Search Results (31,907)

Background and Objectives: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., “acoustic trauma,” “blast injury,” “traumatic brain injury,” “head trauma”) with terms related to auditory dysfunction (e.g., “tinnitus,” “hearing loss,” “auditory dysfunction”). Eligible studies included observational studies (cohort, cross-sectional, case–control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. Results: The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. Conclusions: Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens. Full article

This study assesses improved maize variety (IMV) adoption, as well as yield effects among smallholder farmers in Benue State, Nigeria, having implications for sustainable crop management and resource-use efficiency. Benue state is commonly known as the “Food Basket of the Nation,” but the average maize yield remains less than 2 t/ha, compared to 7–10 t/ha when achieved under improved technologies, and it shows a key sustainability challenge for food security and land-use efficiency. With primary cross-sectional survey data from 205 smallholder farmers with 107 adopters and 98 non-adopters, selected across Local Government Area (LGAs) in Benue State, this study adopts Propensity Score Matching (PSM) for controlling selection bias and estimating the Average Treatment Effect on the Treated (ATET). Nearest Neighbour Matching acts as a primary estimator through robustness checks while using Radius and Kernel Matching. However, the logit model shows that IMV is greatly determined by gender, use of fertilizer, formal education, cooperative membership, access to irrigation, and extension contact, highlighting the crucial parts of human capital, complementary inputs, and institutional support in promoting sustainable adoption of technology. Following the control for observable differences across matching, a 0.399 log-unit yield gain was achieved by adopters, which is equivalent to approximately 49% higher output per hectare compared to non-adopters, an effect that is robust throughout alternative matching algorithms, and it surpasses the 38.7% national-level yield increase, indicating a regional sustainability premium in Benue State. The gains in productivity can promote land-use efficiency, decrease pressure for agricultural intensification on vulnerable lands, and enhance the case for integrated crop management. But adoption remains limited by access to quality seeds, complementary inputs, credit, and sustained gender barriers. Improving input supply chains, extension services, and institutional support is therefore crucial for developing productivity, resource-use efficiency, and food security across smallholder farming systems. Full article

Fibroblast growth factor receptor 2 (FGFR2) inhibitors such as pemigatinib are targeted therapies for cholangiocarcinoma with FGFR2 alterations. While generally well tolerated, they are associated with unique adverse events. Calciphylaxis, a potentially fatal vascular calcification disorder, is a rare complication. We present a 43-year-old woman with metastatic intrahepatic cholangiocarcinoma harboring an FGFR2 fusion who developed calciphylaxis after seven months of pemigatinib therapy. Despite drug discontinuation, antibiotics, and multidisciplinary supportive care, she deteriorated rapidly and died from sepsis and advanced disease. Histopathological analysis confirmed dermal and vascular calcifications consistent with calciphylaxis. This case highlights the importance of early recognition of cutaneous lesions in patients on FGFR inhibitors. Prompt cessation of therapy, management of metabolic derangements, and consideration of sodium thiosulfate may be lifesaving. Full article

This article examines the representation of mental illness, emergency treatment, and recovery, in Ned Vizzini’s 2006 Young Adult novel, It’s kind of a funny story. Existing criticism has predominantly pursued what we term “diagnostic realist” approaches, which evaluate fictional representations against clinical criteria. We both affirm what this work achieves and make the case for extending it. Drawing on work on disability representation in Young Adult Literature and perspectives from Mad Studies, we propose that a social model lens, which locates mental difference within social and structural contexts rather than within individual pathology, opens out further possibilities for understanding what this and related novels do. We then demonstrate how close attention to Vizzini’s artistry—including to his use of romance conventions, figurative language, intertextuality, and first-person focalisation—reveals a text that does not simply mirror mental illness realistically, but which actively dramatises how social environments, institutional structures, and modes of creative expression shape the experience of and recovery from mental ill health. Rather than displacing diagnostic approaches, we argue that these wider critical paradigms, inclusive of the social model and attendant attention to craft, can enhance understanding of the help such novels can provide for different kinds of readers. Full article

Background and Clinical Significance: Animal hoarding is a recognized form of animal cruelty characterized by the accumulation of animals under conditions of inadequate care, leading to compromised welfare and an increased risk of disease transmission. Veterinarians are often the first to identify such cases through clinical presentation. This case report describes a forensic investigation of a dog associated with animal hoarding and environmental neglect in Bangkok, Thailand. Case Presentation: A 7-year-old male mixed-breed dog was presented with seizures, emaciation, dehydration, and ectoparasite infestation. Hematological findings revealed leukopenia and anemia, and diagnostic testing confirmed infection with canine distemper virus (CDV) and Dirofilaria immitis. Despite supportive treatment, the dog died within 48 h. A subsequent site inspection, conducted using the TRACE model and based on crime scene investigation principles, identified 13 dogs housed in overcrowded and unsanitary conditions. Environmental assessment revealed poor sanitation, waste accumulation, and fluorescent stains of unknown origin detected under ultraviolet light (365 nm) in the cage areas. Among the animals, infections with CDV (23.08%), Dirofilaria immitis (53.85%), and Ehrlichia canis (61.54%) were identified, indicating a high burden of infectious and vector-borne diseases. Conclusions: This case demonstrates the value of integrating clinical veterinary findings with forensic investigation in the assessment of animal neglect. The combined use of clinical, laboratory, and environmental evidence strengthens documentation and supports potential legal action. Enhanced veterinary forensic training and standardized protocols are recommended to improve early detection and intervention in animal cruelty cases. Full article

The maxillary second premolar, while frequently single rooted, exhibits a high degree of morphological diversity in its internal canal system. This unpredictability can lead to clinical oversights if a simple anatomy is assumed. The aim of this study was to review current knowledge regarding the number of roots and root canal configurations in permanent maxillary second premolars across different populations. A comprehensive literature search was conducted using the PubMed database for studies published between 2015 and December 2025, with the keyword “maxillary second premolar anatomy.” Out of 358 identified articles, 27 studies met the inclusion criteria and were analyzed. Only human-based studies on maxillary second premolars that used CBCT imaging and were written in English were included. The reviewed studies revealed that single-rooted maxillary second premolars are the most prevalent morphology, occurring in over 70% of cases, although significant variations exist among different ethnic groups. The presence of two roots was the second most common configuration, while three-rooted teeth were rare (<2%). Gender-related differences were also observed, with a higher prevalence of two-rooted teeth in males. Analysis of root canal configurations based on Vertucci’s classification demonstrated that all eight types can occur, with Type I being the most frequent in most populations with a result of more than 50% of all teeth. However, substantial variability was noted, with certain studies reporting a higher prevalence of more complex configurations such as Types IV and V. The findings emphasize the importance of thorough knowledge of root canal anatomy and its variations to ensure successful endodontic outcomes. Advanced imaging techniques, particularly cone beam computed tomography (CBCT), play a crucial role in improving diagnostic accuracy and proper endodontic treatment. Further research is needed to better understand anatomical differences across populations and enhance clinical decision-making in endodontics. Full article

Background/Objectives: Oral and maxillofacial infections present polybacterial profiles, including both aerobic and anaerobic bacteria. Increasing antibiotic resistance poses a significant challenge to pharmacological treatment of these infections. The aim of this study was to present a bacterial profile and assess antibiotic resistance found in these infections. Methods: This retrospective analysis is based on medical records of 224 patients affected with maxillofacial infections. Microbiological cultures and antibiotic susceptibility testing were performed for all patients. Results: In 78.57% of the patients, a positive microbiological culture was obtained. A total of 72.72% of culture-positive patients showed multi-bacterial cultures (128/176). Predominant bacteria included Streptococcus, detected in 156 cases (39%), followed by Staphylococcus, found in 64 cases (16%), and Prevotella, detected in 56 of 400 total bacterial isolates (14%). The most often isolated aerobic strains were Streptococcus mitis/oralis detected in 64 (16%) cases and Staphylococcus epidermidis detected in 48 cases (12%), while the most common anaerobic strains were Prevotella buccae detected in 14 cases (3.5%). Streptococcus and Staphylococcus exhibited the greatest resistance to clindamycin, accounting for 51.74% and 47.63%, respectively. Aerobic Gram-positive cocci were more resistant to penicillin and amoxicillin than to cephalosporins. Among obligate anaerobes, the lowest antibiotic resistance seen was to metronidazole. The obligate anaerobes except Prevotella were sensitive to clindamycin. Conclusions: A high rate of clindamycin resistance among aerobic and facultatively anaerobic Gram-positive cocci indicates the need to reassess the use of clindamycin in empirical therapy. The bacterial composition of infections suggests the need to use combined antibiotic therapy. First- and second-generation cephalosporins may be an effective alternative to penicillin and its derivatives. Full article

Background: Sepsis remains a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Despite international guidelines and diagnostic criteria, real-world variability in coding, treatment, and outcomes persist. This retrospective study analyzed 13,994 coded sepsis-related hospitalizations identified through administrative ICD-9-CM algorithms between 2016 and 2024 to evaluate the burden of sepsis, temporal trends, clinical outcomes, and healthcare costs within a regional health system. Methods: Hospitalization data across four local health authorities (ASL 201–204) over an 8-year period were analyzed. The coded sepsis cases were identified using validated ICD-9-CM-based algorithms and classified into four groups according to available microbiological coding: Gram-positive, Gram-negative, anaerobic and unspecified. Variables included patient demographics, length of stay, costs, outcomes (in-hospital and post-discharge mortality) and presence of septic shock. Comparative analyses were conducted using descriptive statistical methods and One-way ANOVA test and chi-squared tests were applied to evaluate the significance of differences. Multivariable logistic regression models were used to identify independent predictors of 6- and 12-month mortality. Results: The dataset included 13,994 coded sepsis-related hospitalizations, with the largest subgroup being ‘unspecified’ (48.0%). Among cases with specified etiology, coded anaerobic sepsis categories, though rare (0.7%), were associated with higher in-hospital mortality (45.5%) and economic burden (avg. € 8563). Mortality remained high at 6 and 12 months across all types, exceeding 50% post-discharge. Increasing age (OR ≈ 1.06 per year) and septic shock (OR ≈ 4.5–4.8) were the strongest independent predictors of mortality. Differences across microbiological groups should be interpreted cautiously given the high proportion of cases without organism-specific coding. Despite a modest reduction in mortality over time, sepsis was associated with persistently high 6- and 12-month mortality, highlighting a substantial long-term burden beyond the acute phase of illness. These findings suggest that sepsis-related hospitalizations are associated with substantial long-term mortality beyond the acute phase of illness. Discussion: These findings underscore the clinical and economic impact of sepsis in hospitalized patients, across microbiological coding categories. The high mortality rate at 6–12 months may support the need for further investigation into structured post-discharge follow-up strategies. Sepsis represents a substantial clinical and economic burden within the regional healthcare system, with persistently elevated short- and mid-term mortality. Incomplete organism-level documentation limits direct etiologic comparisons and highlights the need for improved integration between clinical, microbiological, and administrative data systems. Future research should integrate clinical variables and lab results to enable risk stratification and intervention planning. Full article

Reproductive emergencies in male dromedary camels (Camelus dromedarius) threaten fertility, health, and welfare but remain poorly documented. This review consolidates knowledge on the diagnosis, management, and prognosis of acute reproductive pathologies, including traumatic injuries (testicular trauma, penile hematoma, and preputial laceration), obstructive conditions (urethral obstruction, phimosis, and paraphimosis), vascular emergencies (spermatic cord torsion, priapism), inflammatory diseases (orchitis, epididymitis, pizzle rot), congenital anomalies (persistent frenulum), iatrogenic complications, and pharmacologic-induced dysfunction. Systematic breeding soundness examination and ultrasonography are indispensable for assessing testicular perfusion and guiding intervention. Given the scarcity of camel-specific literature, this narrative clinical review integrates evidence from published camelid studies, relevant reports from other domestic species, and representative clinical observations documented by the authors to provide a practical framework for diagnosis and management. Field constraints, the stoic nature of camels, and harmful ethnoveterinary practices often delay diagnosis and compromise outcomes. Prognosis varies considerably depending on the condition and timeliness of intervention; early aggressive management can preserve reproductive function, while delayed treatment frequently results in permanent infertility or death. Given the economic and cultural importance of camels in arid regions, improving outcomes for reproductive emergencies is essential for sustaining breeding programs and enhancing animal welfare. This narrative clinical review integrates published literature with representative clinical observations and retrospective field cases to summarize the diagnosis, management, and prognosis of reproductive emergencies in male dromedary camels. It also provides a structured clinical framework to support veterinarians in managing these acute conditions and highlights critical gaps requiring further research. Full article

Lymphatic malformations (LMs) are rare congenital low-flow vascular anomalies that frequently involve the head and neck and may be managed with surgery, laser therapy, sclerotherapy, or multimodal approaches depending on lesion type, size, depth, and relationship with adjacent structures. Ultrasound-guided sclerotherapy with doxycycline is an established treatment option for macrocystic lesions, whereas the practical role of high-frequency superficial ultrasound as a technical adjunct has been less specifically discussed. We report the case of a 32-year-old man presenting with a painless left submandibular swelling of approximately two years’ duration. Magnetic resonance imaging showed a well-encapsulated cystic lesion measuring 56 × 35 mm in the left submandibular region, extending into the internal paralaryngeal space and causing mild compression of the laryngeal wall. Previous fine-needle aspiration cytology had not conclusively established the lymphatic nature of the lesion; therefore, an incisional biopsy was performed and confirmed a macrocystic LM. The patient underwent day-surgery intralesional doxycycline sclerotherapy under real-time high-frequency ultrasound guidance using an 18 MHz hockey-stick transducer. After aspiration of the main cystic compartment through a 25-gauge needle, 100 mg of doxycycline diluted to 10 mg/mL in normal saline was slowly injected under continuous visualization. The procedure was well tolerated under topical local anesthesia, without pain, complications, or adverse effects. A partial clinical reduction was observed after the first session; the treatment was repeated after three months, resulting in apparent complete clinical resolution at one-year follow-up; no post-treatment imaging was available to confirm radiological resolution. This case highlights the potential technical value of high-frequency superficial ultrasonography, particularly for needle positioning, improved delineation of superficial locules, and real-time monitoring of sclerosant distribution. Full article

Background/Objectives: Hip arthroscopy is a minimally invasive procedure with rare complications that can occur due to air entry outside the joint space. Case Presentation: A 19-year-old patient underwent right hip arthroscopy with attempted joint venting. The next morning, she had pain in her right leg, neck, and chest with paresthesias over her hands and feet. A subsequent emergency department physical exam revealed crepitation of the lower extremities, abdomen, chest, and neck caused by air entrance during arthroscopy. The patient also reported blurred near vision. Additionally, the pupils were fixed, did not accommodate, and were dilated at 7 mm. Computed tomography scans revealed subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, and cervicofacial emphysema. Magnetic resonance imaging of the brain revealed a Chiari I malformation. The patient received four hyperbaric oxygen treatments. By the fourth treatment, near visual acuity had improved, but far visual acuity had worsened. Vision had returned to normal eight days after discharge. Conclusions: It is proposed that the patient’s reduced near vision, accommodation paralysis, and fixed and dilated pupils were brought about by pneumomediastinum and cervicofacial emphysema, inhibiting the ability of the pupils to constrict, causing bilateral mydriasis and accommodation paralysis for near targets. Additionally, the subsequent transient myopic shift is a known complication of hyperbaric oxygen therapy, which increases the refractive index of the crystalline lens. Full article

Background: Vertebral column resection (VCR) has historically been recognized as the most efficacious corrective intervention for severe rigid spinal deformities. Nevertheless, advancements in preoperative optimization, staged corrective methodologies, osteotomies, and contemporary instrumentation have broadened the spectrum of therapeutic options available. The definitive role of VCR in the modern management of rigid congenital spinal deformities remains a topic of ongoing scholarly discourse. Methods: This study presents two illustrative cases of severe congenital spinal deformities that were addressed employing various surgical methodologies, alongside a comprehensive review of the current literature pertaining to VCR and less invasive alternatives, including halo-gravity traction (HGT), temporary internal distraction techniques, pedicle subtraction osteotomy (PSO), asymmetric pedicle subtraction osteotomy (APSO), and multi-rod constructs. Results: The cases elucidated herein underscore the necessity for treatment strategies to be tailored specifically to the characteristics of the deformity, its flexibility, the neurological risks involved, and the individual patient’s specific attributes. In one case, significant deformity correction achieved via preoperative HGT facilitated successful management through multilevel Ponte osteotomies and posterior spinal fusion, thereby obviating the need for VCR. In other patient suffering from severe rigid congenital kyphotic deformity with pronounced anterior column deficiencies, VCR was deemed essential to realize adequate correction and neural decompression. All patients exhibited substantial radiographic correction, enhancements in health-related quality-of-life metrics, diminished disability and pain, while maintaining correction without neurological complications or implant failure at the final follow-up evaluation. Conclusions: VCR continues to be a vital element within the surgical repertoire for the treatment of severe rigid spinal deformities; however, it should not be deemed obligatory in every instance. Diligent preoperative evaluation, staged correction methodologies, and less invasive osteotomy techniques may permit satisfactory correction while mitigating surgical morbidity in suitably selected patients. Treatment approaches should be customized, favoring the least invasive procedure capable of achieving safe and lasting correction whenever practicable. Full article

Background: Uterine fibroids (leiomyomas) are the most common benign tumors in women of reproductive age and represent a significant cause of abnormal uterine bleeding, pelvic pain, infertility, and reduced quality of life. Contemporary management has evolved toward individualized, uterus-sparing approaches, incorporating pharmacological and minimally invasive strategies alongside traditional surgical methods. Methods: This narrative review was conducted based on a comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science databases for studies published between January 2010 and December 2025. The search strategy combined Medical Subject Headings (MeSH) and free-text terms related to uterine fibroids and their management. Eligible studies included clinical trials, systematic reviews, and meta-analyses focusing on pharmacological, minimally invasive, and surgical treatments in adult women. The review was prepared in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) recommendations to improve methodological transparency and quality of reporting. Results: A total of 97 studies were included in the qualitative synthesis. Minimally invasive techniques, including uterine artery embolization (UAE), radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU), demonstrate high efficacy in symptom control and improvement of quality of life, with shorter recovery times and lower complication rates compared to conventional surgery. However, their impact on fertility remains variable and requires careful patient selection. Pharmacological therapies, particularly GnRH analogues and antagonists, effectively reduce bleeding and fibroid volume, although their long-term use is limited by side effects. Conclusions: The management of uterine fibroids should be individualized, taking into account symptom severity, fibroid characteristics, patient age, and reproductive plans. Minimally invasive and pharmacological treatments represent effective alternatives to surgery in appropriately selected patients, while surgical approaches remain essential in advanced or refractory cases. Future research should focus on optimizing personalized treatment strategies and evaluating long-term outcomes, particularly regarding fertility and recurrence. Full article

Background: Systematic infectious screening is recommended before initiation of biologic therapies in chronic inflammatory rheumatic diseases (CIRDs), yet the clinical impact of this strategy in low-prevalence settings remains insufficiently characterized. This study aimed to evaluate the proportion of abnormal findings and their impact on treatment management. Methods: We conducted a retrospective single-center study including adult patients with CIRDs who underwent systematic pre-biologic infectious screening between January 2019 and June 2025. Screening included HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), interferon-γ release assay (IGRA), and chest radiography. The primary outcome was the proportion of abnormal results and their impact on biologic initiation. Results: A total of 418 patients was included (mean age 48.2 ± 14.6 years; 69.1% female). No active HIV, HBV, or HCV infections were detected. Past HBV infection markers were identified in 2.6% of patients, and anti-HCV antibodies in 0.7%, all without detectable viremia. None of these findings required modification of biologic therapy. IGRA positivity was observed in 4.3% of patients and indeterminate results were seen in 3.1%. Preventive antituberculous therapy was initiated in most newly identified IGRA-positive cases, leading to delayed biologic initiation in several patients. Chest radiography yielded limited additional diagnostic value. Conclusions: In this population, systematic pre-biologic infectious screening identified few clinically actionable viral infections, whereas latent tuberculosis screening represented the main determinant of therapeutic modification. These findings support continued emphasis on tuberculosis risk assessment and warrant further prospective studies to evaluate optimized and potentially targeted screening strategies incorporating cost-effectiveness analyses. Full article

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses. Full article