Background: Malaria and peptic ulcer disease (PUD) remain major causes of illness in many tropical and subtropical areas, where both diseases occur in the same populations and share similar epidemiological and socioeconomic factors. Although malaria has traditionally been considered a parasitic disease affecting the whole body, growing evidence shows that its effects go beyond the destruction of red blood cells to involve vascular, inflammatory, and metabolic disturbances that can interfere with the normal function of the gastrointestinal tract. The present review examines the existing evidence regarding the biological relationship between malaria and PUD, with a focus on the mechanisms that may damage the integrity of the gastric mucosa. Methods: A structured narrative review was conducted using peer-reviewed publications indexed in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar between January 2000 and March 2026. Experimental, observational, clinical, and translational studies addressing malaria pathophysiology, gastric mucosal injury, Helicobacter pylori infection, oxidative stress, endothelial dysfunction, intestinal barrier impairment, gut microbiota alterations, and antimalarial therapy were assessed and incorporated into a mechanistic framework. Results: The available evidence shows that malaria can affect mucosal homeostasis through several closely linked biological pathways. These pathways involve the sequestration of parasitised erythrocytes in the microvasculature, activation of the endothelium, reduced tissue perfusion, the release of inflammatory cytokines, oxidative stress, depletion of nitric oxide associated with haemolysis, and tissue hypoxia resulting from anaemia. Conclusion: The available evidence indicates a biologically plausible interaction between malaria and peptic ulcer disease rather than establishing a definite causal link. This review, by combining results from the fields of vascular biology, immunology, gastroenterology, oxidative stress research, and microbiome science, offers a comprehensive mechanistic view that could enhance understanding of the gastrointestinal complications associated with malaria.
Background: Garcinia indica (Thouars) Choisy (Vrikshamla), a medicinal and culinary plant of the family Clusiaceae, is used in Ayurveda and is valued for its organic acids, anthocyanins, phenolics, flavonoids, and related phytoconstituents. Reliable botanical and analytical reference characteristics are important for authentication and quality assessment of fruit-rind material. Aim and Objectives: The present study aimed to generate integrated baseline pharmacognostical, physicochemical, phytochemical, and chromatographic reference parameters for the authentication, identification, and quality assessment of Garcinia indica fruit rind. Methodology: Pharmacognostical evaluation included macroscopic, organoleptic, transverse-section, and powder-microscopic examination. Foreign matter, loss on drying, total ash, water-soluble extractive, ethanol-soluble extractive, and pH were determined according to Ayurvedic Pharmacopoeia of India procedures. Preliminary phytochemical screening was performed on aqueous, ethanolic, methanolic, and chloroform extracts using standard qualitative tests. HPTLC fingerprinting of the methanolic and chloroform extracts was performed on silica gel 60 F254 plates using n-pentane: ethyl acetate: formic acid (7:3:0.5, v/v/v) as the mobile phase, followed by densitometric evaluation at 254 and 366 nm. Results: The authenticated fruit-rind material showed characteristic macroscopic, microscopic, and powder-microscopic features. The measured physicochemical values were loss on drying 43.77% w/w, total ash 2.73% w/w, water-soluble extractive 52.20% w/w, ethanol-soluble extractive 12.30% w/w, and pH 2.0; foreign matter was not detected. Qualitative screening showed terpenoids in all four extracts, with other phytochemical classes varying according to solvent. The HPTLC profiles showed prominent chromatographic components in the Rf region of approximately 0.47-0.58 at 254 nm and 0.48-0.57 at 366 nm for the methanolic extract, while the chloroform extract showed prominent components around Rf 0.47-0.49. The band patterns remained broadly comparable across the tested application volumes. Conclusion: The study provides an integrated baseline pharmacognostical, physicochemical, qualitative phytochemical, and HPTLC fingerprint profile for the analysed Garcinia indica fruit-rind material under the reported experimental conditions. These data may support routine authentication and future quality-control studies, while wider pharmacopoeial specifications will require multi-batch evaluation and formal analytical validation.
Aim: To describe an uncommon cutaneous horn on the volar surface of a finger in a young Nigerian adult and highlight the unusual age and anatomical site. Presentation of Case: A 29-year-old man presented with a solitary lesion over the volar aspect of the proximal interphalangeal joint of the right ring finger that had been present for 2 years. He reported no preceding trauma or surgery and no pain, itching, or bleeding. Examination showed a firm, horny lesion approximately 1 cm in length with a broad base and no basal erythema. The lesion was excised along the digital crease with a 3 mm margin, extending to just above the flexor tendon sheath. Histopathology demonstrated protuberant hyperkeratosis without appreciable parakeratosis, with mild papillomatosis, focal hypergranulosis, acanthosis, and mild perivascular lymphocytic infiltrates in the superficial dermis. Discussion: Cutaneous horns are more commonly reported in older individuals and at sun-exposed sites, whereas this lesion occurred at a relatively photoprotected volar digital site in a young adult of African descent. As the horn represents a morphological presentation rather than the underlying pathology, assessment of the lesion base remains important. Conclusion: Cutaneous horns may occur at unusual anatomical sites and in younger patients. Further documentation may help clarify their clinical spectrum in African populations.
Pandemics and pandemic-scale emergencies of the past three decades have produced an unusually large and heterogeneous body of evidence, yet the epidemiological, mechanistic and clinical literatures have largely developed in parallel and have rarely been appraised together. This review examines that literature critically, taking as its material the human immunodeficiency virus pandemic, the 2003 severe acute respiratory syndrome epidemic, the 2009 influenza A(H1N1) pandemic, Middle East respiratory syndrome, the West African and Congolese Ebola virus disease epidemics, the Zika virus epidemic, the ongoing seventh cholera pandemic, coronavirus disease 2019, the multi-country mpox emergencies, and the panzootic spread of highly pathogenic avian influenza A(H5N1). Literature was identified through searches of three openly accessible bibliographic resources and selected institutional sources, with all bibliographic records verified against registry metadata. The synthesis identifies four persistent problems. First, the operational category of a pandemic remains unstable, which affects the timing of declarations, the comparability of burden estimates and the allocation of resources. Second, the principal epidemiological quantities used to guide policy, including reproduction numbers, case fatality ratios and excess mortality, are estimated by methods whose assumptions are frequently unstated and whose disagreements are substantial enough to alter conclusions. Third, mechanistic accounts of severe disease have converged on a small number of shared processes, in particular innate immune dysregulation, endothelial injury and immunothrombosis, but the inferential basis for these accounts rests heavily on cross-sectional and post-mortem material from severely ill patients in high-income settings. Fourth, evidence on countermeasures is markedly stratified, with randomised evidence for vaccines and several therapeutics but predominantly observational and model-based evidence for non-pharmaceutical interventions. Confidence is strongest for the age gradient of severity, for the efficacy of several vaccine platforms and for the existence of a substantial post-acute symptom burden, and weakest for the comparative effectiveness of individual non-pharmaceutical interventions and for the mechanistic basis of post-acute syndromes. Research priorities that follow from these findings concern standardised burden estimation, prospective mechanistic cohorts recruited across the severity spectrum, and pre-agreed trial infrastructure capable of producing interpretable results during the acute phase of an emergency.
Background: High blood cholesterol is a major modifiable risk factor for cardiovascular disease, but evidence on associated factors among Indigenous adults in Canada remains limited. Objective: To identify demographic, socioeconomic, lifestyle, and clinical factors associated with high blood cholesterol among Indigenous adults in Canada. Methods: A cross-sectional study was conducted using data from the 2022 Canadian Community Health Survey. The analysis included 1,632 Indigenous adults aged ≥18 years, representing 607,893 adults after survey weighting. Survey-weighted multivariable logistic regression with bootstrap replicate weights estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for self-reported high blood cholesterol. Results: Older age, diabetes, hypertension, and province of residence were independently associated with high blood cholesterol. Compared with adults aged 18–34 years, higher odds were observed among those aged 50–64 years (aOR=5.16, 95% CI 1.88–14.16) and ≥65 years (aOR=5.80, 95% CI 2.05–16.42). Diabetes (aOR=7.06, 95% CI 2.77–17.99) and hypertension (aOR=2.36, 95% CI 1.18–4.70) were also associated with higher odds. Compared with Atlantic Canada, lower odds were observed in Quebec (aOR=0.25, 95% CI 0.07–0.98) and the Prairies (aOR=0.28, 95% CI 0.10–0.81). Sex, education, body mass index, smoking, and alcohol consumption were not significantly associated with the outcome. Conclusions: Older age, diabetes, hypertension, and geographic region were associated with high blood cholesterol among Indigenous adults in Canada. These findings support integrated cardiovascular risk assessment and early identification of dyslipidaemia in Indigenous populations.
Nanoscale modification of titanium (Ti) implant surfaces is widely presented as the natural successor to the moderately rough microtextures that underpin contemporary clinical success. This critical narrative review evaluates whether the accumulated evidence supports that claim, moving beyond a catalogue of surface technologies to interrogate the strength, consistency and translational maturity of the underlying literature. Peer-reviewed studies, authoritative reviews and institutional evidence were selected through structured searching of openly accessible scholarly indexes and appraised for methodological quality, evidence-claim alignment and internal consistency. The synthesis is organised around biological mechanisms, fabrication-related confounding, the unresolved question of optimal feature dimensions, the transition from cell culture to living tissue, and the competing design objectives introduced by antibacterial and immunomodulatory functionalisation. The available evidence indicates that nanoscale features engage integrin-mediated adhesion and can accelerate early osteoblast responses and peri-implant bone formation. Confidence in a single defined optimum is nonetheless undermined by a genuine and unreconciled disagreement over the most favourable titania nanotube diameter, by the near-inseparability of nanotopography from co-varying changes in surface chemistry, oxide crystallinity and wettability, and by a pronounced dependence of outcomes on cell type and maturation state. Early gains in stability and bone-to-implant contact observed in animal models and short clinical series tend to attenuate as healing progresses, and no consistent long-term advantage over modern microrough controls has been demonstrated. Antibacterial and osteoimmunomodulatory strategies add functional value but introduce trade-offs, because the feature dimensions that favour osteogenesis do not necessarily coincide with those that maximise bactericidal or pro-healing immune responses. The field remains dominated by short-term in vitro endpoints, heterogeneous characterisation and small clinical samples concentrated in a limited number of laboratories. Nanoscale engineering is therefore best regarded as a promising but incompletely validated refinement rather than an established clinical improvement, and priority should shift towards decoupled mechanistic studies, standardised reporting and adequately powered long-term trials.
Background: Undergraduate dental education imposes substantial cognitive demands because of dense curricula, the integration of theoretical and clinical knowledge, and continuous skill acquisition. Excessive instructional load may exceed learners’ working-memory capacity, leading to information overload, reduced retention, and inefficient learning. Objective: To assess perceived information overload and cognitive load among undergraduate dental students and interns and to conduct a preliminary psychometric evaluation of a structured questionnaire designed to measure these constructs. Methods: A cross-sectional, questionnaire-based study was conducted over one month among 173 Bachelor of Dental Surgery (BDS) students and interns at a private dental institution in Andhra Pradesh, India. Participants attended standardised lecture sessions and completed a 15-item Likert-scale questionnaire assessing information overload, mental effort, lecture organisation, retention, and academic adaptation. Content and face validity were established through expert review and pilot testing. Exploratory factor analysis (EFA) and reliability assessment using Cronbach’s alpha were performed. Results: EFA provided preliminary evidence of a dominant factor and demonstrated excellent sampling adequacy (KMO = 0.88; p < 0.001). A dominant unidimensional factor representing “global academic cognitive load” was identified. The questionnaire showed high internal consistency (Cronbach’s alpha = 0.905). Most participants reported moderate-to-high levels of information overload (approximately 74%), mental fatigue (approximately 67%), and difficulty integrating concepts (approximately 72%). Retention challenges were prominent, with 84% requiring repeated revision. Although 79% reported some improvement in academic adaptation, the overall cognitive burden remained substantial across all academic levels. Conclusion: Perceived cognitive load and information overload were common among dental students despite academic progression. Current instructional practices may exceed learners’ processing capacity, indicating a need for curriculum restructuring and cognitive-load optimisation strategies to improve learning efficiency and retention.
Background: Female infertility remains a significant reproductive health concern in sub-Saharan Africa, with tubal and uterine pathologies accounting for a substantial proportion of cases. Hysterosalpingography (HSG) continues to play a pivotal role in the initial radiological assessment of infertility, particularly in resource-limited settings where advanced imaging modalities may not be readily available. Aims: This study aimed to evaluate the indications for HSG and analyse the spectrum of diagnostic findings obtained during HSG examinations performed in the investigation of female infertility at a private radiodiagnostic centre in southern Nigeria, thereby providing evidence to inform appropriate clinical management. Methodology: A retrospective descriptive study was conducted using HSG examinations performed for infertility evaluation between January 2020 and December 2024. Patients’ demographic data, procedural indications, radiographic techniques, and findings were extracted from the Vitrea system and hospital records. Data were analysed using descriptive statistics. Results: A total of 312 women were included, with a mean age of 32.8 ± 5.4 years. The predominant indication was secondary infertility (71.8%), followed by primary infertility (28.2%). Abnormal HSG findings were observed in 72.4% (n = 226) of cases. Tubal abnormalities were the most frequent findings (50.6%), comprising unilateral tubal blockage (18.6%), bilateral tubal blockage (27.2%), and hydrosalpinx (3.8%). Uterine abnormalities were identified in 28.5% of patients and included fibroids, intrauterine adhesions, and congenital anomalies. Conclusion: Hysterosalpingography remains a valuable, cost-effective, and accessible tool in the diagnostic work-up of female infertility in Nigeria. Tubal abnormalities constituted the majority of detected abnormalities, underscoring the importance of early radiological evaluation in guiding appropriate management.
Aims: To identify independent risk factors for perioperative neurocognitive disorder (PND) in school-age children after general anaesthesia, develop a predictive risk model, and evaluate the clinical efficacy of combined neurometabolic pharmacotherapy and digital cognitive training in children with confirmed PND. Study Design: A prospective cohort study with a nested, non-randomised, two-arm treatment comparison. Place and Duration of Study: The study was conducted in the Departments of Pediatric Surgery, Anesthesiology-Reanimatology, and Dermatology at the Clinic of Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan, from March 2024 to January 2025. Methodology: A total of 206 school-age children aged 7–17 years were studied: 181 underwent elective non-cardiac surgery under general anaesthesia, while 25 healthy children served as normative controls. PND was defined on postoperative day 7 using the ISPOCD composite Z-score method (|Z| ≥ 1.96 on at least two of seven instruments). Independent predictors were modelled using multivariable logistic regression. Among 56 children with confirmed PND, 30 received one month of combined therapy (hopantenic acid [Pantogam] plus the NeyroCog.uz digital cognitive-training platform), while 26 received standard follow-up. The groups were compared using analysis of covariance (ANCOVA) adjusted for baseline scores, and effect sizes were expressed as Cohen’s d. Results: PND occurred in 56 of 181 children (30.9%). Independent predictors were the number of anaesthetic agents used (OR=3.81, P<.001), premorbid neurological background (OR=3.62, P=.02), anaesthesia duration per minute (OR=1.02, P<.001), and age, which was associated with lower odds of PND (OR=0.67, P<.001). The composite model showed good discrimination (AUC=0.78; Nagelkerke R²=0.45). Combined therapy produced significantly greater covariate-adjusted gains than standard follow-up in selective attention (Δadj=15.13, P<.001), verbal memory (Δadj=16.03, P<.001), psychomotor speed, working memory, and auditory gnosis (all P<.001; Cohen’s d=1.0–2.9). No significant between-group differences were observed in clinical-neurological status or EEG (P=.37 and P=.77, respectively). Conclusion: The four-factor model showed potentially useful discrimination for PND risk. Combined neurometabolic–digital cognitive rehabilitation was associated with large, domain-selective gains compared with standard observation. These findings support external validation of the risk model and further randomised evaluation of the combined rehabilitation protocol before routine clinical adoption.
Background: Dental occlusion and tooth morphology may influence oral cavity configuration, jaw position, and phonation, but their relationship with vocal performance remains insufficiently characterized. This case report describes clinical changes observed after correction of occlusal discrepancies in a professional opera singer. Case Presentation: A female opera singer in her 40s presented with occlusal discomfort, mild headaches, right shoulder stiffness, impaired sitting balance, and difficulty producing high-pitched notes. Symptoms began approximately two weeks after placement of a three-unit metal bridge in the upper right molar region. Clinical examination identified no temporomandibular joint abnormalities but revealed an anterior crossbite and minor tooth morphology irregularities, including protrusions affecting the lower left canine and lower left first molar. Intervention: Occlusal adjustment and tooth morphology refinement were performed using conventional dental assessment. The Bi-Digital O-Ring Test was used only as a supplementary clinical indicator and did not determine diagnosis or treatment independently. Results: After treatment, the patient reported improved occlusal discomfort, resolution of headaches within several days, improved right shoulder mobility, and stabilized sitting balance. She also reported easier high-pitched phonation, greater vocal stability, reduced strain, and improved resonance, with maintenance of improvements for more than two months. Conclusion: This case suggests a possible association between correction of occlusal discrepancies and improved subjective vocal performance, although causal inference cannot be established from a single case.
Telescopic denture systems, distinguished by their double-crown construction and programmable retention, have occupied an established position in prosthodontic rehabilitation for more than a century. In recent years, the field has been reshaped by two converging developments: the emergence of high-performance biomaterials and the widespread adoption of digital fabrication technologies. This review examines the current state of evidence on material innovations—including zirconia ceramics, polyetheretherketone (PEEK), noble metal alloys, and base metal alternatives—alongside digital workflows encompassing computer-aided design and manufacturing (CAD/CAM), intraoral scanning, and additive manufacturing, as applied specifically to telescopic prosthetic systems. Searches were conducted for literature published between January 2010 and March 2026 in all primary databases, with the date range selected to ensure contemporary clinical and materials science relevance. Clinical outcomes, retentive mechanisms, biological considerations, and patient-centred measures are addressed throughout. The review identifies a trend towards increased precision, improved aesthetics, and enhanced customisation in telescopic prostheses fabricated through digital means, whilst acknowledging that the evidence base—particularly for newer materials in this specific prosthetic category—remains in a developing phase. Challenges related to material standardisation, clinical validation, cost, and practitioner expertise are discussed, and directions for future research are identified.
Background: Bell’s palsy is the most prevalent cause of acute unilateral facial paralysis and often results in functional deficits, facial asymmetry, and psychosocial impairment. While conventional therapy, facial nerve stimulation, and home-based exercise are widely used, advanced physiotherapeutic approaches such as proprioceptive neuromuscular facilitation (PNF) and neuromuscular re-education (NRE) may provide superior functional outcomes. Objective: To systematically compare the effectiveness of PNF and NRE with conventional therapy combined with home-based exercise (HBE) and facial nerve stimulation in improving facial function, disability, and quality of life in patients with Bell’s palsy. Methods: This review was conducted according to PRISMA 2020 guidelines. Electronic databases including PubMed, Scopus, Web of Science, PEDro, and Cochrane Library were searched for studies published between 2000 and 2026. Results: Randomized controlled trials, cohort studies, and interventional studies involving Bell’s palsy patients receiving PNF, NRE, electrical stimulation, conventional therapy, or combinations were included. Evidence consistently suggests that PNF and NRE demonstrate greater improvements in facial symmetry, facial grading scores, disability reduction, and synkinesis management compared to conventional approaches alone. Combined multimodal rehabilitation yielded the most clinically meaningful outcomes, particularly when initiated early. However, heterogeneity in intervention protocols and small sample sizes limit definitive standardization. Conclusion: PNF and NRE appear to offer superior rehabilitation benefits over conventional therapy and home programs alone, particularly in enhancing neuromuscular control and facial function. Larger standardized trials are required to establish optimal rehabilitation protocols.
Maxillofacial soft tissue reconstruction presents some of the most technically and conceptually demanding challenges in surgical practice, combining requirements of anatomical precision, functional preservation, and aesthetic restoration within a region of profound psychosocial significance. The emergence of artificial intelligence (AI), augmented reality (AR), and virtual reality (VR) has begun to redefine each phase of the reconstructive process, from preoperative analysis and simulation to intraoperative navigation and postoperative outcome assessment. This critical review examines the current evidence for the individual and integrated application of these technologies in maxillofacial soft tissue reconstruction, with particular attention to their translational readiness and clinical implications. A comprehensive search of peer-reviewed literature published between January 2007 and February 2026, supplemented by foundational methodological studies, was undertaken across multiple indexing databases. The review evaluates machine learning approaches to soft tissue deformation prediction, deep learning frameworks for anatomical segmentation and cephalometric landmarking, AR-based intraoperative navigation systems, and VR platforms for surgical training, preoperative planning, and patient communication. The evidence demonstrates that while individual applications—particularly AI-driven preoperative planning and VR simulation training—have achieved a meaningful clinical foothold, fully integrated multimodal systems remain largely confined to research environments. Persistent barriers include the absence of standardised data pipelines, insufficient multicentre validation, evolving regulatory frameworks, and concerns regarding algorithmic bias and inequitable access in lower-resource clinical settings. This review contends that realising the transformative potential of precision surgical informatics in maxillofacial reconstruction requires sustained interdisciplinary collaboration, prospective multicentre validation, and a design philosophy that prioritises generalisability, equity, and real-world implementability. The convergence of AI, AR, and VR represents a genuinely consequential development in reconstructive surgery, but its translation to routine clinical benefit demands rigorous, evidence-grounded progress.
Background: Harmful alcohol consumption remains a major global public health challenge and is strongly associated with a wide range of hematological and cardiovascular disorders. Chronic alcohol intake can disrupt normal blood rheology by altering erythrocyte deformability, plasma protein balance, inflammatory responses, and vascular dynamics, thereby compromising blood viscosity and microcirculatory flow. These haemorheological disturbances may contribute significantly to cardiovascular morbidity and impaired tissue perfusion. Despite the growing burden of alcohol-related diseases in Nigeria, there is limited data on the haemorheological consequences of chronic alcohol consumption among Nigerian populations. This study therefore investigated the effects of chronic alcohol intake on selected haemorheological parameters among alcohol consumers in Akure, Nigeria. Aim: This study aimed to evaluate the effects of chronic alcohol consumption on selected haemorheological parameters among chronic alcohol consumers. Methodology: A cross-sectional comparative study was conducted among 75 participants aged 20–50 years. Fifty chronic alcohol consumers constituted the study group, while 25 apparently healthy non-alcohol consumers served as controls. Sociodemographic and alcohol consumption data were obtained using structured questionnaires. Venous blood samples were collected and analyzed for packed cell volume (PCV), erythrocyte sedimentation rate (ESR), plasma fibrinogen concentration (PFC), whole blood viscosity (WBV), and plasma viscosity (PV). PCV was determined using the microhematocrit method, ESR by the Westergren method, fibrinogen concentration by the clot-weight method, and viscosity measurements using the Ingram method. Data analysis was performed using SPSS version 25. Student’s t-test and analysis of variance (ANOVA) were used to compare means, with statistical significance set at p < 0.05. Results: Chronic alcohol consumers demonstrated significant alterations in haemorheological indices when compared with non-alcohol consumers. Packed cell volume was significantly lower among alcohol consumers (36.90 ± 3.96%) compared with controls (39.44 ± 2.82%) (p = 0.005). Similarly, plasma fibrinogen concentration was markedly reduced in alcohol consumers (2.07 ± 0.59 g/L) relative to controls (2.63 ± 0.67 g/L) (p < 0.0001). Conversely, erythrocyte sedimentation rate was significantly elevated among alcohol consumers (29.28 ± 8.28 mm/hr) compared with controls (24.20 ± 4.97 mm/hr) (p = 0.006). Whole blood viscosity and plasma viscosity were also significantly higher among alcohol consumers (6.65 ± 0.63 cp and 2.11 ± 0.52 cp, respectively) than controls (5.95 ± 0.58 cp and 1.76 ± 0.50 cp, respectively) (p < 0.01). Furthermore, significant variations in all measured parameters were observed according to the frequency of alcohol intake, type of alcoholic beverage consumed, and alcohol concentration (p < 0.0001). Conclusion: Chronic alcohol consumption is associated with significant haemorheological alterations characterized by reduced packed cell volume, decreased plasma fibrinogen concentration, elevated erythrocyte sedimentation rate, and increased blood viscosity. These abnormalities may adversely affect microcirculatory blood flow, promote vascular dysfunction, and increase the risk of cardiovascular complications. The findings underscore the need for increased public health awareness regarding the hematological and cardiovascular consequences of excessive alcohol consumption and highlight the importance of early monitoring among chronic alcohol consumers.
Insomnia and hypertension each represent major global health burdens, and their co-occurrence in women of African ancestry has emerged as a clinically and epidemiologically distinct phenomenon warranting urgent scientific scrutiny. Women of African ancestry — encompassing populations across sub-Saharan Africa, the Caribbean, the Americas, and other regions of the African diaspora — experience disproportionately high rates of both insomnia and hypertension relative to women of other racial and ethnic backgrounds. The convergence of these conditions is not merely coincidental; accumulating evidence suggests a bidirectional, mechanistically complex relationship mediated by dysregulation of the autonomic nervous system, the hypothalamic–pituitary–adrenal axis, pro-inflammatory pathways, and the renin–angiotensin–aldosterone system. Structural inequities, including chronic exposure to racial discrimination, socioeconomic disadvantage, neighbourhood deprivation, and the cumulative physiological toll of chronic psychosocial stress — encapsulated in the concept of allostatic load — further compound biological vulnerability in this population. Despite this, women of African ancestry have been systematically underrepresented in sleep research and in hypertension trials, limiting the generalisability of existing evidence and perpetuating health disparities. This review synthesizes current epidemiological, mechanistic, and public health literature to characterize the insomnia–hypertension relationship in women of African ancestry, identify persistent gaps in knowledge, and propose culturally sensitive directions for future research and policy. The findings argue for the integration of systematic sleep health assessment into hypertension management pathways, for investment in culturally adapted and community-anchored sleep interventions, and for the dismantling of structural barriers to care that disproportionately disadvantage women of African ancestry.
Pancreatic ductal adenocarcinoma is a highly aggressive malignancy characterized by late diagnosis, rapid progression, and poor survival outcomes. Despite its higher incidence in older men, typically between the ages of 60 and 85, rising rates among younger populations and an incompletely understood etiology underscore the need for improved mechanistic insights and therapeutic strategies. Early detection remains challenging due to the lack of reliable biomarkers, and although surgical resection offers the only curative option, fewer than 20% of patients present with resectable disease. Current standard treatments rely primarily on chemotherapy, often combined with radiotherapy or surgery, but the overall prognosis remains poor. This review synthesizes and critically evaluates emerging therapeutic approaches for pancreatic ductal adenocarcinoma, focusing on immunotherapeutic strategies, tumor microenvironment modulation, microbial-based interventions—including fecal microbiota transplantation and dietary modification—and microRNA (miRNA)-targeted diagnostics and therapeutics. Particular attention is given to the role of the tumor microenvironment in mediating immune resistance and shaping therapeutic responses. Growing evidence highlights the influence of the microbiome, modulated by factors such as diet, obesity, and smoking, on pancreatic ductal adenocarcinoma progression and treatment efficacy. Integrating microbiome research with immunogenomic approaches presents novel therapeutic opportunities, although challenges such as donor selection and the optimization of microbiota-based therapies persist. By elucidating mechanistic interconnections among these modalities, this review assesses their translational potential and proposes integrative frameworks for future clinical development. Comprehensive strategies incorporating tumor microenvironment modulation, microbiome-based interventions, cancer stem cell targeting, and miRNA therapeutics within adaptive clinical trial designs are essential to advance precision medicine and improve patient outcomes in pancreatic ductal adenocarcinoma. Graphical Abstract Challenges, emerging opportunities, and comprehensive therapeutic approaches in pancreatic ductal adenocarcinoma (PDAC).
Dental implants have become the standard of care for replacing missing teeth, with survival rates that are generally favourable but not uniform across patient populations. Over the past decade, a growing body of clinical and preclinical literature has raised the possibility that antidepressant medications, and selective serotonin reuptake inhibitors in particular, may compromise osseointegration and increase the risk of implant failure. This critical review synthesises the available evidence on the association between antidepressant use and dental implant failure, drawing on cohort studies, retrospective clinical series, systematic reviews and meta-analyses, and mechanistic work in cell and animal models. The biological plausibility of the association rests on the dual role of serotonin in skeletal homeostasis: peripherally derived serotonin appears to inhibit osteoblast proliferation and bone formation, while centrally derived serotonin favours bone mass accrual. Selective serotonin reuptake inhibitors disturb this balance in ways that may impair bone healing around titanium fixtures. Clinical studies consistently report a roughly two-fold increase in implant failure among users of selective serotonin reuptake inhibitors relative to non-users, although effect sizes vary across populations, drug subclasses and methodological approaches, and most studies are retrospective and susceptible to confounding by indication, polypharmacy, smoking, and the systemic correlates of depression itself. The review also considers the bidirectional relationship between depression, periodontal disease and oral health behaviours, the differential effects of antidepressant subclasses, the contribution of antidepressant-associated bruxism and xerostomia to peri-implant complications, and the methodological limitations that temper causal interpretation of the existing literature. Clinical implications are discussed, including preoperative risk stratification, multidisciplinary communication with prescribing physicians, and individualised rather than categorical decision-making when planning implant therapy in patients receiving antidepressant treatment. The review concludes that, while the weight of evidence supports a measurable association between selective serotonin reuptake inhibitor use and increased implant failure risk, the absolute risk increase is modest in most reported cohorts and should not by itself constitute a contraindication to implant therapy. Prospective, adequately powered studies that account for depression severity, drug dose and duration, and concurrent risk factors are needed before firmer clinical guidance can be issued.
Background: Tooth germ osteomyelitis is a rare inflammatory condition involving the developing tooth follicle and surrounding alveolar bone in paediatric patients. Due to its uncommon occurrence and nonspecific clinical presentation, the condition is often overlooked, leading to delayed diagnosis and management. If not identified early, the infection may compromise the developing permanent dentition and result in disturbances in mandibular growth. Case Presentation: A 7-year-old child presented with swelling and discomfort in the left mandibular posterior region. Clinical examination revealed localised intraoral swelling and tenderness in the mandibular left premolar region, associated with mild facial asymmetry. Radiographic evaluation using Cone Beam Computed Tomography (CBCT) revealed an ill-defined radiolucent lesion associated with the developing premolar tooth germ, suggestive of inflammatory bone destruction. Based on the clinical and radiographic findings, a provisional diagnosis of tooth germ osteomyelitis was established. Management and Intervention: The patient underwent surgical exploration and debridement of the infected bone along with removal of necrotic tissue under appropriate antibiotic coverage. Care was taken to preserve surrounding anatomical structures and minimise damage to the developing dentition. Postoperative management included systemic antibiotics, analgesics, and regular clinical and radiographic follow-up. Outcome: The postoperative course was uneventful, with gradual resolution of swelling and pain. Follow-up radiographic evaluation demonstrated progressive bone healing without evidence of recurrence or persistent infection. Mandibular growth and development of adjacent teeth were preserved. Conclusion: Tooth germ osteomyelitis is a rare but potentially serious paediatric condition. Early diagnosis with the aid of advanced imaging such as CBCT, appropriate surgical intervention, and close follow-up are essential to prevent damage to developing tooth germs and ensure normal mandibular growth. Increased clinical awareness is crucial for the timely management of this uncommon entity. Highlight: This case highlights the importance of early CBCT-based diagnosis and prompt surgical intervention in managing tooth germ osteomyelitis to prevent damage to developing permanent dentition and mandibular growth.
Introduction: Urolithiasis is a common and increasingly prevalent condition that is influenced by environmental, dietary and metabolic factors. Infrared spectrophotometry is considered a reference method for stone analysis. However, regional data on the morphoconstitutional characteristics of urinary stones in Northern Morocco remain limited. Objective: To analyse the morphoconstitutional profile of urinary stones in Northern Morocco and determine their epidemiological and metabolic characteristics. Materials and Methods: This cross-sectional analytical study included 108 adult patients and 150 urinary stones. All stones were analysed using morphological examination and sequential infrared spectrophotometry. Results: Male predominance was observed (male-to-female ratio: 2.86). Renal localisation was the most frequent site, accounting for 75.92% of cases. Three-component mixed stones represented 42.59% of cases. Calcium oxalate was the predominant constituent (66.7%). Carbapatite was identified in 46.2% of cases, followed by amorphous carbonated calcium phosphate (33.3%) and uric acid (27.7%). Percentages may exceed 100% because stones may contain mixed components. Conclusion: The lithiasis profile in Northern Morocco is dominated by calcium oxalate, particularly whewellite, reflecting a chronic metabolic imbalance. Infrared spectrophotometric analysis has a key role in aetiological assessment, guiding therapeutic management and preventing recurrence.
Extracellular vesicles (EV) are particles enclosed by a lipid bilayer and secreted by various cell types under both normal and pathological conditions. EV secretion plays a key role in maintaining normal physiological functions, while aberrant EV-mediated signaling has been associated with numerous diseases. This study aimed to standardize a protocol for the isolation of EVs from human plasma and their characterization by conventional flow cytometry. Peripheral blood (PB) samples from patients with pro-inflammatory conditions were used due to their higher circulating EV levels, facilitating detection and supporting method standardization. Our results demonstrated the feasibility of EV enrichment using serial centrifugation and their detection using conventional flow cytometer, enhancing the accessibility of EV analysis in laboratories with limited infrastructure. However, this approach has inherent limitations, including reduced sensitivity for particles smaller than 200 nm and limited representation of the full heterogeneity of circulating EVs. Therefore, this method should be considered a practical and accessible strategy for EV detection rather than a comprehensive characterization approach, with potential applicability to different clinical conditions in future studies. The analysis of extracellular vesicles (EV) has been proposed as a potential biomarker strategy for various pathological conditions. However, standardized methodologies are required to ensure reliable detection and quantification. Therefore, the aim of this study was to standardize a flow cytometry protocol for the analysis of EV in FACSCanto II, enabling their detection and quantification in human plasma samples.
