Search Results (237)

Background: Cardiovascular risk models, such as the Framingham and atherosclerotic cardiovascular disease (ASCVD) calculators, have improved risk prediction but often fail to identify individuals who experience ASCVD events despite low or intermediate predicted risk. This suggests that underrecognized, non-traditional risk factors may contribute significantly to the development of atherosclerosis. Objective: This narrative review synthesizes and summarizes recent evidence on high-yield non-traditional risk factors for atherosclerosis, with a focus on clinically significant, emerging, and applicable contributors beyond conventional frameworks. This review is distinct in that it aggregates a wide array of non-traditional risk factors while also consolidating recent data on ASCVD in more vulnerable populations. Unlike the existing literature, this manuscript integrates in a single comprehensive review various domains of non-traditional atherosclerotic risk factors, including inflammatory, metabolic, behavioral, environmental, and physical pathways. An additional unique highlight in the same manuscript is the discussion of non-traditional risk factors for atherosclerosis in more vulnerable populations, specifically South Asians. We also focus on clinically actionable factors that can guide treatment decisions for clinicians. Results: Key non-traditional risk factors identified include inflammation and biomarker-based risk factors such as C-reactive protein or interleukin-6 levels, metabolic and microbial risk factors, behavioral factors such as E-cigarette use, and environmental or infectious risk factors such as air and noise pollution. We explore certain physical exam findings associated with atherosclerotic burden, such as Frank’s sign and Achilles tendon thickness. Conclusions: Atherosclerosis is a multifactorial process influenced by diverse and often overlooked factors. Integrating non-traditional risks into clinical assessment may improve early detection, guide prevention and personalize care. Future risk prediction models should incorporate molecular, behavioral, and environmental data to reflect the complex nature of cardiovascular disease. Full article

Objectives: The triangular fibrocartilage complex (TFCC) is critical for wrist stability. The incidence of TFCC injury among adolescent athletes is rising due to increased participation in high-demand sports. Here, we investigated the therapeutic outcomes of arthroscopic TFCC repair in adolescent elite athletes. Methods: We retrospectively recruited 24 elite adolescent athletes (mean age 15.5 ± 1.3 years) treated arthroscopically for peripheral TFCC tears between March 2018 and January 2025. Clinical outcomes—including numeric rating scale (NRS) for pain, grip strength, wrist range of motion (ROM), DASH scores, and physical exam tests—were collected preoperatively and at 6-month follow-up. Statistical analysis included paired t-tests for continuous variables and chi-square tests for categorical comparisons. Results: At 6 months postoperatively, the mean NRS decreased from 6.9 ± 1.2 to 0.6 ± 0.7, grip strength increased from 26.3 ± 6.9 kg to 40.8 ± 5.6 kg, and all measured ROMs and DASH scores improved significantly. Positive findings on ballottement, Waiter’s, and piano key tests decreased significantly. There were no major complications. All athletes returned to their pre-injury sport levels. Conclusions: Arthroscopic peripheral TFCC repair in adolescent elite athletes is a safe, minimally invasive, and effective treatment, leading to rapid pain relief, functional recovery, and return to sport with their pre-injury sport levels. Full article

Examinations are typically used by educational institutions to assess students’ strengths and weaknesses. Unfortunately, exam malpractices like cheating and other forms of academic integrity violations continue to present a serious challenge to the evaluation framework because it seeks to provide a trustworthy assessment. Existing methods involving human invigilators have limitations, as they must be physically present in examination settings and cannot monitor all students who take an exam while successfully ensuring integrity. With the developments in artificial intelligence (AI) and computer vision, we now have novel possibilities to develop methods for detecting students who engage in cheating. This paper presents a practical, real-time detection system based on computer vision techniques for detecting cheating in examination halls. The system utilizes two primary methods: The first method is YOLOv8, a top-of-the-line object detection model, where the model is used to detect students in video footage in real time. After detecting the students, the second aspect of the detection process is to apply pose estimation to extract key points of the detected students. For the first time, this paper proposes to measure angles from the geometry of the key points of detected students by constructing two triangles using the distance from the tip of the nose to both eyes, and the distance from the tip of the nose to both ears; one triangle is sized from the distance to the eyes, and the other triangle contains the measurements to their ears. By continually calculating these angles, it is possible to derive each student’s facial pose. A dynamic threshold is calculated and updated for each frame to better represent the body position in real time. When the left or right angle pass that threshold, it is flagged as suspicious behavior indicating cheating. All detected cheating instances, including duration, timestamps, and captured images, are logged automatically in an Excel file stored on Google Drive. The proposed study presents a computationally cheap approach that does not utilize a GPU or additional computational aspects in any capacity. This implementation is affordable and has higher accuracy than all of those mentioned in prior studies. Analyzing data from exam halls indicated that the proposed system reached 96.18% accuracy and 96.2% precision. Full article

Background: Medical students are at high risk for depressive symptoms, but few longitudinal studies have examined changes over time, especially among those repeating academic years. The aim of this study was to assess the prevalence and temporal trends of depressive symptoms and self-rated health among Hungarian medical students, examining the influence of demographic and lifestyle factors and the independent impact of academic repetition on mental health risk. Methods: In a four-year cohort study at the University of Pécs Medical School, students were classified as original-entry cohort (progressing according to the standard curriculum) or repeaters (those who began studies before 2016). Sample size was N = 196 in the first semester of the first year, N = 192 in the second semester of the first year, N = 157 in the second year, N = 147 in the third year, and N = 155 in the fourth year. Data were collected at five time points on lifestyle factors and depressive symptoms using the Beck Depression Inventory and a self-rated health questionnaire. Multivariate logistic regression identified risk and protective factors. Results: In the original-entry cohort, depressive symptoms peaked in the first two years (up to 52.6%), then declined to 24.6% by year four. Compared to age-matched peers, students had 3.1-fold higher odds of depressive symptoms at entry (OR = 3.10, CI: 2.007–4.773; p < 0.001), rising to 5.2-fold after the first exam period (OR = 5.20, CI: 3.375–8.000; p < 0.001). Among repeaters, odds of depressive symptoms remained over threefold higher than the general population (OR = 3.64, CI: 1.888–7.022, year IV/1), and self-rated health was significantly lower (p < 0.001). Financial hardship increased risk, while regular physical activity was protective. Conclusions: This study highlights the elevated and persistent mental health risks among repeaters and medical students with financial difficulties. Stratifying by academic progression reveals unique vulnerabilities, underscoring the need for targeted support in medical training. Full article

Background/Objectives: While a growing body of research indicates an increased psychiatric burden, including depression comorbidity, among individuals with irritable bowel syndrome (IBS), evidence from large claim-based databases remains limited. This study aimed to investigate the association between IBS and depression among a nationally representative sample of 3.9 million Korean adults. Methods: We used data from the 2021 Korean National Health Insurance Service (NHIS), including a total of 3,864,586 individuals aged 19–64 years who participated in the national biennial health screening exam between 1 January 2021 and 31 December 2021. Exposures and outcomes were identified based on the International Classification of Diseases, Tenth Revision (ICD-10), codes: F32 and F33 for depression and K58 for IBS. Multivariable logistic regression analysis adjusted for age, sex, residential area, comorbidity, smoking, alcohol use, physical activity, and body mass index was conducted. Results: One-year prevalence of depression among the entire sample was 4.0%. The prevalence among individuals with IBS (7.3%) was significantly higher than that among those without IBS (3.6%, p < 0.001). Multivariable logistic regression analysis confirmed this relationship (OR = 1.77, 95% CI: 1.74, 1.79) after adjusting for all covariates. Conclusions: Our findings suggest that individuals with IBS are vulnerable to depression, emphasizing the need for integrated approaches in clinical management and public health policy responding to the rising burden of IBS. Full article

Diurnal enuresis can significantly affect a child’s biopsychosocial well-being; however, there is a lack of diagnostic and management algorithms on the diagnosis. The purpose of this literature review is to dissect the development of the evaluation and management of diurnal enuresis. A total of 44 articles published from January 1900 to December 2024 were chosen through literature searches in PubMed, Science Direct, Embase, and Google scholar. Search terms were “Diurnal Enuresis” or “Daytime Incontinence” as Mesh terms, and subsequent terms included “pediatrics”, “urinary bladder, overactive”, and “therapeutics”. Inclusion criteria included studies involving pediatric study subjects aged 5–18 years old with a specific diagnosis of diurnal enuresis, exclusion criteria were studies before 1900 and involving night-time wetting diagnoses. A consensus among the literature and the American Academy of Family Physicians recommends a stepwise diagnostic evaluation, including history taking followed by a focused physical exam, for diurnal enuresis has proven to be the most effective. Regarding treatment, biofeedback was shown to improve symptoms in 74% of cases in one study by Wiener, while pharmacological treatment via Mirabegron (beta 3 agonist) showed a 70% improvement in one study by Fryer, but older drugs such as oxybutynin (anticholinergics) are still preferred. A multidisciplinary approach with TENS therapy, behavioral modification, biofeedback, and pharmacology can enhance effectiveness, improve reliability, and provide more successful results while minimizing the impact of diurnal enuresis on a child’s well-being. Further research is needed to optimize pharmacologic management strategies and improve adherence to increase the likelihood of reaching treatment goals. Full article

Background and Clinical Significance: Primary Cutaneous Cribriform Apocrine Carcinoma (PCCAC) is a rare, inert low-grade cutaneous malignancy that is diagnosed on histopathologic assessment. PCCAC usually presents in middle-aged adults as a solitary, subcutaneous nodule on the extremities. Characterized by anastomosing tubules and solid/cribriform nests of atypical epithelial cells generating a sieve-like display, the tumor is a histopathological variant of apocrine metaplasia of the skin. PCCAC also follows characteristic staining patterns. It is important to distinguish PCCAC from other similar histological variants, which may hold more grievous indications. Case Presentation: A 47-year-old female presented with an enlarging, itchy growth of several months on her back. On physical exam, an indurated pink, nontender papule of 8 mm on the left lateral side wall was noted. Histopathology demonstrated a well-circumscribed, pandermal tumor composed of anastomosing solid and cribriform nests, tubules, and cords of mildly atypical, eosinophilic epithelial cells forming a glandular lumina. An immunohistochemical study revealed the tumoral epithelium to express CK7, CK5/6, BER-EP4, CD117 (C-kit), and S100. Positive EMA and CEA staining highlighted intratumoral glandular ductal differentiation and apocrine secretion. Immunohistochemical stains for CK20, GATA-3, and p63 were negative. Conclusions: We present this case to distinguish the histological attributes of PCCAC and help differentiate it from more concerning visceral metastatic malignancies. We follow with a narrative review of the histopathologic differential for PCCAC and feature reconciliation of corresponding staining patterns reported in the literature. Full article

Background and Objectives: Large language models (LLMs) offer promising applications in healthcare, including drafting referral letters. However, access to LLMs specifically designed for medical practice remains limited. While ChatGPT is widely available, its ability to generate comprehensive and clinically appropriate neurology referral letters remains uncertain. This study aimed to systematically evaluate the completeness and quality of neurology referral letters generated by ChatGPT for standardized clinical scenarios. Materials and Methods: Five standardized clinical scenarios representing common neurological complaints encountered in family medicine settings (headache, memory problems, stroke/TIA, tremor, radiculopathy) were used. Using a consistent prompt, ChatGPT (GPT-4o, 2025 release) generated 10 referral letters per scenario (50 letters in total). A dual board-certified neurologist and family physician scored the letters using a 30-point rubric across multiple domains: completeness (demographics, chief complaint, history of present illness, physical exam findings, management, and consultation questions) and quality (language level, structure, and letter length). Descriptive statistics and inferential analyses (ANOVA and Kruskal–Wallis tests) were applied to assess performance across scenarios. Results: The mean total score was 25.76/30 (95% CI: 24.85–26.67). Completeness averaged 87%, while language and structure consistently scored above 90%. Content gaps appeared in 36 out of 50 letters (72%), mainly in the history of present illness and physical examination sections. Variability was observed across letters, though not statistically significant between scenarios (ANOVA: F = 1.14, p = 0.352; Kruskal–Wallis: H = 3.52, p = 0.475). Conclusions: ChatGPT produced neurology referral letters of high linguistic quality but variable completeness, especially for clinically complex content. The variability pattern among letters reflected model inconsistency rather than case type. The reliance on a single rater and use of a non-validated rubric represent limitations. Future studies should include multiple raters, inter-rater reliability testing, and validated scoring frameworks. Ultimately, access to tailored LLMs exclusively trained for medical documentation could improve outcomes while safeguarding patient privacy. Full article

Primary Care Pharmacy (PCP) plays a vital role in healthcare systems. This study evaluated the competencies of pharmacy graduates from a community-focused curriculum, emphasizing their skills and personal traits. A structured questionnaire assessed four domains: general characteristics (11 items), PCP skills (16 items: 13 home visit and 3 community engagement skills), PCP personal traits (7 items), and readiness for PCP practice. Two sets of questionnaires were distributed in 2018 to recent pharmacy graduates: one for self-assessment and the other for evaluation by supervisors or co-workers. A 5-point scale (1 = least competent, 5 = most competent) was used. Co-workers gave higher scores than the graduates themselves. In home visit skills, “providing medicine advice” scored highest (4.4 ± 0.6 by graduates; 4.5 ± 0.2 by co-workers), while “performing essential physical exams” scored the lowest (3.5 ± 0.7). For co-workers, the lowest score was “working with a multidisciplinary team” (3.9 ± 0.9). Among community engagement skills, “solving health-related problems” rated highest (3.4 ± 0.7), and “identifying community health needs” rated lowest (3.2 ± 0.7). “Being friendly” and “responsibility” were top-rated personal traits by graduates and co-workers, respectively. The lowest was “coordinating with local organizations.” Graduates showed strong PCP traits and home visit skills but moderate community engagement. Community-based exposure is recommended to enhance these competencies. Full article

Background/Objectives: Infection is a major complication during the early postoperative period following pediatric liver transplantation (LT). Prompt diagnosis and treatment are essential to prevent death. We aimed to assess the diagnostic value of procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein (CRP) levels for detecting bacterial infection and SIRS within the first week after LT. Methods: Demographic data, vital signs, laboratory results (PCT, CRP, WBC), and culture findings on the 1st, 4th, and 7th days between January 2010 and 2024 were collected retrospectively. Results: The study included 88 patients. Seventy-two percent had cirrhotic liver disease. SIRS was present in 17% (n = 15), and bacterial growth was detected in 20% (n = 18). Bacterial growth was found in 80% of patients with SIRS (n = 12/15) and in 8% of SIRS-negative patients (n = 6/73). PCT levels were significantly elevated on days 1, 4, and 7, and CRP levels on days 4 and 7 in patients with SIRS. PCT elevation was significant on days 1, 4, and 7, while WBC increase was noted on day 7 in patients with bacterial growth. Body temperature ≥ 37.1 °C and PCT ≥ 5.1 ng/dL on the first day together showed a sensitivity of 72.2% and specificity of 84.3% for bacterial growth. Similarly, body temperature ≥ 37.1 °C and PCT ≥ 9.2 ng/dL on the first day yielded 73% sensitivity and 95% specificity for diagnosing SIRS. Cirrhotic patients exhibited limited or no WBC response to bacterial growth. Conclusions: PCT, CRP, and WBC alone are insufficient for diagnosing infection. Combined assessment of body temperature changes and PCT elevation may serve as more accurate indicators. Nonetheless, close monitoring of culture results and clinical signs, with serial physical exams, can aid timely infection management or prevent unnecessary antibiotic adjustments. Full article

Objective: Our aim was to investigate the oral health-related quality of life (OHRQoL) and dental care experiences of adults with Cerebral Palsy (CP). Methods: In 2023, adults with CP and their caregivers from four Australian states completed questionnaires, including the Oral Health Impact Profile-14 (OHIP-14). Non-parametric tests were conducted to analyze associations between demographic and CP-related variables and OHRQoL. Results: A total of 69 respondents participated, including n = 22 adults with CP and n = 47 caregivers of adults with CP. Most adults with CP were diagnosed with a spastic motor type (46/69, 66%), with bilateral spasticity being the most common (30/46, 65%). The mean OHIP-14 score was 10.3 ± 9.3 (mean ± SD). Nearly 70% reported challenges cleaning their teeth, over 25% lacked a dentist, more than 60% found dental exams challenging, and nearly 50% required specialized dental care. In bivariate analysis, OHIP-14 was associated with daily oral care routines (p = 0.012) and “simple dental check-up” (p = 0.017). There was a statistically significant relationship between socio-economic status and scores for the handicap dimension (p = 0.040). Higher OHIP-14 scores were associated with greater levels of impairment regarding gross motor (p = 0.199), manual functioning limitations (p = 0.001), speech (p = 0.123), and communication function scales (p = 0.319). Conclusion: Adults with CP reported challenges participating in and maintaining oral health and accessing dental care, influenced by physical, functional, and socio-economic factors. These findings indicate the need for inclusive care and strategies to support access to services. Full article

Background/Objectives: Routine preventive care, including physical examinations, mammography, and cervical cancer screening, is critical for long-term health maintenance and recurrence surveillance among breast cancer survivors. Community-based organizations (CBOs) may play a key role in supporting adherence to these services through education, navigation, and survivorship care planning. Methods: A secondary analysis was conducted using data from N = 777 breast cancer survivors who contacted a national cancer-focused CBO for resources, including no-cost patient navigation. Preventive care adherence was measured via a composite index based on self-reported receipt of physical exams, mammograms, and Pap smears at guideline-recommended intervals. Patient-reported outcomes were assessed 30 days post-contact, including Survivorship Care Planning (SCP) receipt and quality of life (QoL). Results: Adherence to all three guideline-based screenings was reported by 66% of BCS, 29% adhered to two, and 6% to one or fewer. Physical exams had the highest adherence rate (97%), followed by mammograms (88%) and Pap smears (73%). Bivariate analyses showed higher adherence among younger survivors (t = 4.59, df = 711, p < 0.001), non-white survivors (t = −3.27, df = 267, p < 0.001), those in partnered relationships (t = 1.76, df = 54, p < 0.05), and individuals with better QoL (r = −0.09, p < 0.01). Receipt of SCP components was associated with a trend toward improved adherence: 56% received a care summary, 64% received follow-up instructions, and 45% received written materials (r = 0.05, p < 0.10). In multivariable regression adjusting for partnership status and SCP receipt, younger age (B = 1.13, p < 0.001), non-white race/ethnicity (B = 1.00, p < 0.01), and higher QoL scores (B = 0.09, p < 0.05) were significantly associated with greater adherence. Conclusions: Engagement with a CBO was associated with high levels of adherence to preventive care among breast cancer survivors—especially those who were younger, non-white, and with better QoL. SCP, particularly when delivered in written form with follow-up instructions, may support improved adherence. These findings highlight the value of CBO-led survivorship support in promoting long-term health maintenance for breast cancer survivors. Full article

Background: Physical activity (PA) and adequate micronutrient intake are essential for brain development and may influence cognitive function and academic achievement. However, few large-scale studies have assessed the combined effects of PA and multi-micronutrient supplementation (MMNS) in school-age children. Methods: A cluster-randomized placebo-controlled trial in four peri-urban Tanzanian schools assigned children to one of four groups: (i) PA alone; (ii) MMNS alone; (iii) PA plus MMNS; or (iv) placebo. Children were followed over two school years with assessments at baseline, 14 months, and 26 months. Cognitive function was assessed using computerized Flanker tasks. Academic achievement was evaluated through end-of-year exams in mathematics and Kiswahili subject scores. Anthropometric measures determined nutritional status. Data were analyzed using generalized estimated equations (GEE). Results: Complete data from 559 children (326 girls, 233 boys) aged 6–12 years showed differing characteristics across groups, particularly age and body mass index. No significant intervention effects on cognitive function were found. MMNS groups (alone or combined with PA) showed significantly higher Kiswahili scores, while PA alone had the lowest performance compared to placebo. No intervention effect was found in mathematics. Sex, hemoglobin level, and baseline measures were key predictors for cognition or academic performance. Conclusions: PA and MMNS interventions showed no significant cognitive or academic improvements versus placebo. Further research should optimize school-based nutrition and PA programs for improved learning outcomes. Full article

Background/Objectives: To prevent potential complications for patients with metal hypersensitivity requiring total knee arthroplasty (TKA), implant coatings have been developed. Thermal nitriding of the titanium surface creates a TiN layer that increases hardness and wear resistance while preventing release of cobalt and chromium ions. The aim of this study was to evaluate the clinical safety and performance of an anatomic implant system comprised of thermally nitrided Ti-6Al-4V. Methods: This is an ongoing prospective, multicenter observational cohort study of primary and revision TKA patients. Patient-reported outcome measures including the Oxford Knee Score (OKS), Knee Society Score (KSS) Expectations subscale, EQ-5D-5L, physical exams, and radiographic assessments to document abnormalities were investigated in 94 patients who provided at least two years of follow-up data. The primary endpoint was improvement in the Oxford Knee Score (OKS), defined as the minimal clinically important difference (MCID, 7.0 points). Results: All outcome measures including patient-reported function (OKS) demonstrated significant improvements (19.4–22.6 points) exceeding the MCID with no between-group differences by bearing types utilized. Health-related quality of life as measured by EQ-5D-5L improved over the cohort and was maintained at 2-years post-operative. In total, three (1.4%) radiographic abnormalities were observed, all of which resolved at two-year follow-up. 12 (5.3%) serious complications were reported, none of which were related to the device. Two revisions have occurred, one due to infection and one due to a fall, in the ultracongruent bearing cohort (survivorship 98.1%, 95%CI 87.4–99.7). Implant survivorship was 100% in all other bearing cohorts. Conclusions: This anatomically designed, thermally nitrided titanium alloy implant demonstrated clinically significant improvements in function, PROMs, and quality of life in patients undergoing TKA regardless of bearing type. Excellent two-year implant survivorship between 98.1% and 100% across cohorts were observed, with no radiographic abnormalities at 2 years. Full article

Background/Objectives: Academic stress arises when students perceive that university demands exceed their coping resources, leading to cognitive, behavioral, and physiological stress responses. This study examines the predictive role of academic stressors and sociodemographic variables across five dimensions of stress response. Methods: The sample comprised 1014 Spanish university students (64.5% women, 35.5% men; M = 20.56, SD = 3.50). Participants completed the Academic Stressors Scale (E-CEA) and the Stress Responses Scale (R-CEA). Hierarchical regression analyses were conducted in two blocks: sociodemographic variables were entered in the first block, followed by academic stressors in the second. Results: Academic stressors accounted for substantial variance in all five stress response dimensions: negative thoughts (47.8%), physical exhaustion (39.5%), physical agitation (32.9%), irritability (29.7%), and sleep disturbances (26.8%). The most recurrent predictors were beliefs about performance, exams, and academic overload. In contrast, sociodemographic variables explained a much smaller portion of the variance (5.9%) and were specifically linked to higher irritability among women and younger students, more negative thoughts among students in Arts and Humanities, and fewer physical symptoms and sleep disturbances in students from science and technical fields. Conclusions: The findings reveal that academic stressors are key contributors to psychological distress among university students, highlighting the need for institutional interventions to alleviate the most frequent stressors. Identifying student groups particularly vulnerable to academic stress further supports the implementation of tailored strategies that address the diversity of students’ profiles and needs. Full article