Therapeutic use exemptions (TUEs) allow athletes to use prohibited substances or methods when there is a justified medical indication and the criteria established by anti-doping regulations are fulfilled. Although TUEs are commonly associated with professional sport, family physicians may care for federated athletes or individuals subject to anti-doping testing at different levels of competition. In primary care, commonly prescribed treatments such as systemic glucocorticoids, β2-agonists, beta-blockers or diuretics may have regulatory implications if the substance used, dosage, route of administration, timing in relation to competition and clinical context are not adequately considered. In addition, substances of abuse, cannabinoids, and some cold remedies and decongestants may lead to unexpected adverse analytical findings. This article provides practical recommendations aimed at identifying patients at risk, using official consultation tools, adequately justifying medical indications and safely managing common situations related to TUEs in daily clinical practice. .
Advances in neonatal intensive care in Kazakhstan have improved the survival of preterm infants, including those with very low birth weight (VLBW) and extremely low birth weight (ELBW). However, after hospital discharge, these medically vulnerable children may remain insufficiently protected against vaccine-preventable infections because of prolonged temporary medical exemptions, clinical caution, parental concerns, and fragmented coordination between specialized follow-up services and primary health care. This study aimed to assess vaccination coverage in a 10-year cohort of high-risk preterm infants and to identify clinical, parental, and organizational factors associated with delayed immunization. We conducted a retrospective cohort study of 331 high-risk preterm infants followed at a specialized pediatric center in Astana, Kazakhstan, between 2015 and 2024. Vaccination status at hospital discharge and at 24 months of chronological age, documented temporary medical exemptions, reasons for delayed or missed vaccination, and confirmed cases of pertussis and measles were analyzed. A supplementary cross-sectional survey of parents, physicians, and health care managers was conducted to further explore barriers to catch-up immunization. At hospital discharge, 259 infants (78.2%) had not received the BCG or hepatitis B vaccine. By 24 months of age, 34.1% (n = 113) were fully vaccinated according to age, whereas 49.8% (n = 165) remained completely unvaccinated. During the observation period, 30 cases of measles and 17 cases of pertussis were recorded within the cohort, primarily during nationwide outbreaks. Among the 10 children with a history of measles before 12 months of age, 2 developed subacute sclerosing panencephalitis (SSPE), 1 developed profound hearing loss, and 1 required prolonged oxygen therapy following pneumonia. In addition, 2 children with periventricular leukomalacia (PVL) experienced clinical deterioration, while 1 infant with pertussis required hospitalization during the acute phase of illness. High-risk preterm infants in this cohort experienced substantial and persistent gaps in immunization after hospital discharge. These findings underscore the importance of regular reassessment of temporary medical exemptions, improved coordination between specialized follow-up services and primary health care, and strengthened catch-up immunization strategies for medically vulnerable children.
Identifying traits of narcissistic personality disorder (NPD) is clinically challenging, yet early detection can significantly improve outcomes. Online forums have become a major source of self-expression, offering new opportunities to understand mental health. However, analyzing this complex language requires new tools. This study aims to determine whether a machine learning model could be trained to reliably detect language patterns associated with NPD traits in Reddit posts. Specifically, we sought to identify both authors who exhibit these traits and posts discussing individuals with these traits. We analyzed 75,985 posts from 4 Reddit communities (r/Narcissism, r/DeepThoughts, r/Showerthoughts, and r/ImposterSyndrome). A subset of 966 posts was annotated by 2 psychiatrists to create a reliable dataset. Using a range of machine learning techniques, from traditional text analysis to modern transformer-based embedding models, we trained the system to distinguish posts containing NPD-trait markers from general reflective posts. This secondary analysis of deidentified public Reddit data was exempted by the Boğaziçi University FMINAREK (Fen Bilimleri ve Mühendislik Alanları İnsan Araştırmaları Etik Kurulu) Institutional Review Board (exemption/application number 2025-13). Our models demonstrated high accuracy. The modern embedding-based models were particularly effective, achieving a mean F1-score of 0.90, indicating a strong balance between recall and precision by correctly identifying posts with NPD-trait markers while minimizing false positives. The models remained effective even when common keywords such as "narcissism" were removed, with a mean relative F1-score decrease of 3.6% for the frequency-based baseline classifier and less than 2% (1.9% and 0.8%) for the embedding models. This study demonstrates that automated analysis of online posts is a promising approach for understanding and identifying NPD traits. Although this technology has potential for future clinical applications, it is currently a research tool and should be used only with strict ethical oversight, not for public-facing diagnosis.
As artificial intelligence (AI), particularly generative AI, is being actively introduced and utilized in medical research and manuscript writing, new challenges are emerging in academic publishing, specifically regarding author attribution, transparency, and conflicts of interest. This review examines the current status of AI use in medical publishing by focusing on three key areas: author attribution, disclosure methods regarding AI usage, and conflicts of interest. The prevailing view to date is that AI cannot be recognized as an author because it lacks the capacity to assume the responsibility that is a core requirement of authorship. Therefore, AI contributions are generally disclosed in the acknowledgment section. As AI becomes more deeply involved in the analysis and manuscript writing processes, it is expected that discussions regarding the attribution of intellectual contributions and the boundaries between tools and contributors will become more active in the future. The transparency of reporting AI usage depends on how the AI contributes to the research or manuscript. While AI used for purposes such as grammar or spelling correction is often exempt from disclosure requirements, if AI contributes more substantially to the content of the paper-such as text generation, data analysis, or code development-it is necessary to report this by indicating such details explicitly within the paper. However, stances on the level of disclosure vary among journals, such as whether to reveal all details like model specifications or prompts. Nevertheless, when generative AI is used in the research itself, detailed reporting is increasingly emphasized to ensure the reproducibility and scientific validity of the findings. Furthermore, AI adds a new dimension to conflicts of interest. This includes financial interests related to AI development, data ownership, and potential biases inherent in training datasets and algorithms. Since these factors can influence research results in subtle ways, more transparent and comprehensive disclosure of conflicts of interest in AI-based research is crucial.
Endodontic access through retained full-coverage restorations (FCRs) is a preferred option for patients because of its high cost-effectiveness. However, the clinical performance of FCRs after repaired access cavity remains insufficiently characterized. This systematic review investigates the effects of endodontic access cavity preparation through retained FCRs on fracture resistance, retention, and microleakage based on in vitro studies. A comprehensive search was performed in PubMed, Web of Science, and Scopus databases. Studies investigating the influence of endodontic access on the fracture resistance, retention, and microleakage of FCRs were included. Two independent reviewers conducted study selection, data extraction, and risk-of-bias assessment using the QUIN tool. Meta-analysis was employed to estimate fracture resistance and retention, with sensitivity analysis and subgroup evaluation also performed. Microleakage was summarized qualitatively. Twentythree studies were included: fracture resistance (n = 15), retention (n = 5), and microleakage (n = 3). Endodontic access significantly reduced fracture resistance for zirconia (p = 0.0002) and lithium disilicate (LD) restorations (p = 0.007), but not for resin-matrix ceramic (RMC) restorations (p = 0.25). Abutment tooth type contributed to heterogeneity within the LD and RMC subgroups. Retention was significantly reduced when access cavities were left unrepaired (p = 0.03), whereas appropriate repair protocols restored or enhanced retention relative to baseline. Accelerated aging increased microleakage in retained FCRs. Surface pretreatments and flowable resin liners tended to reduce microleakage, but findings were inconsistent. Endodontic access significantly reduces fracture resistance of zirconia and LD FCRs, whereas RMC restorations show no significant change. Appropriate repair protocols can restore or improve retention, potentially exceeding original values. Limited evidence suggests that effective sealing is achievable with appropriate materials. However, well-designed and in-vivo researches are needed to provide more detailed clinical guidance. When performing endodontic access through retained FCRs, reduced fracture resistance must be carefully considered for zirconia and LD restorations, while RMC restorations may be exempt from this concern. Loss of retention with access can be restored after repair. Surface pretreatment and flowable resin liners help decrease microleakage.
Medical students nationwide suffer from increasing costs associated with tuition, supplemental learning resources, and costs of living. National reports show an average graduating debt burden of $234,597, excluding undergraduate loans. Fiscal year 2026 interest rates will increase debts of $125,000 or more by at least five figures annually. Legislation and accreditation measures offer little guidance for schools to develop financial wellness curriculum. Interpretive ambiguity exists between the lines, and students absorb the impact from the execution of these guidelines. USD IRB exemption was obtained. Surveys were developed with input from an interdisciplinary team of advisors from Sanford School of Medicine and Beacom School of Business. Likert scale responses and qualitative feedback were analyzed to assess student attitudes stratified by Pillars. Initial data yielded an 18% response rate with respondents representing all years of training, with a majority from the clinical phase. Early analysis revealed that while students expressed general interest in financial literacy, most reported low confidence in managing student loans, budgeting, and long-term financial planning. A recurring theme in open-ended responses was a strong preference for more individualized financial education, with several students comparing their ideal experience to the academic advising model. Many noted that current offerings felt too generic or disconnected from their specific financial situations and career plans. These preliminary findings suggest a need for tailored, relationship-based approaches to financial education within medical curricula. Data will be collected again in May 2026. Preliminary findings highlight a clear demand among medical students for more personalized, longitudinal approaches to financial education that mirror the structure of academic advising. While overall financial literacy and confidence remain limited, students value individualized guidance over generalized sessions. These results underscore the importance of integrating tailored, mentorship-based financial programming into medical education to better support learners' financial well-being and preparedness for residency and beyond.
Simpliciti anatomic total shoulder arthroplasty (aTSA) and Tornier Pyrocarbon hemiarthroplasty (PyroC-HA) have been utilized with predictable benefit for the treatment of glenohumeral osteoarthritis (GHOA). The purpose of this study was to compare the rate of recovery and 2-year clinical outcomes in a matched group of patients undergoing these procedures. Prospectively collected preoperative, 3-, 6- and 24-month data were obtained from two Investigational Device Exemption studies evaluating the outcomes of patients who underwent stemless aTSA or PyroC-HA (n=157 each). A 1:1 propensity-score match was performed based on gender, age, BMI, diagnosis, glenoid morphology, baseline American Shoulder and Elbow Surgeon (ASES) and adjusted Constant scores. Seventy-four patients were identified for each cohort with no significant differences in covariates (all p>.103). Final outcome, change from baseline, and number of patients meeting the Minimal Clinically Important Difference (MCID) were evaluated for ASES score, total Constant, Constant strength, and pain score (0-10 scale). At baseline, each cohort (n=74) included 63 males (85%), and the primary diagnosis was GHOA in all patients. The average age of the aTSA cohort was 60.8 ± 7.3 years and 58.9 ± 6.6 years in the PyroC-HA cohort (p=0.103). Walch A1 was the most prevalent glenoid type in both cohorts (38% of aTSA patients and 45% of PyroC-HA). At 2 years there were 68 aTSA patients and 71 PyroC-HA patients included in the analysis. No significant differences in ASES scores were noted at any time point except for the 6 month score, which favored aTSA (83.5 points vs. 77.5, p=0.031). Average total Constant scores were not significantly different at any compared time point. There was a less than 1 point difference in pain between aTSA and PyroC-HA which was statistically significant at the 6-month and 24-month timepoints, with aTSA reporting an average pain level of 1.1 ± 1.5 compared to 1.8 ± 2.0 (p=0.018) at 6-months and 0.45 ± 0.95 vs. 1.06 ± 1.84 at 24-months (p=0.016). A statistically equivalent percentage of patients from each group achieved the MCID for ASES, Constant, and pain scores. Simpliciti aTSA and Tornier PyroC-HA are effective surgical treatments for younger patients with GHOA with similar outcomes at short-term follow-up. This study demonstrated that patients experienced similar recoveries and nearly identical two-year outcomes, with the exception of a statistically significant, less than 1 point difference in pain at 24 months postoperative.
This cross-sectional study evaluates state-level limitations and exemptions regarding cellphone use among public school students.
Declining childhood vaccination rates have fueled a resurgence of measles in the United States. Surveillance systems may not accurately measure the true extent of outbreaks. As of May 2026, the largest ongoing measles outbreak in the United States originated along the Utah-Arizona border in a community with high vaccine exemption rates and limited engagement with healthcare systems, leading to incomplete testing and reporting. To quantify the true outbreak size, we used two independent approaches with complementary data sources: a phylodynamic analysis and an agent-based model. Both methods found significant underreporting, estimating the true outbreak size to be 3.1- to 4.8-fold larger than reported, with confirmed cases representing only 20.96%-32.5% total infections. These findings suggest that substantial underreporting of measles occurs, especially in tight knit communities. The use of complementary analytical approaches to evaluate completeness of reporting can reveal the extent of measles transmission and aid control efforts.
To assess the rates of usage of anterior cruciate ligament injury prevention programs (AIPPs) among high school athletes and identify barriers to implementation. After Institutional Review Board exemption, high school sports teams covered by a regional multispecialty orthopaedic practice were identified. Athletic directors, trainers, and coaches for each school were contacted for completion of a survey on (1) sex, level, size, and coaching/training staff of each team; (2) incidence of anterior cruciate ligament injuries among players over the past 5 years; (3) team's use of AIPPs; and (4) interest and perceived barriers related to AIPP use. Thirty-eight representatives from 522 teams (54.0% boys' teams, 46.0% girls' teams) across 22 high schools responded to the survey. Eighteen teams (3.5%) were found to use AIPPs. The 27 (87.1%) of the 31 representatives from the remaining 504 teams reported being aware of the existence of AIPPs. The most common barrier reported against implementing AIPPs was a lack of trained staff (43.6%), followed by time constraints (33.0%). Despite widespread knowledge of AIPPs across high school athletic team coaching and training staff, only 3.5% of teams currently utilize these programs. Most common barriers to implementing these programs include a lack of trained staff and time restraints during training. Numerous AIPPs show promising results, but their adoption remains inconsistent. It is important to evaluate the awareness and implementation of AIPPs among coaches and trainers and investigate barriers to their adoption. Information from this study may help increase the use of AIPPs and thereby reduce the incidence of anterior cruciate ligament injuries in young athletes.
The Illinois Perinatal Quality Collaborative (ILPQC) aims to enhance perinatal care in Illinois. However, up to 50% of women do not attend postpartum care. This study assessed the impact of universal screening for social determinants of health (SDoH) during labor and delivery on postpartum care attendance. A retrospective chart review was conducted for women who delivered at a large academic medical center. The study received exempt status from Loyola University Institutional Review Board. Universal SDoH screening was implemented in March 2022. Data were collected from a control group (six months pre-implementation) and an intervention group (six months post-implementation). The primary outcome was attendance at both scheduled postpartum visits. Comparisons were made using Pearson chi-square for categorical variables and ANOVA for continuous variables. Finally, a multinomial regression model, adjusted for patient characteristics, was used to estimate the effect of universal screening on postpartum appointment attendance. Significance was set at p < .05. The sample included 1,098 women, with 541 in the control group and 557 in the intervention group. The SDoH screening completion rate was 75.0% (n = 415). Basic demographics were similar, with minor differences addressed in regression models. Women in the intervention group were 1.69 times more likely to attend both postpartum visits (RRR = 1.69, 95% CI [1.14, 2.51], p = .009) compared to those in the control group. Implementing SDoH screening at our hospital improved postpartum visit attendance.
Translating artificial intelligence (AI) research in orthopedics from proof-of-concept studies into production-grade clinical systems requires the systematic satisfaction of four prerequisite domains: interdisciplinary team architecture, technical data management, ethical and regulatory governance and production-grade technology and deployment infrastructure. Despite a tenfold increase in orthopedic AI publications, fewer than 6% of studies reach routine clinical deployment, reflecting persistent gaps in each of these domains. This article provides a technically rigorous, evidence-based framework organized around these four pillars. The interdisciplinary team may be structured using a product-centric topology that decouples stream-aligned clinical teams from platform infrastructure teams, following Huffman et al.'s six-step AI project lifecycle: obtain/curate/label data; establish a reference standard; develop the model; evaluate performance; externally validate and iteratively reinforce until clinical implementation is viable. Data management requires data extraction protocols, integration for bulk exports and a multi-component de-identification pipeline. A multi-stage Institutional Review Board framework governs ethical oversight, scaling from Exempt review for retrospective de-identified studies to Full Board Review with prospective validation and mandatory human-override mechanisms for interventional deployment. Responsible clinical deployment requires a multi-layer Clinical Machine Learning Operations framework, implementing privacy-preserving deployment, clinical observability, compliance audit trails and human-in-the-loop governance. Model drift has to be monitored with a degradation threshold triggering mandatory human review. Level V.
The US Centers for Disease Control and Prevention Increasing Community Access to Testing (ICATT) program rapidly expanded no-cost COVID-19 testing through commercial pharmacies in 2021, prioritizing rural and high Social Vulnerability Index (SVI) communities. Using public health emergency (PHE) authorities and Federal Acquisition Regulation (FAR) waivers, ICATT achieved its initial goal of 10,000 sites. However, a subsequent shift to FAR-based competitive contracting without waivers limited participation by key retail vendors, leading to the discontinuation of over 1,700 testing sites and constraining further expansion to a 20,000-site target. This case highlights structural limitations in Department of Health and Human Services (HHS) contracting authorities that hinder rapid scaling of medical countermeasure (MCM) services during emergencies. Specifically, limited statutory access to Other Transaction Authorities (OTAs)-flexible contracting mechanisms exempt from standard federal procurement requirements-restricted ICATT's ability to engage nontraditional vendors with extensive community reach. Existing OTA authorities within HHS are largely confined to product development (eg, vaccines, therapeutics) and do not adequately encompass service delivery models such as diagnostic testing. Expanding OTA authority across HHS agencies and broadening its scope to include MCM services could address these gaps. Drawing on precedents from the US Department of Defense, enhanced OTA use would enable more agile partnerships, reduce administrative barriers, and support rapid prototyping and scale-up of public health interventions. Key policy recommendations include congressional action to extend OTA applicability across HHS and to explicitly authorize their use for service-based public health responses, alongside investments in workforce capacity and acquisition policy development. Strengthening HHS contracting flexibility is critical to ensuring equitable access to essential services and improving responsiveness in future public health emergencies.
To analyse the structural and operational divergences between NF EN ISO 15189:2022 and Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) in the context of medical laboratory practice in Europe. This article provides a structured comparative analysis of ISO 15189:2022 and the IVDR across key regulatory domains relevant to medical laboratories. The analysis focuses on legal scope, classification of in-house in vitro diagnostic devices, validation and performance evaluation requirements, quality management systems, risk management, traceability, and post-market surveillance. Particular attention is given to the implications of Article 5(5) IVDR governing health institution exemptions and its interaction with ISO 15189:2022 accreditation requirements. The comparison is based on a thematic framework synthesising regulatory texts, international standards, and interpretative guidance relevant to laboratory medicine practice. Although ISO 15189:2022 and the IVDR share the common objective of ensuring patient safety and diagnostic reliability, they are grounded in fundamentally different regulatory paradigms. ISO 15189:2022 is focused on healthcare service quality and laboratory competence, whereas the IVDR introduces a device-centric lifecycle approach. This divergence may result in overlapping or partially conflicting requirements, particularly for laboratories developing or modifying in-house diagnostic methods. In certain cases, laboratory activities compliant with ISO 15189:2022 may still fall within the scope of IVDR obligations. Greater regulatory clarity and proportionate interpretation of IVDR requirements for health institution laboratories are needed to ensure both compliance feasibility and continued access to specialised and patient-specific diagnostic testing across Europe.
Background/Objectives: Psoriasis is a chronic inflammatory skin disease leading to substantial psycho-physical and social burden and reduced quality of life. Biologic agents have transformed its therapeutic landscape. This real-world Italian study described the pattern of treatment with biologic drugs in patients with psoriasis. Methods: A retrospective observational study was conducted using administrative databases from Italian Local Health Units, covering nearly 12 million individuals. The study included adults with psoriasis identified from January 2015 to March 2025 by hospitalization, co-payment exemption code, or topical anti-psoriatic prescriptions. Patients initiating a biologic drug (anti-TNFα, anti-IL12/23, anti-IL17, and anti-IL23) were selected and further analyzed in terms of treatment switching, drug survival, and healthcare resource utilization and related costs within the first year after biologic initiation, and compared. Results: A total of 10,270 biologic-naïve adult patients was included in the analysis (anti-TNFα N = 5078; anti-IL12/23 N = 767; anti-IL17 N = 2574; anti-IL23 N = 1851). Most patients (95.0%) starting an anti-IL23 agent did not switch. Compared with anti-TNFα, initiating an anti-IL23 inhibitor was associated with a significant reduced risk of switching (HR = 0.186; 95%CI: 0.144-0.240; p < 0.001). According to the cost analysis stratified by switching status, remaining on the index biologic was associated with a lower economic burden. Although differences between switchers vs. non-switchers among anti-IL23 users did not reach statistical significance (€12,052 vs. €11,406, respectively, p = 0.132), data support the economic advantage associated with greater treatment stability. Conclusions: Anti-IL23 agents showed effective, durable first-line use with potential long-term clinical and economic benefits in moderate-to-severe psoriasis.
Background: Lymphoma is the most common hematologic malignancy diagnosed in active-duty service members (ADSMs). Service members treated for lymphoma often face uncertainty regarding their fitness for duty, which carries implications for individual careers and force readiness. In this retrospective, exploratory study we aimed to (1) determine the proportion of previously deployed ADSMs who deployed after a lymphoma diagnosis, and (2) characterize those deployments. Methods: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) cases diagnosed between 2001 and 2022 were identified from the Defense Health Agency Cancer Registry using International Classification of Diseases for Oncology, Third Edition histology codes. Deployment variables were obtained from the Defense Manpower Data Center. Analysis was restricted to service members who were on active duty at diagnosis and had a history of deployment; those who had never deployed were excluded. This study was exempt from full institutional review board review. Results: A total of 866 previously deployed ADSMs with lymphoma were identified (455 HL, 411 NHL). Of these, 119 (13.7%; 95% CI 11.6-16.2) deployed after their lymphoma diagnosis, including 86 of 455 with HL (18.9%; 95% CI 15.6-22.8) and 33 of 411 with NHL (8.0%; 95% CI 5.8-11.1). HL survivors were significantly more likely than NHL survivors to deploy after diagnosis (p < 0.001). The mean interval from diagnosis to deployment was 5.1 years (SD 3.7) for HL and 4.5 years (SD 2.3) for NHL. As of 2022, all 119 individuals were alive at last follow-up. Conclusions: Among previously deployed ADSMs with lymphoma, roughly one in six deployed after their diagnosis and treatment, typically within five years. These findings indicate that deployment after lymphoma treatment is achievable for a significant subset of service members, highlighting both the success of cancer care in military treatment facilities and the favorable impact of modern oncologic care on operational readiness.
Police officers have long been tasked with translating drug policies into practice; as a key public-facing side of the criminal justice system, they influence how drug policy messages are conveyed to the public through everyday enforcement practices. The government of British Columbia, Canada, received a 3-year exemption from federal drug laws to decriminalize the possession of small amounts of most illicit substances starting January 31, 2023. In this context, we explored what people who use drugs learned from drug policy as it was taken up into policing practice. We use constructs from curriculum theory as a framework to understand what policing explicitly and implicitly communicates to people who use drugs. We analyzed 40 qualitative interviews with people who use drugs in socioeconomically stable positions (housed and employed) in the first year of decriminalization in British Columbia to understand lessons gleaned from policy and policing in this policy context. Findings show that the formal curriculum of drug policy provided a sense of relief for many participants who could ease their fears of being labelled "criminals." However, the way that drug policies were applied by officers in practice, making explicit a hidden curriculum, shaped how participants saw themselves and other people who use drugs in ways that were stigmatizing. Our research shows the value of analyzing the hidden curriculum of drug policy to illuminate how it shapes the way in which people who use drugs construct and position themselves.
American Indian/Alaska Native (AI/AN) communities experience persistent oral health disparities shaped by a range of social determinants of health (e.g., social, economic, and healthcare access factors). However, associations between demographic and socioeconomic characteristics and oral health outcomes among AI/AN populations remains understudied. The objective of this study was to conduct an exploratory analysis of demographic and socioeconomic factors and oral health outcomes among the Tribal Behavioral Risk Factor Surveillance System (TBRFSS) population. Demographic and general health variables were assessed through the TBRFSS. Exposure variables included age, sex, income, employment status, and dentist office type. The nine independent, ordinal outcome variables included: difficulty with chewing, difficulty with speech, dry mouth, felt anxious, felt embarrassment, avoided smiling, reduced social activities, problems sleeping, and experienced pain. Multivariable ordinal logistic regressions were conducted to produce proportional ORs and 95% CIs. A total of 379 responses from participants who identified as AI/AN were included for analysis. Amongst those 379 participants, most identified as female (62% n = 224), had healthcare coverage (92%, n = 343), were Oklahoma residents (78%, n = 295), and were employed full-time (60%, n = 220). Multivariable ordinal logistic regression analyses revealed a statistically significant association between household income and oral health for seven out of the nine outcomes. The age group categories, income, and sex varied in association with the outcomes. Understanding factors associated as it relates with oral health among AI/AN communities is an integral component of addressing health inequities.
To compare perioperative and functional outcomes of standard holmium, Moses 1.0, and Moses 2.0 laser enucleation performed at an academic center with trainee involvement. We retrospectively reviewed men undergoing HoLEP between June 2022 and May 2024. Patients were grouped by laser platform: standard holmium, Moses 1.0, or Moses 2.0. Baseline demographics, perioperative data, complications, and functional outcomes up to six months were analyzed using analysis of variance or Kruskal-Wallis tests. Among 389 patients (standard holmium 206; Moses 1.0 126; Moses 2.0 57), baseline characteristics were similar. Median operative times were 95, 105, and 100 min for standard holmium, Moses 1.0, and Moses 2.0, respectively (p = 0.25), and median prostate weights were comparable (84 g, 85 g, 79 g; p = 0.44). Hospital stay was slightly longer with Moses lasers (1.6 vs. 1.4 days, p < 0.001), though this difference is unlikely to be clinically significant. Objective measures of bleeding-postoperative hemoglobin drop (1.7-2.0 g/dL) and transfusion rates (0-1.6%)-did not differ significantly between groups. Postoperative catheter duration, hospital stay, and complication rates were also comparable. Functional outcomes improved in all groups through 6 months, with no intergroup differences. HoLEP is safe and effective across conventional holmium, Moses 1.0, and Moses 2.0 platforms, with comparable perioperative and functional outcomes. Although the literature suggests that Moses 2.0 may facilitate same-day discharge, its absence should not limit HoLEP availability, and platform selection may reasonably reflect institutional resources and surgeon preference.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can resemble central nervous system infection in children because fever, headache, vomiting, cerebrospinal fluid pleocytosis, and multifocal brain lesions may coexist. We report a previously healthy 13-year-old boy who developed headache, fever, vomiting, and binocular horizontal diplopia. Examination showed transient exotropia with apparent adduction limitation but no encephalopathy, seizures, limb weakness, pupillary abnormality, optic neuritis, or spinal cord lesion. Cerebrospinal fluid showed mononuclear-predominant pleocytosis with mildly elevated protein. Brain magnetic resonance imaging showed evolving patchy fluid-attenuated inversion recovery hyperintensities in the right temporal lobe, basal ganglia, periventricular region adjacent to the fourth ventricle, and later the right frontal lobe. Extensive microbiological testing was unrevealing. Serum myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) was repeatedly positive by live cell-based assay, whereas aquaporin-4 immunoglobulin G (AQP4-IgG) and autoimmune encephalitis antibodies were negative. Clinical improvement occurred during overlapping treatment with intravenous immunoglobulin and corticosteroids. On illness day 97, during prednisone tapering following an individualized off-label decision to use rituximab, the patient remained clinically stable. This case highlights that pediatric MOGAD should be considered when an infection-like central nervous system presentation is accompanied by evolving multifocal magnetic resonance imaging abnormalities and negative pathogen studies. Diplopia can be an important focal clue; however, because the ocular motor examination was incomplete, internuclear ophthalmoplegia could not be confirmed.