Search Results (438)

Background/Objectives: The present study aimed to assess the understandability and actionability of Arabic text generated by a large language model for commonly searched Arabic queries on dry mouth. Methods: Using Google Trends, the top 10 searches worldwide related to ‘oral dryness’ were entered in OpenAI’s Generative Pretrained Transformer 5.1. Generated texts were achieved independently. Assessments were performed using the Patient Education Materials Assessment Tool (PEMAT) to evaluate the content, word choice, and style. Results: Causes, symptoms, and treatment of dry mouth were the most common dry-mouth-related queries. The highly temporal distribution of search interests among Arabic-speaking countries peaked between 2020 and 2021, then remained high throughout 2023, before declining in November 2025. The mean PEMAT understandability and actionability scores were 89% and 80%, respectively. It was notable that all generated responses lacked visual aids, which could have made the content difficult to understand and insufficient for acting on the information. Moreover, the formal Arabic form of ‘causes of dry mouth’ with a glottal stop yielded lower actionability scores (60%) than the informal Arabic form (80%). Conclusions: Clinicians could actively supplement clinic-based discussions with advice on using large language models to help patients recognise dry mouth symptoms and improve self-care. Also, they could improve their effective adoption by clearly explaining expectations, limitations, and language/cultural differences when adopting these models. Full article

Objective: Polycystic ovary syndrome (PCOS) and nonclassic congenital adrenal hyperplasia (NCAH) overlap clinically, but direct comparative data specifically addressing non-National Institutes of Health (non-NIH) Rotterdam phenotypes of polycystic ovary syndrome are limited. We compared women with polycystic ovary syndrome, of whom 66.7% were classified as having non-NIH Rotterdam phenotypes, with women with nonclassic congenital adrenal hyperplasia and healthy controls to characterize the extent of phenotypic overlap and evaluate the discriminatory performance of individual androgen measures. Methods: This single-center, prospective, exploratory cross-sectional study evaluated 58 women divided into three groups: PCOS (n = 24, Rotterdam criteria), NCAH due to 21-hydroxylase deficiency (n = 16, previously confirmed by adrenocorticotropic hormone (ACTH)-stimulated 17-hydroxyprogesterone (17-OHP)), and healthy controls (n = 18). Demographic, clinical, metabolic, and hormonal parameters were compared using analysis of variance (ANOVA), Kruskal–Wallis with Dunn’s post hoc test (Bonferroni-adjusted), and chi-square or Fisher’s exact tests. A sensitivity analysis was performed after excluding 12 participants receiving oral contraceptives (n = 8) or glucocorticoids (n = 4). Results: Within the PCOS group, 66.7% had non-NIH Rotterdam phenotypes. Hirsutism, defined as a modified Ferriman–Gallwey (mFG) score ≥ 8, was more frequent in both patient groups than in controls (p = 0.003) but did not differ between PCOS and NCAH. Total testosterone levels were 0.40 [0.20–0.60], 0.59 [0.45–0.94], and 0.20 [0.15–0.20] ng/mL in the PCOS, NCAH, and control groups, respectively, and androstenedione levels were 1.40 [1.20–2.20], 2.55 [1.64–4.07], and 0.87 [0.56–1.00] ng/mL, respectively; both were higher in the patient groups than in controls (both p < 0.001), without differing between PCOS and NCAH. Basal 17-OHP was the only parameter distinguishing NCAH from both PCOS and controls (p < 0.001). Dehydroepiandrosterone sulfate (DHEAS) levels were 356.5 [217–422], 292 [156–448], and 219 [146–240] µg/dL, respectively (p = 0.020), with a significant difference only between PCOS and controls. Anti-Müllerian hormone (AMH) levels were 3.27 [3.02–4.13], 3.13 [2.87–3.54], and 3.34 [2.93–5.37] ng/mL, respectively, with no between-group difference (p = 0.600). Other metabolic parameters, gonadotropins, estradiol, and prolactin showed no between-group differences. The principal hormonal findings remained unchanged after excluding women receiving oral contraceptives or glucocorticoids. Conclusions: In this PCOS cohort, in which 66.7% of women were classified as having non-NIH Rotterdam phenotypes, PCOS and NCAH showed substantial clinical, metabolic, and hormonal overlap, whereas basal early-follicular 17-OHP was the only parameter that consistently distinguished NCAH from both PCOS and healthy controls. These findings support the inclusion of basal 17-OHP in the evaluation of women presenting with hyperandrogenism. Full article

Background: Amoxicillin–clavulanate (AC) is the antibiotic most frequently implicated in idiosyncratic drug-induced liver injury (DILI) worldwide, and it characteristically produces a cholestatic or mixed pattern in older adults. A predominantly hepatocellular presentation is distinctly less common in this age group, and reports from the Arabian Peninsula are scarce. Case presentation: A 66-year-old Saudi man developed painless, progressive jaundice after a seven-day course of oral AC (500/125 mg three times daily) prescribed for a thumb laceration. He described a similar self-limiting jaundice after the same antibiotic approximately five years earlier, an episode that was never investigated and had not been entered in his allergy record, so the drug was prescribed again unknowingly. Liver biochemistry, documented as normal four months earlier, showed alanine aminotransferase (ALT) peaking at 587 U/L (14.3 × the upper limit of normal, ULN) and aspartate aminotransferase at 335 U/L, with total bilirubin 249 µmol/L (11.9 × ULN) and a 69% conjugated fraction, whereas alkaline phosphatase (ALP) never exceeded 245 U/L (1.9 × ULN). The R-value at the ALT peak was 19.3 using the same-day ALP, and 7.6 even when the peak ALT is paired with the highest ALP recorded at any point in the illness; the pattern was therefore hepatocellular (R > 5) throughout the injury phase. Hy’s law criteria were met, although the international normalised ratio remained 1.0 and no encephalopathy developed. Peripheral eosinophilia (peak 1.05 × 10⁹/L) was documented. Hepatitis B surface antigen, hepatitis B core antibody, hepatitis C antibody and HIV serology were non-reactive; antinuclear, anti-smooth-muscle, anti-liver-kidney microsomal type 1 and antimitochondrial antibodies were negative and serum ceruloplasmin was normal; ultrasound with contrast-enhanced triphasic computed tomography excluded biliary obstruction and malignancy. Hepatitis A and E serology and cytomegalovirus/Epstein–Barr studies were unavailable at our institution, which we report as a limitation. AC was withdrawn and management was supportive. Liver biochemistry normalised completely over the following three months (ALT 25 U/L, ALP 103 U/L, and total bilirubin 22 µmol/L). Updated Roussel Uclaf Causality Assessment Method (RUCAM) scoring on the hepatocellular scale gave 7 points (probable); no credit was taken for the historical episode, since RUCAM requires documented enzyme re-elevation for a positive re-administration response. Conclusions: AC can cause hepatocellular, Hy’s-law-positive injury in older adults, not only the cholestatic phenotype emphasised in the literature. The decisive failure here was administrative rather than diagnostic: an adverse drug reaction that is never recorded will be repeated. Full article

The rapid adoption of vat photopolymerization (3D printing) in restorative and prosthetic dentistry has outpaced the independent biological characterization of the dimethacrylate resins on which it relies, even though incompletely converted networks can release residual monomers that are cytotoxic to the adjacent oral tissues. This study reports a qualitative in vitro cytotoxicity screening of three commercial photopolymer resins optimized for additive manufacturing: a general-purpose resin (ANYCUBIC) and two resins with a declared dental indication (TEMP PRINT and V-PRINT) performed according to the morphological evaluation described in ISO 10993-5. Aqueous extracts were prepared following ISO 10993-12 and applied to normal human fibroblasts (BJ line, ATCC CRL-2522) at 100% and 50% concentration for 24 h; morphological reactivity was graded on the standardized 0–4 scale by inverted light microscopy against an unexposed control, and supported by a semi-quantitative visual estimate of the proportion of affected cells. All three materials produced a concentration-dependent response. TEMP PRINT retained the best cellular compatibility (grade 1 at 50%, grade 2 at 100%), V-PRINT was intermediate, and ANYCUBIC showed the most pronounced reactivity (approaching grade 3 at 100%), giving an estimated cytotoxicity order of ANYCUBIC > V-PRINT > TEMP PRINT. As a qualitative morphological screening, the findings indicate that the dental-grade resins elicited a milder fibroblast response than the general-purpose photopolymer and support the recommendation that general-purpose resins should not be substituted for certified materials in intraoral use. Confirmation by quantitative viability assays with independent replicates is required before firm conclusions are drawn. In line with the qualitative nature of ISO 10993-5 morphological screening, the reported proportions of morphologically affected cells represent visual scoring rather than direct measurements of cell viability, and the study is therefore presented as an initial biological screening. Full article

Background: The global prevalence of oral disease including dental caries varies significantly across different regions, and South Africa is no exception. Although dental caries is a major public health concern, it is largely preventable through the promotion of proper oral hygiene practices and screening. The study aimed to assess the oral health status of school children within selected primary schools in the Tshwane District, South Africa. Methods: The study used a quasi-experimental design employing a quantitative research approach, structured into three phases: a pre-test assessment, the implementation of the intervention, and a post-test evaluation. A total of 390 primary school learners from five selected schools underwent dental screening and were included in the study on a voluntary basis. Data analysis was conducted using IBM SPSS version 30, incorporating both descriptive and inferential statistical tools. Results: Prior to screening, 75.9% of participants exhibited dental caries, while only 24.1% showed no signs of tooth decay. Following the intervention, improvements in oral hygiene status were observed among participants. The proportion of children presenting with high plaque scores decreased markedly from 19.0% at baseline to 1.8% post-intervention. Similarly, the prevalence of poor oral hygiene declined from 30.1% pre-intervention to 16.2% after the intervention, indicating an overall enhancement in hygiene practices. The proportion of dmft in primary teeth recorded 37.3% pre intervention, higher than post intervention (23.2%). Additionally, the record of DMFT in permanent teeth (49.2%) pre-intervention compared to the post intervention (40.8%). The study reported a similar percentage on the treatment during pre and post intervention (75.9%). Conclusions: Dental screening intervention yielded promising short-term results, particularly in plaque reduction and caries detection. However, its long-term success hinges on integrating school efforts with parental support and improving access to follow-up dental care. A comprehensive, multi-stakeholder approach remains essential to ensure lasting oral health benefits for children. Full article

Background/Objectives: Existing oral-health questionnaires differ in scope from an instrument that combines objectively scored knowledge with separate attitude, practice, and self-efficacy domains across multiple adolescent oral and maxillofacial topics. This study developed the Adolescent Oral and Maxillofacial Health Knowledge–Attitude–Practice and Self-Efficacy Questionnaire (AOMH-KAPQ) and evaluated its initial psychometric properties. Methods: A 46-item pool derived from the KAP framework, literature, and clinical education content was refined through consultation with 18 experts and cognitive interviews with 10 adolescents. The questionnaire was administered to 1006 adolescents aged 12–18 years, and the sample was randomly divided for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA; n = 503 each). Reliability, measurement invariance, and knowledge-item performance were also examined. Results: The final 38-item questionnaire comprised knowledge (15 items), attitude (9), practice (9), and self-efficacy (5). EFA identified one attitude and two provisional practice factors. In CFA, SRMR was ≤0.051 across dimensions; self-efficacy showed CFI = 0.991, TLI = 0.982, and RMSEA = 0.082, whereas robust RMSEA remained elevated for attitude (0.137) and practice (0.145). Cronbach’s α was 0.855–0.929, McDonald’s ω 0.867–0.930, and test–retest ICC 0.797–0.866. Conclusions: The AOMH-KAPQ showed good reliability in this sample, but structural evidence for the attitude and practice dimensions remains preliminary. At present, use should be limited to research and group-level educational needs assessment rather than individual clinical decisions. Full article

The present study was designed to evaluate the structural and biochemical efficacy of Omega-3 fatty acids in preventing renal injury in streptozotocin (STZ)-induced diabetic kidney injury and to correlate systemic oxidative stress parameters with histological and ultrastructural parameters. Twenty-eight male Wistar Albino rats were randomly divided into four groups (n = 7) as follows: Control, Omega-3 (500 mg/kg, orally), Diabetes Mellitus (DM; 50 mg/kg STZ, i.p.), and DM+Omega-3 (STZ, followed by 500 mg/kg Omega-3 for 42 days). Biochemical analysis of renal function (blood urea nitrogen (BUN) and creatinine) and oxidative status (malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI)) was measured by ELISA. Histopathological scoring and Caspase-3 staining were performed by Hematoxylin and Eosin (H&E) and immunohistochemically, respectively. Transmission Electron Microscopy (TEM) was used to examine the renal tissues. Our results showed that the DM group presented with severe hyperglycemia, uremia, and a significant oxidative shift, as evidenced by increased MDA/TOS levels and depleted antioxidant defenses. Light microscopy showed extensive glomerular damage, tubular degeneration and inflammatory infiltration in the kidneys of diabetic rats. Immunohistochemical analysis revealed strong Caspase-3 expression in the tubular and glomerular compartments. TEM showed severe podocyte effacement and damage to the glomerular basement membrane (GBM). Notably, Omega-3 supplementation significantly reversed renal dysfunction, restored the pro-oxidant/antioxidant balance and reduced histopathological injury scores. Moreover, Omega-3 treatment efficiently blocked Caspase-3-mediated apoptotic signaling and preserved the ultrastructural integrity of the glomerular filtration barrier (GFB) and tubular mitochondria. Our results demonstrate the potent nephroprotective effects of Omega-3 fatty acids in reducing oxidative stress, preventing programmed cell death and maintaining the stability of the renal parenchyma’s microarchitecture. These findings suggest that Omega-3 fatty acids could be an effective adjuvant therapeutic agent for the management of diabetic nephropathy. Full article

Background: Acute liver failure (ALF) is a rare, yet potentially fatal clinical syndrome characterized by the rapid deterioration of hepatic function in individuals without pre-existing liver disease, typically occurring over a period of days to weeks. It is associated with substantial morbidity and mortality, particularly in low-income settings, and is clinically defined by the presence of jaundice, coagulopathy, and hepatic encephalopathy. Among its various etiologies, acetaminophen (APAP) overdose is the leading cause of drug-induced liver injury and ALF, especially in industrialized countries such as the United States and the United Kingdom. In the present study, we compared two experimental approaches for inducing APAP-mediated ALF in mice: oral and intraperitoneal (IP) administration. Methods: While most studies reported in the literature rely on a single route of administration, this comparative analysis provides a more comprehensive evaluation of the advantages and limitations associated with each method, thereby enhancing the reproducibility and translational relevance of experimental ALF models. Results: Our results demonstrate that both administration routes effectively recapitulate key clinical and biochemical features of human ALF, including hepatic encephalopathy, marked elevations in serum transaminases, and high mortality rates. However, the effective APAP dose required to achieve these outcomes differed between the two routes, with 400 mg/kg for IP administration and 500 mg/kg for oral administration, as would be expected based on pharmacokinetic considerations. From a clinical assessment perspective, the use of adapted scoring systems, such as the O’Grady criteria, is essential for evaluating encephalopathy in animal models. Notably, oral administration via gastric gavage requires greater technical expertise, which may influence experimental consistency. Conclusions: Taken together, these findings underscore the importance of route selection in experimental design and highlight the value of comparative approaches for optimizing preclinical models of ALF. Full article

Background: A substantial proportion of patients with chronic migraine (CM) with previous failures among oral standard-of-care migraine medications do not respond to monoclonal antibodies targeting the calcitonine gene related peptide pathway (CGRP-mAbs), leaving limited evidence-based options for subsequent preventive strategies. The present multicentre real-world study evaluated the effectiveness of onabotulinumtoxin-A (BoNT-A) in CM patients with previous CGRP-mAb failure and multiple prior oral preventive failures. Methods: This prospective, observational, non-randomized multicentre study enrolled patients with CM who had failed ≥3 classes of oral preventive treatments and ≥1 CGRP-mAb due to lack of efficacy or intolerance. Participants received BoNT-A according to the PREEMPT “follow-the-pain” paradigm every three months and were followed for 6 months. Co-primary outcomes were change in monthly headache days (MHD) after three and six months and ≥50% MHD responder rates at both time points. Results: Fifty-three patients were analysed (85% female, aged 48.5 ± 15.2 years, range 20–73). Compared to the baseline, at the third month and sixth month, MHD decreased from 22.83 (SD 6.74) to 15.38 (SD 7.91; p < 0.001) and 14.55 (SD 9.35; p < 0.001), respectively. The percentages of participants achieving the response status in MMD at the third month and sixth month were 30% and 45%, respectively. In the third and sixth months, 22 patients (41.5%) and 27 patients (50.9%), respectively, converted from chronic to episodic migraine, while the prevalence of medication-overuse headache decreased from 81.1% of patients at baseline to 45.3% and 43.4%, respectively. Migraine-related impact and disability scores improved over follow-up, alongside improvements in anxiety and depressive symptoms and in migraine-specific quality of life. Conclusions: The present findings support the use of BoNT-A in difficult-to-treat patients with CM following CGRP-mAb failure and provide further evidence that its therapeutic effects may rely on mechanisms that are at least partially distinct from, and potentially complementary to, those of CGRP-targeted therapies. Full article

Background/Objectives: Large language models (LLMs) show promise for clinical decision support, yet their accuracy in interpreting specialized medical guidelines remains uncertain. Retrieval-augmented generation (RAG) may enhance performance by grounding responses in authoritative knowledge bases. This study aimed to compare the accuracy, comprehensiveness, and safety of RAG-enhanced versus standard LLMs for answering clinical questions derived from the German S3 guideline for oral cavity carcinoma. Methods: We conducted a prospective, single-blind benchmark study evaluating six LLMs: one RAG-enhanced model (Custom GPT with guideline access), one consensus-based model (ConsensusGPT), and four standard models (DeepSeek-V3.2, Mistral Small 3.2, Qwen3-Next-80B, GPT-OSS-120B). Fifty clinical questions covering 17 guideline domains were presented to each model three times, yielding 900 evaluations. Three expert reviewers assessed responses using 5-point Likert scales for accuracy, comprehensiveness, and clarity, under a single-blind procedure, the effectiveness of which was tested by a pre-specified manipulation check. We then ran a paired within-model experiment in which each base model was queried with and without guideline access through a transparent, openly released retrieval pipeline, and scored every response with a condition-blind automated judge alongside deterministic retrieval metrics computed from the logs. Secondary outcomes included hallucination rates and guideline citation behavior. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: In a paired within-model design that held each base model fixed, adding transparent guideline retrieval improved accuracy—significantly in the three weaker open-weight models (Mistral, Qwen3, and GPT-OSS) and directionally in the already-strong DeepSeek and GPT-5 bases. Because a pre-specified blinding check found that experts could still identify retrieval-augmented answers with 98.5% accuracy, we anchored causal interpretation on measures that do not depend on the human raters, ranked by their independence: deterministic, log-derived retrieval metrics first, and then an automated, condition-blind LLM judge, whose agreement with the experts (Spearman ρ = 0.81, 95.7% within-one agreement) establishes shared calibration rather than independence from their bias. Deterministically from the retrieval logs, citation groundedness rose from 0% to 51–89% and retrieval recall@5 was 92%. On the judge, content-level hallucination fell from 42% to 4% and accuracy rose by a pooled +0.64 points (95% CI 0.47–0.80); the accuracy gain persisted after adjustment for response length (+0.48, 95% CI 0.22–0.73), which retrieval shortened rather than lengthened. The accuracy gain was large for weaker base models and small or non-significant for already-strong ones, whereas the hallucination and auditability gains were consistent across all models. The human ratings reproduced the judge’s accuracy effect (+0.61, 95% CI 0.49–0.74), and GPT-5 run through the transparent pipeline showed no significant difference from the proprietary Custom GPT (judge accuracy 4.48 vs. 4.58). Conclusions: Guideline retrieval yields a reproducible, largely base-independent improvement in the safety and auditability of LLM answers to clinical guideline questions, with accuracy gains concentrated in weaker base models. Because retrieval-augmented answers are recognizable to experts, rigorous evaluation should rely on rater-independent measures, and residual hallucination continues to require human oversight. Full article

The aim of this systematic survey was to evaluate the quality of clinical practice guidelines (CPGs) that provide recommendations for the detection, diagnosis, and treatment of oral cavity cancer (OCC). We conducted a systematic search in MEDLINE, EMBASE, Epistemonikos, CPG websites, and scientific societies to identify documents providing recommendations for the detection, diagnosis, and treatment of OCC. Two reviewers independently assessed the included CPGs using the AGREE II instrument. We calculated standardized scores for the six domains and provided a final recommendation for each CPG. We identified twenty-five CPGs published between 2019 and 2024. The mean scores (higher scores indicate better domain assessment) per domain were as follows: scope and purpose, 80.5 ± 11.6%; stakeholder involvement, 55.6 ± 16.7%; rigor of development, 48.3 ± 20.1%; clarity of presentation, 83.8 ± 8.2%; applicability, 33.6 ± 19.1%; and editorial independence, 57.3 ± 22.4%. The overall mean rate was 4.8 ± 0.8, with a maximum score of seven. Reviewers recommended five guidelines for use in practice, twelve were recommended with modifications, and eight were not recommended. The overall quality of CPGs on OCC was suboptimal. CPG developers should strengthen the use of systematic, transparent methodologies and frameworks for evidence synthesis and recommendation formulation, thereby improving the quality of recommendations and facilitating implementation across diverse clinical contexts. Full article

Background/Objectives: Depressive symptoms are more frequent following pregnancies complicated by gestational diabetes mellitus (GDM), prompting postpartum depression screening recommendations in the German S3 guideline. Although GDM is associated with increased postpartum depression risk, the relationships between postpartum metabolic parameters and the Edinburgh Postnatal Depression Scale (EPDS) scores remain unclear. We investigated whether metabolic markers measured during diabetes screening 6–12 weeks postpartum are associated with depressive symptoms. Methods: We retrospectively analyzed EPDS screenings conducted during postpartum testing at our inpatient clinic between 07/2021 and 02/2024. The EPDS is a validated 10-item tool (score range 0–30), with scores ≥10 indicating potential depression. Metabolic parameters included HbA1c, the 75 g oral glucose tolerance test (oGTT), insulin, and the Homeostasis Model Assessment index (HOMA index). Group comparisons were performed using non-parametric tests and receiver operating characteristic (ROC) analyses, with the Youden index identifying optimal cutoffs. Results: Among the 102 women presenting for postpartum testing, 43.1% had normal glucose tolerance, 54.9% prediabetes, and 2.0% diabetes. A total of 13.7% (n = 14) screened positive for potential depression, including two who reported suicidal ideations. Women with positive EPDS scores had significantly higher HbA1c [5.7% (38.3 mmol/mol) vs. 5.4% (35.5 mmol/mol), p = 0.013]. An HbA1c cutoff of 5.42% (35.75 mmol/mol) showed discriminatory ability for depressive symptoms with an Area Under the Curve (AUC) of 0.708 (CI 0.567–0.849). Other metabolic parameters showed no significant associations. Conclusions: Elevated postpartum HbA1c is associated with depressive symptoms after GDM pregnancies. An HbA1c threshold of 5.42% (35.75 mmol/mol) may help identify women at increased postpartum depression risk and prompt subsequent psychological assessment when depression screening is otherwise omitted. Full article

A 40-year-old man presented with thunderclap headache (TCH) and vomiting post-masturbatory ejaculation. He reported a similar episode with posterior neck pain five days earlier after ejaculation. Unlike his migraine history, these headaches were unusually severe. Upon arrival, physical and neurological examinations were unremarkable except for an elevated blood pressure (154/110 mmHg). Brain MRI/MRA systematically ruled out intracerebral/subarachnoid hemorrhages, aneurysms, cerebral venous thrombosis, and cervical artery dissection, with preserved flow voids on B-PASS, T2, and T2-FLAIR. Notably, MRA demonstrated multiple segmental vasoconstrictions compared to a baseline MRA from five years prior. With an RCVS₂ score of 8, he was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). Symptoms resolved within 10 days of starting oral verapamil (120 mg/day), and follow-up MRA at one month showed partial improvement. This case highlights RCVS manifesting as a secondary cause sharing features with the proposed headaches associated with sexual activity (HSA) spectrum. RCVS is the predominant secondary cause of HSA (67–90%), often indistinguishable from primary HSA at onset due to the shared presentation of sudden TCH. Its pathophysiology likely involves an orgasm-induced sympathetic surge causing transient dysregulation of cerebral vascular tone. This case emphasizes that thorough neurovascular imaging is important in HSA to differentiate RCVS from primary headaches, ensuring the prompt initiation of calcium channel blockers and the avoidance of triptans. Full article

Introduction: This study presents the first systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of oral clonidine in spinal surgery to guide clinical practice and inform future research. Methods: RCTs were identified through four databases (PubMed, Scopus, Web of Science, Cochrane Central) up to August 2025. Risk of bias was assessed, and intraoperative and postoperative outcomes were extracted. Data were pooled using mean differences (MD) or risk ratios (RR) with 95% confidence intervals. Results: Eight RCTs with 474 patients (237 clonidine, 237 control) were included. Four studies had a low risk of bias, while two had some concerns, and two had a high risk. Clonidine had no impact on surgery duration but significantly reduced blood loss (MD = −177.76 mL), mean arterial pressure (MD = −11.33 mmHg), and heart rate (MD = −21.18 bpm). Regarding postoperative outcomes, clonidine was associated with improved analgesia, including lower pain scores up to 12 h and a longer time to first analgesic request, with no significant difference in pain scores at 24 h or total postoperative opioid consumption. No significant increase in postoperative complications, including bradycardia, dizziness, headache, or visual disturbances, was observed. Surgeon satisfaction was higher in the clonidine group. Despite high heterogeneity in some outcomes, sensitivity analyses confirmed the robustness of most findings. Conclusions: Prophylactic oral clonidine in spinal surgery significantly reduces blood loss, heart rate, and mean arterial pressure, with added analgesic benefits and good tolerability. Further high-quality RCTs are needed to confirm these results in broader patient populations. Full article

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article