Browse Articles

The association between long-term opioid therapy and composite infection-related dental outcomes

Background The Food and Drug Administration’s warning that transmucosal buprenorphine, a partial opioid agonist used to treat opioid use disorder and chronic pain, may cause dental disease opens questions about potential class-wide adverse effects involving more widely prescribed opioid analgesics. Methods This was a retrospective matched national cohort study of patients in care at the Department of Veterans Affairs (VA) between October 2010-September 2019. Patients prescribed LTOT were matched 1:2 to patients not prescribed LTOT on age, sex, service region, and VA dental coverage. Cox regression models estimated the association between LTOT and a composite infection-related dental outcome (CIDO). Sensitivity analyses excluded patients with cancer, restricted to patients with comprehensive dental coverage, and to patients with ≥180 days of follow-up time, respectively. Results The cohort comprised 2,173,435 patients including 787,825 (36%) receiving LTOT; 612,101 (28%) experienced CIDO. In both simple and multivariable regression models, LTOT exposure was associated with greater CIDO risk; HR (95% CI) =1.24 (1.23, 1.25); aHR (95% CI) =1.08 (1.07, 1.08), respectively; p < 0.001. Sensitivity analyses showed similar results except among patients with full dental coverage for whom CIDO rates were substantially higher and LTOT was not statistically significantly associated with risk. Conclusions he observed positive association between LTOT and CIDO in this large VA sample may inform patient-provider discussions and decision-making around use of LTOT. High CIDO rates among patients with full VA dental coverage may reflect their unique vulnerability to dental infection associated with service-related dental or disabling conditions. Limitations include risk for ascertainment bias, unclear generalizability to a broader clinical population, and the potential for residual confounding.

Study of element concentrations in blood serum of patients receiving parenteral nutrition using total reflection X-ray fluorescence analysis

Total reflection X-ray fluorescence (TXRF) analysis was used to determine element concentrations in blood serum samples of patients receiving parenteral nutrition. The concentrations of elements were measured in the serum samples two times, namely in the first day (measurement I) of the treatment and on the seventh day (measurement II) after nutrient supplementation. For comparison purposes, also serum samples of 50 patients without nutritional disorders, admitted to a planned cholecystectomy (surgical procedure of the gall bladder removal), were analyzed and treated as the control group. Descriptive statistics of measured concentrations of P, S, Cl, K, Ca, Cr, Fe, Cu, Zn, Se, and Br were determined both for the studied and control groups. Statistical analysis of the results concentrates on verifying the type of element concentration distributions. Next, the comparison of element concentration between groups of women and men was done. Parenteral nutrition resulted in a significant increase in supplemented Se and a decrease in Cu concentrations between measurement I and II. Parametric as well as nonparametric approaches were applied to verify the hypothesis. Additionally, it was found out that for some elements differences between the studied and control groups can be observed (P, S, Ca, Fe, Cu, Zn, Se, Br). The analyses were also performed taking into account the gender of the patients. Correlation coefficients were calculated for the studied and control groups as regards the determined elements. It was observed that in all groups positive correlations were obtained between S and Ca, and for Zn and Se. In studied and control groups a negative correlation between Ca and Cr was obtained. This paper discusses also prediction of trace element concentrations following seven days of parenteral nutrition therapy, based on the knowledge of various anthropometric, biochemical and immunological parameters describing the patient’s condition. The procedure is discussed for Br concentration.

Mediating effect of smoking abstinence self-efficacy on association between health literacy and nicotine dependence of smokers in Qingdao, China

Objective Research on the mediating effect of smoking abstinence self-efficacy (SASE) on the relationship between health literacy and nicotine dependence is limited. This study examines the mechanisms through which health literacy influences addictive behavior and provides additional scientific evidence to inform smoking cessation interventions. Methods A total of 500 participants were recruited from 20 communities in Qingdao between June 2023 and June 2024. Spearman correlation analysis was used to explore relationships between nicotine dependence and other factors. Linear regression analyses were conducted to examine the relationships between health literacy, SASE, and nicotine dependence. Path analysis was performed using AMOS to assess the interactions among nicotine dependence, SASE, and health literacy, with mediation effects tested using the bootstrap method. Results After adjusting for potential confounders such as age, marital status, education level, and occupation, path analysis revealed a significant positive correlation between health literacy and SASE in habitual/addictive situations (SASEH; β = 0.185, p < 0.01). Nicotine dependence showed significant negative correlations with both health literacy (β = −0.289, p < 0.001) and SASEH (β = −0.513, p < 0.001). Bootstrap mediation tests confirmed that both the direct and indirect effects were statistically significant, with the mediating effect accounting for 24.7% of the total effect. Conclusions SASEH partially mediates the relationship between health literacy and nicotine dependence. Increasing health literacy not only directly reduces nicotine dependence but also improves SASE, which in turn further reduces dependence.

The novel mineralocorticoid receptor modulator balcinrenone protects against diet-induced cardiac microvascular dysfunction and plasma potassium elevation in mouse models

Overactivation of the mineralocorticoid receptor (MR) promotes tissue remodeling in patients with heart failure (HF) and/or chronic kidney disease (CKD). These patients may benefit from MR antagonists (MRAs); however, MRAs are underutilized, partly due to the risk of hyperkalemia. Balcinrenone is a novel, selective MR modulator that demonstrated renoprotection without an acute effect on urinary electrolyte excretion in preclinical studies, suggesting reduced hyperkalemia risk. Here, we present in vivo and in vitro studies comparing balcinrenone with eplerenone, an approved MRA. Myocardial perfusion reserve (MPR), an indicator of coronary microvascular remodeling, was evaluated in mice with diet-induced HF with preserved ejection fraction (HFpEF). MR target gene expression and markers of cardiac remodeling were evaluated using a clonal cell line of rat cardiomyocytes stably expressing MR (H9C2/MR+), and inflammatory and fibrotic processes were evaluated in primary human cardiac fibroblasts. Potassium (K + ) homeostasis was evaluated in mice with nephrectomy-induced CKD. In mice with diet-induced HFpEF, 30 mg/kg/day balcinrenone or 100 mg/kg/day eplerenone restored MPR to levels seen in mice without HFpEF. Balcinrenone and eplerenone inhibited aldosterone-induced expression of MR target genes and markers of cardiac remodeling in H9C2/MR+ cells, and excretion of collagen 1 and interleukin-6 in primary human cardiac fibroblasts, in a concentration-dependent manner. An overnight K + challenge in eplerenone-treated mice with nephrectomy-induced CKD yielded a higher plasma K + elevation than that observed in vehicle-treated CKD mice. By contrast, the plasma K + response in balcinrenone-treated mice with CKD was similar to what was observed in vehicle-treated CKD mice. Urinary K + excretion was not affected by balcinrenone or eplerenone treatment, but fecal K + excretion was elevated in CKD mice that were administered balcinrenone versus eplerenone. These results suggest that balcinrenone may be suitable for patients requiring additional cardiorenal protection through MR modulation but are at high risk of hyperkalemia.

In-silico identification of anti-cholera phytochemicals from Indian medicinal plants

Cholera is a severe diarrheal disease caused by ingestion of food or water contaminated with pathogenic Vibrio cholerae . Treatment for cholera includes rehydration therapy and antibiotics to avert death and reduce bacterial burden to prevent rapid transmission of the disease. In addition, in Indian subcontinent, there is historical evidence of using plants for treating cholera. This study was designed to investigate the cholera toxin-inhibitory properties of phytochemicals sourced from Indian medicinal plants. For this, three reported genotypes of cholera toxin subunit B (ctxB) associated with 7PET V. cholerae O1 El Tor strains were used as targets in molecular docking. Analysis results showed strong binding affinities (≤−7.5 kcal/mol) for 298 out of 7,607 phytochemicals, with minor variations for the ctxB genotype-specific targets. Multiple phytochemicals from the same plants were identified with high binding affinities, e.g. , 101 from Morus alba, 24 from Citrus aurantium, 17 from Emblica officinalis, and 16 from Capsicum annuum . However, further analyses, including drug-likeness, pharmacokinetics, and toxicity, identified five promising phytochemical candidates, namely, Abyssinone V ( Azadirachta indica ), Diosgenin ( Achyranthes bidentata ), Yamogenin ( Borassus flabellifer ), and two other unnamed phytochemicals (one from Azadirachta indica and one from Morus alba ) for cholera toxin inhibition. Molecular dynamics simulation using YASARA and GROMACS showed structural stability of the ctxB-phytochemical complexes, while exhibiting adaptive rearrangements of ligand within the active binding sites of the proteins. In the simulations, MM-PBSA binding free energies showed a favorable total binding energy for the complexes. Per-residue energy decomposition analysis identified different highly contributing sets of amino acids to the binding energy with variation for both ctxB genotypes and phytochemicals, suggesting bacterial evolutionary changes may affect binding patterns of the drug candidates. This study suggests five inhibitors of cholera toxin with varying genotypes, which may have potential as an alternative medication for cholera.

National data meets AI: Machine learning for predicting overweight/obesity among ever-married Bangladeshi women

Overweight/obesity has become a critical global health issue, as these conditions are strongly associated with elevated risk of diabetes, stroke, cardiovascular disorders, and certain types of cancer. In recent decades, Bangladesh has faced a notable rise in overweight/obesity prevalence—women are more prone to obesity than men. This study presents a comprehensive strategy for identifying risk factors and predicting overweight and obesity through machine learning (ML) classifiers among ever-married Bangladeshi women aged 15–49 years. Data from the 2017–2018 BDHS, a nationally representative survey, were examined. The data were pre-processed and subsequently balanced using the synthetic minority over-sampling technique and edited nearest neighbors (SMOTE-ENN) approach. Various feature identification techniques, including Chi-Square, LASSO, and Sequential Forward Selection, were employed to determine the key risk features. Later, permutation feature importance and SHAP analysis were employed to assess the influence of these risk factors on overweight/obesity. The classification of overweight and obesity was conducted using seven machine learning models: Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), K-nearest Neighbors (KNN), eXtreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), and Multilayer Perceptron (MLP). Among the evaluated models, SVM performed best, reaching 95.79% accuracy and 97.32% precision when combined with SMOTE-ENN and hyper-parameter tuning. The study found that key factors contributing to being overweight/obese include age, division, type of residence, educational levels of both the respondent and her partner, number of children, frequency of television viewing, and wealth status; where wealth status, age, and frequency of watching television have strong influences. Therefore, integrating the balancing algorithm with the embedded feature selection strategy was effective in classifying overweight/obese women and could enhance decision-making for preventive measures in public health through timely predictions of overweight/obesity.

Regulation of tension-dependent localization of LATS1 and LATS2 to adherens junctions

The LIM domain protein LIMD1 is a critical regulator of the Hippo signaling pathway, acting to sequester the kinases LATS1/2 to adherens junctions (AJs) in response to mechanical strain. Here, we identify the molecular basis for LIMD1 binding and recruitment of LATS1/2 to AJs. We show that while the LIM domains of LIMD1 are sufficient for AJ localization and binding to LATS1/2, recruitment of LATS1 to AJ requires both the intrinsically disordered region (IDR) in the N-terminus as well as the LIM domains. We further dissected the LIM domains and found that LIM1 and LIM2, but not LIM3, are necessary for LATS1 AJ localization. Point mutations that disrupt strain sensitivity in either the first or second LIM domain disrupt both binding and recruitment of LATS1/2 to AJs. Mechanistically, LIMD1 binds LATS1/2 through a conserved linear motif, the LATS-LATCH, which we identified by AlphaFold modeling and confirmed by biochemical and localization assays. The LATS-LATCH is required for mechanical strain-dependent recruitment of LATS1 and LATS2 to AJs. Further analysis of the LATS2-LATCH showed that it is sufficient for binding to LIMD1 and localization to AJs. Mutation of predicted contact residues within the LATS2-LATCH both disrupts its binding to LIMD1 and localization to AJs. These findings define a bipartite mechanism for LIMD1-dependent recruitment of LATS1/2 involving LIM domain-LATCH interactions and N-terminal IDR functions, providing insight into how mechanical signals are transduced through the Hippo pathway.

Dynamic metabolic modeling of Streptomyces clavuligerus in complex medium highlights nutrient-dependent metabolic transitions associated with clavulanic acid biosynthesis

Background Streptomyces clavuligerus is the main industrial producer of clavulanic acid (CA), a potent β-lactamase inhibitor. However, the metabolic interplay linking amino acid utilization, nitrogen regulation, and CA biosynthesis remains poorly understood, particularly under complex medium conditions. Methods The genome-scale metabolic model iLT1021 was used to simulate the dynamic metabolism of S. clavuligerus cultivated in GLYCAS-5 medium. Dynamic flux balance analysis (dFBA) captured the transition from primary to secondary metabolism, while robustness analysis and amino acid network topology identified key metabolic control nodes. Results Integration of dFBA with experimental exometabolome data revealed a clear temporal pattern of amino acid consumption: glutamate, aspartate, and serine were rapidly depleted during exponential growth, whereas histidine and tryptophan were consumed later, coinciding with the onset of CA biosynthesis. Glutamate and glutamine emerged as central nitrogen carriers connecting the α-ketoglutarate and Arg–Orn pathways. Robustness analysis indicated that Arg and Orn enhanced CA fluxes, while Lys and Val had inhibitory effects. Under nitrogen limitation, accumulation of fructose-1,6-bisphosphate and reduced TCA activity reflected a redirection of carbon toward CA precursors. Conclusions This study provides the first genome-scale dynamic modeling of S. clavuligerus in a complex medium, demonstrating that amino acid availability and their temporal utilization pattern govern the metabolic switch from growth to CA biosynthesis. This integrative framework helps to interpret the metabolic behavior of S. clavuligerus growth in complex medium, offering valuable insights into nutrient regulation and secondary metabolism in filamentous bacteria.

Community voices: Exploring beliefs, attitudes, practices and recommendations for improving stroke prevention and stroke care in rural and urban communities in Nigeria

Introduction Globally, stroke is a leading cause of mortality with higher incidence in low- and middle-income countries. However, stroke beliefs and knowledge among community partners are essential considerations for tailoring of interventions in West Africa. Purpose To describe differences in beliefs, attitudes, and practices related to stroke risks, prevention, and care delivery from alternative/complementary providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria. Methods Six focus groups with community members and leaders (n = 57) and key informant interviews with health providers (n = 24) from alternative/complementary and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Socio-Ecological Model guided selection of participants, and the Health Belief Model guided the development of questions for participants. Results Participants perceived stroke as disabling, though manageable, and having higher odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants. Conclusion Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

Correction: Genetic, clinical, lifestyle and sociodemographic risk factors for head and neck cancer: A UK Biobank study

The cost and cost drivers of delivering COVID-19 vaccines in low- and middle-income countries: a bottom-up costing study of rollouts in seven countries

Introduction While COVID-19 vaccines were crucial in containing the pandemic, there is limited evidence on the cost of delivering them in low- and middle-income countries. We estimated the cost of delivering COVID-19 vaccines in Bangladesh, Côte d’Ivoire, the Democratic Republic of the Congo, Mozambique, the Philippines, Uganda, and Vietnam. Methods We retrospectively estimated the financial and economic cost of COVID-19 vaccine delivery from a payer perspective, using a bottom-up approach. Cost data were collected from 290 sites, while qualitative interviews were conducted with 192 key informants. We estimated volume-weighted average costs per dose in 2022 USD, for introduction phases, delivery modalities, and strategies. Results The financial cost per dose ranged from $0·29-$2·18 across countries, driven by per diem and supplies. The economic cost per dose ranged from $1·14-$9·50, driven by the cost of labor. Newly hired health workers were a cost driver only in the Philippines. The economic delivery cost per dose was inversely correlated with daily vaccine volume delivered at vaccination sites. Similarly, delivering through campaigns came at a lower unit cost than continuous delivery, and when programs scaled up, the cost per dose decreased dramatically. Political prioritization, health workers’ commitment, and volunteers were highlighted as success factors, while resource constraints at implementation level and health workers shortages were flagged as key challenges. Conclusion Our findings demonstrate how under-resourced health systems managed to deliver massive amounts of vaccines with relatively few resources. However, they also expose significant gaps and inefficiencies, and underscores the need to invest in resilient health systems to improve future pandemic responses.

Assessing research productivity in addiction datasets using OpenAlex

The Open Science model has fostered new communication and archiving processes, supported by information technology. Within this framework, the open deposit of health-related datasets and their use in evaluating researchers and institutions are encouraged, with emerging information systems offering open alternatives to traditional databases. This study aims to analyse OpenAlex as a tool for retrieving research-derived datasets in a pilot study in the field of addictive substances, to determine whether it serves to automatically evaluate researchers and institutions inherent in the retrieved datasets. Results show that four repositories accounted for 85.8% of the 2782 datasets related to the addictive substances, being 30% of the records properly datasets followed by Comments on scientific investigation (21.4%), Monographs (15.1%) and Periodical publications (7.6%). In addition, missing information such as author identification (30.2%) or affiliation (69%) in the source repositories and data aggregators have been detected. Consequently, the assessment of researchers and institutions through datasets retrieved by OpenAlex would be improved by subsequently curating the information records. In conclusion, OpenAlex is a powerful tool in the Open Science medical ecosystem, and its accuracy could be enhanced by verifying the datasets collected via research information management infrastructures as well as by training professionals.

Relationship between lactate-to-albumin ratio and all-cause mortality among critically ill pediatric patients: Results from the pediatric intensive care database

Background The lactate-to-albumin ratio (LAR) has emerged as a valuable prognostic marker in adult critically ill patients. However, evidence regarding its association with mortality in pediatric intensive care unit (ICU) patients remains limited. The present study utilized data from the Pediatric Intensive Care (PIC) database to investigate the relationship between LAR and clinical outcomes among critically ill pediatric patients. Methods This study enrolled 4,162 pediatric patients from the PIC database as study participants. A piecewise multivariate Cox regression model was constructed, incorporating subgroup analysis and restricted cubic spline (RCS) curve analysis, to investigate the association between the LAR and all-cause mortality during hospitalization and ICU stay. Results In the fully adjusted model, for every one-unit increase in LAR, the risk of in-hospital mortality increased by 23% (HR: 1.23, 95% CI: 1.17–1.30), and the risk of ICU mortality increased by 22% (HR: 1.22, 95% CI: 1.15–1.28). The risk of in-hospital mortality and ICU mortality for patients in the highest LAR quartile were 2.30 and 2.17 times those of patients in the lowest quartile, respectively. RCS analysis revealed a non-linear positive correlation between LAR and 30-day all-cause mortality in critically ill children, with a threshold of 0.4468. Moreover, the predictive performance of LAR (AUC = 0.725) was superior to that of lactate alone (AUC = 0.712) or albumin alone (AUC = 0.608). Conclusions Research shows that in critically ill pediatric patients, LAR is nonlinearly and positively correlated with the 30-day all-cause mortality rate. Moreover, the higher the LAR value, the more significantly the mortality rate increases, suggesting that it is a promising predictor for short-term mortality risk, although this requires further prospective validation.

Association between carbohydrate quality and glycemic control in individuals with type 1 diabetes: A cross-sectional and meal-based analysis

The aim of the study was to investigate the association between the quality of carbohydrates in the diet and glycemic control in individuals with Type 1 Diabetes (T1D). In this cross-sectional study, a dietary survey involving 155 individuals with T1D used a food frequency questionnaire (FFQ) and 3-day dietary records from 65 individuals to analyze 538 meals. The relationship between short-term dietary factors and postprandial glycemic fluctuations was evaluated by a mixed-effects model. The FFQ survey indicated that a higher intake of dietary fiber was associated with better long-term glycemic control (HbA1c≤6.5%) in T1D individuals (OR=1.101, p = 0.031). Analysis of 3-day dietary records and continuous glucose monitoring (CGM) data showed an inverse correlation between whole grain intake and postprandial glycemic variability, measured by standard deviation (SD), large amplitude of glycemic excursions (LAGE) and mean amplitude of glycemic excursions (MAGE) (Est. = −0.83, p < 0.01; Est. = −2.4, p < 0.01; Est. = −1.47, p = 0.04). Specifically, blood glucose fluctuations (SD, LAGE, MAGE) were more significant after lunch (p < 0.05), and these fluctuations were negatively related to the intake of whole grains (Est. = −0.45, p = 0.02; Est. = −1.52, p = 0.01; Est. = −1.39, p < 0.01). From a long-term glycemic control perspective, higher dietary fiber intake appears to be associated with improved HbA1c levels, while in terms of short-term glycemic variability, increased whole grain consumption is associated with reduced glucose fluctuations. However, as a cross-sectional analysis, these findings represent observational associations rather than causal evidence. Further validation through prospective cohorts and randomized trials is needed to assess clinical applicability.

Leveraging videos and community health workers to address social determinants of health in immigrants (LINK-IT): Protocol for a randomized controlled trial

Background Chinese immigrants face numerous social determinants of health (SDOH) challenges that limit access to evidence-based diabetes self-management education and support programs (DSMES). To address these challenges, our team developed the LINK-IT intervention. This manuscript presents the study protocol for the LINK-IT trial. Methods The LINK-IT trial is a 12-month, 3-arm randomized controlled trial aiming to enroll 405 Chinese immigrants with T2D (HbA1c≥7%) from multiple community and clinical settings in New York City. A total of 405 participants will be randomly allocated to one of three groups (n = 135 per group): (1) video-based DSMES plus community health worker (CHW) support (VIDEO+CHW), (2) video-based DSMES only (VIDEO), or (3) wait-list control (CONTROL). The VIDEO+CHW group will receive 24 culturally and linguistically tailored DSMES videos (one per week for 24 weeks) delivered via text message links, along with biweekly (every other week) phone calls from trained CHWs to review video content, support goal setting, and address SDOH barriers. The VIDEO group will receive the same video intervention without CHW support. The CONTROL group will receive usual care and will be offered access to the videos upon study completion. The primary outcome is the change in HbA1c at 6 months. Secondary outcomes include changes in HbA1c at 12 months, self-efficacy for diabetes, dietary intake, physical activity, medication adherence and emotional support at 6 and 12 months. Data will be analyzed using an intention-to-treat approach with linear mixed-effects models. Ethics and Dissemination This study protocol has been approved by the Institutional Review Board of the NYU Grossman School of Medicine (S23-01274). All study procedures will adhere to the ethical principles outlined in the Declaration of Helsinki. Written or verbal informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed publications, presentations at scientific conferences, and community events. Trial registration The LINK-IT trial was registered on March 20, 2024, on ClinicalTrials.gov under the identifier NCT06319716; https://clinicaltrials.gov/study/NCT06319716 .

Psychosocial and occupational predictors of health among Spanish University Employees: The role of job type, contract status, and seniority

The digital transformation of work environments, particularly in academia, has introduced new psychosocial risks, including technostress. This cross-sectional study analyses the relationship between technostress and general health among university employees at the University of Zaragoza, examining the moderating effects of job type, contract status, and seniority. A total of 458 staff members, including academic and research staff and administrative and service staff, completed an online survey assessing general health, technostress, perceived stress, burnout, job satisfaction, resilience, social support, and other occupational variables. The results revealed that perceived stress was the most consistent predictor of emotional symptomatology across all subgroups. Technostress also emerged as a significant predictor, especially among permanent employees and those with longer tenure. Conversely, resilience and job satisfaction functioned as protective factors. Differences in health outcomes were observed depending on employment conditions, highlighting the importance of organizational context. These findings underscore the need for tailored interventions to mitigate psychosocial risks associated with information and communication technologies use and to enhance well-being in academic institutions. This study contributes to the growing evidence base on the health implications of digital work environments in the higher education sector.

Assessing the accuracy and educational value of YouTube videos on a novel regional anesthesia technique (PENG block)

The Pericapsular Nerve Group (PENG) block is a novel regional anesthesia technique that provides adequate analgesia while preserving motor function. This cross-sectional study evaluated the quality, reliability, and educational value of YouTube videos on the PENG block. Thirty-six videos were analyzed using validated scoring systems (GQS, JAMA, DISCERN, and modified DISCERN). Overall video quality was moderate, with higher scores observed in procedural and institutional videos. The findings highlight both the educational potential and the need for quality control in online medical content.

Discovery of a novel Keap1 inhibitor for neurodegeneration through virtual screening and molecular dynamics simulations

Oxidative stress is a key feature of Alzheimer’s disease (AD) and other neurodegenerative disorders. The Kelch-like ECH-associated protein 1 (Keap1)–nuclear factor erythroid 2–related factor 2 (Nrf2) pathway controls redox balance, and disrupting the Keap1–Nrf2 protein–protein interaction (PPI) has become a promising therapeutic approach. Marine natural products (MNPs), because of their structural diversity and bioactivity, are an underexplored source of potential neuroprotective compounds. This study aimed to identify novel marine-derived inhibitors of the Keap1–Nrf2 interaction using a comprehensive in silico pipeline. A total of 14,492 compounds from an open-access MNP database were virtually screened against the Keap1 Kelch domain through molecular docking. The top 1,329 candidates exhibited strong binding affinities, with several reaching scores comparable to the co-crystallized reference ligand L5F. Absorption, distribution, metabolism, excretion, and toxicity (ADMET) profiling was employed to assess pharmacokinetic properties, brain penetration, and safety, leading to the identification of compound 145398-61-4 as the most promising hit. Molecular dynamics (MD) simulations verified the structural stability of the Keap1–145398-61-4 complex, while binding free energy calculations indicated energetically favorable interactions. Additional validation using principal component analysis (PCA) and highest occupied molecular orbital–lowest unoccupied molecular orbital (HOMO–LUMO) energy analysis further confirmed the stability of this interaction. Overall, our in silico study identified compound 145398-61-4 as a novel Keap1–Nrf2 inhibitor, highlighting its potential as a lead candidate for developing treatments for Alzheimer’s disease and other neurodegenerative disorders, such as amyotrophic lateral sclerosis and multiple sclerosis.

Professionalism and associated factors among health professions education students: A primary mixed-methods study from Qatar

Background Professionalism, the judicious use of communication, knowledge, and values for benefits of individuals and communities, is a keystone in health education, and is demarcated by distinct tenets. Professionalism among health professions education students at Qatar University (QU) has not been previously explored. The current study aimed at assessment of professionalism and its tenets among students at the five QU Health Sector colleges, and exploring associated factors. Methods A mixed-methods convergent parallel design was used. For the quantitative phase, data were collected anonymously from students using the Pharmacy Professionalism Instrument (PPI), which assesses overall professionalism score, and scores of six tenets: Excellence, Respect, Altruism, Duty, Accountability, and Honor/Integrity. The qualitative phase involved focus groups exploring students’ perspectives on professionalism and opportunities for its fostering. Results A total of 536 survey responses were analyzed. The mean PPI score indicated fair levels of professionalism and Excellence, Altruism, Duty and Honor/Integrity tenets, while Accountability and Respect exhibited excellent levels. Scores statistically increased with study progress for overall professionalism, as well as Excellence and Respect tenets. Focus groups confirmed student views on tenets of Excellence, Respect, Altruism, Accountability, and Honor/Integrity. Yet, a slight discrepancy in the latter tenet emerged regarding necessity of reporting errors, with some students expressing concerns about potential consequences. Conclusion Favorable professionalism development across years of study and some excellent professionalism tenets were revealed among students. Amidst evolution in education and sociocultural norms, health education curricula should uphold cultivation of professionalism concepts, and establish an environment of recognition and nurturing of professionalism.

Clinical and metabolic profile of adults with obesity attending lifestyle medicine clinics

Background Lifestyle Medicine Clinics (LMCs) in primary care provide structured, multidisciplinary obesity care, but evidence from Saudi Arabia on patient profiles and the effectiveness of pharmacologic therapy in this setting is limited. Methods We conducted a retrospective cohort study at a primary health care center in Prince Sultan Military Medical City, Riyadh (2023–2024). Adults aged 18–75 years with Body Mass Index (BMI) 30–40 kg/m² and at least one obesity-related comorbidity were included. Patients received either Liraglutide plus lifestyle modification or lifestyle modification alone. Data from the LMCs electronic registry were analyzed after 1:1 propensity score matching. Within-group changes were evaluated using paired tests; between-group differences over time were analyzed using repeated-measures ANOVA. Results Among 664 patients (299 receiving Liraglutide and 365 receiving lifestyle modification alone), 280 matched pairs were analyzed (median age 40 years; 73% female). Both groups achieved significant within-group reductions in BMI, systolic and diastolic blood pressure, and HbA1c (all p < 0.05). Between-group comparisons showed a statistically significant difference only in waist circumference change (p = 0.03). Mean BMI change was − 0.75 kg/m² with Liraglutide versus − 0.71 kg/m² without Liraglutide (p = 0.939). No significant between-group differences were observed for glycemic control, blood pressure, or lipid parameters. Conclusions In a real-world primary care setting, Liraglutide plus lifestyle modification and lifestyle modification alone both produced a substantial benefit in metabolic and anthropometric parameters. The incremental benefit of Liraglutide was confined to a modest reduction in waist circumference and did not translate into clinically meaningful differences compared with lifestyle intervention alone. Structured, multidisciplinary lifestyle care should remain the foundation of obesity management, with pharmacotherapy targeted to selected patients.