Medical Science: Recent Advances and Applications Vol. 11

Rooting Out Pain: PIPS and SWEEPS in the Battle against Postoperative Discomfort

2025-09-20T11:23:17+00:00

Background: A successful root canal isn’t just about shaping the canals—it’s about making sure they are completely clean and free from bacteria. Traditional syringe irrigation often struggles to reach the tiny, hidden spaces inside a tooth, which can leave bacteria behind and cause pain after treatment.

Aim: This article looks at how two modern laser-based techniques—Photon-Induced Photoacoustic Streaming (PIPS) and Shockwave-Enhanced Emission Photoacoustic Streaming (SWEEPS)—help improve cleaning and reduce post-treatment discomfort, comparing them with ultrasonic, sonic, and conventional irrigation methods.

Methods: We reviewed recent research, including laboratory and clinical studies, that evaluated how well PIPS and SWEEPS remove debris and bacteria, and how they affect patient comfort after treatment.

Results: Both PIPS and SWEEPS use bursts of Er:YAG laser energy to create shockwaves in the cleaning solution like EDTA, NaOCl and saline, pushing it deep into complex canal spaces without inserting tips into the canal. SWEEPS, with its well-timed dual pulses, produces stronger waves that are especially effective in curved or narrow canals. Studies consistently show these techniques clean better and cause less discomfort afterwards than older methods. Still, the cost, need for training, and equipment care can limit their use.

Conclusion: PIPS and SWEEPS are changing how dentists clean root canals, offering better results and a smoother recovery for patients. As the technology becomes more advanced and accessible, it’s likely to play a bigger role in everyday dental care.

Fascial Planes in Head and Neck Malignancies: Predictors of Tumor Spread and Guides for Surgical Management

2025-09-20T11:29:05+00:00

Fascial planes in the head and neck play a dual role as barriers and conduits for tumor spread, making them clinically significant in the management of malignancies. This review synthesizes evidence from anatomical, surgical, and imaging studies to highlight their role in predicting invasion pathways, guiding resection margins, and improving oncologic outcomes. Surgical techniques that incorporate fascial boundaries have been shown to increase nodal yield, reduce recurrence, and preserve vital functions. Advances in imaging, including MRI and novel PET tracers, further enhance visualization of tumor margins and perineural spread, supporting more precise planning and intraoperative decision-making. Despite their importance, inconsistencies in nomenclature and classification of fascial planes continue to limit standardization and interdisciplinary communication. Future research should focus on consensus-driven terminology, integration of emerging technologies such as deep learning, and validation of fascial plane-based approaches in large-scale, prospective studies. Integrating fascial anatomy into clinical practice may enhance oncologic outcomes while supporting functional preservation in patients with head and neck cancer.

Augmented Reality-Guided ENT Surgery: Enhancing Accuracy with High-Fidelity Anatomy

2025-09-20T11:33:06+00:00

Augmented reality (AR) is increasingly being adopted in otolaryngology for enhancing anatomical visualisation and guiding complex surgical procedures. This review synthesises current evidence on the role of AR in ear, nose, and throat (ENT) surgery with an emphasis on high-fidelity anatomy. Published studies demonstrate that AR systems provide sub-millimetric accuracy in intraoperative navigation, reduce operative time, and improve surgeon confidence, particularly in anatomically intricate regions such as the temporal bone, middle ear, and skull base. Advances in optical see-through head-mounted displays, marker-less registration, and multimodal imaging integration have improved reliability and ergonomics in the operating room. Beyond intraoperative use, AR has shown strong potential in surgical education and simulation, offering interactive training modules that outperform conventional teaching methods in skill acquisition and anatomical comprehension. Despite these benefits, challenges remain regarding registration drift, device ergonomics, cost, and the absence of standardised evaluation metrics. Current evidence is largely based on feasibility studies and small clinical series, underscoring the need for large-scale randomised trials. Overall, AR-guided ENT surgery is a rapidly advancing field with significant implications for surgical safety, efficiency, and training, poised to become an integral component of routine clinical practice in the near future.

Comprehensive Characterisation and Therapeutic Evaluation of EGFR-Targeted Gelatin Nanoparticles for Cancer Therapy

2025-09-20T11:37:35+00:00

The emergence of nanotechnology-based drug delivery systems has revolutionized cancer treatment by enabling targeted therapeutic approaches that can specifically accumulate within tumor tissues while minimizing off-target effects. Epidermal growth factor receptor (EGFR)-targeted gelatin nanoparticles represent a promising approach for cancer therapy through selective drug delivery to EGFR-overexpressing tumour cells. A better understanding of the biological barriers and the pathophysiological principles of GE11- modified tumor-targeting nanoparticles will be promoted, especially through the study of the targeting delivery process of GE11 peptide-modified liposomes. This research paper comprehensively examines the observation methods and analytical processes for characterizing EGFR-targeted gelatin nanoparticles, focusing on their synthesis, modification, and therapeutic applications. The study evaluates various characterisation techniques including transmission electron microscopy (TEM), scanning electron microscopy (SEM), dynamic light scattering (DLS), Fourier transform infrared spectroscopy (FTIR), and in vitro cellular assays. The methodology encompasses both experimental design principles and analytical protocols based on established practices in the literature. Secondary data analysis was conducted through a comprehensive review of recent literature published between 2020-2024. A total of 40 peer-reviewed publications were systematically analyzed to extract quantitative data on nanoparticle properties, targeting efficiency, and therapeutic outcomes. Primary data analysis encompasses original research findings from laboratory studies conducted to evaluate EGFR-targeted gelatin nanoparticle systems. The analysis includes experimental data from nanoparticle synthesis, characterisation, and biological evaluation studies. Primary data analysis reveals that GE11 peptide-modified gelatin nanoparticles demonstrate enhanced cellular uptake in EGFR-positive cancer cell lines, with particle sizes ranging from 150-300 nm and encapsulation efficiencies exceeding 85%. Secondary data analysis from recent studies indicates significant therapeutic improvements, with targeted formulations showing 60-75% greater efficacy compared to non-targeted controls in various cancer models. The findings demonstrate that multi-modal characterization approaches are essential for optimizing EGFR-targeted gelatin nanoparticle systems, providing critical insights for translating these therapeutic platforms from laboratory research to clinical applications. The successful translation of these research findings into clinical applications has the potential to significantly improve outcomes for cancer patients while reducing treatment-related side effects.

Current Approaches to the Management of Recurrent Inguinal Hernias: A Review

2025-09-20T11:41:01+00:00

Recurrence of inguinal hernias after repair is a problem in the surgical management of this condition. The management of recurrent inguinal hernia remains an area of concern, with the choice of surgical repair dictated by the primary repair performed. The principle of management is that if an anterior approach is performed, then the recurrence is repaired with a posterior approach, and vice versa. The aim here is to repair the hernia in a clean, adhesion-free anatomical plane. A literature review was conducted using PUBMED, Cochrane database of clinical reviews, and Google Scholar, focusing on clinical trials, observational studies, cohort studies, systematic reviews, and meta-analyses from 1995 to 2025. The common approaches include the laparoscopic repairs, like the transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP). The open pre-peritoneal repair can also be performed for recurrent inguinal hernias. This review discusses the various surgical procedures that are performed for recurrent inguinal hernias and the risk factors for recurrence. The optimal management of recurrent inguinal hernias depends on the initial repair technique. For recurrences after a Lichtenstein repair, a pre-peritoneal approach (open or laparoscopic) is preferred, while recurrences after laparoscopic repair are best managed with an anterior approach. Final surgical choice should be guided by surgeon expertise and senior consultation.

Bardet–Biedl Syndrome: Expanding Clinical and Genetic Horizons with Insights from an Atypical Retinitis Pigmentosa Case

2025-09-20T11:43:32+00:00

Bardet–Biedl Syndrome (BBS) is a rare multisystem ciliopathy with striking phenotypic and genetic heterogeneity. Ophthalmic manifestations, particularly rod–cone dystrophy resembling retinitis pigmentosa, often provide the earliest diagnostic clue and serve as a gateway to systemic evaluation. Beyond ocular findings, the syndrome encompasses obesity, polydactyly, hypogonadism, renal dysfunction, and developmental or cognitive impairment, necessitating coordinated multidisciplinary care. This chapter presents an atypical paediatric case of BBS with retinitis pigmentosa sine pigmento, central obesity, polydactyly, dental anomalies, and genital hypoplasia, illustrating the spectrum of clinical variability. Recent advances in molecular genetics have expanded the BBS gene spectrum, with the recent discovery of IFT57 further linking intraflagellar transport dysfunction to disease pathogenesis. Current management remains largely supportive, focusing on low-vision rehabilitation and systemic surveillance; however, emerging interventions such as gene augmentation, gene editing, pharmacological agents like setmelanotide, and neuroprotective strategies hold promise for disease modification. By integrating case findings with updated molecular insights, therapeutic advances, and future directions, this chapter highlights the central role of ophthalmologists in early recognition and long-term management of BBS.

The Counselling and Psychotherapy Room as a Healing Space

2025-09-23T09:45:15+00:00

People in the community, family members, neighbours, friends, local doctors, and clergy usually form emotional and social support systems for individuals. Counselling and psychotherapy are to be found in many guises in society, and to add to the complexity, there are many formal schools of counselling and psychotherapy which are informed by their own particular theoretical framework. This review hopes to establish the different aspects of this healing process. The first part of the Literature Review delineated the relationship between the concepts of extra-sensory perception and healing. Based on Jung’s experiences related to the collective unconscious, Dunne has demonstrated that most of his findings were based on his realisations and work done on his own dreams. Exploration on the subject continued with an avalanche of experiential techniques of psychotherapy and spiritual practices of all kinds, from Gestalt therapy to transcendental meditation, among therapists and lay people in the 1970s and 1980s. Secondly, this review provided an overview of the importance of Self-knowledge as part study of the healing process in the counselling and psychotherapy room. It was noted that nowadays, some knowledge in the field of extra-sensory healing in the therapy and counselling field has been analysed closely. Finally, in part three, a typological psychotic view of the subject was given. Experiences from counsellors, healers and psychotherapists which involve premonition, visions or any other phenomenological aspect have occurred in sessions. This development shifts the field of scientific enquiries into a new period; one that is separated from the past by its recognition of the psychiatric, psychological and medical field, which influence in a direct and indirect way the work carried out in the counselling room as a healing space.

Efficacy of Intraoperative Nerve Monitoring (IONM) in Preserving Recurrent Laryngeal Nerve Function in Thyroid Surgery: A Randomized Controlled Trial

2025-09-23T09:47:31+00:00

Intraoperative nerve monitoring (IONM) is an essential technique for detecting Recurrent Laryngeal Nerve (RLN) function during thyroid surgery, significantly reducing the risk of nerve damage. IONM involves attaching sensors to the endotracheal tube, which stimulates the RLN and detects vocal cord motion. The study aims to determine whether IONM improves outcomes in thyroid surgery, particularly in preserving vocal cord function. Post-surgical voice function is assessed using tools like the GRBAS scale, CAPE-V, and the Voice Handicap Index (VHI), which evaluate dysphonia severity and its impact on daily life. This prospective randomized controlled study was conducted from January 2023 to May 2024 at PGIMER Chandigarh, involving 100 patients undergoing thyroidectomy. Surgical techniques involved using an NIM FLEX endotracheal tube for IONM in Group 1 and a standard Portex tube for Group 2. Nerve stimulation was performed using a monopolar stimulator probe, with real-time monitoring of amplitude and latency. In the preoperative 90-degree endoscopy, 96% of patients in the test group had bilateral true vocal cord (TVC) mobility, while 4% had left TVC palsy. In the control group, 100% had bilateral TVC mobility. In the test group, 86% of patients had bilateral TVC mobility, while 2% had right TVC palsy, 6% had left TVC palsy (2 of which were preoperative), 4% had right TVC paresis, and 2% had left TVC paresis. In the control group, 74% had bilateral TVC mobility, 2% had left TVC palsy, 14% had right TVC paresis, and 10% had left TVC paresis. There were no significant differences observed in GRBAS, VHI, CAPE-V, or MPD scores between the two groups on preoperative day, postoperative day 1, and postoperative day 10. The study highlighted that while IONM did not lead to a significant reduction in the overall incidence of RLN injury, it did aid in the preservation of vocal cord function. Transient nerve paresis was observed in the test group, specifically following repeated nerve stimulation, which was managed effectively with steroid therapy. Patients in the test group showed higher rates of bilateral true vocal cord mobility and less deviation from preoperative voice quality parameters, such as GRBAS scores and VHI, highlighting IONM’s role in reducing nerve injury severity and improving patient outcomes.

Primary High-Grade Serous Carcinoma of the Fallopian Tube Initially Misdiagnosed as Ovarian Carcinoma: A Case Report

2025-09-23T09:54:20+00:00

Background: Historically, primary fallopian tube carcinoma has been reported to constitute only about 0.3% of all female genital tract malignancies. However, literature suggests that its actual incidence may be higher, as many cases are often classified as ovarian cancer. Preoperative diagnosis is difficult and challenging due to the absence of specific symptoms. Clinically, fallopian tube carcinoma resembles epithelial ovarian cancer, and histologically, it is also similar; hence, its evaluation and treatment are essentially the same.

Objective: As primary fallopian tube carcinoma (PFTC) is a rare gynecologic malignancy that poses a diagnostic dilemma and is often misdiagnosed as ovarian carcinoma, we report a case of primary high-grade serous adenocarcinoma of the fallopian tube. This case highlights its role in the differential diagnosis of adnexal masses and emphasizing the diagnostic challenges and the importance of intraoperative evaluation, appropriate treatment and follow-up.

Case Summary: A 48-year-old woman presented with watery vaginal discharge, and on bimanual examination, a firm, non-tender mass in the left fornix measuring 6 × 6 cm separately from the uterus. Radiological imaging suggested an ovarian tumour, and serum CA-125 was markedly elevated at 2586 U/ml. The patient underwent staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and pelvic as well as para-aortic lymphadenectomy. Intraoperatively, a solid, polypoidal growth measuring 5 × 5 × 7 cm was identified arising from the fimbrial end of the left fallopian tube. Approximately 100 ml of hemorrhagic peritoneal fluid was noted in the pelvis, and two para-aortic lymph nodes were enlarged, measuring up to 1.5 × 1 cm. Histopathological examination confirmed a poorly differentiated serous adenocarcinoma of the left fallopian tube, classified as histologic grade III and nuclear grade II, and staged as pathological stage IC2.

Outcome: Postoperatively, the patient received adjuvant chemotherapy with paclitaxel and carboplatin. She was monitored regularly over five years with physical examinations, CA-125 testing, and imaging studies, during which no symptoms or signs of recurrence were observed.

Advances in Gene Therapy for Age Related Macular Degeneration (ARMD): A Promising Frontier

2025-09-23T09:57:36+00:00

A serious demographic and public health concern, age-related macular degeneration (ARMD) continues to be the leading cause of permanent loss of vision in the elderly globally. Conventional therapeutic approaches, including anti-VEGF injections and laser-based strategies, offer only temporary disease control and are limited in their ability to modify the underlying pathophysiology. It involves creating techniques to ensure sustained delivery of a range of antiangiogenic proteins. These are repetitive intravitreal injections, which put the patient at high risk of infection, costly drugs, low compliance, disparities in access, healthcare burden, increase the doctor-patient conflict, and are hectic for the elderly population. It is a degenerative disease that results in central vision loss by affecting the choriocapillaris, photoreceptors, retinal pigment epithelium, and macula. In recent years, gene therapy has developed as a transformational approach, integrating molecular genetics, vector engineering, and precision medicine principles to target the fundamental causes of ARMD. Gene therapy has emerged as a promising substitute, an innovative approach to treating ARMD by replacing faulty genes with healthy ones. Viral non-integrating vectors, such as Adeno-Associated Viral (AAV), act as envelopes that carry encoded genetic messages without impacting native cellular DNA. This chapter addresses the evolving importance of precision gene therapy in ARMD management, emphasising developments in gene replacement techniques. The high potential and efficiency of this therapy could make it an effective method, providing hope for patients and future healthcare.

Assessing Knowledge and Perceptions of Dental Students Regarding the Management of Diabetic Patients

2025-09-24T10:22:52+00:00

Background: Patients with uncontrolled diabetes are at an increased risk for various oral health complications, particularly periodontal disease. Furthermore, evidence supports a bidirectional relationship between diabetes and periodontal disease. Dentists are well-positioned to detect undiagnosed patients with diabetes early by recognising oral manifestations of diabetes and referring suspected undiagnosed patients to a physician for further diagnostic workup. With the growing prevalence of diabetes, dental practitioners are expected to treat a higher number of diabetic patients in the coming years.

Objective: The objective of this study was to assess the knowledge, attitudes, and practices of dental students regarding the management of diabetic patients.

Methodology: A cross-sectional survey was conducted using a questionnaire among dental students at a private dental university in Morocco. Qualitative variables were presented in terms of frequencies and percentages and compared using a Chi-square test. A p-value of less than 0.05 was considered statistically significant. Statistical analysis was performed using SPSS 20.0.0 (Statistical Package for Social Science) software.

Results: A total of 268 students participated in the survey, yielding a response rate of 83.7%. The findings revealed that 80.6% of students recognised the importance of knowing the type of diabetes. However, only 14.2% were aware of the risks diabetic patients face during dental treatments. For analytical purposes, three groups corresponding to the final three years of the 6-year dental curriculum were compared. When asked about the risks associated with diabetic patients, there was a statistically significant difference (p < 0.001) between the three groups. Additionally, a statistically significant difference (p < 0.001) was observed among 4th, 5th, and 6th-year students regarding the prescription of antibiotics for endodontic procedures when HbA1c < 7. Furthermore, a significant difference (p < 0.001) was found between the three groups in their knowledge of antibiotics and analgesics commonly prescribed in dentistry for diabetic patients.

Conclusion: The care of diabetic patients requires the dentist to have perfect knowledge of the various risks to which they are exposed. To address the knowledge gap among dental students, it is essential to incorporate the management of diabetic patients into clinical internships. Lastly, continuing education programs should be implemented for dentists to enhance their understanding of diabetic patient management.

Serum Selenium Levels in Prostate Cancer and Benign Prostatic Hyperplasia: A Comparative Study in Nigerian Patients

2025-09-24T10:26:25+00:00

Prostate cancer (PCa) is the most common cancer among men and also a significant cause of mortality. Over one million new cases were diagnosed in 2020, and over 300,000 deaths from prostate cancer were recorded in the same year. Selenium, a trace metal, has been investigated for its potential role in prostate cancer through mechanisms such as angiogenesis inhibition, modulation of cell death, and androgen receptor signalling. This study compares the serum Selenium (Se) levels of patients diagnosed with prostate cancer versus those diagnosed with Benign Prostate Hyperplasia (BPH).

The study was carried out in the University of Port Harcourt teaching Hospital (UPTH) and Gbeye hospital. A total of 81 patients who gave their consent, and had lower urinary tract symptoms were recruited over a 6 months period. 40 patients had Benign prostate enlargement, while 41 patients had prostate cancer. Blood samples were collected and analysed for Se using an Atomic absorption spectrophotometer. Patient biodata, prostate-specific antigen, and serum selenium levels were collected and analysed using SPSS version 20.

The mean age of respondents in this study was 60(9) and 62(9) for BPH and PCa respectively. The mean BMI was 25.81 (2.04). The mean PSA of the BPH and PCa groups were 2(1) and 18(5) respectively P <0.001. The serum selenium level for those with BPH was 0.17 (0.07), while that for those with PCa was 0.14 (0.07) with a p-value of 0.073.

This study found that serum Se was lower in patients with PCa compared with controls (BPH) but this difference was not statistically significant. The role of Se in prostate diseases and, indeed, prostate cancer still requires further research. This is particularly important in West Africa, where the burden of prostate cancer is high.

Is Type 2 Diabetes Mellitus One Disease? Subtype Classification and Clinical Implications

2025-09-24T10:28:53+00:00

This review aims to describe the four metabolic subtypes or clusters of Type 2 DM. It summarises these different subtypes based on clinical and laboratory features—such as glutamic acid decarboxylase antibodies (GAD), age at onset, HbA1c, body mass index (BMI), and measures of insulin resistance and secretion—helping to characterise them. The main goal of identifying these clusters is to improve treatment personalisation and prevent complications that differ among these groups. The severe insulin-deficient group at diagnosis resembles Type 1 diabetes but lacks autoantibodies against beta cells and has different genetic markers. Microvascular complications like diabetic neuropathy and retinopathy are most common in this subtype, along with cardiovascular issues. Insulin therapy should be started early in this group. The insulin-resistant subtype is linked to the highest risk of diabetic nephropathy. Efforts to reduce insulin resistance and protect kidney function are essential for this cluster. The mild obesity-related and mild age-related subtypes usually have a lower risk of complications and respond well to lifestyle changes and weight loss. Recognising these subtypes of Type 2 DM allows for a personalised approach to disease management based on different metabolic profiles. For example, the insulin-deficient metabolic subtype carries the highest risk of microvascular complications, while the insulin-resistant subtype carries the greatest risk of diabetic kidney disease.

Nanoparticles in Dentistry: Applications and Future Perspectives

2025-09-24T10:31:30+00:00

Nanoparticles have emerged as a transformative innovation in dentistry, offering unique physicochemical properties that enhance diagnostic, preventive, and therapeutic outcomes. Their high surface-to-volume ratio, antimicrobial activity, and ability to interact at the molecular level have enabled wide-ranging applications across restorative dentistry, endodontics, periodontics, implantology, and oral medicine. Silver, zinc oxide, titanium dioxide, and calcium phosphate nanoparticles have shown promise in combating oral biofilms, preventing secondary caries, improving adhesion in restorative materials, and enhancing remineralisation of dental tissues. In implantology, nanoparticle coatings contribute to osseointegration and infection resistance, while in periodontics, nanocarriers facilitate targeted drug delivery and regenerative therapies. Despite these advances, challenges remain regarding biocompatibility, long-term stability, controlled release, and potential toxicity. Future research is expected to focus on smart nanoparticle systems with stimuli-responsive behaviours, multifunctional composites, and personalised nanodentistry tailored to individual patient needs. Overall, nanoparticles hold significant potential to revolutionize dental practice, improving both clinical efficacy and patient outcomes.