Disease and Health Research: Recent Developments Vol. 2

A Directory of Poor Prognostic Markers of Breast Cancer for the Oncology Practice

2026-09-15T09:54:57+00:00

Breast cancer is biologically heterogeneous, and the prognostic significance of a biomarker depends on molecular subtype, disease stage, treatment exposure, assay method and the clinical outcome under evaluation. This narrative evidence directory organises reported biomarkers associated with unfavourable outcomes in breast cancer and distinguishes their potential roles in prognosis, treatment response and disease monitoring. The literature was identified through an iterative manual search of peer-reviewed publications and relevant review articles. Eligible material included clinical studies and evidence syntheses that reported an association between a tissue, cellular, molecular, immune, circulating or clinicopathological marker and recurrence, metastasis, treatment resistance, progression-free survival, disease-free survival or overall survival. The extracted markers were grouped by general or unspecified breast cancer, triple-negative breast cancer, invasive disease, metastatic disease, luminal subtypes, HER2-positive disease, basal-like disease, male breast cancer, uncommon presentations, immunotherapy-related settings and treatment-associated contexts. The resulting tables contain more than 200 reported markers. This breadth illustrates the intensity of biomarker discovery but does not imply equivalent evidentiary strength or clinical readiness. Established markers such as oestrogen receptor, progesterone receptor, HER2, tumour stage, histological grade and selected validated multigene assays have substantially greater clinical support than most exploratory single-gene or bioinformatic candidates. The directory is therefore intended as a structured map of published associations rather than a clinical testing guideline. Translation into routine oncology practice requires analytical validation, independent clinical validation, clearly defined cut-offs, demonstration of incremental prognostic value and evidence that testing improves clinical decision-making.

Low-grade Chronic Inflammation as a Common Pathway for Chronic Diseases: A Review from a Public Health Perspective

2026-09-15T10:00:10+00:00

Low-grade chronic inflammation is increasingly invoked as a shared biological pathway linking diverse chronic diseases, yet the phrase often compresses distinct tissue processes, biomarkers and causal relationships into a single explanatory label. This critical narrative review evaluates when chronic systemic inflammatory activity functions as a mechanistic contributor, when it is primarily a marker of disease burden, and when disease-specific pathways limit the usefulness of a unifying model. Literature published from 1 January 1990 to 31 May 2026 was selected through searches of PubMed/MEDLINE and OpenAlex, supplemented by citation tracing and bibliographic verification against authoritative records. Evidence was appraised across experimental studies, longitudinal cohorts, genetic analyses, systematic reviews and outcome-driven clinical trials. The strongest support for a causal inflammatory pathway occurs in atherosclerotic cardiovascular disease, where interleukin-1/interleukin-6 signalling, clonal haematopoiesis and randomised anti-inflammatory trials converge. In obesity, type 2 diabetes and metabolic dysfunction-associated steatotic liver disease, nutrient excess, adipose immune remodelling, inflammasome activation and impaired resolution form reciprocal loops with insulin resistance and tissue injury. In chronic kidney disease, cancer and neurodegeneration, inflammation is biologically important but more context-dependent, frequently acting as both cause and consequence. Ageing, senescent-cell secretomes, trained immunity, gut-barrier disturbance, sleep loss and psychosocial adversity can amplify inflammatory tone across organ systems. Nevertheless, single measurements of C-reactive protein or interleukin-6 are temporally variable, biologically non-specific and insufficient to identify the relevant tissue source or therapeutic target. Lifestyle interventions can reduce inflammatory biomarkers, but biomarker improvement does not automatically establish reduced clinical risk. Broad immunosuppression is therefore an unsuitable population strategy; benefit depends on disease stage, pathway selection and baseline inflammatory risk. A defensible common-pathway model treats low-grade inflammation as a network amplifier within multimorbidity rather than a universal initiating cause. Progress requires repeated and tissue-informed phenotyping, causal triangulation, diverse longitudinal cohorts and trials that connect pathway modulation to patient-important outcomes.

Biodentine and Mineral Trioxide Aggregate in Endodontic Repair and Regeneration: A Critical Appraisal of Material Biology, Clinical Evidence and Translational Limitations

2026-09-15T10:10:24+00:00

Hydraulic calcium silicate cements have changed endodontic repair from passive defect filling towards materials that can seal in moist fields, release biologically active ions and support mineralised tissue formation. Mineral trioxide aggregate (MTA) established this class, whereas Biodentine was designed to improve handling, setting speed and colour stability. This critical narrative review evaluates whether these differences translate into clinically meaningful advantages across vital pulp therapy, perforation repair, root-end surgery, apexification and regenerative endodontic procedures. Literature published from 1993 to 31 May 2026 was selected through live searches of biomedical indexes, full-text repositories, DOI records and citation chains, followed by critical appraisal of methodological quality, clinical relevance and consistency. Both materials hydrate to calcium silicate hydrate phases and calcium hydroxide, generating alkaline, calcium-releasing interfaces that can promote apatite precipitation and reparative mineralisation. Biodentine generally offers faster setting and easier placement, while MTA has a longer and broader clinical evidence base. Direct comparative trials in pulpotomy and primary-tooth therapy usually show similar short- to medium-term success, but estimates remain constrained by modest sample sizes, heterogeneous diagnostic criteria, operator-dependent protocols and limited follow-up. MTA has stronger longitudinal evidence for perforation repair, apical plugs and root-end filling; evidence for Biodentine in these indications is biologically plausible but less mature. In regenerative endodontics, both act principally as coronal barriers rather than as complete regenerative systems, and favourable radiographic outcomes should not be equated with restoration of a normal pulp-dentine complex. Discolouration, washout, radiopacity, restoration timing and blood contamination remain formulation- and context-dependent concerns. The most defensible conclusion is not universal superiority of one cement, but indication-specific selection based on evidence maturity, operability, aesthetic risk and quality of coronal sealing. Future progress requires standardised material characterisation, core outcome sets, adequately powered pragmatic trials and mechanistic studies that link laboratory bioactivity to patient-centred outcomes.

Assessment of Dietary Intake and Body Mass Index among Tuberculosis Patients Receiving Anti-tuberculosis Treatment in Namibia: A Cross-Sectional Study

2026-09-15T10:16:07+00:00

Background: Tuberculosis (TB) remains a major global public health problem. It is strongly associated with undernutrition, which adversely affects immune function, disease progression and treatment outcomes. Although the role of nutrition in the management of TB is well recognised, evidence on dietary intake and the nutritional status of patients with TB in Namibia remains limited.

Aim: This study aimed to assess dietary intake and body mass index (BMI) among patients with TB receiving anti-tuberculosis treatment in Namibia.

Methods: A descriptive cross-sectional study was conducted among 111 patients with TB receiving anti-tuberculosis treatment at Katutura, Havana and Okuryangava Health Centres from September 2022 to March 2023. Dietary intake was assessed using a two-day, interviewer-administered 24-hour dietary recall, and anthropometric measurements were used to determine BMI according to World Health Organization classifications. Nutrient intake was analysed using Cronometer software, and the data were analysed using IBM SPSS Statistics version 27. Descriptive statistics, Pearson's correlation analysis and chi-square tests were performed, with statistical significance set at p < 0.05.

Results: Dietary assessment showed inadequate intakes of energy, protein, fat, calcium, zinc and folic acid. Intakes of vitamins A, C, D, B12, thiamine and riboflavin were particularly inadequate. Only carbohydrate, iron and niacin intakes reached fair levels of nutritional adequacy. Weak, non-significant correlations were observed between dietary nutrient intake and BMI, with vitamin C showing the strongest positive correlation (r = 0.164, p = 0.086). Nutritional status was significantly associated with age group, marital status, educational level and employment status (p < 0.05). Sex, religion, cigarette smoking, alcohol consumption, TB type and DOTS participation were not significantly associated with nutritional status.

Conclusion: Patients receiving anti-tuberculosis treatment had widespread inadequacies in macro- and micronutrient intake despite a mean BMI at the lower limit of the normal range. The results suggest that BMI alone may not provide an adequate measure of nutritional status. The results emphasise the need to improve nutritional care within tuberculosis programmes in Namibia. Anthropometric and dietary assessments should form part of routine nutritional review to identify macro- and micronutrient deficiencies early.

Artificial Intelligence, the Clinician–patient Relationship and the Democratisation of Health Care: A Critical Narrative Review

2026-09-15T10:19:20+00:00

Artificial intelligence has moved from retrospective evaluation into everyday clinical settings, and two claims now dominate professional and policy discussion. The first holds that these systems will return relational time and attention to the consultation by absorbing administrative labour. The second holds that they will democratise health care by widening access to expertise that has historically been rationed by geography, workforce supply and cost. Both claims carry considerable normative weight, and both are being used to justify rapid procurement decisions, yet the evidence supporting them originates in separate research traditions and has rarely been appraised together. This critical narrative review examines the strength, consistency and limitations of that evidence, treating relational quality and distributive justice as interdependent rather than as parallel concerns. Literature was identified through structured searching of biomedical and multidisciplinary indexes, supplemented by backward and forward citation tracking and by authoritative institutional guidance. The synthesis is organised around five analytical problems: the reallocation of clinician attention through ambient documentation and drafted correspondence; the evidentiary status of machine-generated empathy; the redistribution of epistemic authority and its consequences for trust; cognitive dependence, skill erosion and the location of responsibility; and the conditions under which broader access translates into narrower inequity. The available evidence indicates that documentation technologies reliably improve clinician-reported workload and burnout, that objective efficiency gains are far less consistent, and that direct measurement of patient-experienced relational quality remains conspicuously scarce. Comparative studies favouring machine-generated communication rest predominantly on asynchronous text and clinician-rater judgements rather than on encounters with real patients. Evidence bearing on democratisation is weakest precisely where the claim is strongest, since deployment, evaluation and training data remain concentrated in high-income and academic settings. Confidence in current conclusions is limited by short observation periods, single-site designs and reliance on self-report. Priorities are proposed for evaluation that measures relational and distributive outcomes directly.

Spondylodiscitis: A Practical Approach to Diagnosis and Treatment Integrating Current Evidence with a Single-Center Clinical Series

2026-09-15T10:22:40+00:00

Aims: To provide a practical, evidence-based approach to bacterial spondylodiscitis and to integrate current recommendations with the clinical experience of a tertiary infectious diseases centre.

Study Design: Narrative clinical review complemented by a retrospective descriptive case series.

Place and Duration of Study: Infectious Diseases clinical practice in Timișoara, Romania; the local series included 18 patients managed between 2024 and 2026.

Methodology: Current recommendations and recent literature on native vertebral osteomyelitis/spondylodiscitis were synthesised with emphasis on diagnostic microbiology, magnetic resonance imaging, antimicrobial treatment, surgical indications and follow-up. An anonymised retrospective dataset of 18 selected patients with bacterial spondylodiscitis was analysed descriptively. Continuous variables are reported as median and interquartile range (IQR) where appropriate, and categorical variables as numbers and percentages.

Results: Median age was 71 years [IQR 69-79], 72.2% of patients were women and 50.0% had diabetes mellitus. Back pain was present in all patients, whereas fever occurred in 27.8% and neurological deficit at diagnosis in 38.9%. Median time from symptom onset to diagnosis was 105 days [IQR 90-180]. Median initial C-reactive protein was 156 mg/L [IQR 145-189]. Blood cultures were positive in 4/18 patients (22.2%); documented pathogens included methicillin-resistant Staphylococcus aureus and extensively drug-resistant Klebsiella pneumoniae. MRI was performed in all cases. Paravertebral and psoas abscesses were recorded in 77.8% and 72.2%, respectively. All patients were treated conservatively, with a median of 30 days of intravenous therapy followed by oral treatment; total treatment duration was usually 12 weeks. Clinical improvement was recorded in all patients and no deaths were documented.

Conclusion: Spondylodiscitis requires early clinical suspicion, prompt MRI and active pursuit of microbiological aetiology. Stable patients should ideally undergo microbiological sampling before empirical antibiotics. Most uncomplicated bacterial cases can be treated for approximately 6 weeks, while longer courses may be appropriate in selected complicated patients. The local series highlights diagnostic delay, low frequency of fever and limited microbiological confirmation as practical challenges.

Horizontal and Vertical Root Fracture: A Literature Review

2026-09-15T10:27:23+00:00

Root fractures are a biomechanically heterogeneous group of dental hard tissue injuries. They are broadly classified into horizontal (transverse) and vertical fractures, which have different aetiology, clinical behaviour and prognosis. Horizontal root fractures are primarily of traumatic origin, most often observed in the maxillary central incisors of young patients. They have a considerable biological capacity for healing by calcified tissue, connective tissue or a combination of bone-and-connective-tissue interposition, when the coronal fragment is immediately repositioned and splinted. Vertical root fractures, however, are more likely to be a fatigue-failure phenomenon of structurally compromised, often endodontically treated teeth. They may present insidiously with non-specific symptoms such as localised deep periodontal pockets, sinus tracts and angular bone loss that closely resemble periodontal or persistent endodontic disease. Therefore, diagnosis is one of the main clinical challenges in this field. This review summarises the current evidence on classification, pathogenesis, clinical features and diagnostic pathways for both types of fracture, with particular emphasis placed on the comparative value of clinical testing, conventional periapical radiography and cone-beam computed tomography (CBCT), together with adjunctive techniques such as transillumination, dye-based staining and surgical exploration. Management strategies based on fracture type are discussed, including repositioning, splinting and selective endodontic therapy for horizontal fractures and intentional replantation, surgical repair, root resection or hemisection and extraction for vertical fractures. Prognostic factors such as fracture completeness, periodontal involvement, contamination and timeliness of diagnosis are discussed in the light of new diagnostic and therapeutic advances such as artificial intelligence-assisted image analysis, high-resolution CBCT and calcium silicate-based biomaterials. We suggest a structured clinical decision-making algorithm to support evidence-based management of suspected root fractures in routine practice.