Journal of Advances in Medicine and Medical Research

Occlusal Discrepancy Correction and Improvement in Vocal Performance: A Case Report of an Opera Singer

Yoshiro Fujii — 2026-06-27

Background: Dental occlusion and tooth morphology may influence oral cavity configuration, jaw position, and phonation, but their relationship with vocal performance remains insufficiently characterized. This case report describes clinical changes observed after correction of occlusal discrepancies in a professional opera singer.

Case Presentation: A female opera singer in her 40s presented with occlusal discomfort, mild headaches, right shoulder stiffness, impaired sitting balance, and difficulty producing high-pitched notes. Symptoms began approximately two weeks after placement of a three-unit metal bridge in the upper right molar region. Clinical examination identified no temporomandibular joint abnormalities but revealed an anterior crossbite and minor tooth morphology irregularities, including protrusions affecting the lower left canine and lower left first molar.

Intervention: Occlusal adjustment and tooth morphology refinement were performed using conventional dental assessment. The Bi-Digital O-Ring Test was used only as a supplementary clinical indicator and did not determine diagnosis or treatment independently.

Results: After treatment, the patient reported improved occlusal discomfort, resolution of headaches within several days, improved right shoulder mobility, and stabilized sitting balance. She also reported easier high-pitched phonation, greater vocal stability, reduced strain, and improved resonance, with maintenance of improvements for more than two months.

Conclusion: This case suggests a possible association between correction of occlusal discrepancies and improved subjective vocal performance, although causal inference cannot be established from a single case.

Neuroendocrine Carcinoma of the Cervix: A Case Report

Imane Chahbounia — 2026-06-30

Neuroendocrine carcinoma of the uterine cervix is a rare and highly aggressive malignancy that accounts for less than 2% of all cervical cancers and is usually associated with human papillomavirus infection. Cases lacking evidence of this association remain uncommon and may present diagnostic difficulty. This case report describes a 60-year-old woman who presented with postmenopausal bleeding. Clinical examination suggested a tumoural cervical lesion, and transvaginal ultrasound identified a heterogeneous cervical mass extending to the uterine body. Pelvic magnetic resonance imaging showed a cervico-isthmic lesion with parametrial extension, while 18F-FDG positron emission tomography/computed tomography demonstrated an intensely hypermetabolic cervical mass and right external iliac lymph node involvement. Histological and immunohistochemical examination of the cervical biopsy confirmed poorly differentiated neuroendocrine carcinoma of the uterine cervix. The tumour showed epithelial marker positivity, partial neuroendocrine marker expression, high Ki-67 proliferative activity, and an unusual p16-negative profile. The disease was classified as FIGO stage IIIC1 according to the 2018 classification. Following multidisciplinary assessment, the patient received induction chemotherapy with etoposide and cisplatin, followed by concurrent chemoradiotherapy and brachytherapy. Post-treatment evaluation demonstrated complete response according to RECIST criteria. This case highlights the diagnostic and therapeutic complexity of p16-negative cervical neuroendocrine carcinoma and underscores the need for integrated morphological, immunohistochemical, and radiological assessment.

Transcutaneous Electrical Nerve Stimulation Versus Interferential Therapy, Each Combined with Neck Strengthening Exercises, in the Management of Cervical Radiculopathy: A Critical Narrative Review

Prabhjot Kaur — 2026-06-27

Cervical radiculopathy is a debilitating condition that arises when one or more cervical nerve roots are compressed or chemically irritated, producing radicular pain, sensory disturbance, and motor dysfunction in the corresponding dermatomal and myotomal distributions. Conservative physiotherapy remains the cornerstone of initial management, and electrotherapy — most commonly transcutaneous electrical nerve stimulation (TENS) and interferential therapy (IFT) — is routinely paired with structured therapeutic exercise. Yet despite how widely both modalities are used, the comparative efficacy of TENS combined with neck strengthening exercises against IFT combined with neck strengthening exercises has never been comprehensively characterised in the published literature. This critical narrative review brings together the available mechanistic and clinical evidence on both treatment combinations. TENS works largely through gate-control inhibition at the spinal dorsal horn and through activation of endogenous opioid pathways, offering analgesia that the patient can apply and control directly. IFT, by contrast, delivers medium-frequency alternating currents whose interference generates therapeutically active beat frequencies at greater tissue depth, which may give it an advantage in reaching deeper cervical structures while producing less skin discomfort. When either modality is paired with structured neck strengthening exercises that target the neuromuscular deficits and biomechanical vulnerabilities sustaining nerve root irritation, both appear to produce clinically meaningful gains in pain intensity, functional disability, and cervical range of motion. The evidence available to date does not point to a consistent advantage for one combination over the other. Practical factors — TENS's portability and suitability for self-management against IFT's depth-penetration profile and the treatment fidelity that comes with clinic-based supervision — may reasonably tip clinical decision-making in the absence of a clear superiority signal from trials. What is genuinely needed going forward is a properly powered, direct head-to-head randomised trial using standardised electrotherapy parameters and a comprehensive outcome battery.

Depth-dependent Spatial Clustering of Gene Expression in the Middle Temporal Gyrus is Elevated in Advanced Alzheimer's Disease Tissue

Ethan Ingoo Jung — 2026-06-29

Aims: Alzheimer's disease (AD) produces spatially heterogeneous molecular and cellular changes across the human cortex. This study tested whether spatial clustering of gene expression differs between low- and high-Braak-stage middle temporal gyrus (MTG) tissue and whether these differences are organised along normalised cortical depth.

Study Design: Retrospective secondary computational analysis of publicly available, de-identified spatial transcriptomic data.

Methodology: Multiplexed Error-Robust Fluorescence in Situ Hybridisation (MERFISH) data from the Seattle Alzheimer's Disease Brain Cell Atlas (SEA-AD) were analysed. MTG sections were grouped as Low Braak (I-III; n = 14 sections) or High Braak (IV-VI; n = 55 sections). Global Moran's I was computed for 140 measured genes using k-nearest-neighbour spatial weights. Group differences were evaluated with Mann-Whitney U tests and Benjamini-Hochberg false-discovery-rate correction. Cortical depth was normalised from pia to white matter, and expression-depth gradients were estimated with mixed-effects models and bootstrap resampling to reduce the effect of unequal group sizes.

Results: Eight genes showed significantly higher global spatial clustering in High Braak tissue (q < .05 and Delta I > .01): NRG1, FGF13, SEMA3E, SCUBE1, PEX5L, KCNIP4, KIAA1217, and FRMPD4. None of the blank control probes met these criteria. All eight genes showed preferential expression towards deeper cortical layers, and seven genes, excluding SCUBE1, showed steeper expression-depth gradients in High Braak sections. Local Moran's I depth profiles did not show a uniform disease-associated depth pattern, indicating that increased expression magnitude and local spatial clustering are partially separable features.

Conclusion: Advanced AD MTG tissue shows amplified laminar expression gradients for a limited set of genes related to synaptic regulation, neuronal structure, excitability, oxidative stress, and vascular biology. Because the MERFISH panel included 140 genes and the primary global screen used tissue sections as the analytical unit, the findings should be interpreted as exploratory and require donor-aware, cell-type-resolved, and independent validation. The results nevertheless support cortical depth as an important spatial axis of AD-related transcriptional remodelling.

Epidemiological Description of the Socioeconomic and Demographic Factors of Breast Cancer in the State of Pará, Brazil (2015-2024)

Jhennifer De Sousa Leão — 2026-06-29

Background: Breast cancer is a major public health concern, and regional epidemiological descriptions are important for understanding patterns of notification, screening and access to diagnosis.

Objective: This study aimed to analyse the epidemiological profile of socioeconomic and demographic factors associated with breast cancer in the State of Pará, Brazil, between 2015 and 2024.

Methods: This was an ecological, epidemiological and quantitative study based on secondary data obtained from the Department of Informatics of the Unified Health System (DATASUS). Records related to breast cancer cases, diagnostic mammography, screening mammography, age group, ethnicity and mesoregion of residence were analysed descriptively for the period 2015–2024.

Results: Reported cases increased over the study period, from 150 cases in 2015 to 2,007 cases in 2024, with a decline in 2020 and subsequent increases in the following years. The Metropolitan Region of Belém, Northeastern Pará and Southeastern Pará concentrated most notifications. Screening mammography was the predominant indication for mammography, with 466,162 examinations, whereas 136 diagnostic mammograms for cancer lesions were recorded. The highest proportion of cases occurred among women aged 45–49 years, followed by those aged 50–54 and 40–44 years, together representing 40.9% of cases. Records were most frequent among women classified as yellow ethnicity, followed by mixed-race and white women.

Conclusion: The findings indicate increasing breast cancer notifications in Pará, with regional concentration of cases, low recorded diagnostic mammography and demographic differences that require careful interpretation and strengthened surveillance.

Computer-Guided Full-Arch Maxillary Rehabilitation Using the All-on-6 Protocol in a Patient with Severe Generalised Periodontitis

Sarepally Godvine — 2026-06-29

Severe generalised periodontitis may result in terminal dentition associated with progressive alveolar bone destruction, pathological tooth migration, impaired mastication, compromised phonetics and reduced facial aesthetics. Rehabilitation in these patients remains challenging, particularly in the maxillary arch, where reduced bone density and sinus pneumatisation can complicate implant positioning. This case report describes comprehensive rehabilitation of a 56-year-old male patient with severe generalised periodontitis using a computer-guided All-on-6 maxillary implant protocol with immediate loading. After clinical examination, panoramic radiography, cone-beam computed tomography (CBCT), digital intraoral scanning and prosthetically driven virtual planning, the remaining hopeless maxillary teeth were extracted, the sockets were debrided, and six endosseous implants were placed using a stereolithographic surgical guide. Posterior implants were planned with distal angulation to optimise anterior-posterior spread and avoid extensive sinus augmentation. Primary implant stability of 35–45 Ncm permitted immediate screw-retained provisionalisation within 24 hours. Definitive rehabilitation was completed after approximately four months using a CAD/CAM-milled titanium framework and screw-retained hybrid prosthesis. Follow-up at one week, one month, three months, six months and one year demonstrated stable peri-implant soft tissues, stable crestal bone levels, absence of peri-implant radiolucency, no biological or mechanical complications, satisfactory prosthetic function and high patient satisfaction. No complications were observed during the reported follow-up period. The reported case indicates that, with careful case selection, digital planning, guided surgical execution and strict maintenance, an All-on-6 protocol can support predictable full-arch maxillary rehabilitation in a periodontally compromised patient. Long-term monitoring remains necessary because previous severe periodontal disease increases the need for continued peri-implant maintenance.

Integrating Artificial Intelligence, Augmented Reality, and Virtual Reality in Maxillofacial Soft Tissue Reconstruction: Toward Precision Surgical Informatics

G. V. Reddy — 2026-06-27

Maxillofacial soft tissue reconstruction presents some of the most technically and conceptually demanding challenges in surgical practice, combining requirements of anatomical precision, functional preservation, and aesthetic restoration within a region of profound psychosocial significance. The emergence of artificial intelligence (AI), augmented reality (AR), and virtual reality (VR) has begun to redefine each phase of the reconstructive process, from preoperative analysis and simulation to intraoperative navigation and postoperative outcome assessment. This critical review examines the current evidence for the individual and integrated application of these technologies in maxillofacial soft tissue reconstruction, with particular attention to their translational readiness and clinical implications. A comprehensive search of peer-reviewed literature published between January 2007 and February 2026, supplemented by foundational methodological studies, was undertaken across multiple indexing databases. The review evaluates machine learning approaches to soft tissue deformation prediction, deep learning frameworks for anatomical segmentation and cephalometric landmarking, AR-based intraoperative navigation systems, and VR platforms for surgical training, preoperative planning, and patient communication. The evidence demonstrates that while individual applications—particularly AI-driven preoperative planning and VR simulation training—have achieved a meaningful clinical foothold, fully integrated multimodal systems remain largely confined to research environments. Persistent barriers include the absence of standardised data pipelines, insufficient multicentre validation, evolving regulatory frameworks, and concerns regarding algorithmic bias and inequitable access in lower-resource clinical settings. This review contends that realising the transformative potential of precision surgical informatics in maxillofacial reconstruction requires sustained interdisciplinary collaboration, prospective multicentre validation, and a design philosophy that prioritises generalisability, equity, and real-world implementability. The convergence of AI, AR, and VR represents a genuinely consequential development in reconstructive surgery, but its translation to routine clinical benefit demands rigorous, evidence-grounded progress.

Antidepressant Use and Dental Implant Failure: A Critical Review of Clinical Evidence, Biological Mechanisms, and Practical Implications

Alexandre de Lima Alves — 2026-06-30

Dental implants have become the standard of care for replacing missing teeth, with survival rates that are generally favourable but not uniform across patient populations. Over the past decade, a growing body of clinical and preclinical literature has raised the possibility that antidepressant medications, and selective serotonin reuptake inhibitors in particular, may compromise osseointegration and increase the risk of implant failure. This critical review synthesises the available evidence on the association between antidepressant use and dental implant failure, drawing on cohort studies, retrospective clinical series, systematic reviews and meta-analyses, and mechanistic work in cell and animal models. The biological plausibility of the association rests on the dual role of serotonin in skeletal homeostasis: peripherally derived serotonin appears to inhibit osteoblast proliferation and bone formation, while centrally derived serotonin favours bone mass accrual. Selective serotonin reuptake inhibitors disturb this balance in ways that may impair bone healing around titanium fixtures. Clinical studies consistently report a roughly two-fold increase in implant failure among users of selective serotonin reuptake inhibitors relative to non-users, although effect sizes vary across populations, drug subclasses and methodological approaches, and most studies are retrospective and susceptible to confounding by indication, polypharmacy, smoking, and the systemic correlates of depression itself. The review also considers the bidirectional relationship between depression, periodontal disease and oral health behaviours, the differential effects of antidepressant subclasses, the contribution of antidepressant-associated bruxism and xerostomia to peri-implant complications, and the methodological limitations that temper causal interpretation of the existing literature. Clinical implications are discussed, including preoperative risk stratification, multidisciplinary communication with prescribing physicians, and individualised rather than categorical decision-making when planning implant therapy in patients receiving antidepressant treatment. The review concludes that, while the weight of evidence supports a measurable association between selective serotonin reuptake inhibitor use and increased implant failure risk, the absolute risk increase is modest in most reported cohorts and should not by itself constitute a contraindication to implant therapy. Prospective, adequately powered studies that account for depression severity, drug dose and duration, and concurrent risk factors are needed before firmer clinical guidance can be issued.