Medical Science: Updates and Prospects Vol. 12

Histopathological Findings of Persistent Periapical Radiolucent Lesions of Endodontic Origin Obtained during Apical Resective Surgery: An Analysis of 128 Surgical Cases

Jorge Paredes Vieyra, Francisco Javier Jiménez Enríquez, Alan Hidalgo Vargas — Thu, 09 Jul 2026 00:00:00 +0000

Background: Apical periodontitis is an acute or chronic inflammatory lesion that develops around the apex of a tooth as a consequence of persistent bacterial infection within the root canal system. It is one of the most common pathological conditions of endodontic origin and is characterised by inflammatory and immunological responses in the periapical tissues. Persistent apical radiolucent lesions may remain after endodontic treatment and can represent different histopathological entities, including periapical granulomas, radicular cysts, and abscesses. Histopathological examination of these lesions is essential for establishing an accurate diagnosis and improving understanding of persistent periapical disease.

Aims: The aim of this study was to evaluate the histopathological findings of 128 persistent apical radiolucent lesions of endodontic origin obtained during apical resective surgery.

Materials and Methods: The study was conducted at the Universidad Autónoma de Baja California, Facultad de Odontología, Tijuana, Mexico. The case group comprised 128 biopsies obtained through apical surgery. The biopsies were examined to establish the diagnosis as periapical granuloma, radicular cyst, or abscess. The radiographic size of the lesion (area in cm²) was measured before surgery and after two years of follow-up. Statistical analysis was performed using analysis of variance. The hypothesis tests were conducted at the 0.05 level of significance.

Results: The study comprised 128 patients, 79 women (61.71%) and 49 men (38.28%), with a mean age of 43.54 years. Histopathological analysis of the 128 apical lesions showed that 74.21% were from the maxilla, especially from the anterior teeth and premolars, and 25.78% were from the mandible. The lesions comprised 72.65% granulomas, 21.85% periapical cysts, 4.68% periapical abscesses, and 0.78% scar tissue. Apical lesions were associated with overfilled canals.

Conclusions: Overall, this study reinforces the importance of histopathological examination for the accurate diagnosis of periapical lesions and supports the view that chronic apical periodontitis is mainly represented by granulomatous and cystic lesions. These results contribute to a better understanding of the distribution and characteristics of apical lesions and may assist in improving diagnostic and treatment strategies in endodontic practice.

Ischemia-Free Kidney Transplantation

Gerry George Mathew — Thu, 09 Jul 2026 00:00:00 +0000

Kidney transplantation remains the gold-standard treatment for end-stage kidney disease (ESKD), conferring superior long-term survival, quality of life, and cost-effectiveness over maintenance dialysis. Despite substantial advances in immunosuppressive pharmacology, perioperative care, and organ preservation technology, ischemia-reperfusion injury (IRI) persists as a fundamental pathophysiological challenge in deceased-donor transplantation. Conventional preservation strategies — including static cold storage (SCS), hypothermic machine perfusion (HMP), and normothermic machine perfusion (NMP) — reduce but do not eliminate ischemic injury, thereby contributing to delayed graft function (DGF), immunological sensitization, and chronic allograft dysfunction. Ischemia-free kidney transplantation (IFKT) has emerged as a conceptually novel preservation approach aimed at maintaining uninterrupted normothermic oxygenated perfusion across all three phases of transplantation: donor procurement, ex vivo preservation, and recipient implantation. The first human case, reported by He and colleagues in 2019, demonstrated proof-of-concept feasibility with immediate graft function and absent dialysis requirement in a brain-dead donor pair. The first retrospective comparative cohort study, published by Yu and colleagues in 2024, reported comparable one-year patient and graft survival between IFKT and conventional kidney transplantation (CKT) in six donor pairs, though DGF occurred in one pair in both treatment arms (Yu et al., 2024). Concurrently, the landmark COPE randomised controlled trial demonstrated that one hour of end-ischemic NMP did not significantly reduce DGF in donation after circulatory death (DCD) kidneys compared with SCS alone, highlighting the importance of perfusion duration and timing. The NKP1 phase 1 cohort study confirmed the safety and feasibility of prolonged NMP up to 24 hours, with 100% 30-day graft survival and comparable 12-month estimated glomerular filtration rate (eGFR) to matched controls. This narrative review examines the conceptual basis, pathophysiological rationale, technical methodology, international protocols, clinical evidence, and future directions of IFKT, with careful alignment of conclusions to the current maturity of the evidence base. Potential advantages, substantiated limitations, and the substantial remaining evidence gaps — including the absence of multicentre randomised trial data, long-term outcomes, health-economic analyses, and DCD applicability — are critically discussed. Future directions in perfusion technology, biomarker-guided viability assessment, and therapeutic organ reconditioning are presented as investigational rather than established clinical practices.

Odontogenic and Osseous Pathologies of the Maxillary Sinus: Clinical and Radiological Considerations

Carmen López-Carriches, Inmaculada López-Carriches, Rafael Baca-Perez Bryan — Thu, 09 Jul 2026 00:00:00 +0000

Odontogenic sinusitis is a maxillary sinus disease that can arise from dental and maxillofacial pathology and may be difficult to distinguish from rhinogenic sinusitis when clinical signs are non-specific. This case report describes a 38-year-old man who presented with a swollen right cheek, pain and rhinorrhoea of 15 days’ duration. The patient had previously received antibiotic therapy from an otolaryngologist without remission and was referred for assessment of a possible odontogenic cause. Orthopantomography showed displacement of the upper right third molar into the maxillary sinus by a cystic lesion. Computed tomography confirmed a cystic lesion involving bone. The dentigerous cyst and ectopic third molar were surgically removed under local anaesthesia, followed by postoperative treatment with amoxicillin/clavulanic acid and ibuprofen as required. Histopathological examination confirmed an inflamed dentigerous cyst. The patient had no postoperative complications and remained asymptomatic during seven months of follow-up. Follow-up orthopantomography and computed tomography demonstrated extensive abnormal bony occupation of the maxillary sinus. Subsequent biopsy and histopathological analysis confirmed fibrous dysplasia, which was managed conservatively with regular follow-up. The report presents the clinical course, diagnostic imaging, operative management and follow-up findings, while considering how coexisting odontogenic and fibro-osseous pathology may affect interpretation of unilateral sinus disease. This case illustrates the diagnostic complexity of unilateral maxillary sinus disease when odontogenic infection, an ectopic tooth, a dentigerous cyst and an osseous lesion coexist. It also emphasises the value of detailed dental assessment, three-dimensional imaging, histopathological confirmation and postoperative radiological surveillance in identifying lesions that may be overlooked at initial presentation.

Beyond Fasting Guidelines: The Diabetic Stomach under Ultrasound Probe

Ketaki Marodkar, Sampreeti Dungala, Sourabh Vyas — Thu, 09 Jul 2026 00:00:00 +0000

Introduction: Aspiration of gastric contents remains a significant perioperative concern, particularly in patients with diabetes mellitus, who are predisposed to delayed gastric emptying owing to autonomic neuropathy and gastroparesis. Despite adherence to standard preoperative fasting guidelines, variability in gastric residual volume (GRV) persists. Point-of-care ultrasound (POCUS) has emerged as a reliable, non-invasive bedside modality for assessing gastric contents and stratifying aspiration risk.

Aims: The aim of the study was to evaluate the association of POCUS-guided preoperative fasted gastric volume with duration of diabetes and body mass index (BMI) in diabetic patients.

Methods: This prospective analytical cross-sectional study included 112 adult diabetic patients scheduled for elective surgery under general anaesthesia. Gastric ultrasonography was performed in both supine and right lateral decubitus positions using a curvilinear probe. Antral cross-sectional area (CSA) was measured, and GRV was calculated using the Perlas formula (Perlas et al., 2013). Patients were stratified according to duration of diabetes and BMI. Statistical analysis included independent t-tests, ANOVA and multivariable regression.

Results: The mean GRV was 47.54 ± 16.03 mL, with a mean antral CSA of 5.56 ± 1.56 cm². A progressive increase in GRV was observed with increasing duration of diabetes, rising from 38.59 ± 16.48 mL in patients with less than five years of disease to 111.28 ± 1.35 mL in those with more than 20 years (p < 0.001). BMI demonstrated an increasing trend in GRV; however, this was not statistically significant (p = 0.206). Multivariable regression analysis confirmed that both duration of diabetes (β = 2.37; p < 0.001) and BMI (β = 0.63; p = 0.001) independently predicted higher GRV.

Conclusion: POCUS provides a practical tool for preoperative gastric assessment in diabetic patients. Longer disease duration and higher BMI are associated with increased gastric volume, underscoring the importance of individualised perioperative risk assessment.

Digital Twins in Endodontics: Toward Personalized and Predictive Root Canal Therapy

Thu, 09 Jul 2026 00:00:00 +0000

Digital twin technology is an emerging approach for integrating patient-specific data into dynamic virtual models that can support diagnosis, treatment planning, simulation, and monitoring in healthcare. In endodontics, its relevance arises from the complex anatomy of the root canal system, the need for accurate three-dimensional assessment, and the growing use of artificial intelligence and computational modelling in clinical decision-making. This chapter reviews the potential contribution of digital twins to personalised and predictive root canal therapy. It considers the main technological components required for their development, including cone-beam computed tomography, intraoral scanning, digital radiography, three-dimensional reconstruction, artificial intelligence, machine learning, computational modelling, and secure data integration. It also discusses how patient-specific virtual replicas may support endodontic diagnosis, guided procedures, instrumentation simulation, irrigation modelling, obturation assessment, restorative planning, follow-up, and outcome prediction. In addition, digital twins may contribute to endodontic education through virtual patients, simulation-based learning, objective performance assessment, and personalised training pathways. However, implementation remains limited by challenges related to data quality, interoperability, computational demands, cybersecurity, ethical and legal considerations, regulatory requirements, and insufficient clinical validation. Digital twins should therefore be regarded as promising but developing tools that require validation, governance, and careful integration into clinical workflows. With careful implementation, they may contribute to more individualised and evidence-informed endodontic care.

Knowledge, Attitude, and Practice of Healthcare Workers Regarding Antibiotic Use and Antimicrobial Resistance at Dongola Specialized Hospital, Sudan, 2025

Thu, 09 Jul 2026 00:00:00 +0000

Background: An antibiotic is a chemical compound, derived from a living organism or produced synthetically, that has therapeutic activity at very low doses by inhibiting bacterial growth (bacteriostatic effect) or destroying bacteria (bactericidal effect). Bacterial resistance to antibiotics is a major global health threat that leads to treatment failure, increased treatment costs, prolonged hospital stays and increased mortality. It has been estimated that antimicrobial resistance could cause approximately 10 million deaths annually by 2050 if effective efforts are not implemented. Resistance is a complex phenomenon resulting from the natural evolution of microbes; however, it is intensified by human activity and selective pressure due to antibiotic overuse in humans, animals and agriculture. Inappropriate antibiotic use is a main driver of resistance, including overuse, self-medication, failure to complete antibiotic courses and poor adherence to guidelines, often influenced by socioeconomic factors, limited access to diagnostic tools and quality antibacterials, and poor health literacy.

Objectives: To assess the knowledge, Attitudes and practices of healthcare workers regarding antibiotic use and resistance in Dongola locality, Northern State, Sudan, in order to identify gaps and contribute to problem-solving.

Methods: An institution-based, descriptive cross-sectional study was conducted to assess the knowledge, Attitudes and practices (KAP) of healthcare workers regarding antibiotic use and antibiotic resistance at Dongola Specialized Hospital from August 2025 to April 2026. Data were collected using a structured, close-ended questionnaire comprising four sections: sociodemographic characteristics, knowledge, Attitudes and practices. A total of 252 HCWs, including doctors, Pharmacists and nurses, participated in the study; the calculated minimum sample size was 228. Data were collected using Google Forms and analyzed using SPSS.

Among the 252 HCWs investigated, 57.0% had a good level of knowledge, 36.0% had a moderate knowledge and 7.0% had a poor level. Positive attitudes were reported in 56.0%, while 33.0% showed a moderate level of attitude and 11.0% had poor attitudes. Good practices were observed in 23.0%, while 53.0% showed a moderate level of practices and 24.0% had poor practices.

Conclusion: The study revealed that high knowledge does not necessarily indicate optimal practice. Knowledge is necessary but insufficient because medical practice is not an automatic application of information; rather, it is a multifactorial behaviour.This confirms that future interventions should go beyond providing information and should address the reasons for prescribing despite existing knowledge.

Hypertension: Epidemiology, Pathophysiology, and the Evolving Clinical Landscape: A Critical Review

Sunil Natha Mhaske, Shraddha Gunjal — Thu, 09 Jul 2026 00:00:00 +0000

Hypertension in childhood and adolescence has shifted from a rare condition, previously presumed to be secondary to renal or vascular disease, to a common and frequently primary disorder that tracks into adult life and confers measurable cardiovascular risk before the third decade. This critical review synthesises contemporary evidence on paediatric hypertension, addressing global and regional prevalence trends; the evolution of diagnostic thresholds and guideline frameworks; the pathophysiological convergence of obesity, sympathetic overactivity and renal sodium handling; modifiable lifestyle determinants; subclinical and overt target-organ injury; the unresolved controversy surrounding population screening; and current lifestyle and pharmacological management. Particular attention is given to the discordance between professional bodies regarding the value of routine blood pressure measurement in asymptomatic children, the implications of the lower diagnostic thresholds introduced in 2017, and the accumulating longitudinal evidence linking childhood blood pressure elevation to adult cardiovascular events. The review highlights persistent gaps in outcome-based intervention trials, the underrepresentation of low- and middle-income populations in the evidence base, and the emerging but still immature role of risk-prediction modelling. Recognising and managing elevated blood pressure during childhood is presented as an underused opportunity for primordial and primary cardiovascular prevention across the life course.

Neuropsychological Effects and Clinical Applications of Indian Classical Ragas: A Narrative Review

G. Adi Seshu, G. Lalitha Reddy, Ch. Prasanthi — Thu, 09 Jul 2026 00:00:00 +0000

Indian classical music, characterized by its intricate raga system, has been an integral part of traditional healing and wellness practices for centuries. Ragas are believed to evoke distinct emotional states and influence mental and physical health. With growing interest in music-based interventions, contemporary neuroscience and psychological research have increasingly explored the biological and cognitive mechanisms underlying these effects. This review synthesizes current evidence on the impact of Indian classical ragas on neural activity, emotional well-being, cognitive functioning, and physiological regulation, while examining their potential therapeutic relevance.

Relevant literature published between 2010 and 2025 was identified through searches of PubMed, PubMed Central (PMC), Google Scholar, and other scientific databases. Studies investigating neurophysiological, psychological, and clinical outcomes associated with raga exposure were examined, including those utilizing electroencephalography (EEG), autonomic measures, psychometric assessments, and intervention-based research designs.

Findings from the reviewed studies indicate that listening to selected ragas can influence brain function by altering cortical oscillatory activity, particularly within the alpha and theta frequency bands. These changes are frequently associated with enhanced relaxation, improved attentional processes, and better emotional regulation. In addition, raga-based interventions have been linked to reductions in stress, anxiety, depressive symptoms, blood pressure, and heart rate, alongside improvements in sleep quality, memory, concentration, and overall psychological well-being. Emerging evidence from neuroimaging and electrophysiological investigations suggests that these effects may be mediated through interactions among limbic structures, prefrontal cortical regions, reward pathways, and autonomic regulatory systems.

Although the available findings are encouraging, the current body of research is constrained by methodological variability, limited sample sizes, and inconsistencies in intervention protocols. Consequently, further well-designed studies are required to strengthen the evidence base and clarify the mechanisms involved. Nevertheless, the existing literature supports the potential of raga-based music as a safe, accessible, and culturally meaningful complementary approach for promoting mental health and enhancing quality of life. Future investigations should emphasize standardized methodologies, objective biomarkers, and large-scale randomized controlled trials to facilitate the integration of raga-based interventions into evidence-based healthcare practices.

Enhancing Prenatal Care: The Game-Changing Role of Cell-Free DNA

Anshu Priya, Shruti R Kuril, Tejal Pathak, Anoop Kumar Verma — Thu, 09 Jul 2026 00:00:00 +0000

Cell-free DNA (cfDNA) analysis has become an important component of contemporary prenatal screening because it enables the assessment of selected foetal genetic conditions using a maternal blood sample. Cell-free foetal DNA (cffDNA) originates mainly from placental trophoblasts and circulates in maternal plasma as a fraction of total cfDNA. Its detection has supported the development of non-invasive prenatal testing (NIPT), particularly for common foetal aneuploidies involving chromosomes 21, 18 and 13. The approach has also been applied to foetal sex determination, foetal RhD genotyping, copy-number variation assessment and selected single-gene disorders. These applications are supported by advances in next-generation sequencing, targeted sequencing, single-nucleotide polymorphism-based analysis and related molecular methods. Compared with invasive procedures such as amniocentesis and chorionic villus sampling, cfDNA testing avoids procedure-related foetal risk because it requires only maternal blood collection. However, it remains a screening approach in most clinical settings and should not be considered a universal substitute for diagnostic testing. Results may be influenced by low foetal fraction, placental mosaicism, maternal genetic background, technical limitations and bioinformatic interpretation. Positive or uncertain findings, therefore, require appropriate counselling and confirmatory diagnostic evaluation. This chapter summarises the biological origin of cffDNA, the laboratory approaches used for its analysis, the major clinical applications in prenatal care, and the current limitations affecting interpretation and implementation. The available evidence supports cfDNA testing as a valuable tool in prenatal screening when used with careful clinical judgement, standardised protocols, and adequate genetic counselling.