Erdogan H, Senturk Apılıogulları S, Kont Cobankara F
Med Princ Pract
· 2026 May · PMID 42068559
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OBJECTIVE: The severe gag reflex (SGR) is an involuntary protective response to foreign substances. SGR presents a significant obstacle to the provision of standard dental care. This retrospective case series study evalu...OBJECTIVE: The severe gag reflex (SGR) is an involuntary protective response to foreign substances. SGR presents a significant obstacle to the provision of standard dental care. This retrospective case series study evaluates the clinical outcomes and the feasibility of low-dose (2.5 mg) intranasal midazolam administration on SGR control in uncooperative patients with Gagging Severity Index 5. MATERIAL AND METHODS: This retrospective study includes patients who could not receive endodontic treatment due to the severe gag reflex and were referred for general anesthesia. Data from 13 adult patients, one of whom had an intellectual disability, were used. A fixed low-dose (2.5 mg) of intranasal midazolam was administered under the control of an anesthesiologist. Clinical monitoring (vital signs) focused on respiratory effort, skin color, and the maintenance of verbal commands. Endodontic treatment was started with local anesthesia approximately 10 minutes after 2.5 mg midazolam administration, averaging 40 minutes per session. RESULTS: All patients remained conscious, responsive to verbal commands, and cooperative during treatment. One patient received intranasal saline as an ad-hoc clinical observation, but midazolam was later administered due to persistent gagging. SGR was effectively managed in all patients during initial and ongoing sessions of endodontic treatment without side effects. All necessary dental procedures, including root canal treatment and restorations, were performed comfortably. CONCLUSION: A conservative 2.5 mg dose of intranasal midazolam can safely control severe gag reflex in adult patients during long and complex dental procedures, such as endodontic treatment. Also, it is a practical, less invasive alternative to general anesthesia.
Med Princ Pract
· 2026 Apr · PMID 41989964
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OBJECTIVE: Mild autonomous cortisol secretion (MACS) is characterized by cortisol excess without overt Cushing's syndrome. While metabolic complications are well documented, the psychological burden remains incompletely...OBJECTIVE: Mild autonomous cortisol secretion (MACS) is characterized by cortisol excess without overt Cushing's syndrome. While metabolic complications are well documented, the psychological burden remains incompletely understood. This study aimed to assess self-reported depressive and anxiety symptoms and health-related quality of life in MACS patients using validated Turkish instruments and compare findings with Turkish population norms. METHODS: This cross-sectional study included 40 MACS patients (34 women, 6 men; mean age 56.3 ± 9.3 years) from 45 newly diagnosed patients (3 excluded as per exclusion criteria, 2 declined). MACS was diagnosed according to European Society of Endocrinology guidelines. As part of institutional protocol, psychological assessments were routinely performed at diagnosis for all newly diagnosed patients. Assessments included Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Short Form-36 (SF-36) using validated Turkish versions. RESULTS: Mean BDI category score was 1.93 ± 0.80 (minimal-to-mild depressive symptoms) and mean BAI category score was 2.30 ± 0.82 (mild anxiety symptoms). SF-36 scores were significantly lower than Turkish population norms across all domains except emotional well-being (p < 0.001 for all significant domains except bodily pain, p = 0.012). Subgroup analysis by post-dexamethasone cortisol levels showed no significant differences in psychological parameters. CONCLUSIONS: MACS patients exhibit impaired quality of life across most SF-36 domains compared to Turkish population norms, despite only mild self-reported depressive and anxiety symptoms. Although limited by the absence of a matched control group and potential confounding by metabolic comorbidities, these findings suggest that psychological screening and quality of life assessment may be valuable in MACS evaluation.
Takeuchi F, Yoneshige A, Shoya Y
… +3 more, Hagiyama M, Inoue T, Ito A
Med Princ Pract
· 2026 Apr · PMID 41989953
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OBJECTIVE: In atopic dermatitis, skin scratching leads to worsening of the dermatitis. Cell adhesion molecule 1 (CADM1), an immunoglobulin superfamily member, is highly expressed in peripheral nerve fibers, and the anti-...OBJECTIVE: In atopic dermatitis, skin scratching leads to worsening of the dermatitis. Cell adhesion molecule 1 (CADM1), an immunoglobulin superfamily member, is highly expressed in peripheral nerve fibers, and the anti-CADM1 antibody 3E1 preferentially localizes to dermal nerve fibers upon subcutaneous injection and exerts analgesic effects. Whether 3E1 improves atopic dermatitis-like lesions and pruritus was examined in NC/Nga mice. SUBJECTS AND METHODS: The systemic distribution of 3E1 after intravenous injection was examined using indocyanine green imaging, immunostaining, and Western blotting techniques. Atopic dermatitis-like lesions were created by repeated application of the mite antigen Biostir. 3E1 was then administered subcutaneously at the lesion sites (30 μg/day; 3 consecutive days) or intravenously via the tail vein (5 mg/kg; 3 times every other day), and macroscopic inflammatory signs of the skin, such as erythema and crust formation, were recorded. Mice were videotaped, and the duration of skin scratching behavior was measured. RESULTS: Intravenously injected 3E1 accumulated in dermal nerve fibers and dorsal root ganglia. By both routes of administration, the 3E1-treated group showed a shorter duration of scratching behavior in the first week and a faster improvement in dermatitis in the second week after the initial injection than the control group. CONCLUSION: 3E1 has potential as a therapeutic agent for atopic dermatitis owing to its antipruritic effect.
Alshemmari SH, Alsarraf A, Dashti A
… +5 more, Hajji Y, Babul H, Almutairi N, Kunhikrishnan A, Yassin M
Med Princ Pract
· 2026 Apr · PMID 41926535
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OBJECTIVES: We aimed to investigate the prevalence of comorbidities including diabetes mellitus (DM), hypertension, dyslipidemia, and cardiovascular disease in the Middle Eastern chronic lymphocytic leukemia (CLL) popula...OBJECTIVES: We aimed to investigate the prevalence of comorbidities including diabetes mellitus (DM), hypertension, dyslipidemia, and cardiovascular disease in the Middle Eastern chronic lymphocytic leukemia (CLL) population and their correlation with disease outcome at the Kuwait Cancer Control Center (KCCC). METHODS: We performed a retrospective study of the CLL patients diagnosed in the KCCC between 2008 and 2021. The hazards ratio (HR) of death was calculated using Cox regression analysis. Statistical analysis was performed using SPSS (v27). RESULTS: A total of 316 patients had recorded comorbidities. The mean age at diagnosis was 60 years (SD + 13) with a male-to-female ratio of 3:1. Of these, 140 (44%) had hypertension, 132 (42%) had DM, and 32 (10%) had dyslipidemia. Nineteen CLL patients (6%) had vascular disease at diagnosis and 48 (15%) had a cardiac disease. The HR of death in patients with DM, hypertension, and dyslipidemia was 1.74 (1.04-2.89; p value 0.034), 1.14 (0.68-1.91; p value 0.628), and 1.91 (0.91-3.77; p value 0.063), respectively. The vascular disease and the cardiac disease were associated with HR of death of 3.48 (1.69-7.15; p value <0.001) and 1.39 (0.74-2.61; p value 0.312), respectively. In the multivariate analysis, vascular comorbidities remained as an independent predictor of death with an HR of 2.96 (1.41-6.21; p value = 0.004). CONCLUSION: The cardiovascular disease and associated risk factors are prevalent in the Kuwaiti CLL patients, and they are also associated with an unfavorable prognosis.
Ren J, Shi S, Liu Z
… +7 more, Cui J, Su H, Wang J, Ren X, Pei Y, Liu Y, Sun X
Med Princ Pract
· 2026 Mar · PMID 41871213
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OBJECTIVE: This study investigated the association between intra-abdominal pressure (IAP), enteral nutrition tolerance, and the clinical outcomes. METHODS: In this retrospective cohort study, 120 patients admitted to a n...OBJECTIVE: This study investigated the association between intra-abdominal pressure (IAP), enteral nutrition tolerance, and the clinical outcomes. METHODS: In this retrospective cohort study, 120 patients admitted to a neurological critical care unit between 2021 and 2024 were evaluated. Only the patients receiving enteral nutrition for five or more days were included. IAP was measured every 6 h via bladder catheterization. Data regarding gastrointestinal complications, nutritional adequacy (volume ratio), and hospital outcomes were analyzed using multivariate logistic regression and random-effects modeling. RESULTS: Elevated IAP (exceeding 14 mm Hg) was present in 92% of the cohort. Patients with gastrointestinal complications 54 (45%) exhibited significantly higher IAP (16.1 vs. 15.45 mm Hg; p = 0.0212), significantly longer stays in the neurocritical care unit (p = 0.0002) and longer total hospitalizations (p = 0.0002) compared to those without complications 66 (55%). Diarrhea (33%) and constipation (31%) were the most frequent complications. Multivariate analysis identified IAP as an independent predictor of prolonged intensive care stay (RR = 2.209), extended total hospitalization (RR = 2.203), and mortality (RR = 2.062). Furthermore, high IAP was significantly associated with a failure to achieve ninety percent of nutritional goals (p < 0.0001). CONCLUSION: IAP is a reliable indicator of enteral nutrition intolerance and systemic deterioration in neurocritical care. Routine monitoring of abdominal pressure should be integrated into clinical practice to enhance risk stratification and optimize nutritional delivery in patients with acute neurological injury.
Dilrukshi N, Kottahachchi J, Dissanayake T
… +2 more, Muneeswaran K, Fernando N
Med Princ Pract
· 2026 Mar · PMID 41843697
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OBJECTIVE: This study aimed to compare the vaginal microbiome of group B Streptococcus (GBS)-positive and -negative pregnant women in selected tertiary care hospitals in Sri Lanka. SUBJECTS AND METHODS: Fifteen GBS-posit...OBJECTIVE: This study aimed to compare the vaginal microbiome of group B Streptococcus (GBS)-positive and -negative pregnant women in selected tertiary care hospitals in Sri Lanka. SUBJECTS AND METHODS: Fifteen GBS-positive and fifteen GBS-negative women were included in the study. The composition of vaginal microbiome was profiled by sequencing 16S rRNA V3-V4 region. Microbiome diversity and variation were evaluated. RESULTS: Alpha diversity measured by Shannon diversity and Chao 1 index differed significantly between GBS-positive and GBS-negative groups (Chao 1, p = 0.0003; Shannon, p = 0.0003), while beta diversity pairwise permutational multivariate analysis of variance (p = 0.435) showed no significant difference, indicating similar overall bacterial compositions. Gardnerella and Prevotella were more abundant in GBS-positive group, while majority of the GBS-negative group was dominated by Lactobacillus (87.9%). Lactobacillus iners was the most abundant species in both groups. Lactobacillus gallinarum, reported for the first time in Sri Lanka, was the second most common Lactobacillus species. Linear discriminant analysis effect size identified no taxa enriched in GBS-negative group, whereas GBS-positive group showed significantly higher relative abundance with several taxa with Bifidobacterium showed the highest linear discriminant analysis score (4.459). Methylocystis, though of low biological relevance, was significantly abundant in GBS-positive group (p = 0.025). CONCLUSION: Lactobacillus spp. were reduced in GBS-positive women, with higher abundance of other bacterial taxa suggesting that disruption of a Lactobacillus dominant vaginal microbiome may facilitate GBS colonization and potentially increase the risk of neonatal infection.
Raja HAA, Afridi MJ, Asad F
… +12 more, Yasin K, Uzair M, Saleem Y, Sardar H, Bismil I, Saeed A, Ullah I, Riffat G, Khan MHA, Khan H, Rehman MEU, Ali F
Med Princ Pract
· 2026 Mar · PMID 41838832
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OBJECTIVES: This systematic review and meta-analysis assesses the efficacy and safety of procalcitonin (PCT)-guided therapy compared to the standard of care in septic patients. METHODS: A comprehensive literature search...OBJECTIVES: This systematic review and meta-analysis assesses the efficacy and safety of procalcitonin (PCT)-guided therapy compared to the standard of care in septic patients. METHODS: A comprehensive literature search was performed using the Cochrane Library, <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, Embase, and MEDLINE, covering studies from their inception to April 2025. RevMan was used to perform a random effects meta-analysis, and forest plots were used to visualize the pooled estimates. The Mantel-Haenszel method was applied to analyze dichotomous outcomes. The inverse variance method was applied to analyze continuous outcomes. RESULTS: Sixteen randomized controlled trials, with a total of 6,885 patients, were included. PCT-guided therapy was associated with significantly improved antibiotic treatment duration (standardized mean difference [SMD] -0.81, 95% confidence interval [CI]: -1.17 to -0.45, I2 97%), duration of mechanical ventilation (SMD -0.47, 95% CI: -0.57 to -0.37, I2 0%), and antibiotic-free days (SMD 0.14, 95% CI: 0.04-0.25, I2 0%). Both groups were comparable in terms of ICU mortality, hospital mortality, 30-day mortality, 90-day mortality, ICU stay, hospital stay, new infection, and clinical recovery. PCT was associated with greater reinfection (risk ratio 1.12, 95% CI: 1.00-1.26, I2 0%). CONCLUSION: PCT-guided therapy was associated with shorter antibiotic treatment duration, though substantial heterogeneity was observed, while mortality outcomes were comparable between groups. Standardized PCT-based protocols are needed to improve consistency and clinical applicability.
Med Princ Pract
· 2026 Mar · PMID 41838809
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OBJECTIVE(S): The influence of geomagnetic storms (GMSs) on humans has long been questioned. The aim of this study was to assess GMS influence on the functional cardiovascular parameters and human well-being depending on...OBJECTIVE(S): The influence of geomagnetic storms (GMSs) on humans has long been questioned. The aim of this study was to assess GMS influence on the functional cardiovascular parameters and human well-being depending on the presence of arterial hypertension, drug therapy, and smoking status. METHODS: The study participants (n = 31) were analyzed for systolic blood pressure (SBP), vascular stiffness index (VSI), Baevsky stress index (BI) and other indicеs during quiet day and GMS day (K-index >5). Well-being was assessed using a validated "САН" questionnaire (SAN). RESULTS: During GMS, significant SBP decrease was noted among "not taking medications" (108.0 [100.0; 110.0] vs. 103.5 [98.0; 110.0], p = 0.03); SBP increase was noted among "smokers" (120.0 [120.0; 130.0] vs. 130.0 [122.0; 145.0], p = 0.06). VSI decrease was noted during GMS, but significant differences in VSI were obtained among persons without hypertension (2.5 [-11.2; 14.6] vs. -5.3 [-17.6; 6.2], p = 0.04) and "non-smokers" (6.05 [-8.85; 13.5] vs. 0.3 [-10.2; 6.9], p = 0.01). BI increase during GMS was obtained among hypertensive patients and "smokers." The total SAN questionnaire score decreased during GMS, especially among persons without hypertension (173.0 [159.0; 178.0] vs. 158.0 [125.0; 168.0], p = 0.03) and "not taking medications" (175.5 [173.0; 189.0] vs. 157.5 [156.0; 162.0], p = 0.04). β-Blockers and combined drug therapy had a protective effect on the prevention of SAN score decrease (RR 0.31 [0.12; 0.84] and RR 0.54 [0.33; 0.88]). CONCLUSION: This study confirmed GMS influence on functional cardiovascular parameters and human well-being depending on the presence of arterial hypertension, drug therapy, and smoking status. A protective effect of some drugs was noted on the manifestation of "magnetosensitivity" symptoms.
Med Princ Pract
· 2026 Mar · PMID 41802139
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The rapid evolution of telesurgery and advanced telemedicine technologies has expanded access to specialized surgical care while introducing complex legal, ethical, and regulatory challenges. This narrative review examin...The rapid evolution of telesurgery and advanced telemedicine technologies has expanded access to specialized surgical care while introducing complex legal, ethical, and regulatory challenges. This narrative review examines liability considerations associated with telesurgical practice, with particular attention to cross-border care, professional negligence, product liability, and the interaction between human and technological actors. Beyond legal accountability, the review highlights the central role of bioethical considerations, including patient autonomy, transparency, and equity, and explores how these principles are strained by physical distance, technological mediation, and jurisdictional fragmentation. Issues related to informed consent are examined in depth, particularly the adequacy of disclosure regarding technological risks, system failures, data transmission vulnerabilities, and the distribution of responsibility among clinicians, institutions, and technology providers. By synthesizing international legal frameworks, policy approaches, and ethical analyses, this review underscores recurring structural challenges in existing liability models and identifies areas where current consent practices may be insufficient for telesurgical contexts. The findings aim to inform clinicians, policymakers, and regulators seeking to support ethically sound, legally robust, and patient-centered implementation of telesurgery.
Göktaş E, Uzun N, Kurnaz Demir TD
… +3 more, Hira Selen AT, Kılınç İ, Kılıç AO
Med Princ Pract
· 2026 · PMID 41774611
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UNLABELLED: <p>Introduction: This study aimed to examine the association between the rs10314 polymorphism in the 3' untranslated region (3'UTR) of the CLDN5 gene and attention-deficit hyperactivity disorder (ADHD) and to...UNLABELLED: <p>Introduction: This study aimed to examine the association between the rs10314 polymorphism in the 3' untranslated region (3'UTR) of the CLDN5 gene and attention-deficit hyperactivity disorder (ADHD) and to evaluate the serum claudin-5 levels in relation to genotype and clinical severity. METHODS: A total of 323 participants were included: 159 drug-naïve children and adolescents diagnosed with ADHD and 163 age- and sex-matched healthy controls. Genotyping for rs10314 was conducted using a TaqMan® allelic discrimination assay, and serum claudin-5 concentrations were determined by enzyme-linked immunosorbent assay. ADHD severity was assessed using the Turgay DSM-IV-based ADHD Rating Scale. RESULTS: Serum claudin-5 levels were significantly lower in the ADHD group compared with controls (p < 0.001), indicating potential blood-brain barrier dysfunction. The CG genotype was more common in controls (p = 0.021), suggesting a protective effect. Claudin-5 levels did not vary across genotypes, and no correlation was observed between protein levels and clinical severity. CONCLUSION: This is the first study to assess both rs10314 and claudin-5 in ADHD and suggests that CLDN5 genetic variation and reduced claudin-5 expression may contribute to ADHD pathophysiology. Further studies are needed to confirm these findings and clarify their clinical implications. </p>.
Alfraij A, Alghounaim M, Aldaithan A
… +2 more, Awlad Thani S, Kazzaz Y
Med Princ Pract
· 2026 Mar · PMID 41774608
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OBJECTIVE: Regional multicenter research collaborations in pediatric critical care provide valuable insights through diverse patient data and increased sample sizes. However, cross-border studies face challenges related...OBJECTIVE: Regional multicenter research collaborations in pediatric critical care provide valuable insights through diverse patient data and increased sample sizes. However, cross-border studies face challenges related to ethical approvals and logistical constraints. We aimed to describe the process of conducting a multinational study across Arab Gulf region, the institutional review board (IRB) approval time, and the challenges encountered. SUBJECT AND METHODS: A multinational, multicenter retrospective cohort study was conducted for pediatric intensive care units (PICUs) across the six Gulf countries, comprising Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). Participating centers obtained independent ethical approvals, and data sharing agreements were executed to ensure compliance with local regulations. Site-level data on institutional characteristics and IRB timelines were collected. Median approval durations and interquartile range (IQR) were compared between group-based and individual IRB submissions across the region. RESULTS: A total of 35 regional PICUs participated and completed the study requirements successfully. Challenges included variable IRB approval times across facility types: private hospitals 28 days (IQR: 18-55), governmental hospitals 29 days (IQR: 24-146), and university hospitals 52 days (IQR: 30.25-108.75). CONCLUSION: This study demonstrates the feasibility of regional pediatric critical care research across the Arab Gulf region, despite variability in IRB timelines among private, governmental, and academic institutions. Structured coordination and collaborative planning enabled successful implementation and may serve as a model for future multicenter initiatives.
Aminova A, Latypova N, Pak A
… +2 more, Garkalov K, Kamalbekova G
Med Princ Pract
· 2026 Feb · PMID 41729736
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INTRODUCTION: The aim of this study was to assess the short-term clinical effects of individualized, hardware-assisted airway clearance techniques (ACTs) during acute non-cystic fibrosis bronchiectasis (NCFB exacerbation...INTRODUCTION: The aim of this study was to assess the short-term clinical effects of individualized, hardware-assisted airway clearance techniques (ACTs) during acute non-cystic fibrosis bronchiectasis (NCFB exacerbations). METHODS: In this prospective, controlled cohort study, 46 adults hospitalized with computed tomography-confirmed bilateral (CT-confirmed bilateral) NCFB were assigned to an intervention group (ACT plus pharmacological therapy; n = 23) or a control group (pharmacological therapy alone; n = 23). ACT modality (intrapulmonary percussive ventilation [IPV], high-frequency chest wall oscillation, or mechanical insufflation-exsufflation) was selected based on IPV tolerability and respiratory muscle strength maximum inspiratory pressure Z-score. Outcomes included 24-hour sputum volume, dyspnea (modified medical research council dyspnea scale [mMRC], Borg), spirometry, inflammatory markers, and length of hospital stay. RESULTS: Compared with controls, the intervention group showed greater reductions in sputum volume (-15 vs. -10 mL; p = 0.005) and dyspnea (mMRC -1.0 vs. 0.0; Borg -2.0 vs. -1.0; all p < 0.05), as well as a shorter hospital stay (median 7 vs. 9 days; p < 0.05). There were no differences between groups in spirometric or inflammatory outcomes, and no serious adverse events occurred. CONCLUSIONS: Individualized, physiology-guided device-based ACTs improved mucus clearance and dyspnea during acute NCFB exacerbations and were well tolerated, without short-term spirometric change. Larger studies with longer follow-up are needed to confirm efficacy before routine clinical implementation.
Alshaikh G, Alsannan B, Aldabeeb D
… +4 more, Almaghlouth II, Almannie RM, Laganà AS, Omair MA
Med Princ Pract
· 2026 · PMID 41701660
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UNLABELLED: <p>Objectives: This study aimed to determine the prevalence of voiding dysfunction and its impact on quality of life among women diagnosed with rheumatoid arthritis, a chronic autoimmune condition known for j...UNLABELLED: <p>Objectives: This study aimed to determine the prevalence of voiding dysfunction and its impact on quality of life among women diagnosed with rheumatoid arthritis, a chronic autoimmune condition known for joint inflammation and systemic manifestations. METHODS: A cross-sectional observational design was employed at two tertiary care centers in Saudi Arabia. Over an 8-week period, 144 female patients with rheumatoid arthritis completed a self-administered online survey. The questionnaire included demographic data and the International Prostate Symptom Score (IPSS), a validated tool used to assess urinary symptoms and their effect on quality of life. Patients under 18 or with known urological disorders were excluded. RESULTS: Participants had a mean age of 47.2 years, and 72.9% were married. The average IPSS was 11.2, with 41.7% classified as moderately symptomatic, 40.4% mildly symptomatic, and 17.9% severely symptomatic. Only 16.7% discussed urinary issues with family or partners, and 15.3% with physicians. Notably, 35.4% planned to consult a specialist, and this intent was significantly associated with higher IPSS scores (p < 0.03). CONCLUSIONS: Voiding dysfunction is highly prevalent among women with rheumatoid arthritis and significantly affects quality of life. Despite moderate to severe symptoms, many patients do not seek medical help. Routine screening and increased awareness are recommended to improve management and outcomes for this population. Further research is needed to explore regional differences and incorporate objective diagnostic tools. </p>.
Bhamidipaty DL, Bhamidipaty V, Shaikh FM
… +2 more, Bhamidipaty KDP, Botchu R
Med Princ Pract
· 2026 · PMID 41701651
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<p>Biofilms are intricately organized microbial communities enveloped in self-produced extracellular polymeric substances. They display remarkable resilience to environmental and antimicrobial stresses and adhere to vari...<p>Biofilms are intricately organized microbial communities enveloped in self-produced extracellular polymeric substances. They display remarkable resilience to environmental and antimicrobial stresses and adhere to various surfaces. Synthetic biology, which combines molecular biology with engineering principles, offers tools to modulate biofilm behavior for biotechnological applications and to address associated challenges. This review examines recent developments at the intersection of biofilm engineering and synthetic biology, highlighting strategies such as phage therapy, electrogenetic systems, microbial consortia design, quorum sensing regulation, genetic circuits, extracellular polymeric substances modification, and antimicrobial peptide-coated surfaces. These tools allow precise manipulation of biofilm structure, composition, and metabolic output. Biofilms are increasingly optimized for applications such as wastewater treatment, bioremediation, bioenergy, and diagnostics. Enhancements in stability and function are achieved via engineered circuits and extracellular polymeric substances adjustments, while antimicrobial approaches help control pathogenic biofilms. Despite these innovations, challenges remain, including biosafety, heterogeneity, scalability, and regulatory compliance. Continued interdisciplinary efforts are essential for translating these systems into viable technologies. </p>.
Zhu W, Li J, Yang Y
… +3 more, Lv J, Chong H, Deng S
Med Princ Pract
· 2026 Feb · PMID 41689832
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OBJECTIVE: Sepsis-associated liver injury (SALI) occurs in approximately 40% of sepsis cases and is linked to high mortality, a challenge that may stem from the absence of effective prognostic models. We developed a mach...OBJECTIVE: Sepsis-associated liver injury (SALI) occurs in approximately 40% of sepsis cases and is linked to high mortality, a challenge that may stem from the absence of effective prognostic models. We developed a machine learning (ML)-based prognostic model for SALI using conventional biomarkers to guide precise clinical interventions and reduce mortality. METHODS: We retrospectively analyzed 307 SALI patients (2010-2024), stratified into favorable (n = 139) and poor (n = 168) prognosis groups by post-treatment progression. The cohort was randomly split into a training set (80%) and a validation set (20%). The routine biomarkers included hematological indices, liver/renal function parameters, and coagulation profiles. Feature selection used LASSO regression. Nine ML algorithms constructed prognostic models: eXtreme Gradient Boosting, Logistic Regression, Light Gradient Boosting Machine, Random Forest, Adaptive Boosting, Gradient Boosting Decision Tree, Gaussian Naive Bayes, and Multilayer Perceptron. Model interpretability was evaluated via the SHapley Additive exPlanation (SHAP) algorithm. An independent cohort of 37 SALI patients was used for external validation. RESULTS: Key parameters influencing SALI prognosis were red blood cell distribution width-coefficient of variation, anion gap, and high-sensitivity cardiac troponin. Among the nine models, the Random Forest prognostic model performed best, with an area under the curve of 0.816 in the validation set and 0.781 in the external validation. CONCLUSIONS: The Random Forest model developed in this study can provide some guidance for clinical decision-making in SALI patients, but further validation is still required and should only be implemented in clinical practice after further research.