Fibromyalgia (FM) has been increasingly studied in the context of gut-brain-immune interactions, and several reports have suggested an association between FM and alterations in gut or oral microbial communities. However, prior studies have often suffered from heterogeneous comorbidities, inconsistent sampling procedures, and limited control for environmental factors, making it unclear whether FM is associated with a reproducible, site-independent microbial signature. To determine whether women with FM exhibit consistent alterations in gut or oral microbiota when evaluated under strictly standardized physiological, clinical, and environmental conditions. A prospective, observational, case-control study. The Department of Pain Medicine and Department of Medical Microbiology at Gazi University, Türkiye. The patient selection comprised 31 women (16 with FM; 15 healthy controls) who met rigorous inclusion and exclusion criteria, minimizing confounding from diet, metabolic disease, medications, hormonal status, and recent infections. No therapeutic intervention was performed; all patients provided paired oral mucosal and fecal samples during the follicular phase of the menstrual cycle. Sequencing of 16S rRNA V3-V4was performed on DNA extracted from all samples. Alpha and beta diversity metrics, taxonomic profiles, and differential abundance analyses (including LEfSe with FDR correction) were compared between groups. The clinical severity of FM was assessed using scores on the visual analog scale (VAS), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS). No statistically significant differences were observed between FM patients and controls in fecal or oral alpha diversity (Shannon, Simpson, Chao1, Observed OTU indices, all P > 0.05). Beta diversity analyses (Bray-Curtis PERMANOVA) revealed no between-group separation in either compartment (fecal R² = 0.032, P = 0.529; oral R² = 0.032, P = 0.464). Both groups displayed preserved core microbial communities in the gut, dominated by Firmicutes and Bacteroidota and, in the oral cavity, Streptococcus-enriched profiles. Minor genus-level variations were detected, but none remained significant after FDR correction. Cross-site analyses confirmed the expected ecological divergence between oral and fecal habitats but identified no FM-specific microbial pattern. Post hoc sensitivity analysis indicated that the study was powered to detect only moderate effect sizes (R² ≥ 0.11), suggesting that subtle differences might have remained undetected. A modest sample size, a lack of quantitative dietary assessment, and reliance on 16S rRNA sequencing limited the detection of subtle or functional microbial alterations. Additionally, the cross-sectional design precludes causal inference. Under highly controlled sampling and exclusion conditions, FM was not associated with detectable alterations in the diversity or composition of gut or oral microbes. These findings suggest that previously reported dysbiosis may reflect comorbidity-driven or phenotype-specific variation rather than a universal microbial hallmark. Larger, multi-omic and phenotype-stratified studies are needed to clarify functional host-microbiome interactions in FM.
Background Iron-deficiency anemia (IDA) is a major clinical burden, particularly when caused by gastrointestinal or gynecological blood loss and mucosal malabsorption. Oral iron supplementation, while widely accessible, is frequently limited by poor gastrointestinal tolerability and inadequate absorption. Intravenous (IV) iron offers a more direct route to iron repletion, yet real-world comparative data from resource-limited settings remain scarce. Methods We conducted a retrospective observational cohort study of 225 patients with IDA managed at the Hematology Department of Cheikh Khalifa Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco, between January 2020 and December 2023. Patients received either oral ferrous sulfate (n=185) or IV ferric carboxymaltose (n=40) based on clinical indication. The primary efficacy endpoint was post-treatment serum ferritin at three months, the only post-treatment laboratory parameter systematically available across both groups. Secondary endpoints included transfusion requirement and adverse event profile. Results Both groups were well-matched at baseline across all haematological parameters (hemoglobin (Hb): 8.98±2.23 vs. 8.50±1.42 g/dL, p=0.196; ferritin: 5.57±4.25 vs. 4.71±2.96 µg/L, p=0.221). IV iron was associated with dramatically superior iron store repletion at three months (post-treatment ferritin: 412.60±95.87 vs. 8.68±4.38 µg/L; p<0.001), representing approximately a 47-fold difference. Oral iron recipients remained below the accepted thresholds for adequate store repletion (≥30 µg/L) at follow-up. Transfusion rates were 10.3% (19/185) oral vs. 17.5% (7/40) IV, a non-significant difference (p=0.306), reflecting greater baseline severity in the IV group. Gastrointestinal adverse events occurred in 100% of oral iron recipients, while systemic reactions (predominantly arthralgia, myalgia, and fever) occurred in 50% (20/40) of IV iron recipients; one anaphylactic reaction (1/40; 2.5%) was successfully managed. Conclusion In this real-world cohort, IV ferric carboxymaltose achieved markedly superior iron-store repletion compared to oral ferrous sulfate, with a better gastrointestinal tolerability profile, at the cost of a distinct systemic adverse event profile requiring clinical monitoring. These findings support broader consideration of IV iron in patients with IDA who have failed, or are unlikely to benefit from, oral therapy, particularly those with pre-existing mucosal pathology or ongoing haemorrhagic loss.
This study analyzed temporal trends, the impact of the COVID-19 pandemic, and projections up to 2030 for oral cancer incidence and mortality rates in Brazil, stratified by sex and macro-region. This population-based observational study used secondary data from the Department of Informatics of the Brazilian Unified Health System (DATASUS) and the Hospital Information System (SIH/SUS), covering the period from 2013 to 2022. Malignant neoplasms of the oral cavity and major salivary glands (C00-C08, ICD-10) were included. Age-standardized incidence (ASIR) and mortality (ASMR) rates were analyzed using Prais-Winsten linear regression and classified according to the Annual Percentage Change (APC), with significance set at p < 0.05. Projections to 2030 were estimated using double exponential smoothing, and the pandemic's impact was assessed through the ratio of observed-to-predicted rates (RR) for 2020-2022. The study recorded 40,078 deaths and 92,411 cases, 70.8% of which occurred in men, with the highest concentration in individuals aged 55-64 years. The trends revealed a significant increase in incidence across all macro-regions, particularly in the North and South regions, whereas mortality rates remained stable. During the pandemic, an apparent reduction in cases (RR <1) was observed, suggesting underreporting and diagnostic delays. The projections indicate a continuous increase in incidence and a slight rise in mortality through 2030. Limitations include reliance on secondary data that are subject to underreporting and delays, especially during the pandemic. These findings highlight the worsening of regional inequalities and underscore the urgency to strengthen prevention, screening, and early diagnosis policies, particularly in socially vulnerable contexts.
The oral cavity is a complex microbial ecosystem that acts as a reservoir of antimicrobial resistance genes associated with antibiotics used in dental practice, particularly in Gram-positive bacteria. This study aimed to analyze antimicrobial resistance genes in oral isolates of Streptococcus, Staphylococcus, and Enterococcus. Two hundred and fifty isolates were analyzed. Microbiological identification and antimicrobial susceptibility tests were performed using MicroScan in accordance with the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction was used to detect resistance genes; blaZ, erm, mef, msrA, lnu, and aac (6')-aph (2"). Descriptive statistics were applied to assess phenotypic resistance, co-resistance and multidrug resistance (MDR). Gene co-occurrence patterns were evaluated using heatmap analysis in Python (Seaborn). Resistance was primarily associated with blaZ (n = 70). Co-resistance occurred in 15 isolates, most commonly blaZ + aac (6')-aph (2") (4 cases). MDR occurred in 7 isolates, with mecA + mef + lnu + aac (6')-aph (2") as the most frequent pattern (n = 2). The co-occurrence of genes revealed recurrent associations between β-lactam, macrolide-lincosamide-streptogramin and aminoglycoside resistance determinants. The oral cavity acts as a reservoir of transferable antimicrobial resistance genes in Gram-positive bacteria, with co-resistance and MDR patterns relevant to dental practice.
ObjectiveTo systematically characterize anatomical, histopathological and ultrastructural alterations of perioral and velopharyngeal muscles in patients with nonsyndromic cleft lip and/or palate (CL/P).DesignSystematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.SettingSystematic literature search of PubMed, EMBASE, Scopus, CNKI, Cochrane Database of Systematic Reviews, and gray literature sources (ClinicalTrials.gov, International Clinical Trials Registry Platform, Conference Proceedings Citation Index-Science, ProQuest Dissertations and Theses, GreyNet International) from January 1980 to June 2025, supplemented by manual reference screening.PatientsPatients with nonsyndromic CL/P of any age, sex, or cleft severity. Comparator groups included individuals without CL/P or nonaffected contralateral sides.Interventions:Not applicable. This review synthesized observational evidence from cohort, case-control, and cross-sectional studies.Main Outcome(s)Morphological characteristics (imaging and cadaveric dissection), and histopathological features (light microscopy and histochemical staining) of cleft-affected perioral and velopharyngeal muscles.ResultsA total of 21 studies were included. Anatomical investigations consistently demonstrated ectopic muscle insertions, aberrant fiber orientation, and muscle hypoplasia in both the lip and velopharyngeal musculature. Histopathological analyses revealed fiber disorganization, increased myofiber diameter variability, extensive interstitial fibrosis, mitochondrial dysfunction, and, in some studies, a shift toward type II fiber predominance. But the ultrastructural findings are limited to a small number of studies with inconsistent results, yielding low confidence. Methodological heterogeneity and risk of bias precluded meta-analysis. Confidence in findings, assessed using CERQual, was high for anatomical outcomes and moderate for histopathological features.ConclusionsPerioral and velopharyngeal muscles in patients with CL/P exhibit distinct but incompletely characterized pathological alterations. Future research should clarify muscle-specific pathology, regenerative dynamics, and clinically relevant strategies that may improve long-term functional recovery after cleft repair.RegistrationPROSPERO CRD420251115465.
Oral carcinoma cuniculatum (OCC) is a rare subtype of squamous cell carcinoma (SCC). It is characterized by a locally aggressive, burrowing lesion associated with an osteolytic defect yet lacks obvious cytological atypia. Although OCC has been described in the literature, its rarity, clinical unfamiliarity, and distinct burrowing pattern frequently result in misdiagnosis or underdiagnosis during incisional biopsy. This report describes a case of OCC arising on the residual alveolar ridge of a 71-year-old male. Microscopic similarities between conventional SCC and verrucous carcinoma obscure the subtle yet pathognomonic features of OCC. Notably, this case also demonstrates perineural invasion, a finding rarely associated with OCC. Oral carcinoma cuniculatum remains underexplored and overlooked. This report aims to contribute to the scientific literature by emphasizing diagnostic procedure, highlighting the rarity, and deceptive clinical and histopathological features of OCC. It underscores the importance of considering OCC in the differential diagnosis when repeated incisional biopsies fail to confirm malignancy in a clinically suspicious lesion.
The associations between distinct cognitive function trajectories and mortality risk, as well as the potential mediating pathway underlying this relationship, have not been fully elucidated. This cohort study explored the association between cognitive function trajectories and all-cause mortality and the mediating role of oral health-related quality of life (OHRQoL). A nationwide cohort of 5486 individuals aged ≥45 years was included in this study. Longitudinal courses of cognitive function measured using the Mini-Mental State Examination (MMSE) were classified using growth mixture modeling. The OHRQoL was measured using the Geriatric Oral Health Assessment Index. The association between cognitive function trajectories and all-cause mortality was determined using a Cox model. Mediation analyses were conducted to evaluate the mediating role of OHRQoL in this association. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed. Four trajectories of cognitive function were identified: high-stable (n = 4469; 81.5%), moderate-increasing (n = 418; 7.6%), decreasing (n = 454; 8.3%), and low-stable (n = 145; 2.6%). Compared to those experiencing high-stable trajectory, individuals experiencing decreasing (HR = 1.39, 95% CI = 1.08-1.78) and low-stable (HR = 1.84, 95% CI = 1.31-2.57) trajectories had an elevated risk for all-cause mortality. The mediation analyses showed that OHRQoL accounted for 14.6% and 11.5% of the elevated mortality risk among decreasing (indirect HR = 1.04; 95% CI = 1.01-1.08) and low-stable trajectories (indirect HR = 1.06; 95% CI = 1.01-1.11) compared to the high-stable trajectory, respectively. While modest, a moderating role of poor OHRQoL on the association between decreasing or low-stable cognitive function trajectories and all-cause mortality was observed. However, considering the uncertainty in the estimated mediation proportion, these findings should be interpreted with caution and require confirmation in future studies.
Extracranial bleeding is the most common complication of oral anticoagulant (OAC) therapy for atrial fibrillation (AF), but its clinical importance for patients may be underrecognized. We sought to characterize extracranial bleeding events according to standardized severity definitions, identify baseline risk factors for bleeding, and quantify their population attributable fraction in patients with AF receiving OACs. We analyzed patients receiving OACs from 5 pivotal randomized trials testing a direct OAC or warfarin in patients with AF (COMBINE-AF [A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation]). The primary outcome was extracranial clinically relevant bleeding, defined as a first episode of extracranial major or clinically relevant nonmajor bleeding according to International Society on Thrombosis and Haemostasis criteria. The Kaplan-Meier method was used to calculate the cumulative incidence of bleeding by category. Multivariable Cox regression models were used to estimate adjusted hazard ratios (HRs) with 95% CI. Logistic regression models were used to calculate average population attributable fraction with 95% CI. Of 73 737 patients treated with OACs, 10 634 experienced clinically relevant extracranial bleeding over a mean follow-up of 705 days (cumulative incidence, 26% [95% CI, 18%-35%]; 7.6 per 100 person-years). This included 3188 major bleeds (cumulative incidence, 7% [95% CI, 6%-7%]; 2.1 per 100 person-years) and 7446 clinically relevant nonmajor bleeds (cumulative incidence, 19% [95% CI, 12%-28%]; 5.2 per 100 person-years). The distribution of bleeding sites differed by severity, with gastrointestinal bleeds comprising 26% of clinically relevant bleeds, 49% of major bleeds, and 15% of clinically relevant nonmajor bleeds. Risk factors for extracranial bleeding were consistent across severity bleeding categories, and baseline covariates in our multivariable models accounted for 66% to 69% of the population attributable bleeding risk. Extracranial clinically relevant bleeding is common among patients with AF treated with OACs and may more accurately reflect the overall burden of bleeding than major bleeding alone. Our models explained about two-thirds of the average population attributable risk, suggesting that additional unmeasured or unknown factors contribute to bleeding risk.
The circadian clock is an endogenous timing mechanism that enables cellular physiological activities to adapt to environmental changes. It is primarily composed of circadian clock genes and their encoded proteins, which form a transcription-translation negative feedback loop, generating circadian rhythmic oscillations that regulate cellular function. Circadian clock genes interact with multiple molecular pathways that regulate physiological processes such as the cell cycle and metabolism; therefore, the circadian clock plays a vital role in maintaining cellular homeostasis. Studies have shown that circadian clock disruption is closely linked to the development of various cancers, and further research may provide new strategies for cancer prevention and treatment. Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy with poor prognosis, and its mechanisms of onset are not yet fully understood. This review discusses the role and mechanisms of circadian clock disruption in the development and progression of OSCC and summarizes recent advances in chronotherapy and therapeutic strategies targeting circadian clock genes, aiming to provide novel insights for the prevention and treatment of OSCC.
Oral nicotine pouches (ONPs) have recently gained popularity among adolescents. This systematic review and meta-analysis aims to address the literature gap and public health implications of ONP use. Specifically, it focuses on the use prevalence, user characteristics, associated factors, and co-use with other substances. Following a comprehensive database search conducted until September 2025, 14 eligible studies were identified after title/abstract and full-text screening using Rayyan Software. Quality and risk of bias were assessed using the Joanna Briggs Institute Critical Appraisal Tools for cross-sectional studies. Data analysis consisted of a descriptive synthesis and 2 random-effects meta-analyses to estimate the pooled prevalence of ever and current nicotine pouch use among adolescents, followed by sex-stratified subgroup analyses to compare prevalence between males and females. Analysis showed that the ever use of ONPs was more prevalent than the current use. Key user characteristics were male gender, older age, and Hispanic ethnicity. Furthermore, ONP use was strongly associated with the co-use of other tobacco products and substances. ONP use among adolescents reflects rising experimentation, demographic disparities, and emerging health risks, underscoring the urgent need for targeted regulation and research.
A free-ranging road-killed brown howler monkey (Alouatta guariba clamitans) presented multiple mucosal-colored papules and plaques on oral mucosa. Pathological evaluation confirmed the diagnosis of epithelial hyperplasia with koilocytosis. Papillomavirus antigens were demonstrated by immunohistochemistry, and PCR was positive for partial amplification of Alouatta guariba papillomavirus 1 DNA.
Optimal management of oral anticoagulation (OAC) after atrial fibrillation (AF) ablation remains uncertain. We evaluated thromboembolic and bleeding outcomes associated with OAC discontinuation versus continuation at a clinically relevant 6-month post-ablation landmark. This target trial emulation used data from a multicentre prospective registry in China. Patients with CHA2DS2-VA scores ≥2, no prior thromboembolism, and no atrial arrhythmia recurrence within 6 months after ablation were classified according to OAC discontinuation or continuation at the 6-month landmark. The primary outcome was the composite of stroke, systemic embolism, and major bleeding. Inverse probability weighting was applied, with intention-to-treat as the primary analysis. Among 8,339 patients (mean age 68 years; 40.5% women), 4,406 discontinued and 3,933 continued OAC. The risk of the primary outcome did not differ significantly between groups (weighted HR 0.93; 95% CI 0.67-1.29). Thromboembolic risk was similarly comparable (HR 0.96; 95% CI 0.69-1.35). Clinically relevant non-major bleeding occurred less frequently after OAC discontinuation (HR 0.68; 95% CI 0.47-0.97). Findings were consistent in sensitivity analyses. Annualized thromboembolic rates after discontinuation were <1% in patients with CHA2DS2-VA scores 2-3 but 1.52% in those with scores ≥4. Among patients without prior thromboembolism who remained arrhythmia-free at 6 months after AF ablation, OAC discontinuation was not associated with a difference in the composite outcome of stroke, systemic embolism and major bleeding, compared with OAC continuation. Residual risk remained low in patients with CHA2DS2-VA scores 2-3 but exceeded conventional thresholds in those with scores ≥4.
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Mandarin apical vowels [ɹ'] and [ɻ'] have resisted articulatory classification: are they vocalized prolongations of the preceding sibilant or independent vowel targets? Using ultrasound imaging and generalized additive mixed models with simultaneous confidence intervals, the tongue contour over space and time in two comparisons has been modeled: each vowel against its sibilant onset and the three vocalic realizations against one another. [ɻ'] continues the /ʂ/ posture while [ɹ'] diverges from /s/, and the three realizations differ from one another, the two apical vowels from [i] and from each other. The Mandarin "apical vowel" label may subsume more than one articulatory strategy.
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Bradykinin-mediated angioedema, particularly hereditary angioedema due to C1 esterase inhibitor deficiency or dysfunction (HAE-C1INH), is caused by dysregulation of the kallikrein-kinin system with excessive bradykinin generation and subsequent increased vascular permeability. Modern HAE management is based on three major therapeutic strategies: on-demand treatment, short-term prophylaxis (STP), and long-term prophylaxis (LTP). On-demand treatment options include plasma-derived and recombinant C1 inhibitor (C1INH) concentrates, the bradykinin B2 receptor antagonist icatibant, and, more recently, the first orally available plasma kallikrein inhibitor, sebetralstat. Short-term prophylaxis prior to invasive medical procedures is performed as replacement therapy by intravenous administration of C1INH concentrates. The goal of long-term prophylaxis is complete disease control with reduction of attack frequency and/or severity and improvement of quality of life. LTP therapies include subcutaneous and intravenous C1INH preparations, the oral kallikrein inhibitor berotralstat, the anti-kallikrein monoclonal antibody lanadelumab, the factor XIIa inhibitor garadacimab, and the antisense oligonucleotide donidalorsen. Currently under development are the oral bradykinin B2 receptor antagonist deucrictibant, which is intended for both on-demand treatment and long-term prophylaxis in different formulations, long-acting antibodies, such as navenibart, and CRISPR/Cas9-based gene-editing therapies, such as NTLA-2002 with potential functional curative properties. In particular, orally available and long-acting therapies are expected to improve adherence, self-management, and quality of life in affected patients. Bradykininvermittelte Angioödeme, insbesondere das hereditäre Angioödem mit C1-Esterase-Inhibitor-Mangel oder -Dysfunktion (HAE-C1INH), entstehen durch eine Dysregulation des Kallikrein-Kinin-Systems mit überschießender Bradykininbildung und daraus folgender erhöhter Gefäßpermeabilität. Die moderne HAE-Therapie basiert auf drei zentralen Behandlungsstrategien: Akuttherapie („on-demand treatment“), Kurzzeitprophylaxe („short term prophylaxis“ [STP]) und Langzeitprophylaxe („long term prophylaxis“ [LTP]). In der Akuttherapie stehen plasmagewonnene und rekombinante C1-Inhibitor-Konzentrate, der Bradykinin-B2-Rezeptorantagonist Icatibant sowie erstmals der oral verfügbare Plasmakallikreininhibitor Sebetralstat zur Verfügung. Die Kurzzeitprophylaxe vor invasiven Eingriffen erfolgt als Substitutionstherapie durch intravenöse Gabe von C1INH-Konzentraten. Ziel der Langzeitprophylaxe ist eine vollständige Krankheitskontrolle mit Reduktion der Attackenfrequenz und Verbesserung der Lebensqualität. Hierfür stehen subkutane und intravenöse C1INH-Präparate, der orale Kallikreininhibitor Berotralstat, der gegen Kallikrein gerichtete monoklonale Antikörper Lanadelumab, der Faktor-XIIa-Inhibitor Garadacimab sowie das Antisense-Oligonukleotid Donidalorsen zur Verfügung. Aktuell in Entwicklung befindet sich der orale Bradykinin-B2-Rezeptorantagonist Deucrictibant, der in unterschiedlichen Formulierungen sowohl für die Akuttherapie als auch für die Langzeitprophylaxe eingesetzt werden soll, und lang wirksame Antikörper wie Navenibart sowie CRISPR/Cas9-basierte geneditierende Therapien wie NTLA-2002 mit potenziell funktionell kurativem Ansatz. Insbesondere oral verfügbare und lang wirksame Therapieformen sollen Adhärenz, Selbstmanagement und Lebensqualität Betroffener verbessern.
Penicillin allergy is one of the most reported drug allergies, but studies have shown that patients who report an allergy frequently do not have a significant reaction when challenged. Avoidance of penicillin or beta-lactam antibiotics in these patients results in increased hospitalization costs, suboptimal antibiotic therapy, and risk for subsequent infection with multidrug resistant organisms. This was a single-center, retrospective chart review that included patients ≥ 18 years of age with documented penicillin allergy who presented to the emergency department (ED) over a one-year period. Clinical pharmacy specialists in the ED reviewed and stratified patient allergy risk. Patients with low-risk allergy histories who were to be admitted and gave formal consent were given an oral amoxicillin challenge and then observed in the ED for at least one hour. Patients who were eligible for challenge but were to be discharged from the ED were given the option to be seen in the allergy clinic. The primary outcome was the incidence of adverse reactions related to the oral amoxicillin challenge for patients. An exploratory secondary outcome was the average length of stay (LOS) in the ED for oral amoxicillin-challenged patients compared to the average LOS for non-oral amoxicillin-challenged patients. We performed descriptive statistics on all variables. A total of 144 patients received an allergy assessment in the ED, 20 who received an oral amoxicillin challenge and 124 who did not. Baseline characteristics were similar in both groups. The average total LOS in the oral amoxicillin-challenged patients was a non-significant 36 minutes longer compared to the non-challenged patients (P = 0.4). Of 144 patients, 71 (49%) had their penicillin allergy removed as a result of the challenge.. One patient experienced a mild and self-limited reaction to the oral amoxicillin challenge (0.7%; 95% CI, 0.02-3.8%). An ED pharmacist-led, penicillin de-labeling protocol was safe and feasible. A secondary exploratory analysis showed no significant difference in length of stay between patients who received the oral amoxicillin challenge in the ED vs those who did not. Performing a proper penicillin allergy evaluation in the ED can have lasting benefits for patients and antimicrobial stewardship.
Cannabidiol (CBD) has gained sustained public, medical, and scientific attention in recent years. The prevalence of use of commercially available products containing CBD (CPC) is correspondingly high. Overview of the benefits and risks of CPC, taking into account certain aspects related to CBD as a pharmaceutical active ingredient. Selective literature search in the PubMed database. Currently, only one primarily CBD-containing drug is approved in Germany (Epidyolex®). CBD demonstrates good safety and tolerability. Elevated transaminases, sedation, decreased appetite, diarrhea, sleep disturbances, infections, and weight loss are possible side effects. CBD modulates the endocannabinoid system and interacts with numerous other molecular targets. CBD is metabolized via CYP2C19, CYP3A4, and UGT. The potential for pharmacokinetic interactions with CBD has not been well studied, but is theoretically high. The potential for abuse of CBD is negligible when administered orally, but should be investigated more thoroughly for inhalation and higher-dose use. Studies have found significant discrepancies between the stated and actual CBD content in many CPC; THC was frequently detected. There is no evidence supporting the health benefits typically claimed by manufacturers for ≤ 4.3 mg of oral CBD/kg/day, but there are indications of significant hepatotoxicity at ≥ 4.3 mg of oralCBD/kg/day. There is no robust evidence of health benefits associated with CPC. However, given the levels of exposure, product deficiencies, and the EFSA safety concerns, it must be assumed that there are relevant health risks (particularly hepatotoxicity) associated with the use of CPC. HINTERGRUND: Cannabidiol (CBD) hat in den letzten Jahren anhaltende allgemeine sowie medizinische und wissenschaftliche Aufmerksamkeit erlangt. Die Konsumprävalenz von kommerziell erhältlichen CBD-haltige Präparaten (KCP) ist entsprechend hoch. Übersicht über Nutzen und Risiken von KCP unter Beachtung einiger Aspekte, die CBD als pharmazeutischen Wirkstoff betreffen. Selektive Literaturrecherche in der Datenbank PubMeb. Aktuell ist nur ein primär CBD-haltiges Medikament in Deutschland zugelassen (Epidyolex®). CBD weist eine gute Sicherheit und Verträglichkeit auf. Transaminasenerhöhungen, Sedierung, Appetitminderung, Diarrhoe, Schlafstörungen, Infektionen und Gewichtsverlust sind mögliche Nebenwirkungen. CBD moduliert das Endocannabinoidsystem und interagiert mit zahlreichen weiteren molekularen Zielen. CBD wird über CYP2C19, CYP3A4 und UGT metaboliert. Das pharmakokinetisches Interaktionspotential von CBD ist nicht gut untersucht, theoretisch aber groß. Das Missbrauchspotential von CBD ist bei oraler Anwendung vernachlässigbar, sollte jedoch bei inhalativer und höher dosierter Anwendung stärker geprüft werden. In Studien fand sich bei vielen KCP eine ausgeprägte Diskrepanz zwischen angegebenem und tatsächlichem CBD-Gehalt; häufig konnte THC nachgewiesen werden. Es gibt keine die herstellerseitig typischerweise behaupteten gesundheitsbezogenen Vorteile von ≤ 4,3 mg oralem CBD/kg/d unterstützende Evidenz, aber Hinweise auf relevante Hepatotoxizität bei ≥ 4,3 mg oralem CBD/kg/d. Es gibt keine belastbare Evidenz für gesundheitsbezogene Vorteile von KCP. Unter Beachtung erreichbarer Expositionen, der Produktmängel sowie der Sicherheitsbedenken der EFSA müssen jedoch relevante Gesundheitsrisiken (v. a. Hepatotoxizität) bei der Anwendung von KCP angenommen werden.
Mass-fatality incidents involving severe thermal injury pose major challenges for disaster victim identification, particularly when access to the oral cavity is limited and conventional dental radiography cannot be performed. This study reports the first large-scale, real-world deployment of a portable cone-beam computed tomography (CBCT) system during the forensic identification of civilian victims following the October 7, 2023 attack in Israel and evaluates its contribution to odontological identification. We conducted an observational analysis of cases examined by the Israel Police forensic odontology teams, documenting body condition, availability of antemortem dental records, imaging modality used, and final identification outcomes. Portable CBCT was used primarily in victims with severe burns or restricted oral access. All scans were diagnostically interpretable, and repeat acquisition was required in only five cases. CBCT contributed directly to positive identification in 40 of 170 scanned victims (23%), all of which were later confirmed by DNA testing. Most identifications were based on dental treatment patterns, followed by dental morphology and jaw morphology. Brief hands-on training enabled rapid proficiency among forensic odontologists, allowing continuous use under field conditions. These findings demonstrate that portable CBCT is a practical, non-invasive imaging solution in mass-fatality settings, providing diagnostically useful data when conventional methods are not feasible and supporting timely forensic identification.
Behçet's disease (BD) is a multi-system inflammatory disorder characterised by recurrent oral, genital or ocular inflammation, and may present with variable-vessel vasculitis.1 It has a distinctive geographic distribution, with the highest prevalence along the historic Silk Road, particularly in Turkey and Iran.2- 4 In contrast, BD is considered rare in India, with limited epidemiological data and predominantly hospital-based series.5, 6 Although recurrent oral ulcers are nearly universal, systemic manifestations, including ocular, vascular, neurological and gastrointestinal involvement, vary across regions.2, 3 Fever is not a classic presenting symptom in mucocutaneous disease, but may occur in vascular or neuro-Behçet's, where it reflects heightened systemic inflammatory activity.7 Consequently, BD may masquerade as a prolonged febrile illness, particularly before characteristic features emerge. Atypical presentations may delay diagnosis, particularly in low-prevalence regions.