Medical Science: Updates and Prospects Vol. 5

Effectiveness of Closed Reduction in Pediatric Le Fort I Fractures: A Case Study on Minimally Invasive Management

Mekhaeel Shehata Fakhry Mekhaeel — 2026-01-27

Pediatric facial fractures, particularly Le Fort I fractures, present unique challenges in diagnosis and management. Le Fort I fractures involve a horizontal fracture of the maxilla, which can result in facial asymmetry, malocclusion, and difficulty in feeding. Closed reduction has been shown to be an effective method for managing these fractures, with minimal long-term effects on growth and development. This case report details the treatment of a 7-year-old male patient who sustained a Le Fort I maxillary fracture following a fall with a pen inside his oral cavity. Key CT findings confirmed a unilateral maxillary fracture with a deviated nasal septum, with no involvement of orbital structures. The patient was managed with closed reduction techniques, including maxillomandibular fixation (MMF), trans-maxillary fixation, and frontal suspension, under general anaesthesia. Postoperative recovery was uneventful, with the patient resuming oral feeding within 4 hours and being discharged after 5 days. Weekly postoperative follow-up was performed regularly, and the patient showed no signs of malunion or infection till the fixation materials were removed after 4 weeks, with no complications or recurrence. This conservative approach was chosen to preserve growth potential and minimise complications, avoiding the need for open reduction and internal fixation (ORIF), given the patient's age and the risk of disrupting facial growth. The case highlights the effectiveness of closed reduction techniques in pediatric fractures, offering a minimally invasive solution that restores functional and aesthetic outcomes. Additionally, closed reduction may reduce the psychological impact of facial trauma by preserving facial appearance. Based on the positive outcome observed, closed reduction is recommended as a first-line treatment for pediatric patients with similar fracture patterns.

Breast Cancer in Rural India: Clinicopathological Patterns, Molecular Subtypes and Challenges in Resource-Limited Settings

Novhil Bramhankar — 2026-01-27

Breast cancer is the most frequently diagnosed malignancy among women worldwide and represents a growing public health challenge in India. Rural populations face unique barriers, including delayed diagnosis, limited screening facilities, and restricted access to comprehensive oncology care. This chapter presents a detailed clinicopathological and molecular analysis of breast cancer cases managed at a rural tertiary care centre in Central India over a five-year period. A retrospective evaluation of 150 histologically confirmed breast cancer patients was performed, assessing demographic characteristics, tumour pathology, molecular subtypes, staging, and treatment patterns. The mean age at diagnosis was 47.8 years, with a predominance of advanced-stage and high-grade tumours. Triple-negative breast cancer constituted 55.3% of cases, followed by the Luminal A subtype. All patients underwent surgical management, predominantly a modified radical mastectomy. Adjuvant chemotherapy and hormonal therapy were administered based on receptor status. The results demonstrate a younger age at onset, predominance of advanced-stage disease, high-grade tumours, and a high burden of triple-negative breast cancer, underscoring the urgent need for early detection strategies and improved oncology infrastructure.

Cerebral Vasospasm as a “Hidden Danger” after Craniotomy: A Systematic Review of Case Reports and Case Series

Khairunnisai Tarimah — 2026-01-27

Background: Cerebral vasospasm following tumour craniotomy (CVACT) is a rarely reported yet potentially devastating postoperative complication with significant neurological consequences. Unlike cerebral vasospasm associated with aneurysmal subarachnoid haemorrhage, which has been extensively studied, CVACT remains poorly understood with respect to its pathophysiology, early detection, and management. This lack of clarity often leads to delayed diagnosis and suboptimal therapeutic strategies. In this chapter, we present a comprehensive synthesis of the current literature, drawing upon published case reports and case series to identify emerging clinical patterns, key risk factors, available diagnostic approaches, and therapeutic responses associated with CVACT. The objective is to consolidate and interpret existing evidence regarding predisposing factors, potential underlying mechanisms, clinical presentation, diagnostic modalities, treatment strategies, and patient outcomes, thereby improving clinical awareness and informing future research directions.

Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines, utilising the PubMed and ScienceDirect databases. This review employed a Boolean combination of the MeSH terms and keywords "cerebral vasospasm," "craniotomy," and "brain tumour" to identify instances of cerebral vasospasm following tumour craniotomy (CVACT). The study protocol, which outlines the methodologies used in the systematic review, has been registered with the PROSPERO database. The inclusion criteria for this review consisted of case reports and case series published in English and available in full text, with no restrictions on publication year. Furthermore, gray literature was not excluded from the review. The final search was completed in May 2024.

Results: We included 60 inclusion patients from 14 case reports and 13 case series, with 33 (55%) females and 27 (45%) males, with a mean age of 44.05 ± 16.8 years. The most common tumours were pituitary adenomas, which were found in 22 (36.66%). The most common tumour location was the middle cranial fossa (75%), and the most common surgery technique used was transsphenoidal surgery (50%). Most of those who experience vasospasm have a craniotomy with the TSS technique (50%), with complications of intraoperative bleeding. The range of onset of VS symptoms postoperatively was 0–30 days (mean 6.59d). The symptoms included asymptomatic, headache, loss of vision, hemiparesis, diplopia, etc. The vascular involvement was mainly anterior circulation (78.33%). The diagnostic tools most commonly used were angiography and transcranial doppler (TCD). The most common management of VS from the included studies was pharmacology. The survival rate was 61.66%. We found that the tumour location and vascular-affected vasospasm were significantly correlated with mortality rates: p = 0.015 and p = 0.02.

Conclusions: Cerebral vasospasm after craniotomy tumour removal (CVACT) frequently arises in tumours situated in the medial cranial fossa, predominantly pituitary adenomas and meningiomas. The minimally invasive surgical approach of TSS may contribute to the mechanism of CVACT incidence. The existence of preoperative vascular pathology, such as encasement or narrowing, appears to be a predictor alongside the incidence of intra- or postoperative haemorrhage. The vascular structures most susceptible to vasospasm are located in the anterior circulation of the Willis circle, which appears to correlate with the vascular problems that typically undergo preoperative encasement of the internal carotid artery (ICA). The most reliable and real-time diagnostic instrument employed is TCD, while imaging continues to be the gold standard. Nimodipine treatment continues to be a viable therapeutic option that can enhance patient outcomes.

Maternal Mortality Trends in Saudi Arabia: A Review

Abdulhameed G. Albeshr — 2026-01-27

Maternal mortality represents a critical indicator of national health system performance and socio-economic development. Despite progress in obstetric care worldwide, maternal mortality remains unequally distributed between high-income and low and middle-income countries. Saudi Arabia has made significant progress in reducing maternal deaths over recent decades; however, persistent clinical, systemic, and socio-cultural challenges continue to influence maternal outcomes. This review provides an updated maternal mortality trends in Saudi Arabia from July 2020 to December 2023. Literature was identified through structured searches of PubMed, Scopus, and WHO/UNICEF repositories using terms such as “maternal mortality, “Saudi Arabia,” “pregnancy complications,” and “obstetric causes of death”. For this narrative review, themes were synthesised qualitatively, and findings were compared across regions, populations (Saudi vs. expatriates), and facility types (primary vs. tertiary care). The findings demonstrate that Saudi Arabia maintains a low maternal mortality ratio (MMR) compared with global averages, with estimates ranging between 7 and 17 deaths per 100,000 live births during the review period. Nonetheless, variations persist between regions due to disparities in access to specialised care, emergency obstetric services, and referral efficiency. Direct obstetric causes such as postpartum haemorrhage and hypertensive disorders remain predominant, while indirect causes such as cardiac disease, obesity, diabetes, and viral infections have increased in relative significance. Additional determinants include late presentation, limited awareness of warning signs, socio-economic inequities, and cultural factors influencing health-seeking behaviour. The review concludes that strengthening maternal services requires expanded midwifery capacity, improved emergency obstetric response systems, standardised national guidelines, and enhanced data reporting mechanisms. Targeted public-health interventions addressing obesity, diabetes, and high-risk pregnancies are crucial. This review provides insightful recommendations for clinicians, policymakers, and researchers aiming to support Saudi Arabia’s continued progress toward the Sustainable Development Goals.

Idiopathic Intracranial Hypertension and Ocular Changes

Ruchi Shukla — 2026-01-27

Background: Idiopathic Intracranial Hypertension (IIH), previously known as pseudotumor cerebri, is characterised by elevated intracranial pressure without an identifiable secondary cause and predominantly affects overweight women of reproductive age. Visual morbidity due to papilledema and secondary optic atrophy remains the most feared complication.

Objective: To comprehensively review and synthesise current evidence on ocular structural, vascular, and functional changes associated with IIH, with emphasis on modern imaging biomarkers and their role in diagnosis and disease monitoring.

Methods: A narrative review of published literature was performed, focusing on clinical ophthalmic findings, optical coherence tomography (OCT), OCT-angiography (OCT-A), and orbital neuroimaging features in IIH.

Results: IIH primarily affects the optic nerve head and posterior segment, with minimal anterior segment involvement. Peripapillary retinal nerve fibre layer thickening, ganglion cell complex loss, retinal vascular remodelling, and characteristic MRI features such as optic nerve sheath distension and posterior globe flattening are consistently reported. OCT and OCT-A provide quantitative, reproducible biomarkers that correlate with intracranial pressure and visual function.

Conclusion: Ocular imaging plays a pivotal role in the diagnosis, monitoring, and prognostication of IIH. Early detection and longitudinal OCT-based surveillance are essential for preventing irreversible vision loss.

Cognitive Dysfunction in Major Depressive Disorder: Clinical Implications and Interventions

Sharma S — 2026-01-27

Cognitive dysfunction is increasingly recognised as a core and disabling component of Major Depressive Disorder (MDD), extending beyond affective symptoms to significantly impairing everyday functioning. While traditional research has largely focused on mood disturbances, growing evidence indicates that deficits in attention, memory, and executive functioning are highly prevalent and often persist even during symptomatic remission. Such impairments contribute substantially to poor psychosocial and occupational outcomes and represent an important determinant of long-term prognosis.

This chapter provides a comprehensive narrative review of the patterns and mechanisms of cognitive dysfunction in MDD, integrating findings from recent systematic reviews and meta-analyses. Evidence from the literature indicates that clinically significant cognitive impairment affects approximately half of individuals with MDD, with residual deficits frequently observed following remission of mood symptoms. Among cognitive domains, impairments in executive function, processing speed, and memory demonstrate moderate effect sizes and show strong associations with functional disability and reduced quality of life.

The chapter further examines underlying neurobiological and neurophysiological mechanisms, including dysregulation within prefrontal–limbic circuits, hippocampal alterations, hypothalamic–pituitary–adrenal axis hyperactivity, and abnormalities in event-related potentials such as prolonged P300 latency. Clinical implications are discussed, emphasising the importance of routine cognitive assessment and the integration of targeted cognitive interventions alongside standard treatment approaches. Finally, future directions for research and clinical practice are outlined, highlighting the need for individualised cognitive remediation strategies to optimise functional recovery in individuals with MDD.

Circadian Timing of Spinal Anaesthesia Affects Analgesia and Inflammatory Response in Cesarean Delivery

Evangelia Nikouli — 2026-01-27

Background: The timing of anaesthesia administration may influence both drug efficacy and postoperative recovery, and understanding these temporal variations is essential for optimising anaesthetic management and patient outcomes. In particular, circadian physiology modulates cardiovascular stress responses, immune function, hormonal secretion, and the pharmacokinetics and pharmacodynamics of anaesthetic agents, as well as pain perception, making time of day a potentially important determinant of perioperative outcomes. However, evidence on circadian effects in neuraxial anaesthesia for cesarean delivery remains limited, particularly regarding inflammatory and stress markers, highlighting the need to determine whether anaesthesia administration time affects block characteristics, postoperative pain, and biomarkers such as CRP and cortisol.

Aim: To assess how spinal anaesthesia timing affects block duration, postoperative pain, and CRP and cortisol levels in cesarean deliveries.
Methods: Ninety women were divided into three groups based on spinal anaesthesia timing: Group A (08:00–16:00), Group B (16:00–00:00), and Group C (00:00–08:00). Standardised spinal anaesthesia was administered. Sensory/motor blockade and pain (NRS) were assessed every 10 minutes. Blood samples for CRP and cortisol were collected preoperatively and at 2, 4, 24, and 48 hours postoperatively.

Results: Group C showed shorter sensory and motor blockade than Groups A and B (p<0.05). Time to first analgesic request was longest in Group A, while Group C reported the highest pain scores (p<0.05). CRP levels were significantly higher in Group B vs. Group A at 24 and 48 hours, and vs. Group C at 48 hours (p<0.05). Group B demonstrated the steepest CRP velocity, indicating a more rapid physiological stress response. BMI differences may have influenced biomarker dynamics.

Conclusion: Cesarean sections performed under spinal anaesthesia during the early daytime were associated with prolonged sensory and motor block, lower postoperative pain scores, and a more favourable CRP profile compared with procedures later in the day. In contrast, late‑afternoon and nighttime anaesthesia were linked to shorter block duration, higher pain scores, and increased inflammatory responses, with the most pronounced CRP increase observed in the late‑afternoon group. Distinct BMI–CRP correlation patterns across time groups further indicated that both the timing of spinal anaesthesia and patient characteristics shape the perioperative inflammatory profile. These findings indicate that time of day is a clinically relevant, modifiable factor in neuraxial anaesthesia for cesarean delivery and suggest that scheduling spinal anaesthesia in earlier daytime windows may optimise block quality, postoperative analgesia, and inflammatory response.

Digital Eye Strain in the 21\(^{st}\) Century: Preventive and Therapeutic Approaches

Gayathri Rathinavelu — 2026-01-27

Digital eye strain (DES)—often used interchangeably with computer vision syndrome (CVS)—has become a widespread occupational and lifestyle health issue as work, education, and social interaction increasingly depend on screen-enabled devices. DES is not a single disease entity but a symptom complex arising from the interaction of visual demands (sustained near work, accommodative–vergence stress), ocular-surface disruption (reduced blink rate and tear-film instability), and environmental and ergonomic factors (glare, suboptimal lighting, viewing distance and posture). Contemporary prevalence estimates indicate that a substantial proportion of digital device users experience symptoms, with higher burdens reported in populations exposed to prolonged screen time, such as information technology professionals, radiologists, and school-aged children engaged in online learning. Assessment has evolved from ad hoc symptom checklists to validated patient-reported outcome measures, improving comparability across studies and enabling outcome tracking in clinical and workplace interventions. Preventive strategies—particularly task optimisation, ergonomic redesign, and structured breaks—remain central to public health management, while therapeutic approaches focus on correcting refractive and binocular vision anomalies, restoring ocular surface homeostasis, and mitigating exacerbating exposures. Recent experimental evidence suggests that break schedules more frequent than popular heuristics may yield superior symptom relief and accommodation stability, underscoring the need to align advice with emerging data. This review synthesises current evidence on DES mechanisms, assessment, prevention, and treatment, emphasising pragmatic, clinically actionable approaches and highlighting research gaps relevant to modern digital environments. Therapeutic care should prioritise task-appropriate optical correction and targeted management of binocular or accommodative inefficiencies when visual symptoms dominate, while addressing ocular surface stability when discomfort and dryness are prominent. Future progress will depend on wider use of standardised symptom measurement, better characterisation of risk by device type and task pattern, and pragmatic trials that evaluate combined interventions in real-world environments.