Journal of Advances in Medicine and Medical Research

Endocrine Ageing: Adaptive Remodelling or Treatable Hormone Deficiency? A Critical Narrative Review of the GH–IGF-1, Thyroid, Gonadal and Adrenal Axes with Lessons Across the Life Course

Ashraf T. Soliman — 2026-10-30

Age-associated endocrine change is frequently described in the language of deficiency, yet a lower circulating hormone concentration does not necessarily establish disease or demonstrate that replacement will improve health. This critical narrative review examines the growth hormone–insulin-like growth factor-1, thyroid, gonadal and adrenal axes, focusing on the distinction between adaptive remodelling, pathological endocrine failure and potentially reversible effects of illness, adiposity, medication and altered feedback. Peer-reviewed observational studies, randomised trials, evidence syntheses and professional guidance were examined alongside developmental endocrinology literature, with evidence considered up to 23 August 2026. Across the four axes, the clinical implications of similar age-associated laboratory changes are strikingly different. Reduced somatotropic signalling may entail trade-offs between growth, metabolic maintenance and disease resistance, while growth hormone administration to otherwise healthy older adults has not shown compelling functional benefit. Mild thyrotropin elevation in later life often occurs without low free thyroxine, and trials have not demonstrated meaningful average symptomatic gains from routine levothyroxine in older adults with mild subclinical hypothyroidism. Ovarian menopause is a distinctive physiological transition for which hormone therapy may provide important symptom and skeletal benefits in appropriately selected individuals, whereas testosterone treatment requires biochemical and clinical evidence of hypogonadism and careful monitoring. Adrenal androgen decline is not equivalent to adrenal insufficiency, and replacement studies do not support indiscriminate use of dehydroepiandrosterone for healthy ageing. Developmental comparisons show why the same hormone concentration can represent normality, disease or treatment response at different life stages. A clinical decision framework is proposed that weighs trajectory, symptoms, feedback integrity, functional outcomes and intervention evidence rather than chronological age or a single assay result. Future studies should prioritise longitudinal within-person measurements, age-sensitive reference intervals, functional outcomes and life-course follow-up. Endocrine ageing is best understood as heterogeneous remodelling with discrete, clinically important exceptions requiring targeted treatment.

Congenital Haemophilia A and B: An Overview of Pathophysiology, Clinical Expression and Contemporary Management

Yasmin Mohammed Alnajjar — 2026-11-04

Haemophilia A and B are X-linked bleeding disorders caused by deficiency of coagulation factor VIII and factor IX, respectively. Therapeutic options have changed more in the past decade than in the preceding half-century, with subcutaneous substitution and rebalancing agents, ultra-extended factor concentrates and liver-directed gene transfer all entering routine or near-routine use. This critical narrative review examines how far that therapeutic transformation is matched by the underlying evidence, and where the clinical and conceptual foundations of haemophilia care remain unsettled. Literature was identified through structured searching of bibliographic and open scholarly sources, supplemented by citation tracking and authoritative institutional reporting, and was appraised for design, measurement validity, representativeness and consistency rather than catalogued descriptively. Several conclusions are robust: factor activity determines broad bleeding risk but predicts individual phenotype only loosely; early prophylaxis prevents structural joint damage whereas prophylaxis begun after arthropathy is established improves function without reversing structure; and all currently licensed bleed-prevention strategies reduce bleeding rates substantially when compared with episodic treatment. Other widely held positions are weaker than their citation frequency suggests. The relative immunogenicity of plasma-derived and recombinant factor VIII remains contested between a randomised trial and large observational cohorts whose discrepancy is not fully explained by design alone. Annualised bleeding rate, the endpoint on which almost all regulatory evidence rests, is insensitive to subclinical joint bleeding and to the outcomes patients prioritise. Gene therapy produces durable but declining and highly variable factor expression, and its comparative position against modern non-factor prophylaxis has not been tested directly. Across every domain, the evidence base is geographically narrow, drawn predominantly from high-income settings in which fewer than one in five people with haemophilia worldwide receive care. Priorities for the next decade include head-to-head comparisons of bleed-prevention strategies, joint-structure endpoints with demonstrated measurement properties, prospective evaluation of thrombotic risk with rebalancing agents, and evidence generated in the settings where most undiagnosed disease resides.

Relevance of Community-based Education in Mental Health Literacy: A Systematic Review

Celsus Ufawu Akomaye — 2026-10-23

Background: Community-delivered education may improve public recognition of mental-health problems and reduce stigmatising beliefs, but changes in knowledge do not necessarily translate into sustained help-seeking or better outcomes.

Objective: To evaluate changes in mental health literacy, stigma, support behaviour and related outcomes after community-based educational interventions.

Methods: An open access and openly accessible, bounded verification search identified 39 individually visible records from four logged PMC-indexed web queries and four additional targeted primary-report records, within the publication window 1 January 2000 to 13 August 2026. Deduplication and a single reviewer assessment were recorded in an item-level ledger. Primary comparative and non-comparative evaluations were summarised without statistical pooling; source coverage and bias were examined critically.

Results: Seven of 43 records were duplicates; 36 distinct records were screened, 20 reports were assessed, and 18 reports describing 17 studies were included. Six studies used randomised designs. Community Mental Health First Aid, adapted public education and community health-worker training frequently improved recognition, knowledge or selected attitude measures. However, long-term recipient outcomes were uncertain: a parent-training trial detected literacy gains without improved adolescent outcomes, and a large rural Indian multicomponent trial did not improve its behavioural co-primary outcome. Many smaller studies lacked controls.

Conclusions: Community-based education is relevant for mental-health literacy and local workforce capacity, but current accessible evidence gives weaker support for sustained behaviour change and improvements in recipients’ mental health. The source-limited search precludes claims of exhaustive coverage.

Histopathological Changes in Patients with Polyostotic Fibrous Dysplasia of Bone

Ziyadulla E. Zhumanov — 2026-10-17

Background: Polyostotic fibrous dysplasia is an uncommon fibro-osseous skeletal disorder driven by postzygotic GNAS1 mutations; although its general pathology is well described, site-specific histopathological data from surgical cohorts in Central Asia remain limited.

Aims: To describe the histopathological features in surgical specimens from patients with polyostotic fibrous dysplasia and to correlate the findings with clinical complications.

Study Design: Retrospective histopathological study of surgical specimens.

Place and Duration of Study: Department of Pathological Anatomy, Samarkand State Medical University, using operative specimens from patients treated at the Samarkand branch of the Republican Specialised Scientific Practical Centre for Traumatology and Orthopaedics, between 2020 and 2025.

Methodology: Forty-eight surgical specimens were fixed in formalin, paraffin-embedded, sectioned at 5–7 µm, and stained with haematoxylin-eosin, Van Gieson’s, and Weigert’s methods.

Results: Light microscopy consistently showed replacement of medullary bone by fibrous stroma with haphazardly arranged collagen bundles, producing the classic curvilinear, ‘Chinese-letter’ pattern of woven-bone trabeculae. Dystrophic calcification at lesion margins, cortical thickening, myxoid microcysts, thin-walled stromal vessels, and foamy xanthoma cells were identified. Multinucleated giant-cell clusters resembling a giant-cell tumour were present in selected specimens. Pseudoarthrosis with attenuated periosteal sclerosis occurred in two patients (4.2%).

Conclusion: Young individuals were disproportionately affected. The dominant finding was fibrous replacement of bone with peripheral calcification and focal giant-cell aggregates, predisposing to pathological fracture and pseudoarthrosis.

Pathomorphological Changes of the Uterine Myometrium in Pregnancies Complicated by Placenta Previa

Ziyadulla E. Zhumanov — 2026-10-17

Background: Placenta previa is a recognised risk factor for placenta accreta spectrum (PAS); PAS was histologically confirmed in the hysterectomy specimens studied here.

Aims: To identify pathomorphological changes in the uterine myometrium after delivery in pregnancies complicated by placenta previa.

Study Design: Retrospective, descriptive histopathological study of explanted postpartum uteri.

Place and Duration of Study: Department of Pathological Anatomy, Samarkand State Medical University, using uteri explanted at the Samarkand branch of the Republican Scientific Practical Centre for Maternal and Child Health, during 2025 and 2026.

Methodology: Uteri from 24 postpartum women (aged 28–40 years; mean age, 36.6 years) were studied. Tissue pieces (0.5×1.0 cm) from the myometrial layer were fixed in 10% formalin, dehydrated, and paraffin-embedded. Sections 5–7 µm thick were stained with haematoxylin-eosin, Van Gieson’s, and Weigert’s methods.

Results: A large amount of blood was observed in the interstices between myocytes. Massive diapedetic haemorrhages were noted at placental attachment sites, together with diffuse leucocyte infiltration and severe intermuscular oedema. Hydropic dystrophy was observed in most myocytes, accompanied by active fibroblast proliferation and dystrophic/necrotic changes in the interstitial arteries.

Conclusion: The postpartum uterine myometrium in pregnancies complicated by placenta previa shows a consistent pattern of haemorrhagic, dystrophic, and proliferative changes, dominated by diapedetic haemorrhage, leucocyte infiltration, intermuscular oedema, hydropic dystrophy, and fibroblast proliferation. Without a normal postpartum control group, these changes are best interpreted as tissue injury and repair, not previa-specific findings.

Maternal Characteristics and Short-Term Maternal and Neonatal Outcomes of Placental Abruption in Uzbekistan: A Retrospective Comparative Study

Zebiniso Nasirova — 2026-10-26

Background: Placental abruption can cause serious maternal and neonatal complications, but evidence from Central Asia remains limited.

Objective: To compare maternal characteristics and short-term clinical outcomes between hospital deliveries with and without clinically diagnosed placental abruption in Samarkand, Uzbekistan.

Methods: This retrospective single-centre analysis included 76 deliveries with abruption and 76 previously selected comparison deliveries from 2022–2024. Maternal and neonatal variables were compared using Mann–Whitney U and two-sided Fisher exact tests. An exploratory conditional logistic regression model stratified by calendar year examined selected maternal characteristics. The original selection process for comparison records could not be reconstructed.

Results: Of 16,774 hospital deliveries, 76 involved abruption (0.45%). Median body mass index was higher with abruption (29.0 vs 26.9 kg/m²; P = 0.005), whereas categorical obesity was not significantly different. Median recorded blood loss was 850 versus 550 mL (P < 0.001); blood loss of at least 1000 mL occurred in 19.7% versus 2.6%, and transfusion occurred in 22.4% versus 2.6%. Caesarean delivery occurred in 98.7% versus 51.3%. Among singleton pregnancies, the distribution of 5-minute Apgar scores differed (P < 0.001), but the comparison of scores below 7 was not statistically significant (8.0% vs 1.3%; P = 0.063).

Conclusions: Abruption was associated with greater recorded haemorrhagic and operative burden. The associations with maternal body mass index remain exploratory because comparison-sample selection and residual confounding may influence the findings.

Infant Feeding Practices: A Cross-Sectional Study of Barriers and Associated Factors

Jasmeen Saini — 2026-10-26

Background: Appropriate infant feeding practices are essential for child growth, development, and health. However, cultural beliefs, family influence, and practical barriers may affect the adoption of recommended breastfeeding and complementary feeding practices.

Objective: To assess breastfeeding and complementary feeding practices among mothers and examine associations between complementary feeding patterns and selected sociodemographic characteristics.

Methods: A community-based cross-sectional study was conducted during January 2026 to June 2026 among 340 mothers of children aged less than one year from selected urban areas of Chandigarh and Jalandhar District, Punjab, India. Data were collected through face-to-face interviews using a structured questionnaire covering breastfeeding initiation, prelacteal feeding, colostrum administration, exclusive breastfeeding, bottle feeding, complementary feeding, reported barriers, and counselling needs. Descriptive statistics were used to summarise feeding practices. Associations between complementary-feeding categories and sociodemographic characteristics were assessed using statistical tests.

Results: Breastfeeding was initiated within one hour of birth by 64.7% of mothers, while 52.9% reported prelacteal feeding, most commonly ghutti (40.6%) and honey (37.2%). Colostrum was given to 80.3% of infants. Although 74.7% of mothers had correct awareness of exclusive breastfeeding, 44.7% reported practising it up to the child’s current age. Lack of privacy was the most frequently reported breastfeeding barrier (24.7%). Appropriate complementary feeding was reported for 37.6% of children, while 12.4% were classified as having early initiation. Maternal age (p = 0.008), socioeconomic status (p = 0.0003), and working status (p < 0.001) were significantly associated with complementary-feeding categories; mode of delivery was not (p = 0.666). Family members influenced complementary-feeding decisions for 82.6% of mothers.

Conclusion: Suboptimal infant feeding practices and sociocultural barriers were common. Family-centred health education and accessible professional counselling may help improve recommended feeding practices. Further analysis using clearly defined, age-specific indicators is warranted.

Integrated Risk Stratification and Stepwise Diagnostic Algorithm for Clinically Significant Caesarean Scar Defects in Women with Reproductive Dysfunction

L. R. Agababyan — 2026-10-27

Background: A post-caesarean uterine niche may be incidental or associated with postmenstrual spotting, pelvic symptoms and reproductive difficulties. Distinguishing structural abnormalities from clinically important lesions remains challenging when imaging is interpreted in isolation.

Objective: To examine clinical, obstetric, ultrasonographic and Doppler variables associated with clinically significant caesarean scar defects and to describe the apparent discrimination of a combined risk score and sequential imaging strategy in women with and without reproductive dysfunction.

Methods: This two-centre observational comparative study included 150 women aged 18–45 years with a caesarean delivery at least six months earlier: 100 with reproductive dysfunction and 50 without such dysfunction or severe scar-related symptoms (2021–2025). All underwent clinical assessment, transvaginal ultrasonography and Doppler evaluation; MRI was used selectively in 92 women and hysteroscopy in 86. An integrated clinical/imaging assessment classified defect significance. Associations were reported using logistic regression and discrimination using receiver operating characteristic analysis. Because the reference classification included imaging and symptoms, diagnostic accuracy estimates are potentially affected by incorporation and verification biases.

Results: Clinically significant defects were reported in 72/100 women (72.0%) with reproductive dysfunction and 9/50 controls (18.0%). The strongest reported adjusted associations were residual myometrial thickness ≤2.5 mm (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.63–15.43) and a residual-to-adjacent myometrium ratio ≤50% (OR 5.21, 95% CI 2.13–12.73). The reported combined-model area under the ROC curve was 0.94 (95% CI 0.90–0.97); apparent sensitivity and specificity were 90.1% and 89.9%. The proposed 13-point score defined low- (0–3), intermediate- (4–7), and high-risk (8–13) groups with reported defect frequencies of 14.6%, 52.7%, and 95.7%, respectively. Ultrasound plus Doppler showed reported sensitivity of 96.3% and specificity of 88.4%.

Conclusion: Combining symptoms, obstetric history and scar morphometry may aid clinical triage after caesarean delivery. The risk score and apparent diagnostic performance require independent evaluation using an explicitly defined reference standard before clinical implementation.

Bacteriological Profile and Prevalence of Cerebrospinal Fluid Isolates at the University of Uyo Teaching Hospital, Nigeria: A 2-Year Retrospective Study (2024–2026)

Ikechukwu Francis Agwu — 2026-10-28

Background: Cerebrospinal fluid (CSF) culture provides laboratory information about microorganisms recovered from patients investigated for suspected meningitis. Local descriptions of CSF isolates are useful because the distribution of microorganisms may differ between hospital settings and age groups.

Objective: To describe the frequency of CSF culture positivity and the distribution of recovered microorganisms at the University of Uyo Teaching Hospital, Nigeria, between August 2024 and August 2026.

Methods: This retrospective study reviewed 291 CSF culture records from the hospital microbiology database. Available demographic information, hospital location and microbiological results were analysed descriptively using frequencies and percentages.

Results: Of 291 submitted CSF specimens, 76 yielded microbial growth, giving an overall culture-positivity rate of 26.1%. Culture positivity was 52.9% among neonates aged 0–28 days and 6.3% among children aged 1–17 years. The Special Care Baby Unit had six positive cultures among seven specimens (85.7%). Table-based isolate counts totalled 81, comprising 33 Gram-positive cocci (40.7%), 33 Gram-negative bacilli (40.7%) and 15 yeasts (18.5%). Staphylococcus aureus was the most frequently reported organism (30 isolates; 37.0%), followed by Klebsiella pneumoniae (20; 24.7%).

Conclusion: The findings describe the local distribution of organisms recovered from submitted CSF specimens, with substantial variation across age groups and hospital wards. The difference between culture-positive specimen counts and recorded isolate counts requires verification, and the results do not establish population-level meningitis incidence.

Early Blood Glucose Responses to Konjac Glucomannan and Metformin in Alloxan-induced Diabetic Female Wistar Rats in Kenya: An Exploratory Study

Ouma Brian — 2026-10-29

Background: Konjac glucomannan (KGM) has been investigated for glycaemic modulation, but early responses to KGM, metformin, and their combinations remain insufficiently characterised in alloxan-exposed rats. Objective: To describe early blood glucose concentrations and within-animal changes among metformin, KGM, and combination-treated groups. Methods: Twenty-one female Wistar rats were allocated to seven groups (n = 3/group): one non-induced control group, two monotherapy groups, and four combination groups. Alloxan (130 mg/kg, intraperitoneally) was administered to Groups II–VII. Glucose concentrations at pretreatment baseline, 1.5 h, and 3 h were available for all animals; subsequent observation intervals differed by group. Group means, sample standard deviations, and 3-h within-animal changes were calculated. An exploratory one-way analysis of variance compared changes among the six alloxan-exposed groups. Results: Mean (SD) 3-h glucose concentrations in Groups I–VII were 7.57 (0.21), 13.27 (5.22), 20.97 (11.93), 5.73 (2.63), 6.57 (1.63), 16.77 (12.30), and 8.47 (1.20) mmol/L, respectively. Mean changes from baseline were +2.13, −7.37, −0.73, −7.10, −3.17, −3.67, and −1.47 mmol/L. The between-group analysis was not statistically significant, F(5, 12) = 1.755, p = .197. One combination-treated rat had a 3-h glucose concentration of 2.7 mmol/L. Conclusions: Unequal baseline concentrations, limited group sizes, the absence of an untreated diabetic control, and uncertain intermediate-dose assignments prevent causal inferences about comparative efficacy or pharmacological interactions. The observations are hypothesis-generating and highlight the need for controlled efficacy and safety studies.

Hepatitis B Knowledge Across Six Domains among Healthcare Personnel and Trainees in Public Primary Care Centres in Brazzaville

Ebenguela Ebatetou Ataboho — 2026-10-29

Background: Hepatitis B remains an important occupational health concern among healthcare personnel and trainees. Adequate knowledge of its transmission, clinical manifestations, complications and prevention is essential for occupational safety. However, awareness of hepatitis B vaccination may not reflect knowledge across other domains. Assessing these distinct knowledge domains among healthcare personnel in public primary care centres in Brazzaville may help identify areas requiring further educational assessment.

Aims: To describe six questionnaire-defined hepatitis B knowledge domains among healthcare personnel and trainees and to identify priorities for further educational assessment.

Study Design: Cross-sectional survey.

Place and Duration of Study: Seven public primary care centres in Talangaï and Djiri, Brazzaville, Republic of the Congo, July–November 2023.

Methodology: Questionnaire responses from 303 adults were analysed, representing 61.6% of 492 enumerated personnel and trainees. Six binary indicators were reconstructed from the source data. Domain-specific proportions, a descriptive domain count and within-person co-occurrence of vaccine awareness and transmission responses were examined. Exploratory regression analyses assessed associations and sensitivity to age specification and centre dependence.

Results: The proportions meeting the recorded criteria were 37.6% for reported knowledge of the definition, 63.4% for identification of the viral cause, 22.1% for at least three transmission routes, 11.6% for at least three clinical manifestations, 43.6% for reported knowledge of complications and 59.7% for awareness of an effective vaccine. Among 181 vaccine-aware respondents, 119 (65.7%) did not identify at least three transmission routes. The mean domain count was 2.38 of 6; 116 participants (38.3%) met at least four criteria. Higher education was associated with this exploratory outcome (adjusted odds ratio 3.37), but its 95% confidence interval widened from 1.87–6.07 to 0.89–12.69 when centre dependence was explored.

Conclusion: Vaccine awareness frequently coexisted with limited identification of transmission routes. The findings support focused educational assessment in the participating centres. Mixed question formats, non-probability recruitment and uncertain cluster-level precision preclude interpreting these results as validated competence estimates or causal determinants.

Association of Age and Gender with Tooth Shade and Its Components in Individuals Aged 16–30 Years

AO. Arigbede — 2026-11-02

Background: Accurate shade assessment supports aesthetic dental restoration, but information about associations between age, sex and tooth shade components among younger adults remains limited.

Aims: The study aimed to determine the influence of age and sex on tooth shade and its components in young adults aged 16–30 years.

Study Design: Cross-sectional study.

Place and Duration of Study: Port Harcourt, Rivers State, Nigeria, between January 2021 and December 2024.

Methodology: The study included 150 young adults from the Ogoni ethnic group in Rivers State, Nigeria, who had good oral hygiene, normal teeth, and no conditions that could affect tooth shade selection. The participants were divided into the 16–19- and 20–30-year age groups. A Tooth Colour Comparator (Model YS-TCC-A) was used to determine tooth shade and its components objectively (chroma, hue, value) following the manufacturer’s instructions. Three experienced dental surgeons, including one woman, independently determined the tooth shades visually according to the standard protocol. The VITA 3D-Master shade guide was used to match the shade of the upper right central incisor. Participants who were unwilling to remove their bright make-up or jewellery were excluded from the study. IBM SPSS Statistics software version 20.0 (Armonk, NY: IBM Corp.) was used to analyse the data. The chi-square test (Monte Carlo) was used to assess the relationship between sociodemographic variables and tooth shade and its components. The threshold for statistical significance was set at p < 0.05.

Results: Of the 150 participants, those aged 20–30 years (79; 52.7%) and female participants (98; 65.3%) constituted the majority. The chi-square test showed a statistically significant association between age group and tooth shade and between sociodemographic variables and chroma when the instrument-based method was used, but no such associations were found with the visual method.

Conclusion: Sociodemographic variables may be associated with tooth shade and one or more of its components even among individuals aged 16–30 years.

VEGFA rs2010963 (−634G>C) Genotype Patterns Across Obesity Grades: An Exploratory Aggregate-Data Study with Implications for Polycystic Ovary Syndrome Research

N. N. Tursunova — 2026-11-13

Background: Angiogenic signalling is biologically relevant to polycystic ovary syndrome (PCOS) and placental adaptation, but evidence linking VEGFA sequence variants to reproductive complications is inconsistent. Obesity may complicate interpretation of such genetic studies.

Objective: To examine whether aggregated VEGFA rs2010963 (−634G>C) genotype distributions differed between an obesity-stratified study group and a comparison group, and across three obesity grades.

Methods: We reanalysed genotype counts supplied in three summary tables. The obesity-stratified group included 60 individuals (grade I, n=25; grade II, n=30; grade III, n=5); the comparison group included 50. Allele frequencies were reconstructed from diploid genotype counts. Exact Hardy–Weinberg equilibrium (HWE) tests, Fisher tests for binary genotype contrasts, and Monte Carlo Fisher–Freeman–Halton tests for multi-category tables were used. No patient-level pregnancy or PCOS-status records were available for this genetic dataset.

Results: GG, GC and CC genotypes occurred in 42 (70.0%), 15 (25.0%) and 3 (5.0%) participants in the obesity-stratified group versus 30 (60.0%), 18 (36.0%) and 2 (4.0%) in the comparator. The overall 2×3 genotype comparison was not statistically significant (Monte Carlo exact P=0.464). The odds ratio for GG versus GC/CC was 1.56 (95% CI 0.71–3.43; Fisher P=0.317). Variation across obesity grades was not statistically conclusive (3×3 exact Monte Carlo P=0.118). In grade III obesity, the sample comprised only five individuals.

Conclusion: These aggregate data do not establish a reproducible association between rs2010963 and obesity grade. They support careful design of future studies integrating validated PCOS phenotyping, angiogenic biomarkers and pregnancy outcomes; they cannot substantiate a clinical prediction or prevention algorithm.

Mesial Marginal Bone Loss around Calcium-Coated and Conventional Dental Implants under Two Loading Schedules: A 12-Week Prospective Comparative Study

Karan Kumar — 2026-11-13

Background: Implant surface characteristics and the timing of prosthetic loading are relevant to early peri-implant bone-level changes. This prospective study compared radiographic mesial marginal bone loss around calcium-coated and conventional dental implants managed under two loading schedules.

Methods: Forty systemically healthy partially edentulous patients were allocated to four groups (n = 10 each): calcium-coated or conventional implants treated under a shorter postoperative loading schedule (Groups I and II, respectively), and calcium-coated or conventional implants scheduled for loading at approximately three weeks (Groups III and IV, respectively). Mesial marginal bone levels were measured on digital intraoral periapical radiographs at baseline and at nominal 3-, 6-, 9-, and 12-week follow-ups. Group means and standard deviations were summarised descriptively.

Results: At 12 weeks, mean (SD) mesial marginal bone loss was 0.46 (0.02) mm in Group I, 0.61 (0.02) mm in Group II, 0.36 (0.03) mm in Group III, and 0.46 (0.04) mm in Group IV. Mean bone loss increased with time in each group. Within each loading schedule, the calcium-coated group had a numerically lower 12-week mean than the corresponding conventional-implant group.

Conclusion: This four-group comparison documents the short-term trajectory of mesial marginal bone loss after implant placement and loading. The descriptive findings provide a basis for further evaluation of implant surface chemistry and loading schedule in adequately characterised longitudinal studies.

Frequency and Clinical Outcomes of Atypical Bacterial Pathogen Positivity in Adults Hospitalised with Community-acquired Pneumonia: A Prospective Study from a North Indian Emergency Department

Mandip Singh Bhatia — 2026-11-13

Background: Atypical bacterial pathogens are recognised causes of community-acquired pneumonia (CAP), but contemporary data regarding their frequency and clinical significance among adults hospitalised with CAP in India are limited.

Aim: This study examined atypical-pathogen positivity and compared clinical severity and early outcomes according to test results.

Methods: A prospective observational study was conducted among adults hospitalised with CAP through the emergency department of a tertiary-care centre in North India from January to July 2024. Patients were tested for Mycoplasma pneumoniae and Chlamydia pneumoniae using serological assays and for Legionella pneumophila serogroup 1 using urinary antigen testing. Disease severity, organ-support requirements, and clinical outcomes through day 7 were compared according to atypical-pathogen positivity.

Results: Among 50 patients, 5 (10.0%; 95% CI, 3.3–21.8) had laboratory evidence of an atypical bacterial pathogen: 4 (8.0%) had M. pneumoniae and 1 (2.0%) had C. pneumoniae; none tested positive for L. pneumophila. Severe CAP was present in 3/5 atypical-positive patients (60.0%) and 12/45 atypical-negative patients (26.7%) (risk ratio, 2.25; 95% CI, 0.95–5.34). Ventilatory support was required in 3/5 (60.0%) and 5/45 (11.1%), respectively (risk ratio, 5.40; 95% CI, 1.81–16.11), and invasive mechanical ventilation was required in 3/5 (60.0%) and 3/45 (6.7%), respectively (risk ratio, 9.00; 95% CI, 2.44–33.24). Vasopressor support was required in 40.0% and 11.1%, respectively. By day 7, clinical worsening occurred in 40.0% of atypical-positive and 24.4% of atypical-negative patients. No deaths occurred among atypical-positive patients; 3 of 45 atypical-negative patients (6.7%) died.

Conclusions: In this prospective cohort of adults hospitalised with CAP, 10% had laboratory evidence of an atypical bacterial pathogen, predominantly M. pneumoniae. Atypical-pathogen positivity was observed in patients with severe illness and was associated with a greater observed requirement for ventilatory support. Given the small number of positive cases and wide confidence intervals, these findings are hypothesis-generating and require confirmation in larger studies using molecular diagnostics.

Phytochemical Characterization of Aqueous Garlic (Allium sativum) Extract by FTIR, GC–MS and Assessment of Its Antiglycation, Alpha-amylase and Antidiabetic Activities in Alloxan-induced Diabetic Sprague–Dawley Rats and Molecular Docking Study

Johnson Oshiobugie Momoh — 2026-11-14

Garlic (Allium sativum L.) contains phytochemicals of potential relevance to oxidative stress reduction and glucose homeostasis. This study characterised aqueous Allium sativum extract and evaluated its antioxidant, antiglycation and antidiabetic effects in alloxan-induced diabetic Sprague–Dawley rats, together with molecular docking against human alpha-amylase. Mineral composition, FTIR, GC–MS and phytochemical profiles were determined, while antioxidant and antiglycation activities were assessed using established in-vitro assays. Twenty-five rats were allocated to five groups. Diabetic animals received no treatment, glibenclamide (10 mg/kg), or aqueous garlic extract at 250 or 500 mg/kg body weight for 15 days, while a non-diabetic group served as the normal control. GC–MS identified 22 compounds, with 4H-pyran-4-one,2,3-dihydro-3,5-dihydroxy-6-methyl accounting for 22.53% and diallyl disulfide for 17.05%. The extract showed DPPH radical-scavenging activity with an IC₅₀ of 66.67 ± 2.07 µg/mL and inhibited advanced glycation end-product formation with an IC₅₀ of 66.75 ± 0.76 µg/mL. Treatment with the extract was associated with reduced blood glucose, total cholesterol, triglycerides, LDL-cholesterol, atherogenic indices and malondialdehyde, together with increases in HDL-cholesterol and antioxidant parameters compared with untreated diabetic animals. Pancreatic histology also showed better-preserved islet architecture in extract-treated groups. Molecular docking against human alpha-amylase (PDB: 1U2Y) yielded a binding affinity of −5.9 kcal/mol for the highest-ranked garlic-derived ligand (Hydrazine,1,2-dimethyl-), compared with −6.3 kcal/mol for acarbose. Overall, the findings indicate antioxidant, antiglycation and glucose-lowering activity of aqueous garlic extract in this experimental model.

Ameloblastic Fibroma of Posterior Maxilla: A Rare Entity

Rubeena Anjum — 2026-10-31

Background:Ameloblastic fibroma is an uncommon benign mixed odontogenic tumour composed of epithelial and ectomesenchymal elements. It usually affects younger patients and more frequently involves the posterior mandible than the maxilla. This report describes an adult patient with posterior maxillary involvement and a clinical suspicion of recurrent unicystic ameloblastoma.

Case Presentation: A 30-year-old man presented with swelling and pain in the left upper posterior jaw approximately two years after surgery for unicystic ameloblastoma. Examination demonstrated a solitary swelling of the left posterior maxillary/alveolar region extending towards the palate, with focal erythema and ulceration. Radiographic examination revealed a well-defined, expansile, unilocular radiolucency involving the region of teeth 25–28, measuring approximately 35.49 mm superoinferiorly and 33.62 mm anteroposteriorly. Imaging showed cortical expansion, thinning and perforation, with extension towards the infraorbital floor, maxillary sinus, adjacent nasal cavity and oral cavity. Histopathological examination of submitted tissue fragments demonstrated cords, strands and islands of odontogenic epithelium within a hypercellular primitive ectomesenchymal stroma. Peripheral palisading, reverse polarity, stellate-reticulum-like cells and focal myxoid changes were also observed. The overall findings were suggestive of ameloblastic fibroma.

Conclusion: This case illustrates the importance of correlating clinical and radiographic impressions with histopathological findings when assessing an unusual posterior maxillary lesion, particularly in a patient with a history of odontogenic tumour surgery.

Recurrent Giant Cell Tumor of Tibia with Pulmonary Metastases: A Case Report

Bamha Hajar — 2026-11-06

Background: Giant cell tumour of bone (GCTB) is a locally aggressive neoplasm that may recur after treatment and, in uncommon cases, metastasise to the lungs. This report describes pulmonary metastases following recurrent GCTB of the proximal tibia.

Case Presentation: A 43-year-old man had previously undergone curettage and bone cement filling for GCTB of the right proximal tibia. Local recurrence developed one year after the initial diagnosis and was treated with subcutaneous denosumab for five months. The patient discontinued treatment without medical advice. Subsequent enlargement of the recurrent mass prompted further imaging and lower-limb amputation. Approximately one year later, he presented with progressive dyspnoea and persistent cough. Chest imaging demonstrated a left mediastinal–pulmonary mass and multiple lesions with a cannonball appearance. Flexible bronchoscopy showed no endobronchial tumour. Histopathological examination of a computed tomography-guided transthoracic needle biopsy identified mononuclear stromal cells and multinucleated giant cells, supporting pulmonary metastasis from GCTB. Clinical and radiological assessment found no recurrence at the amputation site. Following multidisciplinary review, denosumab was selected for further treatment.

Conclusion: This case illustrates pulmonary metastatic disease following recurrent proximal tibial GCTB despite extensive local treatment. It supports consideration of continued clinical surveillance and individualised assessment of pulmonary lesions. The temporal association between treatment discontinuation and disease progression does not establish causality.

Proposal of Stratified Framework for Dental Management of Children with Special Health Care Needs: A Technical Report

Mahima Singh — 2026-11-02

Background: Managing paediatric patients with special health care needs (SHCN) presents significant behavioural and operational challenges in clinical dentistry. Although medical and functional classification systems are available, they may not directly reflect the adaptations and care settings required for dental treatment.

Aim: To introduce a four-category stratified clinical framework for classifying children with SHCN according to anticipated dental management requirements.

Technical Design: The proposed framework comprises four categories: Category I (Routine Dental Care), for children who can receive care in routine dental settings with minor support; Category II (Modified Dental Care), for children requiring additional behavioural, environmental, communication or accessibility adaptations; Category III (Advanced Dental Care), for children requiring specialised techniques, multidisciplinary coordination or referral to hospital-based dental services; and Category IV (Comprehensive/Complex Dental Care), for children with profound disabilities or life-threatening systemic conditions requiring complex hospital-based dental management. Classification is based on anticipated treatment complexity and necessary modifications to dental care rather than diagnosis alone.

Conclusion and Clinical Significance: The proposed four-category framework may support individualised treatment planning, clinical adaptations, referral decisions and communication among dental teams, caregivers and other healthcare professionals. As a conceptual proposal, the framework requires formal validation before its reliability and clinical utility can be established.