Universal Credit (UC) is a major UK welfare reform that consolidates six means-tested benefits into a single monthly payment, aiming to simplify benefits delivery and incentivize labor market participation. However, concerns have emerged regarding its potential adverse consequences on recipients' mental and physical well-being. Existing evidence is limited by methodological weaknesses, short follow-up time, and a narrow focus on psychological distress. Applying the heterogeneous difference-in-differences approach developed by Callaway and Sant'Anna, we used waves 6-14 of the UK Household Longitudinal Survey (UKHLS), focusing on working-age individuals receiving social benefits to evaluate the short- and long-term effects of that welfare reform on psychological distress (GHQ-12), mental functioning (SF-12 MCS), physical functioning (SF-12 PCS), but also employment, perceived financial outlook, benefits income, and total income. Transitioning to UC significantly increased GHQ-12 scores by 1.20 points (95% CI: 0.33 to 2.07) and decreased SF-12 MCS scores by 2.19 points (95% CI: - 3.79 to - 0.59), indicating deteriorating mental health. No significant effect was observed for SF-12 PCS. UC was also associated with a £93.05 reduction in monthly benefit income, a £222 decrease in total income, and an 8%-point decrease in perceived financial optimism. No significant effect on employment status was detected. Our findings suggest that the transition to UC adversely affected mental health and financial well-being, while yielding limited employment benefits. These adverse impacts reflect both implementation challenges, such as payment delays and benefit deductions, and structural design flaws, including rigid conditionality and reduced income security for vulnerable groups. The results underscore the need for welfare reforms that integrate health considerations and provide more flexible, targeted support to mitigate unintended harms.
Resilience is critical to the health and well-being of last-mile adolescent girls and young women (AGYW) who work in artisanal and small-scale mining (ASM) communities. The COVID-19 pandemic exacerbated the health and economic challenges that AGYW in ASM communities experience. Despite a growing focus and discussion of adolescent resilience in the literature, there is a continued gap in information on the experience of last-mile or hard-to-reach adolescents, such as those in ASM communities, and their resilience. This paper aims to understand adolescent resilience in ASM communities in Uganda and Ghana and identify contributing factors. This study employed quantitative analysis of survey responses from 1618 AGYW in Ugandan and Ghanaian ASM communities. Survey questions focused on resilience and were adapted from the Brief Resilience Scale (BRS). Responses were analyzed (descriptive, bivariate, logistics regression) using STATA and BRS scoring to indicate low and normal/high resilience. Across AGYW in both Ghana and Uganda, an average of 57% had a normal/high resilience score and 43% had a low resilience score. Variables that were significantly related to normal/high resilience (p value equal to or less than 0.05) included residence in Ghana, AGYW 18 years or above, completed secondary education, were migrants, were employed by their parents or other relatives, received fair payments, had savings, drank alcohol, did not experience physical violence or a combination of physical and sexual violence, and had monthly incomes higher than $70. Findings correlate with existing literature on resilience amongst adolescents. Targeted resilience interventions with the AGYW in ASM have the potential to break cycles of vulnerability and should focus on savings and financial literacy, along with advocacy for mitigating sexual and gender-based violence and enhancing girls' rights to continue to build resilience. Long-term multi-stakeholder collaborations are key to building resilience within ASM communities.
Bipolar-spectrum illness emerging after traumatic brain injury (TBI) can be difficult to treat and may present with mixed or agitated depressive features that appear sensitive to glutamatergic modulation. In post-TBI cases, diagnostic certainty is often limited because irritability, impulsivity, sleep disturbance, affective lability, and cognitive change may overlap with frontal-limbic injury syndromes. This case is, therefore, framed as probable bipolar-spectrum disorder secondary to TBI rather than definitive idiopathic bipolar disorder. The Cheung Glutamatergic Regimen (CGR)--low-dose dextromethorphan with CYP2D6 inhibition plus piracetam--is used here only as a shorthand for an open-source, free-to-use, non-proprietary combination of off-patent components, not as a branded product. This report describes a woman in her mid-thirties with right frontal atrophy after a 2009 subdural hematoma who later developed probable bipolar-spectrum illness. On 21 October 2025, she presented with severe depressive relapse, insomnia, persistent rumination, irritability, and hypnagogic phenomena, with a Patient Health Questionnaire-9 (PHQ-9) score of 22. After partial improvement on valproate, risperidone, and Deanxit, dextromethorphan 30 mg nightly and piracetam 600 mg nightly were added on 5 November 2025. Within weeks, rumination decreased and mental flexibility improved, but transient mild hypomanic or frontal-disinhibition-like symptoms emerged, especially inappropriate laughter with a moria-like quality. She self-reduced dextromethorphan to 22.5 mg, piracetam was increased, and euthymia returned. Over the next six months, PHQ-9 scores improved to 10-12 and Generalized Anxiety Disorder-7 (GAD-7) scores to 8-13, with functional gains including exercise and motorcycle riding lessons. Later medications included aripiprazole, paroxetine-controlled release, pregabalin, and low-dose quetiapine. By April 2026, dextromethorphan and piracetam were used as needed during stress-related or premenstrual dips. No further psychotic symptoms were reported, and later mild dissociative or cognitive complaints became manageable after dose adjustment. This single-patient course suggests a three-phase pattern: induction with a narrow therapeutic window and brief activation/overshoot, stabilization after titration, and later PRN maintenance. Dextromethorphan appeared temporally most linked to both clinical benefit and transient activation, while piracetam may have acted as a modulator. However, causal inference is limited by the uncontrolled design, early PHQ-9 improvement before CGR initiation, later polypharmacy, unmeasured pharmacokinetics, absence of standardized mania/cognitive measures, and incomplete PRN-frequency documentation. The case is also only hypothesis-generating in relation to transcriptomic findings implicating bipolar-specific plasticity-related biology. Low-dose oral glutamatergic augmentation may warrant study as a closely monitored induction and consolidation strategy in post-TBI bipolar-spectrum illness, but prospective controlled trials are needed before broader recommendations can be made.
Venipuncture is a fundamental clinical skill that requires repeated practice in a safe learning environment before being performed on patients. However, commercial venipuncture simulators are often expensive and not always available in sufficient numbers for repeated student training. This study aimed to design, manufacture, and evaluate a low-cost, reusable venipuncture training model for medical education. The simulator was developed using a silicone-based soft-tissue model with embedded silicone tubing simulating superficial veins at different depths. A passive hydrostatic pressure system was used to provide visual feedback during successful venipuncture. The model was manufactured using a 3D-printed mold, platinum-cure silicone, silicone tubing, and a porous support layer to improve durability and fluid absorption. The total material cost per model was approximately 4-5 EUR. The model was used in a practical training session with 50 medical students as part of a scheduled educational activity. Following the training, participants were invited to complete a voluntary and anonymous questionnaire designed to evaluate the perceived realism, usability, and educational value of the model. The questionnaire consisted of 10 items rated on a 5-point Likert scale. The instrument was developed specifically for this study and was not previously validated; therefore, the results should be interpreted as exploratory measures of user perception. Students reported high satisfaction across all evaluated categories, particularly ease of use, the ability to perform repeated venipuncture, and the visual feedback system. This low-cost, in-house manufactured venipuncture simulator provides a practical and sustainable solution for procedural training. Its affordability, reusability, and ease of manufacturing make it suitable for widespread use in medical education, particularly in settings with limited access to commercial simulation equipment.
Introduction Antiretroviral therapy (ART) compliance is essential for successful treatment outcomes of children living with human immunodeficiency virus (HIV) infection. The factors affecting adherence to ART, which have not yet been explored in Oman for children living with HIV infection, must thus be investigated. Methods A cross-sectional study was conducted that included all children living with HIV who were receiving care at the pediatric infectious disease clinics of Royal Hospital, a tertiary care center, and who had been on pediatric antiretroviral therapy (ART) formulations for more than one year. After receiving informed consent, 43 caregivers of HIV-positive children were interviewed using a questionnaire. Patients' characteristics, socioeconomic, pharmacological, and health care system factors were analyzed in correlation with adherence to ART using SPSS version 26 (IBM Corp., Armonk, USA). Results Thirty percent of patients (n=13) had high HIV viral loads, and among those, 19% (n=8) had suboptimal adherence. Young and non-educated caregivers, low income, and lack of transportation were significant factors for poor adherence to ART therapy, with a significant p-value. Other important factors noticed were medication not available at home, missed medication refills, and a child's busy schedule at school, and patients' caregivers did not always administer the prescribed medications. Conclusion The study results support the recommendation to provide a pediatric formulation of ART and supply it to peripheral secondary care hospitals for easy access to medications. Psychological assessments and counselling at the adolescent medicine clinic in the same centre would aid caretakers psychologically and gauge children with HIV's preparedness for disease disclosure.
Real-time reverse transcriptase polymerase chain reaction (RT-PCR) is considered the gold standard for the diagnosis of coronavirus disease 2019 (COVID-19); however, this method is expensive, time-consuming, and requires skilled personnel. Therefore, this study aimed to evaluate the clinical performance of loop-mediated isothermal amplification (LAMP), a simpler test method. A multinational prospective clinical performance study was conducted in Indonesia and the Philippines, comparing the LAMP method to RT-PCR for the diagnosis of COVID-19. In total, 256 subjects with COVID-19 symptoms underwent RT-PCR testing, of whom 130 and 126 were positive and negative, respectively. In Indonesia (n = 180), 115 (63.9%) tested positive by RT-PCR and 65 (36.1%) tested negative; in the Philippines (n = 76), 15 subjects (19.7%) tested positive by RT-PCR and 61 (80.3%) tested negative. The LAMP and RT-PCR results were concordant in 243/256 subjects (94.9%; 95% confidence interval, 91.5-97.3) (92.8% in Indonesia, 100% in the Philippines). Among 130 RT-PCR-positive subjects, 117 were also positive by LAMP, yielding a sensitivity of 90%. Of the 126 RT-PCR-negative subjects, 126 were also negative by LAMP, yielding a specificity of 100%. The positive and negative predictive values were 100% and 90.6%, respectively. Our study demonstrated high overall accuracy between the LAMP and RT-PCR methods, suggesting the potential utility of the LAMP method for detecting COVID-19 and highlighting its usefulness in managing cases.
Episode 2 in our podcast series focuses on the critical challenge of identifying patients with HER2-mutant non-small cell lung cancer (NSCLC). We discuss why timely and comprehensive testing for HER2 mutations is vital for optimizing patient outcomes and how next-generation sequencing and molecular profiling are integrated into clinical practice. This episode covers the practical aspects and evolving standards of HER2 mutation testing, including the use of tumor and liquid biopsies, and addresses real-world barriers such as cost, access, and awareness. We also explore potential solutions, such as reflex testing and collaboration with molecular pathologists, to overcome current diagnostic challenges. This episode emphasizes the importance of accurate and early molecular diagnosis in ensuring patients receive the most effective, personalized therapies as the treatment landscape for HER2-mutant NSCLC continues to advance.
Atrial fibrillation (AF) increases cardiovascular risk in patients with chronic kidney disease (CKD). The safety and efficacy of early rhythm control (ERC) in patients with CKD is not fully established. This predefined secondary analysis of the EAST-AFNET 4 trial assessed the effectiveness and safety of ERC in patients with CKD defined by estimated glomerular filtration rate (GFR). EAST-AFNET 4 randomized patients with recently diagnosed AF and comorbidities to ERC or usual care (UC). Key outcomes were analyzed by Kidney Disease Improving Global Outcomes defined CKD groups. The primary efficacy outcome combined cardiovascular death, stroke, hospitalization for worsening heart failure, or acute coronary syndrome. The safety outcome combined death, stroke, and serious rhythm control-related adverse events. Recurrent AF was a secondary outcome. Baseline creatinine was available in 2,742 of 2,789 (98.3%) patients. In this study, 23% had CKD (GFR: <60 mL/min/1.73 m2). Patients with CKD were older (CKD: 74 ± 7.4 years; no CKD: 69 ± 8.3 years; P < 0.001), had higher CHA2DS2-VASc scores (CKD: 4 ± 1.4; no CKD: 3.2 ± 1.2; P < 0.001), and more primary outcome events over 5.1 years of follow-up (HR: 0.98 per mL GFR decrease [95% CI: 0.97-0.99 per mL GFR decrease]). ERC reduced the primary outcome with and without CKD (no CKD: ERC: 3.4%/100 patient-years; UC: 4.1%/100 patient-years; HR: 0.84; P < 0.001; CKD: ERC: 5.8%/100 patient-years; UC: 8.5%/100 patient-years; HR: 0.67; P < 0.001; Pinteraction = 0.133). CKD increased safety outcomes without interaction with ERC (Pinteraction = 0.927). Patients with CKD experienced more AF recurrences with UC (Pinteraction = 0.036). ERC effectively and safely reduces cardiovascular events in patients with recently diagnosed AF and stroke risk factors with and without CKD. (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST); NCT01288352).
Posterior circulation stroke, particularly basilar artery occlusion, represents a neurologic emergency with high morbidity and mortality, often complicated by diagnostic ambiguity and rapid systemic deterioration. We present the case of a 56-year-old male with multiple vascular risk factors who presented with acute altered mental status, dysarthria, and focal neurologic deficits. Initial evaluation considered a broad differential diagnosis, including intracranial hemorrhage, seizure, and metabolic derangements; however, rapid multimodal assessment excluded these etiologies and supported an acute ischemic process. Advanced imaging demonstrated high-grade basilar artery stenosis with a large perfusion mismatch, indicating a substantial volume of salvageable tissue despite minimal early infarction. Based on these findings, intravenous thrombolysis was administered within the therapeutic window, followed by transfer for neurointerventional evaluation and successful endovascular reperfusion. The clinical course was complicated by aspiration pneumonia, acute kidney injury, and metabolic instability, reflecting the systemic impact of posterior circulation ischemia. Magnetic resonance imaging confirmed an acute cerebellar infarction without hemorrhagic transformation. With coordinated multidisciplinary care, the patient demonstrated gradual neurologic improvement and was discharged in stable condition with residual deficits. This case supports a systems-based conceptual framework for posterior circulation stroke as a time-sensitive process, in which outcomes are influenced not only by timely reperfusion but also by early diagnostic clarity and proactive management of secondary physiologic complications.
Rheumatic heart disease (RHD) is a preventable acquired valvular heart disease in children and young adults, which results from damage to the heart valves as a result of one or several episodes of rheumatic fever, resulting in progressive cardiac valvular damage and long-term morbidity. This systematic review and meta-analysis evaluate the pooled prevalence of RHD among school-age children in low- and middle-income countries (LMICs).  A comprehensive search was conducted from inception to the 5th of December, 2025, on PubMed and Google Scholar, and yielded 1,276 articles. Ten articles were included for analysis after undergoing screening using the predefined eligibility criteria. We included original research, published in a peer-reviewed journal, which talks about the prevalence of RHD in school-age children (six to 15 years) in any LMIC. We utilized a random-effects model, Cochrane Q statistic, I2 index, forest plot, and a funnel plot for meta-analysis. The Joanna Briggs Institute (JBI) critical appraisal tool was used for quality assessment of the included studies. A total of 25,292 school-age children participated in this study across eight LMICs, with a mean age ranging from nine to 14 years. Among diagnosed cases, 130 were male, and 152 were female. The pooled prevalence of RHD was 2.46% (95% CI: 1.15%-4.25%), with sustainability heterogeneity observed across studies (I² = 98.3%, p < 0.001). These findings indicate a continued burden of RHD among school-aged children in LMICs. The observed variability in prevalence suggests regional differences and potential gaps in early detection and primary preventive strategies. There is a need to strengthen screening and prophylactic programs in high-burden settings.
Creatine monohydrate is a widely used dietary supplement for performance enhancement among athletes and physically active individuals. Questions regarding its safety in adolescent populations remain an important consideration for clinicians and families. This systematic review evaluates the safety of creatine monohydrate supplementation in adolescent athletes and physically active youth. A comprehensive search of PubMed was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant human studies published between 2015 and 2025. Inclusion criteria required original research involving adolescents or physically active youth receiving creatine monohydrate with reported safety outcomes. Five studies met eligibility criteria and were included in the final analysis, comprising randomized controlled trials and longitudinal cohort studies. Across diverse populations, including youth athletes and adolescents with medical conditions, creatine supplementation was generally well tolerated, with no consistent short-term safety signals reported in renal function, liver enzymes, or cardiometabolic risk markers within the study periods. No serious adverse events were attributed to supplementation. These findings summarize currently available evidence regarding creatine safety in adolescent and physically active pediatric populations and highlight the need for larger prospective studies with standardized dosing protocols and longer follow-up periods.
Xanomeline-trospium chloride (Cobenfy) is a novel muscarinic M1/M4 receptor agonist and a peripherally restricted antimuscarinic combination that represents a non-dopaminergic treatment approach for schizophrenia and related psychotic disorders. Although randomized clinical trials have demonstrated efficacy, published experience with inpatient initiation remains limited, particularly in patients undergoing transition from complex psychotropic polypharmacy. We describe the case of a 25-year-old nonbinary individual with schizoaffective disorder, depressive type, who was admitted for acute worsening of command auditory hallucinations and intermittent suicidal ideation in the setting of persistent psychotic symptoms despite multiple prior medication trials, including clozapine. During hospitalization, a structured medication wash was performed with sequential tapering and discontinuation of multiple psychotropic agents to reduce medication burden and clarify baseline symptomatology. Xanomeline-trospium was subsequently initiated and titrated to a therapeutic dose. Following initiation, the patient demonstrated improvement in the intensity and frequency of psychotic symptoms, resolution of active suicidal ideation by discharge, and good behavioral stability throughout hospitalization. The medication was well tolerated, with no extrapyramidal symptoms or other clinically significant adverse effects. This report highlights the feasibility and short-term tolerability of inpatient xanomeline-trospium initiation during a transition from complex psychotropic polypharmacy in a patient with acute psychotic decompensation.
Genital psoriasis remains underdiagnosed and undertreated despite its substantial impact on quality of life. The sensitive nature of genital involvement contributes to diagnostic delays, patient distress, and treatment challenges. The Genital Psoriasis Wellness Consortium, a multidisciplinary panel of US-based clinicians, previously developed consensus statements on physical diagnosis, patient conversations, quality of life impacts, and treatment. We aimed to build on prior work by providing additional considerations to refine best practices across three areas: physical exam and diagnosis; pediatric and adolescent treatment; and adult and geriatric treatment. The panel used the modified Delphi process and nominal group technique, informed by a systematic literature review, with consensus defined as ≥ 75% agreement on a 7-point Likert scale. The panel emphasized routine genital assessment within comprehensive skin exams and proactive empathetic communication to reduce stigma, with verbal consent and the offer of a chaperone as standard practice. In pediatric care, shared decision making among clinicians, caregivers, and patients fosters adherence. In adults and older patients, treatment decisions should consider comorbidities, polypharmacy, and individual goals; prioritizing therapies with established safety in intertriginous areas and minimizing long-term corticosteroid use. Simple regimens and attention to access barriers were identified as important to support adherence. These considerations aim to enhance diagnosis, optimize treatment, and improve outcomes through personalized empathetic care. Genital psoriasis, a psoriasis variant affecting the skin of the genitalia, often results in physical discomfort and emotional distress that has a direct, and significantly negative, impact on quality of life. Unfortunately, it often goes undiagnosed and undertreated. Patients may be embarrassed discussing their symptoms and healthcare professionals may be unsure how to approach this sensitive topic. A group of US dermatology experts, the Genital Psoriasis Wellness Consortium, worked together to develop expert recommendations to improve care for patients with genital psoriasis. They used a structured approach that included expert discussions, a literature review, and agreement among the panel members. The goal was to provide practical guidance for healthcare professionals treating patients with genital psoriasis, including children, teens, adults, and older adults. The group emphasized the importance of checking for genital symptoms during skin exams and speaking openly but sensitively with patients. For children and teens, involving both the family and the child in decision making can help improve comfort and treatment success. For older adults, treatments should be chosen based on health needs, not strictly on age. Across all age groups, the panel suggested avoiding long-term use of strong topical corticosteroids and simplifying treatment plans. These considerations aim to help providers deliver more personalized, effective, and compassionate care for patients with genital psoriasis.
Rapid computed tomography (CT) interpretation for intracranial hemorrhage is vital for timely care. Large language models (LLMs) have rapidly advanced in image analysis, with some claiming high accuracy in medical imaging interpretation. Evaluate whether LLMs, like Grok-2, ChatGPT-4o, and Gemini 1.5 Flash, can outperform a human medical student in detecting and classifying intracranial hemorrhages. Non-contrast, axial CT head scans were sourced from the Radiological Society of North America (RSNA) 2019 database, in which each slice is annotated by expert neuroradiologists. A random sample of 400 scans was selected, consisting of 200 normal cases and 200 hemorrhage cases, with 40 cases representing each major hemorrhage subtype. Grok-2, ChatGPT-4o, Gemini 1.5 Flash, and a blinded medical student were each given an image and a prompt to determine: (1) whether an intracranial hemorrhage was present, and (2) the specific type of hemorrhage. McNemar's test was used to compare paired classification accuracies, and Cohen's kappa was used to measure inter-rater agreement. LLM accuracy in detecting hemorrhage ranged from 59.3% to 61.0%, with Grok-2 showing the highest specificity and Gemini 1.5 Flash the highest sensitivity. The medical student outperformed all LLMs in accuracy and specificity. Subarachnoid hemorrhages were the hardest to detect. Agreement was lowest between Grok-2 and the human reviewer (κ = 0.0637). Current general-purpose LLMs demonstrate moderate but inconsistent ability to detect and classify intracranial hemorrhages, underperforming compared to a human medical student. None of the LLMs matched human specificity or accuracy. Refinement of task-specific systems may be required to enhance clinical applicability in neuroimaging.
Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome is an underrecognized clinical entity characterized by a synergistic interplay among hyperkalemia, renal dysfunction, and AV nodal blockade. This self-perpetuating cycle can lead to profound bradycardia and hemodynamic instability if not promptly identified and managed. We report the case of a man in his 70s who presented to the emergency department (ED) with acute-onset watery diarrhea followed by a syncopal episode. On evaluation, he was bradycardic and hypotensive, with laboratory findings notable for hyperkalemia and acute kidney injury. His home medications included amiloride, carvedilol, and losartan. The electrocardiogram (ECG) demonstrated complete heart block. The patient was treated medically for hyperkalemia, with subsequent spontaneous resolution of the bradyarrhythmia. He was diagnosed with BRASH syndrome and admitted to the intensive care unit for further monitoring. In the setting of hyperkalemia and concurrent use of AV nodal blockers, there is a risk of worsening bradycardia and cardiovascular collapse if not recognized early. This case highlights the importance of early identification of BRASH syndrome in patients presenting with bradycardia, particularly those receiving AV nodal blockers. Prompt correction of hyperkalemia and supportive care may reverse the cycle and prevent progression to cardiovascular collapse.
Objectives The objectives of this study are to develop and validate a low-cost, low-fidelity simulation model for diagnostic bronchoscopy training among otolaryngology postgraduates (PGs) and to assess realism, educational utility, and learner confidence. Methods We constructed a simulation model replicating pediatric airway anatomy using locally available materials (INR 1,000). Twenty-six otolaryngology residents participated in structured simulation sessions. Face, content, curriculum, and transfer validity were evaluated using a five-point Likert scale survey. Statistical analysis employed the Friedman and Wilcoxon signed-rank tests. Results  The participants reported high validity scores across all domains (median ≥ 4), with significant post-training confidence improvement (p < 0.001). No difference in scores existed between residents from different training years across validity domains (p > 0.05). Conclusion This low-cost bronchoscopy simulator effectively improves procedural confidence and aligns with curricular needs. It provides a practical and scalable training solution for resource-limited settings and early-stage residency programs.
Flat-detector computed tomography (FDCT) is increasingly used for periinterventional cerebral imaging. The recently introduced Sine Spin FDCT (S-FDCT) aims to improve cerebral soft tissue contrast compared with conventional FDCT (C-FDCT). Reliable visualization of healthy brain parenchyma is essential for detecting pathological changes. This study compared gray-white matter differentiation between intraindividually acquired S-FDCT and C-FDCT. A retrospective analysis of a prospectively maintained database included patients with ischemic stroke treated by mechanical thrombectomy who underwent both S-FDCT and C-FDCT within the same interventional session on a latest-generation angiography system. Quantitative image quality was assessed using the contrast-to-noise ratio (CNR). Qualitative image quality was evaluated using a five-point scale at basal ganglia and supratentorial cortex. Analyses focused on healthy brain parenchyma contralateral to infarction. Radiation dose was assessed using entrance-skin dose and dose-area product (DAP). Forty patients (74.2 ± 15.3 years) were analyzed. S-FDCT demonstrated a higher CNR than C-FDCT (mean CNR ± SD: 2.62 ± 1.36 versus 1.03 ± 0.38; p < 0.001). Qualitative ratings were higher for S-FDCT at the basal ganglia (2.45 ± 0.71 versus 1.54 ± 0.53; p < 0.001) and supratentorial cortex (3.01 ± 0.80 versus 1.71 ± 0.60; p < 0.001). Inter-reader agreement was good (κ = 0.798). S-FDCT showed a moderately higher radiation dose than C-FDCT (DAP: 50.6 ± 3.10 versus 46.89 ± 2.86 Gy·cm², p < 0.001). S-FDCT improves cerebral soft tissue visualization compared with C-FDCT in periinterventional imaging. These findings highlight the potential of Sine Spin technology to enhance FDCT image quality and support its role in advanced angiography-suite-based neuroimaging.
Intravesical administration of Bacillus Calmette-Guérin (BCG) has been the standard treatment for non-muscle invasive bladder cancer (NMIBC).  Its efficacy in preventing recurrence and tumor progression has been well established; however, rare immune-mediated complications, particularly parenchymal renal involvement, pose significant diagnostic challenges. This report describes an exceptional case: that of a 73-year-old man who developed renal failure five years after his last BCG instillation. Histopathological examination revealed granulomatous interstitial nephritis. This case is remarkable for its exceptionally long and unusual latency period, which generally manifests within days to months in other patients.  After initiating corticosteroid therapy, the patient experienced partial renal recovery and stabilization of renal function during follow-up, highlighting the potential role of immunological mechanisms in delayed renal injury.  This study underscores the need for long-term renal monitoring in patients treated with BCG immunotherapy.
Burns of the posterior trunk are challenging to manage due to constant pressure, shear stress, and exudate accumulation, which increase the risk of graft detachment and infection. Autologous skin cell suspension (ASCS) is effective for donor-site conservation but may be difficult to retain on posterior trunk wounds. We report two cases of partial-thickness burns treated with ASCS in combination with high-expansion (1:9) Meek grafting. In both cases, debridement was performed using a hydrosurgical system, followed by the application of ASCS and Meek grafts. Rapid epithelialization was achieved, and donor skin harvesting was minimized. These results suggest that combining ASCS with Meek grafting may facilitate wound healing and donor-site conservation in posterior trunk burns, which are often difficult to manage.
Introduction Adherence to post-bariatric supplement intake may be affected by tolerability issues. This study aimed to characterize nausea associated with supplement intake and explore the patient-reported symptom course following structured intake instructions in a real-world customer-support context. Methods This retrospective observational study with prospectively collected data consisted of two parts. Part one: a cross-sectional survey of 540 FitForMe customers after bariatric surgery who reported nausea, assessing the timing of supplement intake, the onset and triggers of nausea, and the impact on daily functioning. Part two: a single-arm, uncontrolled follow-up of a separate sample of 75 French FitForMe customers experiencing nausea, who received structured intake instructions during standardized telephone interviews. Recommendations included switching from capsules to chewable tablets, taking supplements with meals, dividing doses, and allowing slower dissolution. The presence of nausea (yes/no) was reassessed by telephone one week later. Results Part one indicated that a large percentage of individuals did not take the supplement according to intake instructions; 256 (47.4%) took it on an empty stomach. Nausea occurred in 93 patients (17.2%) before the actual intake of the supplement. Overall, 365 patients (67.6%) reported a score of 5 or higher on a 0-10 scale measuring the impact on daily life, where 0 indicated no restriction, and 10 indicated being unable to do anything. In part two, at the one-week follow-up, 55 of 75 patients (73.3%) reported resolution of nausea (within-patient comparison, p<0.001). The recommendation most frequently endorsed by patients as perceived to have contributed to their symptom course was switching from capsule to chewable tablet, reported as helpful by 41 of 44 patients who made this switch (93.2%; 54.7% of the total follow-up cohort, n=75; p<0.001). Taking supplements with lunch or dinner was also commonly endorsed (n=42, 56.0%). Additional complaints were common, including potentially dumping-related symptoms (n=30, 40.0%), food intolerance (n=28, 37.3%), and altered taste or smell (n=31, 41.3%). Conclusion In a selected sample of bariatric patients who reported nausea during multivitamin use, incorrect intake practices and multifactorial symptom patterns were common. In a follow-up cohort, structured intake advice was associated with patient-reported resolution of nausea in many participants. While these observational findings do not establish causality, the recommendations are simple, low-cost, and easy to implement, and may be considered as a pragmatic first step in routine post-bariatric care.