Objectives:Oral health is vital for quality of life and is linked to multiple Sustainable Development Goals (SDGs). This commentary explores the intersection between oral health and each of the 17 SDGs. It seeks to enhance awareness of the SDGs among Oral Health Professionals (OHPs) and to provide recommendations for OHPs to enhance their role in achieving the SDGs. Methods:The commentary contextualizes the contribution of OHPs to achieve the SDGs. It describes the historical background of the Millennium Development Goals and the transition to the more ambitious SDGs. Progress reports on the SDGs are analysed. While oral health is not explicitly mentioned in any of the SDGs, it is intrinsically linked to all SDGs, yet these connections are underexplored. Oral health is connected to poverty reduction (SDG1), health and well-being (SDG3), quality education (SDG4), gender equality (SDG5), and climate action (SDG13). OHPs play a critical role in progress towards achieving SDGs, through advocacy, community engagement, and sustainable practices. However, challenges persist, including health inequalities (SDG10) and insufficient integration into broader health initiatives (SDG17). This commentary contributes to understanding how oral health intersects with each of the 17 SDGs. It advocates for the prioritization of oral health in the global health agenda and emphasizes the need for OHPs to mobilize resources and collaborate with various sectors. By addressing these interconnections, OHPs could diminish inequalities and contribute to a more equitable and sustainable future, underscoring the broader potential of oral health to contribute to progress on social justice and public health.
This study presents the first comprehensive bibliometric analysis of scientific publications in the field of the private sector's role in tuberculosis detection and diagnosis from 1964 to 2025. Using PRISMA, data were extracted from Scopus and Web of Science, yielding 616 original research articles published in 224 journals. Bibliometric performance analysis was done using Pivot Tables. Keyword co-occurrence analysis was performed using VOSviewer software to identify thematic structures. The results reveal a steady increase in publication activity since the early 2000s, reflecting growing recognition of the private sector as a critical actor in tuberculosis control. Analysis of the ten most cited articles revealed four recurring issues: suboptimal quality of care, diagnostic delays, high financial burdens on patients, and the critical need for structured public-private collaboration. The co-occurrence analysis identified five main thematic clusters. The largest cluster, "Delays and Catastrophic Costs," highlights persistent diagnostic delays, high costs, and fragmented care within the private sector. The clusters, "Diagnostic Challenges in Private Practice" and "Case Detection and Private Practitioners", further underscore deficiencies in diagnostic quality and coordination. Conversely, the clusters, "Public-Private Mix" and "Diagnostics and Private Providers", demonstrate the sector's potential to expand diagnostic coverage, enhance case notification, and reduce the burden on public facilities when effective collaboration and regulatory oversight exist. Despite encouraging progress being made, we identified gaps, particularly regarding regulatory mechanisms, cost-effectiveness evaluation, and data standardisation. Strengthening governance, integrating innovative diagnostics, and incentivising quality assurance are future research directions to fully harness the private sector's contribution to ending the tuberculosis epidemic.
Epidural analgesia is the gold standard for postoperative pain therapy following laparotomies. However, its appropriateness for pain management after laparoscopic abdominal surgeries remains uncertain. This systematic review with meta-analysis of randomized controlled trials (RCTs) was conducted according to the guidelines of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement; the quality of evidence was assessed with Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Included were trials with adults undergoing laparoscopic abdominal surgery where epidural analgesia was compared to other approaches. Primary outcomes were pain intensity at rest and during movement 24 hours after surgery and the number of patients with any adverse events related to epidural analgesia. Of 738 screened publications, a total of 41 studies were included in qualitative analysis, 34 studies in quantitative analysis. Fifteen studies compared epidural analgesia with patient-controlled intravenous analgesia (PCIA) with opioids, 10 epidural analgesia with non-patient-controlled opioids, and three epidural analgesia with epidural saline (placebo). Twenty-four hours after surgery epidural analgesia compared to PCIA may slightly reduce pain intensity at rest (n = 10; mean difference [MD]: -0.86 points; 95% confidence interval [CI]: -1.27 to -0.45; 95% prediction interval: -2.06 to 0.34; low-certainty evidence) and may reduce pain during movement even clinically relevant (n = 5; MD: -1.49 points; 95% CI: -2.11 to -0.87; low-certainty evidence). Nonetheless, there are concerns about frequent hypotension due to epidural analgesia (n = 5; relative risk [RR]: 10.1; 95% CI: 2.74-36.6; moderate-certainty evidence) while the impact due to pruritus (n = 4; RR: 0.97; 95% CI: 0.09-10.4; very low-certainty evidence) remains uncertain. Evidence for other comparisons remains limited due to sparse data. Preliminary evidence indicates that epidural analgesia has the potential to slightly reduce early postoperative pain intensity after laparoscopic abdominal surgery compared to PCIA. However, its use may be associated with a frequent incidence of hypotension.
Loiasis is a parasitic infection caused by the filarial nematode Loa loa, endemic to Central and West Africa. Its occurrence in non-endemic regions such as Morocco is rare and may pose a diagnostic challenge. We report the case of a Moroccan patient presenting with an intermittent sensation of a mobile foreign body in the eye, associated with redness and photophobia. The patient reported no recent travel to endemic regions but had close contact with individuals originating from Cameroon, a loiasis-endemic area, raising questions regarding possible indirect or remote exposure. Following several consultations, spontaneous exteriorization of a subconjunctival worm was observed. The diagnosis was supported by clinical observation of the subconjunctival worm, blood parasitological testing demonstrating microfilaremia, and the presence of Calabar swellings. The patient was treated with ivermectin followed by albendazole, resulting in complete clinical recovery without recurrence during follow-up. This case highlights the importance of considering loiasis in the differential diagnosis of atypical ocular symptoms, even in non-endemic settings, and underscores the value of multidisciplinary collaboration for timely diagnosis and appropriate management.
The global burden of ocular surface disorders (OSDs), manifesting as progressive visual impairment and chronic discomfort, has driven urgent exploration of regenerative therapeutic strategies. Mesenchymal stem cell-derived exosomes (MSC-Exos) have emerged as promising candidates for OSD treatment, as they exhibit multifaceted therapeutic properties including immunomodulation, antifibrotic activity, and pro-regenerative capacity. This systematic review consolidates current understanding of MSC-Exo-mediated ocular surface repair mechanisms, with particular emphasis on the molecular dialog established through delivery of bioactive cargo that modulate pivotal signaling pathways. We critically analyze preclinical evidence demonstrating therapeutic efficacy across diverse OSD pathologies, including dry eye disease, corneal epithelial defects, and limbal stem cell deficiency. Notwithstanding these advances, critical barriers to clinical translation persist: (1) methodological heterogeneity arising from variable cell sourcing, culture protocols, and exosome isolation/characterization standards; (2) discordance between animal models and human OSD pathophysiology; and (3) technological limitations in scalable, clinically compatible delivery systems. Addressing these challenges requires interdisciplinary collaboration to standardize exosome production pipelines and establish robust preclinical validation frameworks, thereby accelerating the transition of MSC-Exo therapies from bench to bedside.
Cellular senescence has emerged as an important mechanism linking renal ageing, acute kidney injury, diabetic kidney disease, chronic kidney disease, renal fibrosis, and kidney transplantation-related injury. This study aimed to map the global research landscape, knowledge bases, and emerging frontiers of cellular senescence-related kidney disease research. Publications were retrieved from the Science Citation Index Expanded of the Web of Science Core Collection. After screening by language and document type, 775 English-language articles and reviews were included. CiteSpace and VOSviewer were used to analyze publication trends, citation impact, collaboration networks, productive countries, institutions, authors, journals, highly cited documents, co-cited references, keyword co-occurrence, and citation bursts. The field expanded rapidly after 2016 and reached its highest annual output in 2025. China and the United States were the leading contributors by publication volume. Co-cited reference clustering identified major knowledge bases related to renal ageing, chronic kidney disease-associated premature ageing, maladaptive repair, renal fibrosis, diabetic kidney disease, tubular epithelial injury, SASP, uremic toxicity, transplantation-related injury, and senescence-targeted interventions. Recent hotspots centered on diabetic kidney disease, acute kidney injury, kidney fibrosis, tubular epithelial cells, DNA damage, mitochondrial dysfunction, inflammaging, immunosenescence, extracellular vesicles, and senolytic therapy. Research on cellular senescence-related kidney diseases has shifted from descriptive studies of renal ageing and chronic kidney disease complications toward disease-specific, cell-type-specific, and translational investigations. Future studies should integrate single-cell and spatial multi-omics, establish reliable renal senescence biomarkers, and develop safer kidney-targeted senotherapeutic strategies.
After inadequate response to first-line biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drug (DMARD) therapy in adults with rheumatoid arthritis, there are numerous alternative DMARD options, and current understanding of their comparative benefits and harms is limited. The aim of this living systematic review and network meta-analysis was to compare the benefits and harms of DMARDs after failure of biologic or targeted synthetic DMARDs in adults with rheumatoid arthritis. We searched CENTRAL, MEDLINE, Embase, and two trial registries (ClinicalTrials.gov and the WHO ICTRP) from inception until 28 November 2025, with no restrictions on language or date of publication. We included randomised controlled trials (RCTs) of adults aged 18 years or older diagnosed with rheumatoid arthritis according to 1958, 1987, or 2010 classification criteria who previously demonstrated inadequate response to a b/ts DMARD. Eligible interventions included conventional synthetic DMARDs (methotrexate, antimalarials, sulfasalazine, leflunomide, ciclosporin, and azathioprine), biologic DMARDs (adalimumab, certolizumab, etanercept, golimumab, infliximab, abatacept, rituximab, tocilizumab, sarilumab, and anakinra), and targeted synthetic DMARDs (tofacitinib, baricitinib, and upadacitinib). Our critical outcomes were American College of Rheumatology 50% (ACR50) response, withdrawals due to adverse events, radiographic progression, Disease Activity Score 28 (DAS28) remission, pain as measured by visual analogue scale, function as measured by the Health Assessment Questionnaire (HAQ), and serious adverse events. Important outcomes included ACR20, ACR70, serious infections, fatigue, and quality of life. We used Cochrane's RoB 1 tool to assess risk of bias in the included studies. We first screened the records using an approach that combined machine learning and crowdsourcing to identify probable RCTs. We then reviewed the records identified as RCTs for eligibility and simultaneously classified them to the appropriate Population, Intervention, Comparator, and Outcome (PICO) question(s). Two review authors then extracted relevant data from the included studies in duplicate and independently, with any disagreements resolved by a third review author. A Bayesian random-effects network meta-analysis was conducted using a semi-informative prior probability distribution. We assessed the certainty of evidence for each outcome using the GRADE approach. We included 19 unique studies (4779 participants) in the review, all of which were parallel-design RCTs. Eleven trials were placebo controlled; two trials had an inactive comparator arm; and six trials had an active comparator arm. The trials were performed in a well-established rheumatoid arthritis population, with the median baseline disease duration ranging from 6.4 to 14 years, median age of participants ranging from 49 to 58 years, and median baseline disease activity (DAS28) ranging from 4.87 to 6.79. ACR50 response We found moderate-/high-certainty evidence that using a tumour necrosis factor (TNF) inhibitor not previously tried, interleukin-6 (IL-6) inhibitors, abatacept, rituximab, and Janus kinase (JAK) inhibitors was more effective than placebo: TNF inhibitor not previously tried (odds ratio (OR) 6.04, 95% credible interval (CrI) 2.49 to 16.3; high-certainty evidence), sarilumab (OR 3.11, 95% CrI 1.25 to 7.76; high-certainty evidence), tocilizumab 4 mg/kg intravenous (OR 5.31, 95% CrI 2.09 to 12.09; high-certainty evidence), tocilizumab 8 mg/kg intravenous (OR 10.03, 95% CrI 3.65 to 31.27; high-certainty evidence), subcutaneous abatacept (OR 4.31, 95% CrI 0.97 to 18.28; moderate-certainty evidence), intravenous abatacept (OR 4.57, 95% CrI 2.21 to 10.18; high-certainty evidence), rituximab (OR 5.50, 95% CrI 2.31 to 13.12; high-certainty evidence), upadacitinib (OR 3.93, 95% CrI 1.53 to 10.32; high-certainty evidence), tofacitinib (OR 3.93, 95% CrI 1.53 to 10.32; high-certainty evidence), baricitinib 2 mg (OR 2.00, 95% CrI 0.77 to 5.23; moderate-certainty evidence), baricitinib 4 mg (OR 2.79, 95% CrI 1.10 to 7.22; high-certainty evidence). With an assumed risk for placebo of 78 out of 1000 patients, the expected effects for the active drugs ranged from 143 (baricitinib 2 mg) to 455 (tocilizumab 8 mg/kg). Withdrawals due to adverse events For most interventions, there were sparse data with low-certainty evidence, except for TNF inhibitor not previously tried (risk ratio (RR) 0.32, 95% CrI 0.07 to 1.1; moderate-certainty evidence), which is probably less harmful than placebo, and sarilumab (RR 1.98, 95% CrI 0.57 to 7.19; moderate-certainty evidence), which is probably more harmful than placebo. Low-certainty evidence suggests that intravenous abatacept (RR 0.92, 95% CrI 0.34 to 2.79), upadacitinib (RR 0.41, 95% CrI 0.08 to 1.83), and baricitinib 2 mg (RR 0.93, 95% CrI 0.22 to 4.01) may be less harmful than placebo. Low-certainty evidence suggests that tocilizumab 4 mg/kg (RR 1.39, 95% CrI 0.39 to 5.28), tocilizumab 8 mg/kg (RR 1.49, 95% CrI 0.51 to 4.81), subcutaneous abatacept (RR 3.11, 95% CrI 0.05 to 249.6), rituximab (RR 2.38, 95% CrI 0.44 to 23.31), tofacitinib (RR 1.37, 95% CrI 0.35 to 5.58), and baricitinib 4 mg (RR 1.43, 95% CrI 0.38 to 5.81) may be more harmful than placebo. Data were insufficient to perform a network meta-analysis for radiographic progression. For DAS28 and the HAQ, there was mostly moderate-/high-certainty evidence of a benefit, with some exceptions for comparisons with indirect evidence only that was of low or very low certainty. For the other efficacy outcomes, data were sparse with wide credible intervals, and the certainty of evidence was typically low. We found high-certainty evidence that nine therapies and moderate-certainty evidence that two therapies provide a clinically important benefit in improving disease activity compared to placebo for people with rheumatoid arthritis after failure of b/ts DMARD therapy. There was significant uncertainty surrounding treatment-related harms, with the evidence having been downgraded for serious or extremely serious imprecision. Pair-wise comparisons showed no significant differences among therapies, although the certainty of evidence was low. The lack of clarity regarding safety and comparative efficacy suggests that treatment decisions should be guided by individual patient characteristics and preferences. This work was supported by grants from the Canadian Institutes for Health Research (CIHR) [Funding Reference Numbers (FRN) 178375 and 180324] and the National Health and Medical Research Council (NHMRC) Cochrane Collaboration. This research was supported by Arthritis Society Canada (Doctoral Studentship TGP-23-0211). This study was outlined in a Cochrane protocol (CD013562; DOI 10.1002/14651858.CD013562).
Pulmonary vascular involvement represents one of the most severe manifestations of Behçet's disease. Pulmonary artery aneurysm (PAA) and pulmonary artery thrombosis (PAT) are rare but potentially life-threatening complications. However, data regarding their frequency, coexistence, and clinical course remain limited, particularly from a pulmonology-based long-term follow-up perspective. To evaluate the frequency and clinical characteristics of PAA and PAT in a large single-center Behçet's disease cohort and to describe diagnostic and therapeutic challenges encountered during routine clinical practice. Retrospective single-center observational cohort study. Adult patients diagnosed with Behçet's disease and followed at a tertiary pulmonology center between January 2014 and January 2024 were retrospectively reviewed. Pulmonary vascular involvement was assessed using contrast-enhanced thoracic computed tomography and CT pulmonary angiography. The presence of deep vein thrombosis (DVT), treatment approaches, and clinical outcomes were recorded. Among 279 patients, pulmonary vascular involvement was identified in 9 patients. Pulmonary artery aneurysm was detected in three patients (1.07%), and pulmonary artery thrombosis in six patients (2.1%). Concomitant DVT was observed in a minority of patients with pulmonary vascular involvement. Clinical follow-up revealed heterogeneous disease courses, including aneurysm development during anticoagulant therapy, hemoptysis-related treatment discontinuation, persistent pulmonary thrombosis, and rare interventional complications such as late coil migration. Mortality occurred in patients with severe pulmonary vascular disease. Pulmonary vascular complications in Behçet's disease are rare but associated with significant morbidity and mortality. The coexistence of inflammatory and thrombotic processes creates substantial diagnostic and therapeutic challenges, particularly regarding anticoagulation strategies. Although the limited number of cases precludes definitive conclusions regarding pathogenetic mechanisms, our findings highlight the need for careful, individualized, and multidisciplinary management of pulmonary vascular involvement in Behçet's disease. Pulmonary Blood Vessel Problems in Behcet's Disease: A 10-Year ExperienceBehcet's disease is a chronic inflammatory condition that can affect blood vessels throughout the body. Although involvement of the lungs is uncommon, problems affecting the blood vessels in the lungs can be serious and sometimes life-threatening. These problems may include abnormal widening of the pulmonary arteries or the formation of blood clots within these vessels. In this study, we reviewed the medical records of patients with Behcet’s disease who were followed at our center over a 10-year period. Our aim was to better understand how often lung blood vessel problems occur, how they present clinically, and how they are managed in real-life practice. We also evaluated blood clots in the legs, which are common in Behcet’s disease and may coexist with lung involvement. We found that lung blood vessel complications were rare but associated with significant clinical challenges, including bleeding, treatment-related risks, and, in some cases, death. The clinical course varied considerably between patients, highlighting that there is no single approach suitable for all cases. Treatment decisions, particularly regarding the use of blood thinners, were often complex and had to be individualized. Our findings emphasize the importance of careful evaluation of lung symptoms in patients with Behcet’s disease and the need for close collaboration between different medical specialties. Early recognition and personalized management may help reduce serious complications and improve patient outcomes.
The integration of Digital Health Technologies (DHTs) in clinical trials enhances patient recruitment, streamlines data collection, and provides new endpoints. However, a complex regulatory environment limits their adoption. This report reviews how DHTs have supported regulatory decision-making for drug marketing authorization in the US and Europe, detailing the types and purposes of DHTs utilized. Our analysis using Cortellis® examined drug approvals from September 2021 to March 2025, featuring a quantitative review of 60 DHT-related approvals and qualitative case studies. Of the 60 approvals, 39 (63%) were granted by the EMA and 23 (37%) by the FDA. The predominant DHTs were ePRO tools (70%), with smartphones (66%) as the leading platform. Most DHTs were used in Phase 3 trials (82%) primarily for collecting safety and efficacy data. Notably, no approvals were based solely on DHT-derived primary endpoints. Case studies illustrate the tools' nature and highlight the importance of interaction with health authorities for successful implementation. An analysis of DHT use in clinical trials for investigational drugs on ClinicalTrials.gov showed five references where digital biomarkers were measured through DHTs, while no references for digital biomarkers were found in the approval reports. DHTs are regularly used by clinical trial sponsors and acknowledged by authorities for regulatory decision-making. Current approvals mainly involve ePRO tools with limited capabilities. The landscape is evolving; more sophisticated digital evidence generation tools are emerging, such as sensor-based DHTs (sDHT) and Artificial Intelligence/Machine Learning (AI/ML). Close collaboration between industry and regulators is vital for developing DHT qualification pathways.
Calcitonin-secreting neuroendocrine neoplasms of the lung are extremely rare. Differentiating medullary thyroid carcinoma (MTC) from ectopic calcitonin secretion is challenging. Elevated calcitonin usually triggers a thyroid-focused workup, but ectopic secretion must be considered to avoid misdiagnosis and unnecessary thyroidectomy. We report a 54-year-old man presenting with weight loss and back pain. Serum calcitonin was markedly elevated at 1011 pg/mL (SI: 293 pmol/L) (reference range, <16 pg/mL [SI: <4.67 pmol/L] for basal levels in men). Thyroid ultrasonography showed a >2 cm nodule in the right thyroid lobe. Fine-needle aspiration cytology revealed atypia of undetermined significance, and calcitonin washout was negative. 18F-fluorodeoxyglucose positron emission tomography showed intense uptake in a 4.5 cm right lower lobe pulmonary mass and a 6.5 cm right adrenal mass, with no thyroid uptake. Histopathological analysis of the lung lesion confirmed high-grade pulmonary neuroendocrine carcinoma. Systemic chemotherapy was initiated, but the patient demonstrated disease progression and died from respiratory failure. This case illustrates how ectopic calcitonin production can mimic MTC. Comprehensive evaluation with functional imaging and immunohistochemistry is essential for accurate diagnosis. Multidisciplinary collaboration is crucial in distinguishing thyroid malignancy from ectopic hypercalcitoninemia.
Despite growing public awareness and political attention, the crisis of Missing and Murdered Indigenous Women, Girls, and Two-Spirit People (MMIWG2+) in Canada and the United States remains unresolved. Indigenous families continue to report that the disappearances and deaths of their loved ones are investigated inadequately and without sensitivity. While national inquiries and initiatives have acknowledged systemic failures, current medico-legal death investigation practices continue to reflect colonial frameworks that often exclude Indigenous values, needs, and collaboration. Humanitarian-forensic literature emphasizes the importance of building relationships with impacted communities and developing investigative practices and goals that reflect each context. Although well-established internationally, these humanitarian-forensic principles are often not applied in the investigation of Indigenous deaths in North America. This research used in-depth interviews and surveys to ask humanitarian-forensic professionals if their investigative principles are applicable and what strategies they recommend for Canadian and United States investigators to better assist Indigenous families. Through an inductive thematic analysis, the results reveal an agreement among professionals that humanitarian principles centered on providing dignity for the living and dead can apply. Participants provided strategies to adopt these principles which aligned with three primary themes: (1) community engagement, (2) reaffirming the living in investigative priorities, and (3) political will and existing supports. This paper provides a practical and ethical framework for adapting forensic practices to better serve culturally diverse populations. The research underscores the vital role humanitarian-forensic principles can have in advancing equitable, community-centered approaches to death investigation that uphold both scientific standards and human rights.
Background Several foundational studies have demonstrated that Internal Medicine (IM) residency programs undervalue physical examination skills and infrequently provide direct clinical oversight of residents as they perform physical examinations. This lack of prioritization is consequential. While the literature assessing the accuracy and completeness of IM residents' physical examinations is relatively narrow, certain studies have demonstrated worrisome deficiencies in their clinical skills. Methodology In this single-institution, exploratory, survey-based pilot study, we queried how IM residents perform examinations and their opinions of their own abilities and the adequacy of their training. Results Our most critical findings were that nearly all residents (98.3%) examined patients while they were fully clothed and 42.1% believed that such examinations were "adequate and accurate." Only around half (51.7%) of respondents reported that supervising physicians routinely return to the examination room with them, and nearly 90% said they are rarely provided beside instruction. While a large majority felt that physical examinations help them develop differential diagnoses and diagnose their patients' conditions, only 58.2% felt confident in their examination skills. Conclusions We hope that this preliminary work will lead to collaborations with other training programs in an effort to better understand the state of IM residents' clinical training.
Antimicrobial resistance (AMR) continues to increase at an alarming rate worldwide. Antimicrobial Stewardship Programs (ASPs) play a critical role in mitigating the growing threat of AMR. The objective of this review is to summarize the expanding body of evidence supporting the role of clinical pharmacists as key leaders in ASPs and to highlight the ongoing evolution of their responsibilities. In recent years, the involvement of clinical pharmacists in ASPs has progressed from primarily providing logistical support to serving as essential stewardship leaders and infectious disease specialists. This evolution has been driven, in part, by the formalization of their roles through international guidelines and professional recommendations. Pharmacist-led interventions, including prospective audit and feedback, formulary restriction, dose optimization, and intravenous (IV)-to-oral antimicrobial conversion programs, have demonstrated significant improvements in clinical, microbiological, and economic outcomes. These interventions have been associated with reductions in all-cause mortality (up to a 26% relative risk reduction), shorter hospital stays (1.0- 1.6 days), decreased rates of Clostridioides difficile infection (CDI) (up to a 32% reduction), and substantial healthcare cost savings ranging from $200,000 to $400,000 annually, often yielding a favorable return on investment. Consistent reductions in CDI rates and significant economic benefits further reinforce the value of pharmacist-led stewardship initiatives. Despite these successes, challenges remain in maximizing the impact of clinical pharmacists within ASPs, including limited resources, workforce constraints, and insufficient interdisciplinary collaboration. Nevertheless, emerging opportunities such as the integration of artificial intelligence, expansion into ambulatory care settings, and the development of innovative stewardship models in resource-limited environments offer promising avenues for future growth. The transition from an individual prescribing model to a collaborative stewardship-driven approach represents a significant advancement in contemporary healthcare practice. Clinical pharmacists play a vital role in ASPs and are essential for preserving the effectiveness of antimicrobial agents, improving patient outcomes, and ensuring the sustainability of healthcare systems worldwide.
Despite the rising cancer burden in Soweto, South Africa and the recognized role of Traditional Health Practitioners (THPs) in the pluralistic health system, their role in cancer care remains underexplored. This study provides novel insights into THPs' understanding of cancer and their potential contribution to community awareness and early detection within complex sociocultural and health system contexts. To explore THPs perceptions of cancer and the factors influencing their role in community cancer awareness and early detection in Soweto. An exploratory qualitative design was adopted. Purposive and snowball sampling were used to recruit 13 THPs in Soweto. Each participated in two in-depth interviews. Data were transcribed, coded, and thematically analyzed using Dedoose. Seven of the 13 THPs had encountered clients with cancer-related symptoms. The THPs described navigating cancer care with mixed certainty, drawing on experiential, spiritual, and limited biomedical knowledge. They often referred clients to biomedical facilities when symptoms appeared serious or unclear. Participants saw themselves as accessible community figures, offering psychosocial support and helping patients navigate the health system. While motivated to contribute to cancer awareness and early detection, they reported challenges related to limited recognition and legitimacy within the formal health sector. Traditional Health Practitioners play an informal but important intermediary role in community cancer care in Soweto. Their contributions are shaped by knowledge gaps, social dynamics, and systemic barriers. Strengthening their role in early detection requires interventions that improve training, build trust in biomedical services, and support integration within the health system. Main findings: This study provides novel insights into the underexamined role of THPs in community-based cancer care within South Africa’s pluralistic health system.Added knowledge: The study shows that THPs are motivated to promote cancer awareness and early detection and serve as accessible community intermediaries, but their capacity is limited by insufficient training, systemic barriers, and lack of formal recognition.Global health impact for policy and action: The findings highlight the potential of strengthened collaboration between traditional and biomedical systems to support earlier cancer detection and inform integration strategies in pluralistic health systems.
Anterior mediastinal masses can lead to life-threatening complications, including pericardial effusion and cardiac tamponade. These cases pose significant diagnostic and therapeutic challenges, particularly when mass effect increases procedural risk, necessitating multidisciplinary planning. A 45-year-old man presented with progressive dyspnea and was found to have cardiac tamponade physiology due to a large pericardial effusion in the setting of an anterior mediastinal mass. Transthoracic echocardiography demonstrated tamponade features. Given the extensive anterior mass compression and high risk associated with general anesthesia and surgical intervention, a cardiology-led approach with apical pericardiocentesis was pursued. This case highlights the complexity of managing pericardial disease in the presence of anterior mediastinal pathology. It emphasizes the importance of detailed echocardiographic assessment, individualized procedural planning, and close collaboration between cardiology and cardiothoracic teams. Echocardiography-guided apical pericardiocentesis is an effective strategy for managing tamponade with anterior mediastinal masses when surgical risks are high.
IntroductionThis article explores Shutika, a folk illness from the Barak Valley region in India, through both emic and etic perspectives. Shutika lacks a biomedical equivalent but carries deep cultural significance, reflecting how communities interpret suffering and healing. Situating Shutika within broader South Asian and global health discourses underscores the importance of recognising such illnesses as expressions of socio-cultural and political realities.MethodsAn autoethnographic approach was employed to capture the lived experience of Shutika. The emic perspective is conveyed through the author's narrative as a daughter observing her mother's illness, providing insight into local interpretations of causality, diagnosis, and cure. The co-author's etic perspective contextualises Shutika within medical anthropology and global health.ResultsThe emic and the etic account reveals Shutika as both a physical and social affliction rooted in gendered expectations and structural inequality of traditional interpretation of illness.Traditional healing practices offered meaning and comfort beyond biomedical explanation.DiscussionThe paper highlights the need for medical pluralism and collaboration between biomedical and traditional systems. Shutika emerges as a symbol of marginalised knowledge systems, calling for epistemic flexibility and culturally grounded approaches to global health.
In recent years, the availability of multi-omics data has increased substantially. Multi-omics data integration methods mainly aim to leverage different molecular layers to gain a complete molecular description of biological processes. An attractive integration approach is the reconstruction of multi-omics networks. However, the development of effective multi-omics network reconstruction strategies lags behind. In this study, we introduce collaborative graphical lasso, a novel approach that extends graphical lasso by incorporating collaboration between omics layers, thereby improving multi-omics data integration and enhancing network inference. Our method leverages a collaborative penalty term, which harmonizes the contribution of the omics layers to the reconstruction of the network structure. This promotes a cohesive integration of information across modalities, and it is introduced alongside a dual regularization scheme that separately controls sparsity within and between layers. To address the challenge of model selection in this framework, we propose XStARS, a stability-based criterion for multi-dimensional hyperparameter tuning. We assess the performance of collaborative graphical lasso and the corresponding model selection procedure through simulations, and we apply them to publicly available multi-omics data. This application demonstrated collaborative graphical lasso recovers established biological interactions while suggesting novel, biologically coherent connections. We implemented collaborative graphical lasso as an R package, available on CRAN as coglasso. The results of the manuscript can be reproduced running the code available at https://github.com/DrQuestion/coglasso_reproducible_code, deposited on figshare with DOI: https://doi.org/10.6084/m9.figshare.32324376. Supplementary data are available at Bioinformatics online.
Noonan syndrome (NS) is a rare autosomal dominant disorder characterized by distinctive craniofacial features, congenital heart disease, bleeding disorders, and variable cognitive impairment. Oral manifestations may include malocclusion, delayed tooth eruption, enamel defects, and dental anomalies. This report describes the multidisciplinary management of a 34-year-old man with NS presenting with dental trauma, unaesthetic anterior teeth, and functional concerns. Management involved surgical extractions, endodontic treatment, and prosthetic rehabilitation, coordinated with cardiology and hematology teams to minimize systemic risks. Individualized treatment planning, behavioral adaptations, and tailored hemostatic strategies facilitated safe dental rehabilitation. This case highlights the importance of interprofessional collaboration and risk-adapted dental care in patients with complex systemic conditions.
Autoimmune diseases are chronic conditions in which the immune system abnormally attacks the body's own tissues. Their incidence is on the rise, and the pathogenesis remains incompletely understood. The clinical manifestations are complex and diverse. Despite active treatment, some patients still have poor therapeutic outcomes and rely on immunosuppressants for a long time. Although these drugs can control symptoms, they are associated with increased infection risks and serious side effects such as organ toxicity. Hydrogels are three-dimensional network structures with excellent water absorption properties, good biocompatibility, injectability, and physical and chemical properties. By loading adjuvants, drugs, cells, and other substances, they are applied in the establishment of disease models, drug delivery, bioimaging and biosensors, tissue engineering, and other fields, providing new strategies for studying disease pathogenesis, drug screening, local targeted delivery, and immune regulation. This article aims to systematically review the mechanism of action and research progress of hydrogels in the treatment of autoimmune diseases and assess their potential for clinical translation. Relevant literature on the medical applications of hydrogels published from January 1, 2004 to October 31, 2025 was retrieved, and the scope was narrowed down to studies on their application in autoimmune diseases for summary and analysis. The main findings are as follows: (1) Through bibliometric analysis, it was found that research on hydrogels in the medical field is increasingly prominent, with studies in autoimmune diseases mainly focusing on drug delivery; (2) By constructing injectable bioadhesive hydrogels, the adhesion of hydrogels to joint tissues is enhanced, prolonging drug retention time and improving treatment efficiency; (3) Specific hydrogel designs can actively regulate immune cell functions - for example, inhibiting inflammation-related signaling pathways to reverse M1 polarization of macrophages and ferritin autophagy/ferroptosis in chondrocytes, maintaining the integrity of cartilage structure, and inducing mitochondrial dysfunction to promote apoptosis of FLS and macrophages and regulate the inflammatory microenvironment; (4) Hydrogel microneedle systems, as transdermal drug delivery platforms, have shown good compliance and efficacy in rheumatoid arthritis. Hydrogel technology, through localized, controllable, and intelligent drug delivery, is expected to break through the bottlenecks of traditional autoimmune disease treatment. Current research is gradually evolving from passive carriers to active participants in immune regulation as "intelligent platforms", and their potential to reshape the inflammatory microenvironment has been verified in animal models. However, issues such as material degradability, long-term biological safety, and consistency in large-scale production still need to be further addressed in preclinical and clinical studies. Future interdisciplinary collaboration and translational medical research are key to promoting the development of this field.
To examine parental experiences over time in a parent-led, coaching-supported, home-based power mobility intervention for young children with cerebral palsy (CP), Gross Motor Function Classification System (GMFCS) Level IV-V. A qualitative descriptive study was embedded within a larger non-concurrent, multiple-baseline, A-B-A single-subject study. Semi-structured parent interviews were conducted at baseline and study completion. Interviews were audio-recorded, transcribed verbatim, and analysed using a constant comparative approach to identify themes at each timepoint. Twelve parent-child dyads participated in this study. Each parent completed two qualitative interviews (one per timepoint), resulting in a total of 24 interviews (12 at each timepoint). At each timepoint, unique themes emerged in the data. The themes at baseline were "Feasibility is About Fit," "Learning Preferences Vary," and "More Active Than They Realise" while the themes at the conclusion of the study were "Power Mobility Interventions Are Underutilised," "Collaborative Support Matters," and "Everyone Should Have Access to This.". Parents described changes over time in how they understood power mobility, their role in supporting it, and its place within everyday family life. These findings suggest that introducing power mobility involves more than device access alone and highlight the importance of supporting families as they learn to incorporate power mobility into everyday routines and participation opportunities. Power mobility interventions for infants and toddlers with cerebral palsy may benefit from explicitly positioning parents as intervention partners from the beginning, with therapists clearly identifying and supporting the parent’s role in facilitating mobility experiences within everyday routines.Collaborative, coaching-supported approaches delivered in home environment may help parents build confidence and practical skills for supporting their child’s power mobility use within family routines and contexts.Providing supports aligned with adult learning principles, such as demonstration, hands-on practice, reflection, and goal setting, may improve caregiver engagement when introducing new assistive technology interventions.Therapists supporting young children with cerebral palsy may consider introducing power mobility as one mobility option for supporting exploration, participation, and independence.