Search Results (75)

Background/Objectives: Artificial Intelligence (AI) is improving dentistry through increased accuracy in diagnostics, planning, and workflow automation. AI tools, including machine learning (ML) and deep learning (DL), are being adopted in oral medicine to improve patient care, efficiency, and lessen clinicians’ workloads. AI in dentistry, despite its use, faces an issue of acceptance, with its obstacles including ethical, legal, and technological ones. In this article, a review of current AI use in oral medicine, new technology development, and integration barriers is discussed. Methods: A narrative review of peer-reviewed articles in databases such as PubMed, Scopus, Web of Science, and Google Scholar was conducted. Peer-reviewed articles over the last decade, such as AI application in diagnostic imaging, predictive analysis, real-time documentation, and workflows automation, were examined. Besides, improvements in AI models and critical impediments such as ethical concerns and integration barriers were addressed in the review. Results: AI has exhibited strong performance in radiographic diagnostics, with high accuracy in reading cone-beam computed tomography (CBCT) scan, intraoral photographs, and radiographs. AI-facilitated predictive analysis has enhanced personalized care planning and disease avoidance, and AI-facilitated automation of workflows has maximized administrative workflows and patient record management. U-Net-based segmentation models exhibit sensitivities and specificities of approximately 93.0% and 88.0%, respectively, in identifying periapical lesions on 2D CBCT slices. TensorFlow-based workflow modules, integrated into vendor platforms such as Planmeca Romexis, can reduce the processing time of patient records by a minimum of 30 percent in standard practice. The privacy-preserving federated learning architecture has attained cross-site model consistency exceeding 90% accuracy, enabling collaborative training among diverse dentistry clinics. Explainable AI (XAI) and federated learning have enhanced AI transparency and security with technological advancement, but barriers include concerns regarding data privacy, AI bias, gaps in AI regulating, and training clinicians. Conclusions: AI is revolutionizing dentistry with enhanced diagnostic accuracy, predictive planning, and efficient administration automation. With technology developing AI software even smarter, ethics and legislation have to follow in order to allow responsible AI integration. To make AI in dental care work at its best, future research will have to prioritize AI interpretability, developing uniform protocols, and collaboration between specialties in order to allow AI’s full potential in dentistry. Full article

Background: Hyperventilation Syndrome (HVS) is a well-recognized physiological consequence of acute anxiety, often resulting in respiratory alkalosis and subsequent electrolyte imbalances. Among these, a reduction in ionized calcium levels can lead to neuromuscular irritability and electrocardiographic abnormalities such as QTc prolongation. Although well-documented in specific settings, including autism spectrum disorders and drug-induced crises, such complications are rarely described in otherwise healthy pediatric patients presenting with isolated anxiety episodes. This report aims to raise awareness of anxiety-driven somatic manifestations, particularly in the context of the rising prevalence of mental health disorders among children and adolescents. Methods: We report the case of a previously healthy 10-year-old girl presenting to the emergency department with acute agitation and hyperventilation. Clinical examination revealed neuromuscular symptoms, including Trousseau’s sign and flexion posture. Initial laboratory testing and arterial blood gas analysis indicated respiratory alkalosis with decreased ionized calcium levels, and a resting ECG showed QTc prolongation (510 ms). Treatment included intravenous midazolam, a balanced electrolyte solution, and oral bromazepam during intensive observation with cardiac monitoring. Results: The patient’s symptoms progressively improved following anxiolytic and supportive therapy. Electrolyte abnormalities normalized within 48 h, with complete resolution of the prolonged QTc (430 ms). No arrhythmias or other complications occurred. Outpatient psychological follow-up was arranged upon discharge. Conclusions: This case underscores the importance of considering anxiety as a primary etiology in pediatric patients with apparent metabolic or cardiac abnormalities. Early psychiatric recognition and targeted supportive care can prevent overtreatment and reduce the burden on emergency and cardiologic resources. Full article

Background/Objectives: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare tailor-made medicines. While this principle applies globally, practices vary between countries. In the Netherlands, the preparation of medicines in pharmacies is well-established and integrated into routine healthcare. This narrative review explores the role and significance of extemporaneous compounding, pharmacy preparations and related product care in the Netherlands. Methods: Pharmacists involved in pharmacy preparations across various professional sectors, including community and hospital pharmacies, central compounding facilities, academia, and the professional pharmacists’ organisation, provided detailed and expert insights based on the literature and policy documents while also sharing their critical perspectives. Results: We present arguments supporting the need for pharmacy preparations and examine their position and role in community and hospital pharmacies in the Netherlands. Additional topics are discussed, including the regulatory and legal framework, outsourcing, quality assurance, standardisation, education, and international context. Specific pharmacy preparation topics, often with a research component and a strong focus on product care, are highlighted, including paediatric dosage forms, swallowing difficulties and feeding tubes, hospital-at-home care, reconstitution of oncolytic drugs and biologicals, total parenteral nutrition (TPN), advanced therapy medicinal products (ATMPs), radiopharmaceuticals and optical tracers, clinical trial medication, robotisation in reconstitution, and patient-centric solid oral dosage forms. Conclusions: The widespread acceptance of pharmacy preparations in the Netherlands is the result of a unique combination of strict adherence to tailored regulations that ensure quality and safety, and patient-oriented flexibility in design, formulation, and production. This approach is further reinforced by the standardisation of a broad range of formulations and procedures across primary, secondary and tertiary care, as well as by continuous research-driven innovation to develop new medicines, formulations, and production methods. Full article

Background: Salivary pH plays a critical role in oral health by influencing enamel demineralization, buffering capacity, and the ecology of oral microbiota. Essential oils such as Origanum vulgare (oregano) possess well-documented antimicrobial properties that may reduce acidogenic bacterial activity. However, the effects of edible delivery systems like jellies on salivary pH modulation and their potential interactions with hormonal states remain poorly understood. Methods: This study evaluated the in vitro antimicrobial activity of an oregano-oil-based jelly formulation against standard bacterial (Staphylococcus aureus, Streptococcus pyogenes, and Escherichia coli) and fungal (Candida albicans) strains using the Kirby–Bauer disc diffusion method. Additionally, a human trial (n = 91) measured salivary pH before and after administration of the oregano-oil jelly. Participants were characterized by age, smoking status, menopausal status, and presence of menstruation. Multiple linear regression was used to identify predictors of final salivary pH. Results: The oregano-oil jelly demonstrated strong in vitro antimicrobial activity, with inhibition zones up to 8 mm for E. coli and C. albicans. In vivo, mean unstimulated salivary pH increased from 6.94 to 7.07 overall, indicating a mild alkalinizing effect. However, menstruating participants showed a significant decrease in final pH (from 7.03 to 6.78). Multiple regression identified menstruation as a significant negative predictor (β = −0.377, p < 0.001) and initial pH as a positive predictor (β = +0.275, p = 0.002). Menopausal status was not a significant predictor, likely due to the small sample size. Conclusions: Oregano-oil jellies may represent a promising natural approach to support oral health by increasing salivary pH and providing strong antimicrobial activity. However, physiological states such as menstruation can significantly modulate this response, underscoring the importance of personalized or phase-aware oral care strategies. Further studies with larger, diverse cohorts and controlled hormonal assessments are needed to validate these findings and optimize product formulations. Full article

In recent decades, there has been a marked surge in the development of marine-by-product-derived ingredients for cosmetic applications, driven by the increasing demand for natural, sustainable, and high-performance formulations. Marine animal by-products, particularly those from fish, crustaceans, and mollusks, represent an abundant yet underutilized source of bioactive compounds with notable potential in cosmeceutical innovation. Generated as waste from the fishery and seafood-processing industries, these materials are rich in valuable bioactives, such as chitosan, collagen, peptides, amino acids, fatty acids, polar lipids, lipid-soluble vitamins, carotenoids, pigments, phenolics, and mineral-based substrates like hydroxyapatite. Marine by-product bioactives can be isolated via several extraction methods, and most importantly, green ones. These compounds exhibit a broad spectrum of skin-health-promoting effects, including antioxidant, anti-aging, anti-inflammatory, antitumor, anti-wrinkle, anti-hyperpigmentation, and wound-healing properties. Moreover, applications extend beyond skincare to include hair, nail, and oral care. The present review provides a comprehensive analysis of bioactives obtained from marine mollusks, crustaceans, and fish by-products, emphasizing modern extraction technologies with a focus on green and sustainable approaches. It further explores their mechanisms of action and documented efficacy in cosmetic formulations. Finally, the review outlines current limitations and offers future perspectives for the industrial valorization of marine by-products in functional and environmentally-conscious cosmetic development. Full article

A psoriasis vulgaris flare is characterized by a rapid intensification of symptoms, which is often triggered by various factors that can worsen the condition. The risk factors for these exacerbations are numerous and include obesity, antihypertensive drugs, and psychological stress. Moreover, links have been documented between type II diabetes, hypertension, and psoriasis vulgaris. The present case report describes a 52-year-old female patient who presented at the clinic with disseminated erythematous-squamous plaques and patches covered by thick, white-pearly, easily detachable scales, along with stress, fatigue, anxiety, severe pruritus, irritability, insomnia, and decreased self-esteem. Her past medical regimen included various conventional topical options, including calcipotriol combined with betamethasone, clobetasol, betamethasone combined with salicylic acid, and betamethasone combined with gentamicin, yet the condition remained refractory, with periodic flare-ups. The integrated and personalized therapeutic approach aimed to target both the dermatological issues and the associated systemic and psychological factors contributing to the condition. The therapeutic strategy implemented in this case combined psychological counseling sessions, a very low-calorie ketogenic diet, oral supplementation with anti-inflammatory and antioxidant vitamins and minerals, topical treatments utilizing urea and Dead Sea-mineral-based formulations, and rosemary extract-based scalp care, without requiring additional conventional treatment. This comprehensive approach led to significant improvement, ultimately achieving complete remission of the patient’s psoriasis. The associated comorbidities were well controlled with the specified medication, without any further complications. Thus, the importance of alternative options was emphasized, particularly in the context of an incurable disease, along with the need for continued research to improve the ongoing therapeutic management of psoriasis vulgaris. Such approaches are essential to reducing the risk of flare-ups and to achieving better management of associated risk factors. Full article

The objective structured clinical examination (OSCE) is a well-established tool for assessing clinical skills, providing reliability, validity, and generalizability for high-stakes examinations. Des Moines University College of Osteopathic Medicine (DMU-COM) adapted the OSCE for formative assessments in undergraduate medical education, focusing on interpersonal aspects in the primary care setting. Students are graded by standardized patients and faculty observers on interpersonal skills, history/physical examination, oral case presentation, and documentation. The purpose of the study is to establish the reliability and to identify sources of variation in the DMU-COM OSCE to aid medical educators in their understanding of the accuracy of clinical skills. We examined student performance data across five OSCE domains. We assessed intra- and inter-OSCE reliability by calculating KR20 values, determined sources of variation by multivariate regression analysis, and described relationships among observed variables through factor analysis. The results indicate that the OSCE captures student performance in three dimensions with low intra-OSCE reliability but acceptable longitudinal inter-OSCE reliability. Variance analysis shows significant measurement error in rubric-graded scores but negligible error in checklist-graded portions. Physical exam scores from patients and faculty showed no correlation, indicating value in having two different observers. We conclude that a series of formative OSCEs is a valid tool for assessing clinical skills in preclinical medical students. However, the low intra-assessment reliability cautions against using a single OSCE for summative clinical skills competency assessments. Full article

Background: Administering intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) on direct oral anticoagulants (DOACs) remains a clinical challenge. Current guidelines restrict IVT within 48 h of DOAC intake unless anticoagulant activity can be confidently excluded. However, reliable medication histories are often unavailable, and conventional coagulation tests inadequately detect DOAC activity. This study evaluated whether viscoelastic point-of-care testing (ClotPro^®) could identify the absence of anticoagulant effect in AIS patients on DOACs, thus enabling IVT administration and potentially improving clinical outcomes. Methods: We conducted a prospective observational cohort study of 40 AIS patients with documented DOAC use, admitted between February 2023 and May 2025. ClotPro^® was performed at admission using the Russell’s viper venom (RVV) assay for factor Xa inhibitors and the ecarin clotting time (ECT) assay for dabigatran. Subtherapeutic anticoagulation was defined as a clotting time (CT) of <100 s for RVV and <180 s for ECT, respectively. Patients identified as being subtherapeutic were assessed for IVT eligibility. To evaluate IVT effects, we performed propensity score-matched bootstrap resampling (1000 iterations), matching patients by age, admission National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS). Primary endpoints were NIHSS-shift (change from admission to 72 h) and mRS-shift (change from pre-stroke mRS to 90-day mRS). Predictors of outcomes were analyzed using multivariate regression models. Results: ClotPro^® identified 15/40 patients (37.5%) as subtherapeutic, all on factor Xa inhibitors. Of these, seven received IVT. In matched analyses, IVT-treated patients showed a numerically greater neurological improvement than untreated patients (mean NIHSS-shift: −2.83 vs. 3.94; mean difference: −6.76, 95% confidence interval [CI]: −24.00 to 7.55; p = 0.495). Functional outcome by mRS-shift showed only minor differences between groups (2.74 vs. 2.10 mean difference: 0.64; 95% CI: −2.00 to 2.50; p = 0.510). IVT showed a favorable trend for early neurological recovery (p = 0.081) but was not independently associated with functional outcome (p = 0.380). Conclusions: ClotPro^® identified a substantial subset of AIS patients on DOAC therapy without measurable anticoagulant activity, enabling IVT in cases that would otherwise have been excluded based on medication history. These findings support the feasibility of ClotPro^®-guided decision-making in acute stroke care and highlight its potential to improve IVT selection by enabling real-time assessment of coagulation status at the bedside. Full article

Background/Objectives: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral medications for patients with acute agitation, focusing on adherence to protocols, medication safety, documentation accuracy, and patient outcomes. Methods: A retrospective analysis was conducted on 177 cases from December 2023 to February 2024. The study assessed the demographics, diagnoses, treatment protocols, and patient outcomes, with a particular emphasis on the use of parenteral medications such as benzodiazepines and antipsychotics. The relationship between medication administration and involuntary admission, mechanical restraint usage, and patient outcomes was also explored. Results: The majority of patients were aged between 21 and 30 years, and there was a predominance of male patients across both groups. Schizophrenia was the most common diagnosis, with a higher prevalence in the parenteral group (34%) compared to the oral-only group (24%), and personality disorders were more frequent in the parenteral group. Intramuscular (IM) medication administration was strongly associated with the use of mechanical restraint, with patients receiving IM medication being 35 times more likely to require restraint, emphasizing the link between more intensive treatment approaches and behavioral challenges. The most frequently administered medications were diazepam (40.6%) and olanzapine (36.5%), with olanzapine, droperidol, and diazepam most commonly used parenterally. Documentation of physical assessments prior to parenteral administration was present in most cases, though comprehensive evaluations such as ECGs were inconsistently performed. Conclusions: Parenteral medications, including benzodiazepines and antipsychotics, were effective in rapidly stabilizing patients, but the study emphasizes reducing dependency on mechanical restraints. Tailoring treatment to patient characteristics and employing alternative de-escalation strategies can improve safety and align with recovery-oriented care. This study highlights the need for evidence-based practices to optimize care and improve patient outcomes in ED settings. Further research is needed to explore long-term outcomes and refine non-coercive care approaches. Full article

Background/Objectives: Diabetes mellitus is associated with significant health complications, including challenges in periodontal health. Gingival inflammation is especially common among diabetic patients and can significantly impact overall diabetes management. This study aims to investigate the correlation between glycosylated hemoglobin (HbA1c) levels, an established marker of glycemic control, and gingival inflammation using the Quantitative Gingival Bleeding Index (QGBI) among hospitalized diabetic patients, thereby placing the question within a broader clinical context. Methods: The study enrolled 671 hospitalized patients with diabetes complications at “Mother Theresa University Hospital” in Tirana, AL, USA. Glycemic control was assessed through glycosylated hemoglobin (HbA1c) levels, and gingival health was evaluated using the Quantitative Gingival Bleeding Index (QGBI). Behavioral variables were also documented, including smoking habits and routine oral care practices. Spearman’s correlation coefficient (r_s) was applied to determine the relationship between HbA1c levels and QGBI scores. Results: Our findings revealed a strong positive correlation between glycemic control (HbA1c) and gingival inflammation (QGBI) among the participants (Spearman’s coefficient r_s = 0.868, p < 0.001). Additionally, significant positive associations were observed between behavioral factors, such as smoking habits and regular oral care practices, further underscoring their role in periodontal health in diabetic patients. Conclusions: The study highlights a significant positive relationship between poor glycemic control and increased gingival inflammation, emphasizing the importance of periodontal health in the comprehensive management of diabetes mellitus. Our results support integrating periodontal evaluation and management into standard diabetes care, which could improve patient outcomes and overall well-being. Full article

Tongue-nibbling is a rare and previously undocumented affiliative behaviour in free-ranging killer whales (Orcinus orca), until now seen only in individuals under human care. This study presents the first recorded observation of tongue-nibbling between two wild killer whales in the Kvænangen fjords, Norway. The interaction, captured opportunistically by citizen scientists during a snorkelling expedition, lasted nearly two minutes and involved repeated episodes of gentle, face-to-face oral contact. This behaviour closely resembles sequences observed and described in detail in zoological settings, suggesting that it forms part of the species’ natural social repertoire. The observation also supports the interpretation of tongue-nibbling as a socially affiliative behaviour, likely involved in reinforcing social bonds, particularly among juveniles. The prolonged maintenance of this interaction in managed populations originating from geographically distinct Atlantic and Pacific lineages further indicates its behavioural conservation across contexts. This finding underscores the importance of underwater ethological observation in capturing cryptic social behaviours in cetaceans and illustrates the value of integrating citizen science into systematic behavioural documentation. The study also reinforces the relevance of managed populations in ethological research and highlights the ethical need for carefully regulated wildlife interaction protocols in marine tourism. Full article

Background/Objective: With a prevalence linked to modern lifestyle, erosive tooth wear (ETW) is a growing clinical problem among children and adolescents. The aim of this cross-sectional study was to record the awareness and knowledge of ETW among Greek dentists and to explore their preferred treatment decisions. Methods: A case-based digital questionnaire was distributed to a stratified sample of dentists practising in Athens (n = 218). We collected data regarding clinical scoring, possible aetiological factors, and clinical management of ETW and used descriptive statistics, chi-square tests, and odds ratio calculations to process the outcome. Results: The response rate was 92%. The majority (71%) recorded ETW among their patients, but only 5% used an established and validated scoring system. Almost 1/3 registered only the location of the lesions. Over 70% disclosed the possible causes of ETW, with frequent consumption of fizzy soft drinks (67%) and acidic foods (56%) being the most common. Most respondents managed the ETW patients in their own clinic, while 23% referred them to another dentist or a university clinic. The respondents focused on secondary prevention (dietary advice, oral hygiene, and fluoride exposure) and preferred less invasive options for anterior teeth, with restorative care restricted to the lower molars. Conclusions: The majority of the dentists participating in this survey registered ETW and its possible causes and seem to have adopted a preventive and minimally invasive approach for the management in children and adolescents. For the case documentation, a minority took advantage of standardised scoring systems for lesions and dietary habits, and very few performed salivary diagnostics. The findings underscore the need of continuing education to offer updates on the most current guidelines and focusing on patients’ needs and expectations. Full article

Background: This study aimed to investigate the provision of dental care to patients admitted to a public tertiary hospital due to SARS-CoV-2 infection. Methods: A chart review was conducted using medical records of patients admitted with a confirmed diagnosis of SARS-CoV-2 infection at a public tertiary hospital. Patients hospitalized for at least 10 days were included, and data were collected on demographic variables, comorbidities, oral health status, and hospitalization outcomes. Results: A total of 295 patients were included (mean age 60.8 ± 17.4 years). Comorbidities were common, with 29.8% of patients diagnosed with diabetes and 53.3% with hypertension. Only 47.5% of patients received an oral health assessment upon admission, and 58% received oral hygiene care during hospitalization. Oral health evaluations revealed that older adults exhibited significantly higher rates of total edentulism, received more oral hygiene care during hospitalization, and were more likely to undergo oral evaluation at admission. Regarding clinical outcomes, patients with altered mouth opening had significantly lower Glasgow Coma Scale scores (p < 0.001), and those with altered oral mucosa showed reduced oxygen saturation levels (p = 0.006). Conclusions: These study findings highlight the importance of dental care in critically ill COVID-19 patients, particularly in ICU settings. It emphasizes the need for improved dental documentation and integration of dental professionals into hospital-care teams to reduce complications and enhance both oral and systemic health outcomes. Full article

Purpose: Pharmaceutical parenteral drug products (PDPs) and orally inhaled nasal drug products (OINDPs) are critical medications for patient care, for which the route of administration is intravenous or oral/nasal inhalation, and the drug products directly infuse into the bloodstream or lungs, but they are categorized as high-risk for leachables. Method: These external foreign chemical substances (leachables) may adversely affect and alter patient safety. Results: These primary container closure systems and manufacturing process equipment mainly comprise rubber elastomers, polypropylene, resin, ink, adhesives, glass, or plastic material. To establish the ID of detected compounds and their quantity in the finished parenteral drug formulation and then to assess the formulation for toxicological safety, broad-scope non-specific analytical screening methods are required that are capable of screening out and quantifying the predicted/unpredicted leachable compounds at the levels that pose anticipated toxicological concerns for human patients. Before the selection of the final primary packaging system for the parenteral drug product, their extractable screening profile/knowledge is required to minimize leachable compounds in the finished drug product formulation and to develop and manufacture a safe product for human patients. The adverse effect or toxicity of leachables proportionally increases with an increase in the dose of the drug product or the duration of therapy because the volume of the drug product administered to a patient in a larger quantity is directly proportional to the concentration of the detected leachable. Conclusion: This document outlines the detailed process/scientific approach for conducting an organic leachable screening profile for parenteral drug products with respect to the chemical nature of leachables, i.e., polarity, propensity, volatility, and techniques. Full article

Background: Establishing safe and efficient oral feeds for preterm infants is one of the last milestones to be achieved prior to discharge home. However, this process commonly elicits stress and anxiety in both care providers, such as nurses and the entire healthcare team in the Neonatal Intensive Care Unit (NICU), as well as parents. These feelings of uncertainty are exacerbated by the non-linear progression of oral feeding development and the absence of a systematized approach to initiate and advance feedings. Methods: In this 48-bed tertiary perinatal centre, staff surveys and a needs assessment showed dissatisfaction and increasing stress and anxiety due to the inconsistencies in initiating and advancing oral feeds. This paper describes the formation of a multidisciplinary feeding committee which reviewed various oral feeding training materials and the ultimate creation of two innovative oral feeding algorithms and their corresponding education materials. Results: The Sunnybrook Feeding Committee has developed two evidence-based algorithms, one for initiating oral feeds and another for monitoring progress with objective decision-making points during common oral feeding challenges. To complement and support these algorithms, educational materials and a comprehensive documentation process were also created. These resources included detailed instructions, visual aids, and step-by-step guides to help staff understand and apply the algorithms effectively. Additionally, the educational materials aimed to standardize training and ensure consistency across the NICU, further promoting a systematic approach to preterm oral feeding. Implementation of these algorithms also aimed to provide evidence-based, expert-guided guidelines for assessing readiness, initiating feeds, monitoring progress, and making necessary adjustments. Conclusions: This structured approach lays the foundation for a unit-wide language and systematic process for oral feeding. The next steps in this quality improvement project involve educating and piloting the implementation of the developed oral feeding algorithms, gathering staff feedback, and refining the tools accordingly. The goal is to enhance overall care quality, reduce stress for both care providers and parents, and ensure the best possible start for vulnerable preterm infants, ultimately supporting a smooth and successful transition to home. Full article