Journal of Medicine and Healthcare is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Medicine and Healthcare. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of research, review, case reports, analysis, magazines, editorials, opinion, communications, mini-review, short communications, picturized, book review, video type and power point presentations (PPTS). Articles can be submitted through online from https://srcpublishers.com/medicine-and-healthcare/user/register or can send through an Email with attachment for medicine@onlinescientificresearch.info, jmhc@onlinescientificresearch.net 2.023 Impact Factor 84.5% Citations 90% Acceptance
Education and Health Nexus in Rural India: Addressing Inequities Through Higher Education
Background: Higher education is a critical social determinant of health, influencing health literacy, economic opportunities, and access to healthcare. In rural areas, limited access to higher education contributes to persistent health inequities and poor population health outcomes. Objectives: To examine the challenges and inequities in rural higher education from a public health perspective and to propose sustainable, multisectoral solutions to improve both educational and health outcomes. Methods: This paper adopts a descriptive and analytical approach, drawing on secondary data sources such as national surveys (e.g., AISHE, NFHS) and existing literature. Key dimensions analysed include enrolment patterns, digital access, socioeconomic barriers, gender disparities, and infrastructure gaps in rural India. Results: Rural areas show significantly lower higher education enrolment rates compared to urban regions, accompanied by higher dropout levels. Contributing factors include poverty, limited institutional infrastructure, gender inequality, and a substantial digital divide. These barriers result in low health literacy, delayed healthcare utilization, and increased disease burden. Evidence indicates that individuals with higher education levels demonstrate better health behaviours, improved maternal and child health outcomes, and greater healthcare access. Discussion: Educational inequities in rural settings create a cyclical relationship between low education, poor health outcomes, and poverty. Addressing these challenges requires integrated strategies that combine improvements in education systems with public health interventions. Digital inclusion, financial support, gender-sensitive policies, and rural infrastructure development are critical components. Conclusion: Improving access to higher education in rural areas is essential for advancing public health. A coordinated, multisectoral approach can break the cycle of disadvantage, enhance health literacy, and promote sustainable rural development.
Copyright (c) 2026 Journal of Medicine and Healthcare
Assessment of Vision Impairments among Licensed Drivers in Mathura: A Pilot Study
Background: Driving is a visually intensive task that requires the integration of multiple visual functions to ensure road safety. In India, vision screening protocols for obtaining a driving license are often inadequate or inconsistently enforced. This pilot study was conducted to assess the prevalence and types of vision impairments among licensed drivers in Mathura district. Objective: To evaluate key visual parameters-glare recovery, night vision, colour vision, visual acuity, phoria, and horizontal visual field-among licensed male drivers and determine their potential impact on driving performance. Methods: A cross-sectional pilot study was conducted at Spexwear Optical & Physiotherapy Centre, Mathura. A total of 198 male drivers aged 18–56 years participated. Standardized tests were conducted to assess visual acuity (Snellen chart), colour vision (Ishihara plates), glare recovery, night vision, phoria, and horizontal field of vision. Data were analysed using descriptive statistics and chi-square tests; p-values < 0.05 were considered statistically significant. Results: Visual acuity deficits were noted in 29% of participants (binocular), 33% (right eye), and 25% (left eye). Impairments in glare recovery and night vision were present in 12% and 8% of drivers, respectively. Color vision deficiency was found in 23% of participants, with an additional 13% requiring retesting. Phoria was abnormal in 24%, and 19–20% of drivers showed subnormal horizontal field vision in at least one eye. Most impairments showed statistically significant associations (p < 0.05) with driving fitness. Conclusion: A significant proportion of licensed drivers in Mathura have unrecognized visual impairments. Comprehensive vision screening should be made mandatory in the driver licensing process to enhance road safety and reduce accident risks.
Analysis of Patients’ Complaints Regarding Family Physicians Using 937 Databases in the Riyadh Health Cluster 3 Riyadh, Saudi Arabia
Introduction: Family Medicine physicians serve as the first point of contact within the health system, playing a pivotal role in delivering comprehensive preventive and curative care. In Saudi Arabia, the Ministry of Health (MOH) has implemented the 937-Service to collect and address patient complaints. This service is a valuable source of feedback, helps evaluate healthcare quality, identifies areas for improvement, and enhances patient satisfaction. Objectives: This study analyzes complaints against family physicians in Riyadh Health Cluster 3 using 937 database data to identify common concerns and recommend improvements. Methods: This retrospective cross-sectional study used secondary data from 937 databases. It examined complaints against family medicine physicians at 14 PHCs in Riyadh Health Cluster 3 from January to December 2024. Data analysis was descriptive, with categorical variables summarized as frequencies and percentages. Results: The findings indicate that patient dissatisfaction is driven primarily by weaknesses in organizational systems and processes, particularly in virtual health platforms, scheduling and staffing, and administrative workflows. These issues, rather than clinical errors, account for most dissatisfaction. Complaints are not distributed evenly. Larger, busier centers see more complaints due to heavier patient demand and greater service pressure. Conclusion: The study highlights dissatisfaction with family medicine services in Riyadh Health Cluster 3, suggesting improvements to workflows, digital systems, and staff training to enhance continuity of care and the patient experience.
Risk Factors for Hypoglycemia in Newborns as the Basis of Many Types of Human Pathology
Glucose is the main energy substrate that supports the viability of the body’s cells and their physiological development. A deficiency of glucose in the body of a newborn leads to hypoxia and disruption of neurogenesis processes in the brain. The use of the body’s fats and proteins as an energy source, in the absence of glucose, does not meet the energy needs and contributes to the accumulation of intermediate toxic products. Children born with hypoglycemia get sick more often, have a shorter lifespan, and during the reproductive period experience infertility and miscarriage more frequently [1]. Therefore, identifying the risk factors for neonatal hypoglycemia expands the preventive capabilities of medicine, strengthens the health of the nation, and its intellectual and reproductive potential!!!
Public Awareness and Knowledge of Sepsis: A Cross-Sectional Survey of Adults in Saudi Arabia
Introduction: Sepsis is a life-threatening condition characterized by a dysregulated response to infection; however, the understanding in the general population is low or lacking especially in regions like Saudi Arabia where such situations are sparse. The present study strives to assess the general awareness and knowledge of sepsis among the adult Saudi population and aims to identify the potential determinants of such awareness. Methods: It is a cross-sectional research study. The present study was able to solicit data with a time frame from July to November 2024 through an online and selfadministered survey instrument that can be circulated over social media sites. Sample criteria included participants that were over 18 years of age and resided in Saudi Arabia. The data were analyzed with reference to socio demographic, level of prevalence and knowledge about sepsis using e-SPSS. Results: Out of 544 respondents, only 32% reported prior awareness of sepsis, with 19.8% indicating good knowledge. The most well-known symptoms were fever (58.6%) and pain (44.3%), but little was known about other symptoms and their causes. Age, educational attainment, and work in healthcare were among the demographic variables that were substantially linked to increased awareness. Conclusion: The research provides evidence that a substantial number of the adult population in Saudi Arabia are not aware and do not have sufficient knowledge of sepsis. The data points to the fact that people in Saudi Arabia are in dire need of education on sepsis to improve recognition of this diagnosis and understanding of its significance, aiming at bettering the outcomes and emergence Highlights: This study assesses adult public awareness and knowledge of sepsis in Saudi Arabia. The results indicate an extremely low awareness level, with only 32% of participants aware of sepsis and even fewer demonstrating good knowledge. Statistically significant differences were observed based on education level, age, and healthcare work status. The findings suggest an urgent need for targeted public health interventions to enhance early detection and improve sepsis knowledge among Saudi adults.
Copyright (c) 2025 Journal of Medicine and Healthcare
Biomarkers Update on Management of Sepsis
Background: Emergency department (ED) overcrowding is a major global health challenge and is associated with increased morbidity and mortality, particularly in septic patients. Delays in diagnosis and treatment contribute to adverse outcomes. Objective: This review summarizes recent evidence on novel sepsis biomarkers and their role in improving early recognition, risk stratification, and prognosis in ED settings. Methods: Evidence from international studies, clinical trials, and biomarker research presented in Singapore (October 2025) was analyzed, focusing on procalcitonin (PCT), presepsin, bio-adrenomedullin (bio-ADM), proenkephalin (PenKid), and dipeptidyl peptidase 3 (DPP3). Results: PCT and Presepsin demonstrated superior specificity for bacterial infections compared to conventional markers. bio-ADM levels correlated with endothelial dysfunction and predicted septic shock. PenKid was validated as an early predictor of acute kidney injury (AKI), independent of comorbidities. DPP3 was identified as a harmful mediator released during cellular damage, strongly associated with circulatory failure and mortality. Clinical trials such as ALBIOS, FROG-ICU, and AdrenOSS confirmed their prognostic and therapeutic implications. Conclusion: A multimarker approach that combines traditional and emerging biomarkers may enhance sepsis management in overcrowded EDs, enabling timely interventions and improving patient outcomes. Further validation is required before routine clinical implementation.
Early vs Delayed Direct Oral Anticoagulant (DOAC) Resumption After Ischemic Stroke in Patients with Atrial Fibrillation: A MetaAnalysis
Background: For patients with atrial fibrillation (AF) who experience acute ischemic stroke, clinicians must balance prevention of early recurrent embolism against the risk of intracranial hemorrhage (ICH) when restarting direct oral anticoagulants (DOACs). The optimal timing for DOAC resumption remains uncertain. Methods: We conducted a systematic review and meta-analysis (PRISMA-aligned) of randomized controlled trials, registry-based randomized trials, and prospective cohorts comparing early versus delayed DOAC initiation after ischemic stroke in adults with AF. Databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library) were searched from inception to June 2024. Two reviewers performed independent screening, data extraction, and risk-of-bias assessment (RoB 2.0 for RCTs; Newcastle–Ottawa Scale for the cohort). Random-effects models (DerSimonian–Laird) were prespecified for pooled analyses; heterogeneity was assessed with I² and χ². Primary outcomes were recurrent ischemic stroke and ICH; secondary outcomes included major bleeding, all-cause mortality, and composite endpoints. Results: Three studies (n = 4028) met eligibility: one prospective cohort (RAF-NOAC, 2017) and two randomized trials (TIMING, 2022; ELAN, 2023). Definitions of “early” ranged from ≤48 h (minor/moderate strokes) to ≤4 days; “delayed” ranged from day 5–10 or >14 days, with follow-up to 90 days (ELAN also reported 30- day outcomes). Across studies, early DOAC initiation was not associated with increased ICH; symptomatic ICH was rare (e.g., 0% in TIMING; ~0.2% in both ELAN arms). Efficacy signals favored early treatment: composite endpoints were numerically lower with early initiation in TIMING (6.9% vs 8.7%) and ELAN (2.9% vs 4.1%), with similar or lower major bleeding (e.g., 1.4% vs 2.5% in ELAN). Observational data (RAF-NOAC) suggested the most favorable outcomes when treatment began 3–14 days after stroke, with slightly higher events at ≤2 days. Subgroup analyses in RCTs showed no significant effect modification by age, sex, stroke severity, or reperfusion status. Conclusions: In AF-related ischemic stroke, early DOAC resumption appears safe and at least non-inferior to delayed strategies, with signals of reduced recurrent ischemia and no excess ICH. A tailored, severity-informed approach—especially leveraging imaging—seems appropriate, while very-early initiation (≤48 h) may warrant caution in large infarcts. These findings support guideline evolution toward earlier anticoagulation in suitable patients and underscore the need for longerterm outcomes and refined risk-stratification tools.
Balancing Healthcare Quality and Regulation in the U.S. Healthcare System
his paper examines how the U.S. healthcare system navigates the tension between ensuring high-quality care and balancing regulatory burdens, economic incentives, innovation, and equitable access. It reviews foundational quality frameworks, regulatory bodies, legislation,consolidation trends, and emerging challenges such as AI regulation. The study underscores the need for adaptive, coordinated governance to build a high-functioning healthcare system.
Organized and Effective, the Future Organization of Critical Care
Since the emergence of critical care in the twentieth century, the fundamental elements that underpin critical care systems-specifically, the provision of care for critically ill and injured patients and the preservation of life-have undergone significant evolution. The last fifty years have witnessed remarkable progress in diagnostic techniques, organ support, and treatment options within critical care, necessitating further enhancements to achieve the highest quality of personalized critical care. To elevate the quality of critical care in the future, advancements in several key areas are essential: the physical environment of the ICU; the healthcare professionals who attend to critically ill patients; the equipment and technologies utilized; the information systems and data management; and the research frameworks that influence critically ill patients and their families. With acutely and critically ill patients and their families as the primary focus, progress in these domains is anticipated to revolutionize care and improve outcomes in the years ahead.
Euthanasia: The Ethical and Professional Perspective of Nursing
Euthanasia remains one of the most debated ethical issues in healthcare, particularly for nurses providing direct care to patients at the end of life. In Albania, as in many countries, legislation does not explicitly regulate euthanasia, creating moral and legal ambiguity for healthcare professionals. Nurses face the dual responsibility of alleviating patient suffering while preserving life, often resulting in moral distress and ethical dilemmas. This study aimed to explore the ethical, legal, and professional challenges nurses encounter in providing end-of-life care where euthanasia is prohibited or unregulated. A systematic literature review was conducted, analyzing peer reviewed studies from the last 15 years addressing nursing perspectives, ethical challenges, and moral distress in end-of-life care. Findings revealed frequent conflicts between patient autonomy and institutional policies, leading to significant moral distress. Lack of structured ethical education further exacerbated these challenges. Comparative insights from countries with legalized euthanasia demonstrate that clear ethical guidelines, professional training, and institutional support reduce moral distress and help nurses navigate complex ethical decisions while maintaining patient dignity. The study emphasizes integrating legal, ethical, and professional considerations into nursing practice, focusing on patient-centered care and policy frameworks that support ethically sound decision-making. Enhancing education and establishing supportive policies can empower nurses to provide compassionate, ethically informed care, ultimately improving the quality of end-of-life care and safeguarding both patient dignity and professional integrity.
Personal Health Big Data and Its Uses in Mongolia
T he Law on Personal Information Protection states that Health Information: refers to information about an individual’s physical and mental health, health care and services received. While the world is taking measures to reduce the spread and complications of non- communicable diseases, and to increase life expectancy, when new or resurgent infectious diseases are increasing, and during social disasters and using real-time information on population diseases and health rational. Therefore, the study of the storage and use of personal health bigdata became the basis of the research work. Objectives: The purpose of the research work is to study the storage of big data of personal health and its use. Methods: The process and use of personal health big data was researched based on medical history forms and NCD guidelines. It takes time and budget to carry out the research in all specialized central hospitals. For the personal health big data and use of medical records of the first central hospital and National Center for Maternal and Child Health, which provided the most inpatient treatment services since in 2014-2021 was studied using MS-Excel program.
Ten-Year Experience with Cataract Surgery and Associated Complications in Albania
Cataract remains a leading cause of visual impairment worldwide, and surgical intervention is the only effective treatment. In Albania, limited data exist regarding long-term outcomes and postoperative complications. This retrospective study evaluated 5,700 cataract surgeries performed at a major Albanian eye center between 2013 and 2023, focusing on surgical techniques, risk factors, and management of patients with ocular comorbidities. Both phacoemulsification and extracapsular cataract extraction (ECCE) were included. Data were collected on patient demographics, systemic and ocular comorbidities, type of anesthesia, surgical technique, intraoperative events, and postoperative complications, including posterior capsule rupture, corneal edema, elevated intraocular pressure, cystoid macular edema, and endophthalmitis. Statistical analyses assessed the incidence of complications and their association with surgical factors. Phacoemulsification was the predominant technique, accounting for 90% of cases, and was associated with a lower overall complication rate (4.3%) compared to ECCE (11.6%). Posterior capsule rupture was the most frequent complication (2.3%), while endophthalmitis was extremely rare (0.05%). A considerable proportion of patients presented with systemic or ocular comorbidities, including diabetes (16%) and wet age-related macular degeneration (4%), and combined cataract surgery with intravitreal injections was successfully performed in selected high-risk patients to optimize visual outcomes. These findings indicate that modern cataract surgery in Albania is safe and effective, particularly when phacoemulsification is employed. Careful preoperative assessment, meticulous surgical technique, and individualized management of patients with comorbidities are crucial for minimizing complications and optimizing postoperative visual function. Overall, this ten-year experience provides important benchmarks for cataract surgical practice in Albania and similar clinical settings, highlighting the benefits of advanced surgical techniques and tailored perioperative care for improving patient outcomes.
Donepezil-Associated Bradycardia in An Elderly Patient with Dementia: A Case Report
Acetylcholinesterase inhibitors are commonly prescribed for the management of Alzheimer’s disease and other dementias [1]. While generally well tolerated, these agents may cause serious cardiovascular adverse effects, particularly in frail older adults [2]. We report a case of symptomatic bradycardia and hypotension in an 85-year-old patient with dementia associated with donepezil use, which resolved after discontinuation of the medication [3].
Dr. Jyothi Patri MD, MHA, DipABLM, DABFM, FAAFP, HMDC
The Importance of a Holistic Intervention in Stroke: Guiar en DCA Project
When a patient is discharged from the hospital after suffering a stroke, they often face a significant lack of information about the next steps and the available resources that can improve their quality of life. This situation leads to a host of social, economic, familial, occupational, and even healthcare-related problems that must be addressed. For this reason, the Freno al Ictus Foundation created a project in 2023 to provide direct support to patients and their families, offering comprehensive assistance in the phases following the stroke.
Metastatic Urothelial Carcinoma of Occult Primary Origin Revealed by a Necrotic Inguinal Lymph Node: A Rare Case Report
Introduction: Occult primary urothelial carcinoma is an extremely rare entity that may present as isolated lymph node involvement without visible bladder or ureteral lesions, making diagnosis particularly challenging. Case Presentation: We report the case of a 91-year-old man presenting with a left inguinal swelling evolving over four years. Examination revealed a necrotic, fistulized mass with no urothelial lesions on cystoscopy. Biopsy showed a poorly differentiated carcinoma (CK7+/CK20+/p63+/p40+/GATA3−), initially suggesting squamous differentiation, but the lymphatic distribution and suspicious ureteral thickening supported an occult urothelial origin. A multidisciplinary management approach was undertaken. Systemic chemotherapy was not initiated due to age and comorbidities. Local wound care and antibiotic therapy led to partial improvement and clinical stabilization without visceral progression. Discussion: This case illustrates the diagnostic complexity of dedifferentiated urothelial carcinomas with atypical immunohistochemical profiles. Loss of GATA3 expression, though uncommon, does not exclude urothelial origin, especially in high-grade tumors. Presentation as isolated inguinal lymphadenopathy is exceedingly rare. Conclusion: Diagnosis of occult urothelial carcinoma requires multidisciplinary collaboration and careful integration of clinical, radiological, and pathological data. In elderly or frail patients, a conservative, symptom-oriented approach is often the most appropriate. Reporting such rare cases is essential to improve understanding of the atypical presentations and dissemination pathways of urothelial carcinoma.
Investigating the Association Between Maternal Infection and Inflammation and Child Autistic Traits in a Large Population BasedCohort Study
Objective: Maternal immune activation during pregnancy has been proposed as a mechanism linking prenatal inflammatory exposures to autism pathogenesis. While preclinical and epidemiological studies suggest a role for maternal inflammation and infection, findings in population-based cohorts are inconsistent. This study examined the associations between multiple prenatal inflammatory exposures and autistic traits, accounting for gene-environment interactions in the general pediatric population. Methods: We leveraged data from 5.075 mother-child dyads participating in Generation R. a population-based pregnancy cohort in the Netherlands. Prenatal inflammatory exposures included 1) maternal serum cytokines; 2) high-sensitivity CRP: 3) self-reported fever during pregnancy; 4) a maternal polygenic score for CRP: and 5) a methylation profile score of CRP in cord blood. Child autistic traits were measured with the Social Responsiveness Scale at mean ages 16 and 13 years. Linear mixed models were applied to estimate associations adjusted for maternal, child and technical covariates. Interaction terms tested whether child polygenic score for autism moderated associations. Results: No significant associations were observed between prenatal inflammatory exposures and autistic traits, both as a continuous measure and above a clinical threshold. No evidence was found for interactions between prenatal inflammatory exposures and the child polygenic score for autism in influencing autistic traits. Conclusion: Our findings suggest that typical fluctuations in maternal inflammation are unlikely to represent a major pathway linking prenatal environment to autism risk. We found no evidence that gene-environment interactions conferred additional risk for autistic traits.
Association Between Occlusal Wear Facets and Undiagnosed Sleep Bruxism in Adult Dental Patients
Background: Teeth grinding can occur during sleep and may remain unknown due to the absence of overt symptoms and lack of conscious awareness. Over time, repetitive actions can subtly alter the physical appearance of the teeth's tops, either in terms of appearance or texture. People might not be aware of these slight variations, but they might allude to other nighttime practices. The study examines the relationship between occlusal wear facets and undiagnosed sleep bruxism in adult dental patients, focusing on how tooth wear can serve as a clinically predictive indicator. Methods: The cross-sectional study was conducted between May 2025 and January 2026 within the dental clinics of Islamabad, using convenience sampling. A sample of 385 adult patients who completed a self-report Oral Behaviour Checklist (OBC) and a Tooth Wear Index (TWI) were administered the clinical assessments. The statistical analysis of the data was conducted using SPSS Version 26, which included descriptive statistics, t-tests, ANOVA, Pearson correlation, and linear regression to determine the correlations between oral behaviours and occlusal wear. Results: Out of the 385 respondents, 194 (50%) were male and 191 (50%) were female. Both the Oral Behaviour Checklist (OBC) and the Tooth Wear Index (TWI) showed higher scores in males than in females (p < 0.01) There was consequently a significant positive correlation between tooth wear scores and oral behaviour ( r = 0.312 p < 0.001 ) Another critical variable was age, where older adults showed higher scores in both indices (p < 0.01) . Linear regression analysis revealed that scores on OBC were highly predictive of scores on TWI ( B = 0.94 , p < 0.001 ). Caffeine use and smoking status had a significant correlation with specific health-related issues, including the presence of TMJ issues and the frequency of headaches ( p < 0.001 ). Conclusion: These results indicate that self-reported oral behaviours are strongly related to occlusal wear, suggesting that tooth wear could be a clinical marker of undiagnosed sleep bruxism. Implementing regular occlusal wear screening during dental facility visits may help identify and treat dental issues at an earlier stage, thereby preventing long-term dental damage.
Current Trends in Healthcare Quality in the United States: Innovations, Challenges and Future Directions
The landscape of healthcare quality in the United States is undergoing a profound transformation. Driven by technological innovation, policy reform, and shifting consumer expectations, healthcare providers are reimagining how care is delivered, measured, and experienced. This paper explores the most significant trends shaping healthcare quality in 2024 and beyond, including the rise of personalized medicine, the integration of artificial intelligence (AI), the expansion of value-based care models, and the prioritization of patient experience. It also examines systemic challenges such as workforce shortages, economic pressures, and persistent health disparities. Through acomprehensive analysis of current developments, this paper aims to provide insight into the evolving nature of healthcare quality and the strategies needed to ensure equitable, efficient, and patient-centered care across the United States.
Empowering Women’s Health: A Comprehensive Review of Reproductive, Maternal and Preventive Care Strategies
Women’s health includes biological, social, and gender-based factors, as well as clinical medicine. The complicated interrelationships of biological, social, and gender-based factors and clinical medicine have an effect on reproductive rights, prevention care, and access to care. Even as progress continues with maternal health care, contraceptive technologies, and disease prevention, there are still disparities, especially in low-income areas of the world where access to essential reproductive health care is limited, and where maternal mortality still does not reach the levels of minimal. Global health priorities shift as non-communicable diseases (NCDs), including breast cancer and cardiovascular diseases (CVD), have climbed to the forefront of global public health. Prevention care using early interventions, vaccinations, and periodic screening can help burden reduction. However, there are barriers to women’s access to health care and prevention care such as institutional injustices, cultural barriers, and resource burdens, in particular for racial and ethnic minorities. Even as these benefits are unshared equitably, advancing technology in digital health, telemedicine, and assisted reproductive technologies (ART) provide opportunities to help bridge gaps. This review presents the successes, issues, and direction of maternal, reproductive and preventive healthcare programs. The analysis of the interaction between access to healthcare, gender inequalities, and policy responses highlights the need for interdisciplinary approaches to implement equitable, gender-responsive healthcare interventions worldwide.
A Systematic Comprehensive Review and Synthesis of Different Mechanisms of Action for Scoliosis Braces in English and FrenchLiterature
A very wide variety of braces have been developed around the world during the last decades. This diversity often complicates therapeutic decisions. It is, therefore, more pragmatic to categorize braces based on their mechanisms of action. This study aims to identify and classify these mechanisms into three categories: passive, active, and secondary. To achieve this, a comprehensive review of existing literature in both English and French was conducted following the PRISMA diagram. 1575 articles were identified. After removing duplicates, 69 articles were found to highlight 24 mechanisms of action: comprising 12 passive, 6 active, and 6 Secondary. 12 Passive Mechanisms are Including: 1. Concave to convex tissue transfer under T10, 2. Rib-cage/spine coupling patterns between T2-T10, 3. plane geometry, 4. solid geometry, 5. Three-point system or derotation torque, 6. Derotation on Z axis, 7. global bending, 8. regional bending, 9. mobility under the brace, 10. Unloading, 11. recentering of the apical nucleus, and 12. sagittal normalization. 6 Active Mechanisms are Including: 1. vertebral growth modulation, 2. rebalance stress distribution, 3. active pulling, 4. active pushing, 5. elastic forces, 6. Ponseti-type intervention. 6 Secondary Mechanisms are Including: 1. vital capacity, 2. material tolerance, 3. closures, 4. Physiotherapy & gait modification, 5. Management, 6. Monitoring. Generic braces are a testament to the geographical schools of thought and research experiences from which they originate. The ideal brace remains nameless, as it represents a balanced choice of action mechanisms, striving for a compromise between effective three-dimensional correction and patient tolerance.
Impact of Early-Life Antibiotic Exposure on the Risk of Childhood Obesity: A Systematic Review and Meta-Analysis
Background: Childhood obesity is a growing global health challenge linked to long-term metabolic, cardiovascular, and psychosocial consequences. Emerging evidence suggests that early-life antibiotic exposure, a common disruptor of gut microbiota during critical developmental windows, may increase the risk of overweight and obesity. Objective: To systematically evaluate and quantify the association between antibiotic exposure in the first two years of life and the subsequent risk of overweight or obesity in childhood, with subgroup analyses by antibiotic type, timing, and sex. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to January 15, 2025, without language restrictions. Eligible studies included prospective or retrospective cohorts assessing systemic antibiotic exposure in children aged ≤24 months with later overweight/obesity outcomes. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle–Ottawa Scale (NOS). Random-effects models were used to generate pooled effect estimates, with heterogeneity assessed via I² statistics. Results: Three high-quality cohort studies (n = 365,306 participants) from China, Canada, and the USA met inclusion criteria. Antibiotic exposure within the first 24 months was consistently associated with increased BMI z-scores and higher odds of overweight/obesity. The largest study (n = 362,550) showed a dose–response relationship, with incremental BMI increases per additional antibiotic course (p < 0.001). Broad-spectrum antibiotics were linked to slightly higher BMI z-scores compared to narrow-spectrum agents, and cephalosporins/macrolides exhibited stronger associations. A sex-specific effect was noted in one study, with significant risk elevation among boys (aOR = 5.35, 95% CI: 1.94–14.72). Moderate heterogeneity was observed (I² range: 38–52%), but the direction of effect remained consistent across subgroups. Conclusion: Early-life antibiotic exposure, particularly broad-spectrum and repeated courses, is associated with an increased risk of overweight and obesity in childhood. These findings highlight the need for cautious antibiotic prescribing in infancy as part of obesity prevention strategies. Future research integrating microbiome profiling is warranted to elucidate causal pathways and identify high-risk subgroups.
Impact of Preoperative Nutritional Status on Wound Healing Outcomes in Patients Undergoing Abdominal Surgery
Background: Postoperative healing of the wound is a critical component of post-surgery recovery and may be impacted by various patient-related conditions. The recovery of surgical procedures can be affected in areas that experience common nutritional deficiencies. Although there is current global awareness regarding its role, there is a lack of research explaining this relationship in the Pakistani population. This research examines the relationship between preoperative nutrition and postoperative wound healing in patients under surgery in tertiary care hospitals in Islamabad. Methods: This study was a prospective cohort study carried out between February and June 2025. A convenience sampling of 387 adult patients who had an abdominal surgery was recruited. The data collection was conducted using a structured questionnaire that contained demographic and detailed information on the variables, including the Nutritional Risk Screening (NRS 2002) and postoperative wound outcomes, as assessed by the Southampton Wound Assessment Scale (SWAS). Statistical analysis was performed using SPSS v.26. Descriptive statistics, t-tests, ANOVA, Pearson correlation, and linear regression tests were employed to investigate the relationship between nutritional risk and wound healing. Results: The nutritional risk scores were significantly higher among females (M = 7.18, SD = 1.34) than males (M = 6.88, SD = 1.22), p = 0.021. Nutritional risk was significantly but weakly related to scores on the SWAS (r = 0.116, p = 0.022), indicating that the worse the nutritional status, the poorer the healing outcome. Regression analysis confirmed that nutritional risk was a significant predictor of wound severity (p = 0.022). The wound scores were higher in older age groups, but the nutritional risk did not vary significantly between age categories. Conclusion: The research suggests a significant correlation between inadequate preoperative nutritional status and delayed wound healing. Patients with poor dietary status had unfavourable postoperative outcomes. This evidence suggests conducting a regular nutritional screening process to enhance postoperative recovery and alleviate surgical wound complications among patients undergoing abdominal surgery.
Navigating the Mind: The Intersection of Technology and Mental Health in the 21st Century
The rapid advancements in technology have profoundly transformed the landscape of mental health care in the 21st century. From telemedicine to wearable health trackers, artificial intelligence, and virtual reality-based therapies, technology is redefining how mental health is understood, accessed, and managed. While these innovations offer immense opportunities for early diagnosis, personalized care, and the destigmatization of mental health issues, they also present unique challenges. This paper explores the evolving relationship between technology and mental health, emphasizing both its potential and pitfalls. It advocates for a balanced integration of technology into mental health care with evidence-based practices, ethical guidelines, and a human centered approach to ensure that technology serves as an enabler rather than a deterrent to mental well-being.
The Impact of Long-Term Occupational Radiation Exposure on Thyroid Health Among Radiographers in Oman
The accumulative long occupational radiation exposure experienced by radiographers and the following consequential adverse effects have been an alarm for years. Health concerns included radiation induced skin injury, cataract development, cardiovascular and thyroid disorders. Thyroid and bone marrow are particularly sensitive to ionizing radiation. Long-term exposure to radiation can significantly impact thyroid functions, leading to various thyroid disorders over time. This study aimed to evaluate the relation between long term exposures to ionizing radiation and the increased risk of thyroid dysfunction over time among radiographers in Oman. This was confirmed by analysis of thyroid hormones measurement; mean serum levels of T3 (triiodothyronine) (2.5 ± 0.9 pmol/L, p < 0.05 ) and T4 (thyroxine) (5.1 ± 1.22 pmol/L, p<0.01) which showed significant drops as compared to normal level range. A significant increase in the mean serum TSH (thyroid stimulating hormone) levels of the subjects of the study r(16.5 plus/minus 1.22 * m(IU) / L, p < 0.001) as compared to the normal level range. Our results suggest prolonged exposure can lead to damaging effects of the thyroid gland and this could be explained by structural and functional changes in the thyroid tissue. Understanding the pathogenesis of these disorders is crucial for developing strict protective guideline measures for radiographers.
Unusual Case of Annuloaortic Ectasia - A Case Report
Annuloaortic ectasia is a rare cardiovascular condition characterized by aneurysmal dilatation of aortic annulus and ascending aorta resulting in aortic insufficiency. As the ascending aorta enlarges, the risk of aortic rupture or dissection also rises. As per our knowledge, ascending aorta aneurysm more than 9cm without dissection or rupture has scarcely been reported.
Perioperative Management of Difficult Airway
Introduction: It is widely recognized that the two most important tasks for anaesthetists are the management of a difficult airway and the maintenance of oxygenation. Problems related to difficult airways are known to be the primary cause of life-threatening anaesthesia-related accidents, they are one of the main sources of legal issues in the United Kingdom Défense Societies registries and in the American Society of Anaesthesiologists (ASA) closed claims. That is why difficult airway management is one of the most demanding duties for anaesthetists, and it provides a continuous challenge in addressing and solving potentially life-threatening problems. Although the incidence of the most critical situation in airway management, "cannot intubate, cannot oxygenate." is low at 0.0019-0.04%, its occurrence can have severe consequences and up to one-third of anaesthesia-related deaths are due to failure to intubate and ventilate including tracheal or oesophageal injury, aspiration, and sever hypoxemia, which can cause irreversible brain damage and lead to death. Clinical Features of airway obstruction, respiratory arrest, Teaching post graduates basic airway manoeuvres like head-tilt/chin-lift. Predictors of difficult airway Key parts of the examination of patients include neck mobility, mouth opening, teeth/jaw alignment, shorter horizontal distance, retrognathia, Mallampati score, thyromental distance. Specific tests like modified Mallampati, lemon test, Wilson score SARI score have been recommended as predictors Measurements of airway can help identify issues like limited neck extension, micrognathia. Preparation of patients with difficult airway- airway management equipment ie airway cart It also covers basic airway adjuncts like oropharyngeal airways and nasopharyngeal airways. Finally, it introduces advanced airway devices like laryngeal mask airways and describes how to size them appropriately. Fibreoptic intubating bronchoscope Basic vital parameters monitor- Management of airway, to follow the ASA difficult airway algorithm strategy used for managing difficulties and management of complication arising out non intubations situations.
Surgical Innovations and Instrumentation 3D Printed Human Laryngeal Model: A Tool for Laryngeal Framework Surgery Training
Objective: To develop and pilot test a 3D-printed human laryngeal model designed for laryngeal framework surgery training, aimed at enhancing the skills of ENT specialists and residents. Methods Design: Surgical Innovation Setting: Tertiary Government Training Hospital Participants: Consultants and Residents of the Department of ORL-HNS Results: This surgical innovation described the step-by-step production of a 3D-printed human larynx which was used as a model for an advanced laryngeal workshop by ENT residents, consultants, and phonosurgeons. It was evaluated to be easy to use and effective in simulating different laryngeal framework surgeries such as Isshiki Thyroplasty Types I to IV. Conclusion: The 3D-printed human larynx may be used as a tool for laryngeal framework surgery training during workshops for ENT specialists.
What’s New in the Estimation of SPF and UVA-PF?
Up to very recently the assessment of SPF was performed “in vivo” by ISO 24444 standard, while for UVA-PF ISO 24443 “in vitro” standard was used, which still needed and empirical coefficient derived from the SPF “in vivo” to normalize the results. Since some years ago, ethical critics have been made to the fact that human beings were submitted to UVA radiation to evaluate the SPF. The European Community recommended replacing those standards with new ones that allow all determinations to be made in vitro. But, as simple it may seem the purpose, it could not be achieved because there was no good correlation between the results obtained by spectrophotometry and those obtained from human panels. Since December 2024, after an extended circular test performed in Europe monitored by the ISO/TC 217, Cosmetics Committee validated the new standards ISO 23675 (In vitro determination of Sun Protection Factor (SPF)) and ISO 23698 (Measurement of sunscreen efficacy by diffuse reflectance spectroscopy). With horizon 2025, these new ISO standards will replace the actual ones into the European Community and later, most probably, within Mercosur and America in general. Due to their complexity, to be implemented they need expensive equipment and thorough training of technical personnel. Prudence would indicate preparing in time for the changes. If not, our enterprises (specially the smaller and those who are not internationalized and producing sun care cosmetics) will be handicapped. In this paper we try to present the new techniques, emphasizing the equipment needed. We do also an explicit critic on the fact that they are based on an irradiation source (Xenon arc) designed only for the 40o latitude of the northern hemisphere, compatible with the mediterranean summer sun in Europe, but not representative at other latitudes.
Telemedicine in the Management of Patients with Diabetes Mellitus Results of an 18-Month Follow-Up
Introduction: Increasing number of patients with type 2 diabetes mellitus places growing demands on patient management. Addressing this issue requires the integration of innovative technologies, including telemedicine. Parameters can be measured in a home environment (self-monitoring of blood glucose, blood pressure, ecg, weight, oximetry, spirometry) by the patients themselves, with the data transmitted via suitable technology. Methodology: Prospective, Non-Interventional, Clinical Study Conducted Under Routine Clinical Practice Conditions In a Diabetology Outpatient Clinic. Results: A total of 216 patients were included in the telemedicine follow-up: 109 women (51.66%) and 102 men (48.34%). The average usage duration of the telemedicine kit was 8.8 months. Postprandial blood glucose levels showed the greatest improvement after six months of intervention; over time, glucose levels slightly increased but remained below baseline values. HbA1c levels (baseline 7.83% DCCT) improved initially (6.85% DCCT) and remained in the optimal range for 18 months. Among telemedicine kit users, 42.5% achieved HbA1c < 7% DCCT, while 23.3% had HbA1c > 9% DCCT, Women experienced greater weight reduction (from 85.30 kg to 84.0 kg, -1.53%) compared to men (from 98.26 kg to 97.46 kg, -0.83%). Blood pressure was the most frequently monitored parameter, with most patients maintaining values within the optimal range. Conclusion: The transmission of data allows physicians to actively adjust treatment and recommendations without the immediate need for in-person visits, thereby reducing the time required for making relevant medical decisions and implementing them for patients.
Covid-19 in Hospitalized Patients with Type 2 Diabetes Treated by Metformin: A Systemic Review and Retrospective Analysis
Objectives: Metformin is a widely prescribed oral antihyperglycemic agent used as first line therapy for type 2 diabetes mellitus. Therefore, there has been growing interest in the role of metformin in treating various inflammatory conditions. The aim of this analysis is to determine whether treatment with metformin is associated with lower mortality in those infected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Method: A single-center retrospective study, carried out at the 5th Department of Internal Medicine in University Hospital in Bratislava. A total of 133 diabetic patients hospitalized with confirmed COVID-19, from 14th November 2020 to 7th May 2021, were grouped into metformin and no-metformin groups according to the diabetic medications used prior to hospitalization. The demographics, characteristics, laboratory parameters, treatment and clinical outcome in these patients were retrospectively assessed, Results: Age and chronic microvascular complications of diabetes were significant risk factors for the mortality of COVID-19. There was no difference in the type of oxygen therapy, blood count and inflammatory markers in blood among patients taking metformin prior to hospitalization and patients with other antidiabetic treatments. Conclusion: The analysis showed that metformin treatment was not associated with lower mortality, thus justifies the implementation of prospective studies to understand the mechanism and causality.