Search Results (185)

Şerefeddin Sabuncuoğlu (c. 1385–1470) was one of the most prominent surgeons of the early Ottoman period, particularly noted for his systematic and visually documented surgical approaches to breast tissue. His principal work, Cerrahiyyetü’l-Hâniyye, is based on the 30th volume of the Andalusian physician al-Zahrawi’s Kitab al-Tasrif, yet it goes well beyond a translation by incorporating Sabuncuoğlu’s clinical observations, experiential knowledge, and original surgical explanations. The text provides detailed descriptions of breast pathologies, including gynecomastia, and outlines diagnostic procedures, therapeutic strategies, surgical drainage methods, local wound-cleansing practices, and the definitions and uses of numerous surgical instruments, many of which are illustrated via miniatures. His second major work, Mücerrebnâme, is equally significant from a pharmacotherapeutic perspective, containing experiential prescriptions for swelling, inflammation, and painful breast lesions and reflecting the empirical reasoning he applied to drug-based treatments. Together, these two works portray Sabuncuoğlu as a versatile physician who combined operative techniques with pharmacological knowledge, offering a comprehensive view of medical practice in the early Ottoman period. His detailed account of gynecomastia surgery, supported by observations on pre- and postoperative care, represents an important source for understanding both medieval surgical practice and the development of anatomical and therapeutic knowledge in the Islamic medical tradition. Full article

Even though primary Sjögren disease (pSjD) is mainly associated with sicca symptoms, there are extraglandular manifestations of the disease which affect the quality of life of patients the most and may even be life-threatening. Among the most severe, polyneuropathy and myopathy are worth mentioning. Additionally, clinical observations suggest a higher prevalence of fibromyalgia (FM) in this group of patients, clouding physicians’ assessment and potentially leading to unsuccessful therapeutic decisions. The aim of our study was to evaluate the frequency of pSjD and FM co-occurrence as well as to find the most effective screening tools and markers of such overlap. A total of 97 consecutive patients with diagnosed pSjD were incorporated in the study after obtaining their informed consent. Participants completed a set of broadly available questionnaires, including Fibromyalgia Survey Questionnaire, SF-36 and EULAR Sjögren’s Syndrome Patient-Reported Index (ESSPRI). Data on their laboratory results was collected in the dedicated database. Moreover, patients underwent electroneurographic (ENG) and electromyographic (EMG) testing. Central nervous system (CNS) abnormalities were detected using MRI. Objective disease activity was evaluated based on EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). The mean age was 55.3 (range 19.0–78.0 years, SD = 13.9). The disease duration ranged from 2 to 42 years (M = 9.03 years, SD = 7.1 years). Nearly half of the participants (n = 44, 45%) met diagnostic criteria of FM. Interestingly, the diagnosis of FM correlated with CNS involvement. There was no significant correlation between FM and either polyneuropathy/myopathy nor laboratory findings (however, C3c and folic acid concentrations were near the level of significance—mean 1.2 vs. 1.29; p = 0.075 and mean 11.35 vs. 9.21; p = 0.071, respectively). Within the subcategories of SF-36 and ESSPRI scales, significant positive correlation was noted with ESSPRI total score and ESSPRI pain score (neuropathic subcategory), while a negative correlation was found with SF-36 vitality score, physical functioning score, and the SF-36 total score. FM is common among pSjD patients and should be considered rather a comorbidity requiring different therapeutic approaches. At the fast-paced clinical environment, a concise ESSPRI assessment may be helpful in the initial screening of patients at risk of FM. Even though the origin of this phenomenon is unknown, the concepts of central sensitization and microglia polarization may be potential explanations and more molecular research in this direction could benefit the pSjD patients. Full article

Background: While the 2024 ESC Guidelines provide guidance on utilising incidental CAC findings from non-gated CT scans to enhance risk stratification and guide treatment decisions, there remain gaps in detailed protocols for managing such incidental findings, particularly in inpatient settings. An incidental finding of CAC in a patient without known atherosclerosis provides an opportunity to assess cardiac risk, promote risk factor optimisation and evaluate need for further cardiac work up. The aim of this study was to assess the prevalence of incidental coronary artery calcification on non-cardiac dedicated gated CT thorax scans among general medical inpatients and to evaluate the subsequent management of these findings. Methods: This was a single-centre retrospective observational study of consecutive general medical inpatients aged 40–75, who had undergone a non-cardiac gated CT thorax during their admission, between February and March 2025. Data were collected using local electronic health records. Exclusion criteria were patients with known ischaemic heart disease (IHD). Risk factor assessment was noted by documentation of smoking status, hypertension, diabetes and low-density lipoprotein (LDL) values. Results: A total of 186 patients with thoracic CT scans were identified. On review of all CT reports, 53 (28.4%) patients had CAC reported, of whom 17 had known IHD. Therefore 36 (19.4%) patients were identified for further analysis. An exercise stress test was booked in none of the patients. A coronary angiogram was booked in 1 patient. Conclusions: One fifth of medical inpatients in our study had a new finding of CAC on thoracic imaging. Cardiovascular risk factors of LDL and HbA1c were checked in less than half of patients. None of these patients went on to have functional testing. There is a valuable opportunity to optimise cardiac risk factors and evaluate the need for functional testing in a subset of patients with CAC reported on non-cardiac CTs. This can be facilitated by raising awareness and implementing a flowchart tool for hospital physicians to reference. Full article

Background: Generative AI and synthetic media have enabled realistic human Embodied Conversational Agents (ECAs) or avatars. A subset of this technology replicates faces and voices to create realistic likenesses. When combined with avatars, these methods enable the creation of “digital twins” of physicians, offering patients scalable, 24/7 clinical communication outside the immediate clinical environment. This study evaluated surgical patient perceptions of an AI-generated surgeon avatar for postoperative education. Methods: We conducted a pilot feasibility study with 30 plastic surgery patients at Mayo Clinic, USA (July–August 2025). A bespoke interactive surgeon avatar was developed in Python using the HeyGen IV model to reproduce the surgeon’s likeness. Patients interacted with the avatar through natural voice queries, which were mapped to predetermined, pre-recorded video responses covering ten common postoperative topics. Patient perceptions were assessed using validated scales of usability, engagement, trust, eeriness, and realism, supplemented by qualitative feedback. Results: The avatar system reliably answered 297 of 300 patient queries (99%). Usability was excellent (mean System Usability Scale score = 87.7 ± 11.5) and engagement high (mean 4.27 ± 0.23). Trust was the highest-rated domain, with all participants (100%) finding the avatar trustworthy and its information believable. Eeriness was minimal (mean = 1.57 ± 0.48), and 96.7% found the avatar visually pleasing. Most participants (86.6%) recognized the avatar as their surgeon, although many still identified it as artificial; voice resemblance was less convincing (70%). Interestingly, participants with prior exposure to deepfakes demonstrated consistently higher acceptance, rating usability, trust, and engagement 5–10% higher than those without prior exposure. Qualitative feedback highlighted clarity, efficiency, and convenience, while noting limitations in realism and conversational scope. Conclusions: The AI-generated physician avatar achieved high patient acceptance without triggering uncanny valley effects. Transparency about the synthetic nature of the technology enhanced, rather than diminished, trust. Familiarity with the physician and institutional credibility likely played a key role in the high trust scores observed. When implemented transparently and with appropriate safeguards, synthetic physician avatars may offer a scalable solution for postoperative education while preserving trust in clinical relationships. Full article

Fatigue is a pervasive burden for emerging medical professionals, often impacted by stress and lifestyle factors, yet insufficiently explained by these aspects alone. Considering the profound immediate and long-term consequences for physician well-being and patient care, exploring the interplay between biological factors, such as the oral microbiome and fatigue, emerges as a critical area of investigation. This exploratory longitudinal study investigates the relationship between oral microbiome diversity and fatigue in first-year medical students across four timepoints, where they provided buccal swabs and completed lifestyle and standardized stress, sleep, and fatigue assessments (PSQI, FAS, PSS). Microbiome analysis was performed using 16S rRNA sequencing and QIIME2-based bioinformatics to identify genus-level profiles and core microbiome composition. Forty-five healthy participants were assessed. Significant increases in fatigue and fluctuations in oral microbiome diversity were observed, with alpha diversity peaking mid-year before declining. Illness frequency and antibiotic use also rose, potentially influencing microbial shifts. These fluctuations may be indicative of an adaptation process where oral microbial diversity adjusts to changes in the subject’s environment, which in this case is entering medical school. Despite no clear clustering in biodiversity metrics, associations between fatigue and microbiome richness were noted, suggesting that physiologic fatigue and environmental stressors may contribute to microbial variability. Limitations of the study include a small sample size, attrition, and representativeness of the study population. This study presents a longitudinal baseline that may serve as a reference for future investigations. These findings may support the development of targeted interventions designed to modulate microbial composition as a novel approach to alleviating fatigue. Full article

Over the last decade, additive manufacturing (AM) has been widely investigated for developing on-demand, patient-centric, and personalized medications. Among various AM techniques, fused deposition modeling (FDM), semi-solid extrusion (SSE), inkjet printing, binder jet printing, stereolithography (SLA), and selective laser sintering (SLS) have been most widely studied for developing simple and complex pharmaceutical medications. Implementing the AM platform enables decentralized manufacturing of medications at the hospitals and clinical sites. The dose and release profiles of the dosage forms can be tailored based on patient needs, providing flexibility to the physician. In fact, streamlining the AM process into a continuous manufacturing process equipped with process analytical technology (PAT) tools will ensure the manufacturing and delivery of safe and efficacious medications to the patient population. Complex medications, such as polypills, which are complex and time-consuming to manufacture using traditional manufacturing techniques, can be printed quickly using the AM approach. The pediatric patient population can be attracted to medication by printing the dosage forms with a geometry of interest. The AM platform can be integrated with artificial intelligence (AI) and health records to accelerate drug development and tailor medications based on patient conditions. Despite the various advantages that the AM platform brings to the pharmaceutical field, a few limitations, such as scalability, material innovation, secondary processing, and regulatory evolution, need to be addressed. This review article compares the advantages and limitations of the existing AM techniques along with a note on the recent advancements and future perspectives. Full article

Background: Complementary and alternative medicine (CAM) is increasingly used to supplement evidence-based medicine (EBM), especially in the treatment of cancer patients. Objective: The study aimed to analyze the beliefs, attitudes, and expectations of healthcare professionals and cancer patients regarding the integration of CAM into the Western medical system, and to examine differences between these groups in their expectations for CAM effectiveness. The hypotheses were that there are no statistically significant differences in attitudes between healthcare professionals (nurses and physicians) and cancer patients regarding CAM integration into EBM and the effectiveness of CAM. Methods: The study was conducted on a stratified sample of 832 respondents: 411 cancer patients and 421 health professionals (100 physicians and 321 nurses). Validated questionnaires based on CHBQ and IMAQ instruments were used. Descriptive and inferential statistics were applied in the analysis. Results: Patients showed a significantly more positive attitude toward CAM methods than healthcare professionals. A total of 70% of respondents believed that CAM should be integrated into EBM. Most respondents supported formally noting CAM therapies in medical records and including them in medical history. Healthcare professionals, especially physicians, expressed greater concerns about the effectiveness of CAM, while patients had more positive expectations about its benefits. Conclusions: The findings suggest that healthcare professionals require better education on CAM therapies and that greater openness is necessary to integrate these methods into medical practice. Although patients have high expectations for CAM, its inclusion in the formal medical system requires further research on safety and efficacy. Full article

Background/Objectives: Digital health technologies are increasingly integrated into perioperative care to standardize information delivery and improve patient empowerment. However, the overall effectiveness of preoperative education depends not only on digital tools but also on interpersonal factors, such as physician gender and clinical experience, which may shape patients’ perceptions and responses to digitally delivered content. Methods: Patients scheduled for elective surgery were included in the iPREDICT randomized trial prior to their preoperative anesthesia assessment. After preoperative anesthetic assessment, the anesthesiologist documented the communication quality and the risks explained. Patients completed a questionnaire to assess their knowledge of anesthesia-related risks and whether the consultation alleviated their fears. Results: A total of 275 included patients were consulted by 94 anesthesiologists, 65% of whom were female. Risk recall was mainly determined by patient-related factors, with online education significantly improving recall over time (β = 1.24, p = 0.034). Anesthesiologists with 1–4 years of clinical experience explained more risks than those with <1 year of professional experience (β = 2.30, p = 0.024). A reduction in post-consultation anxiety was noted when the anesthetist was female (β = 0.21, p = 0.022). Communication was overall rated as good, with higher ratings when anesthetists had more than 10 years of experience (β = 0.09, p = 0.049). Conclusions: Although we have shown with the iPREDICT study (registered in the German CTS; DRKS00032514; on 21 August 2023) that online education improves patients’ recall of anesthesia-related risks, the current sub-analysis emphasizes that interpersonal interactions remain essential for alleviating fears and improving the quality of communication. Together, these findings underscore the complementary roles of digital education and face-to-face consultations in optimizing preoperative preparation. Full article

People with disabilities (PWDs) face unique challenges in accessing equitable medical care, due in part to physicians’ limited training in disability-related competencies. This study explored a novel approach to bridging this gap by integrating selected videos and reflective essays into medical education. Third- and fourth-year medical students watched four videos depicting diverse experiences of PWDs and submitted reflective essays, resulting in the analysis of 90 essays by six investigators. Through thematic analysis, 50 concept codes were distilled into six key themes: recovery process, student insight, adjustment to disability, patient-doctor relationship, social model of disability, and support systems. The reflections revealed a growing awareness among students of the need to individualize care and address systemic barriers, though some medicalized views of disability were noted. These findings underscore the potential of video-based education to enhance disability competence in medical training by fostering critical reflection and empathy. However, to maximize impact, educators should prioritize diverse portrayals of disability and challenge sensationalized or “overcoming” narratives common in such media. Overall, this study demonstrates that widely available media can be a valuable, scalable tool for advancing disability education in medical curricula. Full article

Background/Objectives: The global threat of antimicrobial resistance is a significant public health challenge, leading to prolonged hospitalizations, increased costs, and elevated mortality. Romania faces one of Europe’s highest burdens of antimicrobial consumption and resistance. This study aimed to investigate the factors that influence antibiotic prescribing practices among physicians in pediatric care in Romania. Method: This quantitative, cross-sectional study collected data using a self-administered, structured questionnaire from 154 healthcare professionals (family physicians, pediatricians, and other specialists) providing pediatric care in Romania. Participants were recruited via non-probability convenience sampling. The 29-question survey gathered demographic data and explored perceptions and practices regarding antibiotic therapy in children using a 5-point Likert scale. Results: The majority of participants were family physicians (64.94%) with over 15 years of experience (53.90%), primarily practicing in urban settings (61.69%). Only 21.43% had attended an antibiotic stewardship course in the last three years. Physicians generally base their prescribing on clinical symptoms. While physicians strongly agreed they follow guidelines, personal experience also held significant weight. High parental demand for antibiotics was perceived, but physicians largely denied ceding to parental tone or insistence without a medical indication. A strong consensus existed on antibiotic overuse in Romanian children, and a high interest in continuous education on rational antibiotic use was noted. Pediatricians showed significantly higher guideline adherence and diagnostic test use than family physicians. Rural physicians reported lower guideline adherence and less frequent diagnostic testing. Stewardship course participation and access to rapid diagnostic tests were associated with more evidence-based practices. Conclusions: Romanian physicians exhibit a nuanced approach to antibiotic prescribing, balancing guidelines with personal experience and facing significant perceived parental pressure. Professional profile (specialty, experience, practice environment) and access to diagnostic resources significantly influence prescribing decisions. Full article

Electronic Health Records (EHRs) have enhanced access to medical information but have also introduced challenges for healthcare providers, such as increased documentation workload and reduced face-to-face interaction with patients. To mitigate these issues, we propose RAGMed, a Retrieval-Augmented Generation (RAG)-based AI assistant designed to deliver automated and clinically grounded responses to frequently asked patient questions. This system combines a vector database for semantic retrieval with the generative capabilities of a large language model to provide accurate, reliable answers without requiring direct physician involvement. In addition to patient-facing support, the assistant facilitates appointment scheduling and assists clinicians by summarizing clinical notes, thereby streamlining healthcare workflows. Additionally, to evaluate the influence of retrieval quality on overall system performance, we compare two embedding models, gte-large and all-MiniLM-L6-v2, using real-world medical queries. The models are assessed within the RAG-Triad Framework, focusing on context relevance, answer relevance, and factual groundedness. The results indicate that gte-large, owing to its higher-dimensional embeddings, retrieves more informative context, resulting in more accurate and trustworthy responses. These findings underscore the importance of not only the potential of incorporating RAG-based systems to alleviate physician workload and enhance the efficiency and accessibility of healthcare delivery but also the dimensionality of models used to generate embeddings, as this directly influences the relevance, accuracy, and contextual understanding of retrieved information. This prototype is intended for the retrieval-augmented answering of medical FAQs and general informational queries, and is not designed for diagnostic use or treatment recommendations without professional validation. Full article

Background: Allergic diseases in early childhood are influenced by genetic predisposition and modifiable early-life exposures, including epigenetic mechanisms. Understanding the interplay between environmental factors and allergy development in children with atopic heredity is critical for prevention strategies. Objective: To investigate the associations between selected early-life environmental exposures and the development of allergic conditions in children with a positive family history of atopy. Methods: A cross-sectional study was conducted among 120 children aged 2 years (±5 months) with atopic heredity, recruited at the Medical University of Varna, Bulgaria (2017–2020). Data on sociodemographic background, prenatal exposures, birth mode, feeding practices, pet contact, daycare attendance, and infectious burden were collected via structured questionnaires and medical records. Allergic outcomes (food allergy and atopic dermatitis) were physician-confirmed. Statistical analyses included t-tests and chi-square tests. Results: Food allergy was diagnosed in 23.3% and atopic dermatitis in 21.7% of participants. Formula feeding was significantly more common in children with food allergy (66.7% vs. 38.1%; p = 0.020). A lower maternal pregnancy experience score was significantly associated with both food allergy (p = 0.021) and overall allergic outcomes (p = 0.004). Indoor smoking was more common in households of non-allergic children (p = 0.034). Children with food allergy had significantly more rhinopharyngitis episodes (p = 0.014) and longer infection duration. Higher gastroenteritis frequency and hospitalization rates were also noted in food-allergic children. Conclusions: In children with atopic heredity, early formula feeding, prenatal maternal stress, and infection burden were associated with increased risk of allergic conditions. This study underscores the importance of early-life psychosocial and environmental influences, possibly mediated by epigenetic mechanisms, in the development of childhood allergies. These findings highlight novel targets for early prevention and warrant further longitudinal research. Full article

Oral lesions are the first sign in most cases of pemphigus vulgaris. Diagnostic delays involving multidisciplinary consultations, required for the evaluation of oral signs, have been reported. Our aims were to investigate whether there is a correlation between specific oral involvement sites and pain and other disease manifestations and treatment outcome as well as diagnostic delays. In this retrospective study, demographics and clinical data, including pain assessment using the Verbal Analogue Scale and treatment information, of 63 Pemphigus Vulgaris patients were analyzed; 43% of patients were examined by multiple physicians before diagnosis, and the mean time to diagnosis was 5.71 ± 8.96 months. A positive moderate strength correlation (Pearson Correlation = 0.5) between intra-oral and extra-oral Verbal Analogue Scale (VAS) symptom scores was noted. After 4–8 weeks of treatment there was a reduction in the mean number of oral sites and VAS scores from 4.71 ± 1.86 to 2.57 ± 1.34 and 7.64 ± 2.24 to 3.21 ± 3.2, respectively. Significant relationships between lip involvement at onset and both the number of involved oral sites and post-treatment symptoms were found. Lip and floor-of-mouth lesions were present in patients with significantly longer hospitalization periods. The results show that specific sites of oral involvement, mainly the tongue, lip and floor of the mouth, may be related to disease severity. Health-care providers should be aware of oral pain and detailed oral involvement which may affect treatment decisions. Full article

Background/Objectives: Elderly patients with carpal tunnel syndrome (CTS) have more severe clinical, ultrasonic, and electrodiagnostic (EDX) findings compared to younger patients. Thenar weakness and atrophy are more common at initial presentation in the elderly population with CTS. Methods: This is a retrospective review of 187 very elderly patients (aged 80 years and older) with EDX confirmation of CTS. We describe the clinical, EDX, and US features in these patients and compare the severity of the median nerve entrapment at the carpal tunnel (CT) by EDX findings to a middle-aged cohort (ages 40–50 years). Results: The total number of very elderly hands with CTS was 289 (187 patients total, with bilateral symptoms in 102 patients). Of the 289 hands, thenar atrophy was observed in 75 (26.0%) hands, weakness of the abductor pollicis brevis (APB) muscle was detected in 178 (61.6%) hands, and pinprick decrease/loss was noted in 265 (91.7%) hands. Of the total 289 hands, 57 (66.3%) hands’ median nerve stimulation did not evoke compound muscle action potentials over the APB and second lumbrical muscles. Sensory nerve action potentials were not detected in 211 (76.2%) hands. Comparing the sensitivities of various US measurements in diagnosing CTS, the cross-sectional area at the CT inlet had the highest sensitivity among the various measurements. As the CSA at the CT inlet increases, the odds of a greater CTS severity by EDX studies also increase (OR = 1.109, p-value = 0.001). The very elderly patients with CTS more frequently had more severe CTS compared to the middle-aged patients with CTS (chi-squared = 102.65₃, p-value < 0.001). Conclusions: The very elderly patients appear to seek medical care only when the CTS has become severe. The primary care physicians should look for signs and symptoms of CTS in the very elderly and encourage prompt treatment. Surgeons should be cognizant of the differences in the clinical, EDX, and US studies in the very elderly patient cohort with CTS. US is highly useful in evaluating CTS when the EDX studies become non-localizing in severe CTS, as often seen in the very elderly patients. Full article

Background/Objectives: There is growing evidence to support ambient artificial intelligence (AI) scribes in healthcare to improve medical documentation by generating timely and comprehensive notes. Using the Plan–Do–Study–Act (PDSA) methodology, this study evaluated the utility and potential time savings of an ambient AI scribe, Scribeberry, (V2), in a palliative medicine outpatient setting, comparing it to the standard practice of dictation. Methods: This prospective quality improvement study was conducted at an academic medical center by two palliative medicine resident physicians. Residents documented patient visits using a freely available ambient AI scribe software program, Scribeberry, as well as using standard dictation software. Primary outcome measures included the editing time for the AI scribe and the dictating and editing times for a dictated manuscript, as well as subjective assessments of the accuracy, organization, and overall usefulness of the AI-generated clinical letters. Results: A heterogenous response was seen with the implementation of an AI scribe. One resident saw a statistically significant reduction (p < 0.025) in the time spent on clinical documentation, while a second resident saw essentially no improvement. The resident who experienced time savings with the ambient AI scribe also demonstrated a significant improvement in the graded organization and usefulness of the AI outputs over time, while the other resident did not demonstrate significant improvements in any of the metrics assessed over the course of this project. Conclusions: This pilot study describes the use of an ambient AI scribe software program, Scribeberry, in the community palliative medicine context. Our results showed a mixed response with respect to time savings and improvements in the organization, accuracy, and overall clinical usefulness of the AI-generated notes over time. Given the small sample size and short study duration, this study is insufficiently powered to draw conclusions with respect to AI scribe benefits in real-world contexts. Full article