Ventilator-associated pneumonia (VAP) is a common and serious complication in critically ill patients, particularly those requiring prolonged mechanical ventilation. Extensively drug-resistant (XDR) Acinetobacter baumannii has emerged as a significant threat in VAP cases, complicating treatment due to its exceptionally high level of antibiotic resistance. We present a case of a 62-year-old male patient with severe acute ischemic stroke, who developed VAP during his stay in the intensive care unit (ICU). Cultures confirmed XDR Acinetobacter baumannii as the causative organism. The infection was further complicated by the development of a lung abscess, a rare but severe consequence of VAP. The patient was treated with a targeted antimicrobial regimen consisting of colistin, vancomycin, and tigecycline. Despite the pathogen’s resistance profile, the patient’s infection showed gradual improvement with sustained treatment. However, the recovery process was significantly prolonged due to the complexity of the infection, necessitating extended supportive care during hospitalization. This case highlights the challenges posed by XDR infections in critically ill patients and the importance of a tailored antimicrobial approach to effectively manage severe complications such as lung abscess.

Alcohol is a well-known toxic etiologic factor for liver injury. Metabolic substrates of alcohol (especially acetaldehyde) have a major responsibility and genetic susceptibility, alterations in microbiota and immune system are important co-factors for this injury. Major injury in liver is hepatocellular lipid accumulation. Therefore the relationship between non-alcoholic and alcoholic fatty liver diseases should have been defined clearly. Recently two major liver committees adopted new terminologies such as metabolic-associated fatty liver disease (MAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcoholic liver disease (ALD) instead of non-alcoholic fatty liver disease (NAFLD). These terminologies were based on the effects of metabolic syndrome on liver. Alcohol consumption was defined differently according to these nomenclatures. MAFLD defined alcohol intake (regardless of amount) as “dual etiology fatty liver disease” and the Delphi consensus defined MASLD, MetALD, or ALD according to daily consumption of alcohol amount.

According to research, hepatocellular carcinoma (HCC), ranks third globally in terms of cause of death and is the fifth most common type of cancer overall. Finding novel means of diagnosis and treatment is therefore crucial. The use of nanotechnology as a cancer treatment has drawn a lot of interest recently. Despite significant advancements in detection and treatment, there is still a long way to go before this disease is completely eradicated. Therefore, it’s critical to find innovative ways to diagnose and cure conditions. In particular, the substantial inertness of metallic nanoparticles (NPs) and their nanoscale structures, which have sizes comparable to many biological molecules, attract a great deal of interest in the biomedical field. Due to their exceptional optical qualities, chemically modified surface through the attachment of various ligands, biocompatibility (bio-inertness and low cytotoxicity), and superior optical properties, gold NPs (AuNPs) have garnered significant interest. The current review discusses the efficiency of AuNPs in various fields, including imaging, immunotherapy, and photothermal therapy for treating liver cancer. Finally, this review summarized the limitations of the prospects of the AuNPs.

Aim: The study aims to assess laypersons’ perceptions of smile aesthetics before and after gingival depigmentation and to correlate these perceptions with the degree of gingival pigmentation. Methods: The retrospective observational study examined individuals who received gingival depigmentation following orthodontic treatment between 2019 and 2024. Fifteen records were selected based on the inclusion and exclusion criteria. The pre- and post-depigmentation frontal smile photos were standardized, included into a Google Form, and distributed to 40 laypeople for the assessment of smile aesthetics. The laypeople evaluated the attractiveness of smiles using a 10-point Likert scale. Experienced periodontists classified the gingival pigmentation utilizing the oral pigmentation index (OPI). The differences between the pre- and post-treatment OPI scores and smile esthetic scores were assessed using Wilcoxon signed-rank test. Spearman correlation was used to evaluate the association between smile scores and OPI scores. The intraclass correlation coefficient (ICC) was employed to evaluate the inter-rater reliability of the smile ratings and OPI scores. The statistical significance was established at p ≤ 0.05. Results: The average OPI scores before depigmentation were 2.67 ± 0.49; however, following depigmentation, the scores significantly declined to an average of 0.33 ± 0.5 (p < 0.001). The mean smile aesthetic score pre-depigmentation was 6.72 ± 0.32, whereas after depigmentation the scores significantly improved to 7.91 ± 0.18 (p = 0.001). Spearman correlation indicated a statistically significant negative association between smile aesthetics scores and OPI scores (r = –0.76). ICC indicated excellent inter-rater reliability for the OPI (0.923) and good reliability for smile esthetic scores (0.756). Conclusions: The study found that gingival de-pigmentation procedures improve the OPI scores and laypeople perceive gingival hyperpigmentation unattractive. While gingival depigmentation is not mandatory, it may be recommended for individuals seeking cosmetic smile enhancements post-orthodontic therapy to improve the overall patient satisfaction.

The gut microbiota, a complex ecosystem of microorganisms, plays an essential role in maintaining immune and metabolic homeostasis. Disruption of this microbial balance, known as dysbiosis, has been increasingly implicated in the pathogenesis of chronic inflammatory conditions, including cardiovascular, gastrointestinal, and autoimmune diseases, as well as metabolic disorders such as diabetes and obesity. A crucial mechanism through which the gut microbiota exerts its effects on host physiology is via the production of bioactive metabolites. These metabolites, including short-chain fatty acids, bile acids, and tryptophan derivatives, are key in modulating immune responses and regulating metabolic functions. Dysbiosis disrupts the production and function of these metabolites, thereby contributing to immune dysregulation, chronic inflammation, and disease progression. This review examines the role of gut microbiota-derived metabolites in chronic inflammatory diseases, with a focus on their immunomodulatory and metabolic effects. A deeper understanding of these mechanisms may open the way for novel therapeutic strategies aimed at restoring immune homeostasis and mitigating the global burden of chronic inflammatory diseases.

Systemic hypertension, a significant global health issue and a leading risk factor for cardiovascular mortality affects half of the adult population, with increasing prevalence notably in low- and middle-income countries. Despite advancements in diagnosis and treatment, only one in four individuals with hypertension achieve satisfactory control over their condition. Medication adherence, critical for effective hypertension management, is complex and multifaceted. Non-adherence, encompassing late or non-initiation, sub-optimal implementation, and early discontinuation of treatment, is prevalent worldwide, with reported rates of anti-hypertensive medication non-adherence ranging from 30% to 40%. Adherence is influenced by various factors including drug regimen complexity, patient education, and socioeconomic status. Poor adherence is linked to increased cardiovascular risks and is compounded by clinical inertia among physicians. Addressing barriers to adherence and implementing evidence-based interventions can significantly reduce the global burden of hypertension and its associated complications. This review highlighted the critical need for improved adherence strategies to enhance hypertension management. It focused on novel tools such as mobile health interventions and regimen-simplification through single-pill combinations, which can improve treatment persistence and blood pressure control.

The Age-Friendly Health System movement has been a unifying factor in caring for older adults at the University of Utah Health. Despite progress, challenges to efficient healthcare collaboration exist, particularly between geriatric primary care and oral health. This manuscript presents four of those challenges (lack of communication between medical and dental providers, the distance between medical and dental services, patient discomfort with the inclusion of oral health in primary health care, and provider discomfort in requesting oral health information in medical encounters) with the solutions derived at the University of Utah Health. Leaders at University of Utah Health developed five interventions to address these challenges (participation in the development of EPIC Wisdom©, a fully integrated oral health record in the electronic health record (EHR), co-location in new centers and oral health consultation in existing centers, implementing a geriatric health assessment that included oral health, widespread adoption of the 4 Ms framework). Applying the lessons learned from these challenges can benefit all older adults and may help prevent the conditions associated with periodontal disease.

Regenerating gene (Reg) was first isolated in 1988 and proposed to be specifically expressed in rat regenerating pancreatic islets. Since then, many genes homologous to Reg have been discovered in other species, including humans, mice, hamsters, rabbits, sheep, dogs, cats, pigs, giant pandas, chickens, and frogs. Moreover, Reg and its related genes (Reg family genes) have been classified as types I, II, III, and IV. They are closely associated with cell and tissue regeneration, cell proliferation, and anti-apoptosis in various tissues and cells including pancreatic β cells. In particular, focusing on the digestive organs and tissues, there have been reports that they play important roles not only in stomach, colon, liver, and pancreatic duct cancer, but also in intestinal epithelial cells, especially inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC). This review describes and discusses the expression of Reg family genes in intestinal epithelial cells of those affected by IBD and the molecular mechanisms underlying this expression.

Aim: Non-adherence is an important cause of uncontrolled hypertension. We investigated the prevalence of non-adherence to antihypertensive medications by serum drug concentration measurements in a cohort of Norwegian patients from the general population treated for hypertension. We also identified characteristics associated with non-adherence. Methods: Patients with hypertension using ≥ 2 antihypertensive agents were invited to participate in this national study performed in a semi-blinded fashion. Exclusion criteria were dementia, substance or alcohol abuse, pregnancy, terminal illnesses, poor Norwegian language skills, or severe kidney failure [glomerular filtration rate (GFR) < 30 mL/min/1.73 m2]. All patients had their antihypertensive drugs in serum analyzed by ultra-high-pressure liquid chromatography-tandem mass spectrometry to identify their adherence to the 23 most used antihypertensive agents. Additionally, they underwent a thorough standardized interview, office blood pressure (BP), and 24-hour ambulatory BP measurement. Results: n = 1,151 patients were investigated for BP control and drug adherence. Among these, n = 79 (6.9%) patients were identified as non-adherent, and n = 1,072 (93.1%) patients were identified as adherent by pharmacologists who reviewed the drug concentrations in blood in relation to self-reported prescribed medications. We found the non-adherent patients to be younger (56.9 vs. 63.7 years, p < 0.001), with higher systolic and diastolic office BP (150.4/91.4 vs. 143.2/82.0 mmHg, p < 0.01) and less likely to be of European ethnicity (82.9% vs. 95.8%, p < 0.001). Factors associated with non-adherence in logistic regression analysis were age, number of antihypertensive pills, non-European ethnicity, and inversely the use of angiotensin receptor blockers. Conclusions: We found fewer non-adherent patients than expected in patients on ≥ 2 antihypertensive drugs compared to previous investigations of patients on ≥ 3 antihypertensive drugs. We believe that selection at inclusion or possibly a higher confidence in physicians’ authority may be of importance. Adherence was significantly and negatively related to younger age, non-European ethnicity, and increasing number of prescribed antihypertensive pills, and positively to the type of prescribed medication, especially angiotensin receptor blocker (www.ClinicalTrials.gov identifier: NCT03209154).

The International Agency for Research on Cancer (IARC) Monographs Programme plays an important role in cancer prevention by identifying potential carcinogenic hazards. However, the terminology used in IARC’s classifications and Monographs can confuse the public, health professionals, and policymakers. Terms like “carcinogenic to humans” imply causation, although classifications only indicate increased risk under certain conditions. For example, the lifetime incidence of mesothelioma among firefighters is approximately 14 in 10,000, compared to 7 in 10,000 in the general population. Despite doubling the risk, occupational exposure as a firefighter does not cause this type of cancer in 9,986 out of 10,000 firefighters. However, the IARC concludes that “occupational exposure as a firefighter causes mesothelioma” (IARC Working Group on the Identification of Carcinogenic Hazards to Humans. Occupational Exposure as a Firefighter. Lyon: IARC; 2023. pp. 1–730. PMID: 37963216). In addition, the lack of essential information about dosage and context in the IARC carcinogen lists can lead to agents with health benefits under certain conditions (e.g., solar radiation, red meat consumption, approved drugs) being perceived as universally harmful, discouraging beneficial exposures, behaviors, or treatments. Here, I propose renaming the groups of agents classified by the IARC and adding basic labels to specific agents to improve the accuracy and interpretability of the IARC classification lists. These adjustments do not interfere with the IARC’s objective of identifying potential hazards, are easy to implement, and enhance accuracy and clarity, providing stronger support to guide cancer prevention strategies.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging and rapidly growing health problem that currently affects more than one-third of the world general population and more than two-thirds of patients with obesity or type 2 diabetes. MASLD is associated with one or more cardio-metabolic risk factors (CMRFs) that determine the complexity of its natural history and management. Although the term MASLD encompasses a single disease, each CMRF has a different impact on MASLD, and the number of overlapping CMRFs results in a different rate of progression and outcomes of both liver and systemic disease. Its pathogenesis is characterized by insulin resistance, lipotoxicity and a complex cross-talk between liver, adipose tissue, muscle, intestine through the release of hepatokines, cytokines, myokines and inflammatory products. The stage of liver fibrosis is the best predictor of liver outcomes, such as liver failure and mortality, and also predicts the high risk of all-cause mortality associated with the disease. In many cases, the development of hepatocellular carcinoma (HCC) is associated with advanced fibrosis or cirrhosis, although it can occur at all stages of the disease, making prevention difficult. MASLD is characterized by increasing very low-density lipoprotein (VLDL) secretion and chronic low-grade systemic inflammation, which increase the risk of cardio-vascular, renal, and endocrine diseases and extrahepatic cancer. Thus, the management of MASLD requires a holistic approach and treatment of CMRFs through multispecialty collaboration. Currently, diet and physical activity are the effective first-line approaches. There are no approved drugs for the treatment of MASLD, apart from resmetirom, which in a percentage of cases improves metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis. We summarize the wide and varied recent literature on the complex etiopathogenetic, clinical and therapeutic aspects of MASLD, connecting and interpreting it to facilitate clinical and management approaches.

Chronic pain, affecting approximately 30.3% of adults worldwide, presents a significant global health issue, severely impacting individuals’ quality of life and creating substantial socioeconomic challenges. Traditional pain management methods, such as physical therapy and pharmacological treatments, primarily focus on the biological aspects of pain while often neglecting the psychological and social factors. However, recent advancements in neuroscience have revealed that chronic pain is influenced by changes in the central nervous system, including mechanisms like central sensitization and neuroplasticity. This paper examines contemporary neuroscience-informed interventions, including Pain Neuroscience Education (PNE), mindfulness practices, and cognitive functional therapy (CFT), which target these neurobiological changes to improve pain perception and behaviors. These interventions help rewire the brain’s pain pathways, promoting long-term pain relief and functional recovery. Additionally, combining neuroscience-based approaches with conventional therapies has been shown to enhance treatment outcomes. This work emphasizes the need for personalized approaches and the integration of emerging technologies to enhance the accessibility and effectiveness of chronic pain management.

Aim: The present study was designed to assess the effectiveness of topical application of sulfasalazine in combination with topically applied corticosteroids versus using topical steroids alone as the standard control in management of symptomatic oral lichen planus (OLP). Methods: The trial involved 46 participants having symptomatic OLP. Subjects included were divided into two equal groups at random. Group C (control group), in this group patients were treated with topically applied corticosteroids only as the standard treatment of OLP. In Group T (test group) topical sulfasalazine was used in combination with topical corticosteroids in management of the OLP cases. The patients used the topical applications four times per day in an alternate sequence (in Group T). The treatment schedule was continuous for 4 weeks with one visit weekly as a follow-up. Oral hygiene measures were strictly applied with total elimination of plaque with calculus deposits removal as they implement inflammation intra-orally and ‎exaggerate together distribution and signs of OLP lesions. Each group underwent pain assessment and sign score recordings both before and after the used management strategies. Results: The results of all patients reported no unwanted reactions or complications using both treatment strategies. Both study groups reported a significant decrease in the pain scale and sign score recordings over time as shown within the intragroup findings. Group T experienced a significantly higher reduction in pain scale (starting at two weeks) and sign score results (starting at three weeks) as compared to Group C. Conclusions: Based on the data presented in this study, combination of topical sulfasalazine with topical corticosteroids is an efficient treatment in management of OLP in terms of decreasing pain scale and sign score values (Clinical Trials.gov with registration number NCT06060301).

Aim: This study compared curved canal’s apical transportation by using Neoniti A1 with/without Neoniti C1 using cone-beam computed tomography (CBCT). Methods: This experimental in vitro study was conducted to analyze the mesiobuccal canals of extracted mandibular and maxillary molars (n = 62) with 20°–40° curvature. After determining the length of the roots, they were mounted in a custom-made holder and randomly sorted into two groups (n = 31). The roots underwent preoperative CBCT. Root canals in group 1 were only remodeled using the Neoniti A1 file while in group 2, the coronal third of the root canals was first prepared with Neoniti C1, and then the remaining part of the canal was instrumented with Neoniti A1. CBCT images were obtained again, and the preoperative and postoperative CBCT scans were compared using Romexis software to determine canal transportation at 3 mm, 5 mm, and 7 mm from the apex. Data analysis was done using SPSS 18. Results: Canal transportation was lower in the C1 + A1 group compared with the A1 group at all levels, but not significantly (P > 0.05). Canal transportation in both groups was < 0.03 mm at all levels from the apex. In the C1 + A1 group, canal centering was more elevated compared to the A1 group and at 3 mm from the apex, the two groups experienced a significant difference in centering ratio (P = 0.013). Conclusions: The use of Neoniti A1 files alone does not increase canal transportation in curved canals; however, the centering ability was higher in the use of C1 + A1. Therefore, coronal flaring is suggested.

Team-based care is a patient management strategy involving a team of at least two healthcare professionals working collaboratively toward a shared clinical goal. This approach is now increasingly recommended by international hypertension guidelines mainly to improve medication adherence and hence, blood pressure control. The goal of this paper was to review the most recent evidence on the benefits of a team-based care approach in the management of hypertension. The results show that in recent years, numerous controlled clinical trials have demonstrated the efficacy of this strategy to lower blood pressure, achieve blood pressure targets more rapidly, and obtain more hypertensive patients under control. These improvements are due essentially to two factors: improved drug adherence/persistence and a reduction of therapeutic inertia. Best results are obtained when physicians collaborate with pharmacists and/or nurses, but other healthcare professionals may be involved successfully as well. Recent data have also demonstrated that the team-based care approach is cost-effective. These observations should be a strong incentive for hypertension centers to engage in the development of a team-based care strategy.

Aim: Although xerostomia, smell, and taste dysfunctions are prominent signs of COVID-19 infection, long-term data regarding their prevalence and recovery rates is scarce. Accordingly, this study aimed to evaluate the frequency and persistence of xerostomia, taste, and smell disturbances in COVID-19 survivors over 3 years in an Egyptian sample. Methods: This cross-sectional study used an online questionnaire to assess the oral symptoms of xerostomia, which include altered taste and smell. Data was collected from 826 patients recovered from COVID-19. Results: Xerostomia was the most frequent finding affecting 73.6% of the studied sample, followed by smell disturbances affecting 67.8%, and altered taste reported by 54.6%. Xerostomia lasted less than 1 year in 48.3% of cases, up to 2 years in 10.4%, and up to 3 years in 7.2% of the study sample. Altered taste lasted less than 1 year in 77.8% of cases, up to 2 years in 2%, and up to 3 years in 0.4% of the study sample. Smell disturbances lasted around 1 month in 62.1% of cases, from 2–3 months in 36.1%, up to 1 year in 1.6%, and up to 2 years in 0.2% of the study sample. Xerostomia altered taste and smell, which impaired the quality of life and was more frequently observed in females than in males in the studied sample. Conclusions: COVID-19 has a major and long-term impact on oral health, with frequent, intense, and longstanding oral symptoms that may impair a patient’s quality of life.

Aim: This study aimed to explore the feasibility and preliminary efficacy of cinobufacini in patients with oral premalignant lesions (OPLs). Methods: Patients with histologically confirmed OPLs participated in an open-label uncontrolled pilot clinical study and received a 4-week or 12-week treatment, the efficacy and safety of cinobufacini for the treatment of OPLs were assessed. Results: During the treatment course ranging from 4 weeks to 12 weeks, no one withdrew because of adverse effects, no one had clinical or histologic progressive disease. Of the 8 participants who took cinobufacini for 12 weeks, one had a complete clinical response, and 4 had a complete histologic response. Of note, 9 participants had varying degrees of pain reduction. Conclusions: This small pilot study supports the feasibility of a larger clinical trial to evaluate the efficacy of cinobufacini in the treatment of OPLs [Chinese Clinical Trial Registry (chictr.org.cn) identifier: ChiCTR2300068529].

Oral cancer is rare in Western nations but widespread in high-risk regions around the globe. Risk factors, such as tobacco usage, alcohol intake, and betel nut chewing, enhance the chance of the illness, making it mostly avoidable. Due to its high mortality, early detection is crucial. Prevention and diagnosis begin with oral mucosa lesions that may be malignant and local diseases that cause persistent inflammation. Clinical therapies for oral cancer mostly include surgery, radiation, and chemotherapy. Unsatisfactory therapeutic impact and harmful side effects remain clinical treatment’s key issues. Future research should examine the cancer microenvironment and treatment. This review examined oral cancer risk factors, preventative strategies, and early diagnostic approaches. This review also discusses immunotherapy methods for countering this fatal disease. Immunotherapy targeting the cancer microenvironment may provide a novel oral cancer treatment.

Cervical cancer is the fourth leading cause of cancer-related deaths among women worldwide, causing over 660,000 new cases and 350,000 deaths in 2022, with a disproportionately high burden in low-resource countries where access to treatment is limited. Human papillomavirus (HPV) is a common sexually transmitted infection that accounts for approximately 95% of cervical cancer cases. Persistent HPV infection can progress to cervical dysplasia, categorized into varying severities (CIN1, CIN2, and CIN3), which significantly increases cancer risk. The mechanism of HPV-induced malignancy involves the disruption of cellular apoptosis by integrating viral genetic material into cervical cells, particularly within the transformation zone. The viral proteins E6 and E7 play pivotal roles in cervical carcinogenesis by inhibiting tumor suppressor proteins, promoting uncontrolled cell proliferation, and evading immune responses, ultimately driving progression toward malignancy. Timely detection and intervention are essential for managing HPV-related cervical cancers. Preventative measures such as HPV vaccination have demonstrated substantial efficacy. Six vaccines targeting high-risk (HR) HPV strains are recommended before sexual activity or exposure. Despite these advancements, barriers, such as misinformation, logistical challenges, and limited healthcare infrastructure, persist, particularly in underserved regions. Advances in diagnostic and therapeutic technologies have offered new avenues for addressing these challenges. Next-generation sequencing and CRISPR gene editing are emerging as promising tools for HPV-related cancer treatment that enable precise and targeted interventions. Furthermore, artificial intelligence (AI) and imaging innovations have significantly enhanced diagnostic accuracy and personalized care. Pap smears and HPV DNA testing are indispensable tools for early detection. To tackle HPV-related cervical cancer globally, a multifaceted approach is required. Public health education, vaccination programs, research, and international collaboration are crucial. Public health campaigns should combat misinformation, strengthen vaccination programs, and focus on novel therapies, screening technologies, and next-generation sequencing.