origins of ASD has become a priority. Though its etiology is multifactorial, current research highlights two major contributors: genetic susceptibilities and environmental inflammatory exposures leading to oxidative stress during critical developmental periods. We explore how genetic variations, particularly those affecting cerebral folate metabolism, and various inflammatory triggers intersect to influence the development of ASD, each giving rise to specific symptoms seen in autism.
Article
Medicine and Pharmacology
Endocrinology and Metabolism

Denis Gubin,

Sergey Kolomeichuk,

Konstantin Danilenko,

Oliver Stefani,

Alexander Markov,

Ivan Petrov,

Kirill Voronin,

Marina Mezhakova,

Mikhail Borisenkov,

Aislu Shigabaeva

+5 authors
Abstract: In Arctic residents, blood lipids fluctuate seasonally in response to changes in light exposure (LE) patterns. This study investigates which aspects of LE (timing, dynamic range, and duration) are related to lipid profiles. We analyzed actigraphy data measuring LE and blue light exposure (BLE), along with blood determinations from 27 residents across different seasons. We assessed circadian parameters of melatonin in a subset of participants. We found that features of BLE and melatonin significantly predicted lipids: An earlier BLE acrophase was associated with higher HDL-C (β = –0.246, p = 0.013). Nighttime BLE was positively associated with TC (β = 0.290, p = 0.008) and LDL-C (β = 0.253, p = 0.025). The normalized circadian amplitude of BLE was inversely associated with the TG/HDL ratio (β = –0.384, p &lt; 0.001). Finally, earlier melatonin was associated with lower TG/HDL (β = 0.464, p = 0.007). Results remained significant after adjusting for co-factors of photoperiod duration, age, sex, and indigeneity. These findings suggest that patterns of LE (circadian light hygiene) could be a way to improve cardiovascular health.
Article
Medicine and Pharmacology
Immunology and Allergy

Robert W. Chandler

Abstract: Serum free light chain (sFLC) elevation following SARS-CoV-2/COVID-19 infection/illness and COVID-19 mRNA vaccination may indicate adverse immunological responses, such as clonal proliferation or inflammation.[1, 2] To evaluate the use of sFLC measurements, the Vaccine Adverse Event Reporting System (VAERS), maintained by the Centers for Disease Control and Prevention and the Food and Drug Administration, was searched for sFLC abnormalities following COVID-19 vaccination. Seventy-five (75) unique cases were identified that included quantitative sFLC measurement or diagnosis of free light chain disorders following at least one injection of COVID-19 vaccine. Twenty-five cases (33%) had complete quantitative data for serum kappa (κ) and lambda (λ) and kappa/lambda ratio (sFLCR), and 50 cases (67%) had incomplete quantitative sFLC data but carried a diagnosis of sFLC disorder with supporting documentation. Quantitative and qualitative data were extracted and analyzed using Grok 3 (xAI). Severity was classified as hospitalization (H), life-threatening (LT), permanent disability (PD), or death (D), with correlations to vaccine type (Pfizer, Moderna, mixed), number of doses (1–5), and time to onset (0–518 days). Fifty of 75 cases (67%) were severe. A high ratio (sFLCR) (>1.65) was associated with neoplastic and paraneoplastic conditions. Ratios (sFLCR) ≤ 1.65 ≥ 0.26 were associated with inflammation. All three cases with low ratios (< 0.26) had lambda dominance and involved neoplasia (multiple myeloma x 2, lymphoma x1). Organ system analysis identified renal (36%), neurological (16%), hematological (17%), and IgA-related (17%) manifestations. Renal and hematological cases tended to occur early (renal average = 12.5 days, hematologic average = 36 days) with lower doses (renal = 1.86, hematologic = 2.46) and neurological cases later (average 127.5 days) with higher doses (average = 2.92). sFLC measurements should be further evaluated as a tool to diagnose and monitor neoplastic and inflammatory disease activity following COVID-19 vaccination.
Article
Medicine and Pharmacology
Surgery

Ghanim. Hamid. Al-Khattabi,

Hatim. Ahmad. Al-Omari,

Basmah. Amin. Rafie

Abstract: Introduction: There is a remarkable paucity of research that studies the surgical and operating room (O.R.) practice during Hajj, as well as research that compares such practice before and during Hajj, since most of the available reports concentrated on other topics. Surgical problems, either acute surgical emergencies or precipitation of chronic disease, are not uncommon during the Hajj season. Prolonged surgical wait times have been associated with reduced quality of life. Cancellation of surgical operations in hospitals is a significant problem with many undesirable consequences. Cancelled operations can annoy patients and their families. They are a major drain on health resources, increase theater costs, result in wasted operating room time, and decrease efficiency. Therefore, the objective of the current study is to compare the surgical and O.R. practice in Makkah Healthcare Cluster (MHCC) hospitals before and during Hajj 2024. Methodology: A retrospective data analysis using all medical records of the operation rooms departments in MHCC hospitals before Hajj 2024 (Jan-Feb-March) and during Hajj 2024 (April-May-June) (including both pilgrims and non-pilgrims) Results: There is a statistically significant difference between surgery waiting lists for different specialties. P = 0% as well as between surgery waiting lists and different MHCC hospitals. P = 0% The highest waiting list was for general surgery (8735 cases), and the lowest was for the vascular surgery waiting list (490 cases). The highest waiting list was in KAMC (15,473 cases), followed by Al-Noor Specialist Hospital (15,471 cases), and the lowest was in Al-Kamel Hospital (0 cases). There is a statistically significant difference between the type of surgery performed for different specialties (P = 0%) as well as between the type of surgery performed and different MHCC hospitals (P = 0%). General surgery operations are the most common type of operation done in MHCC (1753 cases) compared to oral surgery, which was the least common type of surgical operation performed (74 cases). KAMC was the highest hospital in surgery performance (2704 cases), followed by the maternal and children's hospital (2273 cases). No statistically significant differences between elective surgeries and emergency surgeries are noted between different MHCC hospitals. P = 14% Statistically significant differences between the Operation Room (OR) Surgical Cancellation Rate and the Operation Room (OR) Utilization Rate are noted between different MHCC hospitals (P-Value = 1%). The ratio of emergent surgery to elective surgery (Ee ratio) = 7010.05 / 8802 = 0.7964 = 79.64%. No statistically significant differences between the operating room (OR) surgical cancellation rate and the day surgery cancellation rate are noted between different MHCC hospitals. P-Value = 7% No statistically significant differences between day of admission to day of surgery (percent) and day surgery (percent) are noted between different MHCC hospitals. P-Value = 8% Statistically significant differences between unplanned admission following discharge and day surgery conversion to admission are noted between different MHCC hospitals. P-Value = 1% There is a statistically significant difference among elective surgeries performed regularly before Hajj compared to such practice during Hajj season (P=0.049), as well as for emergency surgeries (P=0.002), day surgery (P=0.02), day surgery conversion to admission (P=0.02), vascular surgery (P=0.025), orthopedics (P=0.006), neurosurgery (P=0.04), general surgery (P=0.0004), and ear-nose-throat (ENT) (P=0.039). Conclusion & Recommendations: Approaches to improving the surgical and O.R. practice in MHCC hospitals can occur on many levels based on the required level of resources and institutional support. Data transparency and communication are critical to improvements, and any intervention should be conducted in the context of overall patient care, especially during Hajj seasons. Such interventions may include improving the quantities and quality of that practice as well as improving the equity and equality distribution of surgical and O.R. manpower, materials, and machines in order to shorten the O.R. waiting list and surgery cancellation rates and improve the O.R. utilization rates in order to attain the goals of value-based health care and a new model of care. To measure operating room (OR) performance and efficiency, hospitals need scorecards or dashboards displaying and tracking core performance indicators. Scorecards should be monitored on an ongoing basis and benchmarked both internally against performance over time and externally against established best practices with the intent of continuous performance improvement. Among the lessons learned from the current study is the need for large-scale scientific studies, including qualitative and quantitative ones, to quantify the factors related to surgical and OR practice. Different types of surgery represent a threat in light of the expected increasing number of pilgrims after the completion of construction in the Grand Mosque and Al-Mashaeer areas of the Hajj. The vast development in surgery problem surveillance after the development of the web-based healthcare network is a welcome achievement of the Saudi Ministry of Health. The optimal utilization of the collected data is yet to be achieved. The existing international collaboration needs to be strengthened and expanded. Application of a new metric for surgical care access and delivery, the ratio of emergent surgery to elective surgery (Ee ratio), is essential.
Review
Medicine and Pharmacology
Other

Reza Ghalamghash

Abstract: Background: Alopecia, encompassing conditions such as alopecia areata (AA), androgenetic alopecia (AGA), telogen effluvium (TE), and traction alopecia (TA), is a global health concern with significant psychosocial impacts. Migrant and ethnic minority communities face unique challenges due to genetic, environmental, socioeconomic, and cultural factors influencing alopecia prevalence and presentation. This review examines the epidemiology of alopecia in these populations, focusing on disparities, psychosocial effects, and barriers to care.Methods: A systematic search was conducted across PubMed, MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library, using keywords and MeSH terms for alopecia types, epidemiology, and migrant populations. Articles from 2014 to 2024, including original research, systematic reviews, and meta-analyses, were selected. Data on prevalence, incidence, risk factors, psychosocial impacts, and care barriers were extracted and synthesized thematically with comparative tables.Results: AA prevalence is higher in Asian, Black, and Hispanic/Latino populations, with ratios up to 3.33 for South Asian children. AGA is increasing in Asian populations, nearing Caucasian rates, likely due to acculturation. TE surged >400% in minority communities during COVID-19, particularly among Hispanic/Latinx and Asians. TA affects up to 31.7% of African descent women due to tight hairstyles. Stigma and anxiety are significant, especially for Black AA patients, who face work absenteeism risks. Structural barriers, including insurance and language issues, exacerbate disparities.Conclusions: Alopecia disparities in migrant communities reflect genetic, environmental, and cultural factors. Culturally competent care, stigma reduction, and innovative data collection are needed. Specialized clinics and digital platforms can enhance access and contribute to research, promoting health equity.
Article
Medicine and Pharmacology
Other

Isaac Sung Him Ng,

Anthony Siu,

Claire Soo Jeong Han,

Oscar Sing Him Ho,

Jonathan Sun,

Anatoliy Markiv,

Stuart Knight,

Mandeep Gill Sagoo

Abstract: Background: While AI chatbots are gaining popularity in medical education, their pedagogical impact remains under-evaluated. This study examined the impact of a domain-specific chatbot on learning performance, perception, and cognitive engagement among medical students. Methods: Twenty first-year medical students completed two academic tasks using a custom-built educational chatbot (Lenny AI by qVault.ai) or conventional study methods in a randomised, crossover design. Learning was assessed through Single Best Answer (SBA) questions over two tasks with corresponding post-task perception surveys using Likert scales, and separate focus group discussions. Statistical analyses were performed to compare performance scores with perception measures, while qualitative data underwent thematic analysis with independent coding (κ = 0.403–0.633). Results: Participants rated the chatbot significantly higher than conventional resources in ease of use, satisfaction, engagement, perceived quality, and ease of understanding. (p < 0.05). Improvements in perceived efficiency and confidence were observed with mixed patterns. Lenny AI use did not result in significant performance gains; however, it was positively correlated with perceived efficiency, confidence in applying information, and perceived quality of information. Thematic analysis revealed accelerated factual retrieval but limited critical thinking and schema integration. Students expressed high functional trust but raised concerns about transparency. The chatbot was seen as a tool for rapid fact-checking, favouring learners who were goal-directed. Conclusion: AI chatbots can substantially enhance ease of use, satisfaction, and knowledge access in medical education. However, their capacity to foster deep learning remains limited. Future designs must prioritise adaptive scaffolding, traceable sourcing, and support for critical engagement to achieve sustained educational value.
Article
Medicine and Pharmacology
Dentistry and Oral Surgery

Keisuke Seki,

Ryo Koyama,

Kazuki Takayama,

Atsushi Kobayashi,

Atsushi Kamimoto,

Yoshiyuki Hagiwara

Abstract: Background and Objectives: To evaluate the effect of antiresorptive agents (ARAs) on periimplant tissues and to examine risk factors for peri-implant medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: The study cohort consisted of patients who underwent implant surgery or maintenance treatment between March 2012 and December 2024. Patients were divided into two groups: those who used bisphosphonates (BPs) or denosumab (Dmab) to treat osteoporosis after implant treatment (ARA group) and a control group. Peri-implant clinical parameters (implant probing depth (iPPD) implant bleeding on probing (iBoP), marginal bone loss (MBL), and mandibular cortical index (MCI)) measured at baseline and at the final visit were statistically evaluated and compared in both groups. Risk factors were examined by multivariate analysis for adjusted odds ratios (aOR). Results: A total of 192 implants in 61 patients (52 female, 9 male) were included in this study. The ARA group consisted of 89 implants (22 patients). Comparison of clinical parameters showed that the ARA group had significantly higher maximum iPPD and iBoP variation over time than the control group. Risk factors for peri-implantitis as objective variables were the use of ARAs (aOR: 3.91, 95% confidence interval [CI] 1.29–11.9) and change in maximum iPPD over time (aOR: 1.86, 95% CI 0.754–4.58). Conclusions: During long-term implant maintenance treatment, patients' health and medication status change. Monitoring of peri-implantitis, the presumed cause of peri-implant MRONJ, is essential, especially in patients who started ARA treatment after implant placement, and special attention should be paid to changes in implant pocket depth.

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