Medical Principles And Practice[JOURNAL]
Sun
200 papers
Longitudinal Psychosocial and Sleep Assessments for Long-Term Cardiovascular Risk Stratification After First Myocardial Infarction in Rural India.
Mukkirla BS, Rai B, Dey D … +8 more , Javvaji SK, Iyer VR, Kambhampati NSV, Ramamurthy SS, Rege G, Haloi N, Kalathur Mohan G, D M
Med Princ Pract · 2026 Jul · PMID 42391160 · Publisher ↗
OBJECTIVES: The risk of myocardial infarction (MI) evolves beyond the acute phase, and in-hospital tools, such as the Global Registry of Acute Coronary Events (GRACE) score, may not fully capture long-term vulnerability....
OBJECTIVES: The risk of myocardial infarction (MI) evolves beyond the acute phase, and in-hospital tools, such as the Global Registry of Acute Coronary Events (GRACE) score, may not fully capture long-term vulnerability. We evaluated whether simple longitudinal clinical and patient-reported measures improved the prediction of major adverse cardiovascular events (MACE). SUBJECTS AND METHODS: In this prospective cohort study, 351 patients with first MI were enrolled at a rural tertiary center in South India, of whom 319 formed the analytic cohort. MACE was defined as cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent coronary revascularization, as ascertained through hospital records and structured follow-up. Baseline clinical, biochemical, echocardiographic, and interviewer-administered psychosocial (PHQ-9 and GAD-7) and sleep variables were collected during hospitalization and follow-up (1, 6, and 12 months). Cox models were developed in stages, with the GRACE score as a baseline anchor and follow-up variables incorporated using the last available observations. Model performance was assessed using Harrell's concordance index (C-index), time-dependent area under the curve (AUC), and bootstrap validation methods. RESULTS: Over a median follow-up of 5.8 years, 94 patients (29.5%) experienced MACE. The baseline model modestly improved discrimination over GRACE alone (C-index, 0.622 vs. 0.556). The extended model showed higher discrimination (apparent C-index 0.684; optimism-corrected 0.660). Follow-up sleep quality, psychosocial symptoms, glycemic measures, and global longitudinal strain contributed to the model, although the estimates were imprecise. CONCLUSION: Longitudinal follow-up measures provided modest incremental prognostic information beyond a GRACE-based benchmark. Findings are exploratory and require external validation before clinical application.
The Effect on Vitamin D Levels and VDR Gene Polymorphism on Clinical Outcomes in Asthma.
Aksu GD, Sarıoğlu N, Çolak M … +4 more , Solmaz Avcıkurt A, Çoban H, Hişmioğulları AA, Erel F
Med Princ Pract · 2026 Jul · PMID 42391152 · Publisher ↗
OBJECTIVE: This study aimed to investigate the relationship between vitamin D receptor gene polymorphism and vitamin D levels with asthma severity, control level and exacerbation status in asthmatic patients. SUBJECTS AN...
OBJECTIVE: This study aimed to investigate the relationship between vitamin D receptor gene polymorphism and vitamin D levels with asthma severity, control level and exacerbation status in asthmatic patients. SUBJECTS AND METHODS: Over a six-month period, 162 patients diagnosed with asthma and 85 healthy volunteers were prospectively evaluated. Blood samples were analyzed for Vitamin D receptor gene polymorphism by PCR and periostin by ELISA. RESULTS: Among the study participants, 163 were females and 84 were males. The median value of Vitamin D in the patient group was significantly lower at 13.95 (3.5-33) compared to 17 (6.1-39.9) in the control group (p = 0.003). A significant positive correlation was found between Vitamin D and Asthma Control Test (ACT), eosinophil count, Peak Expiratory Flow (PEF, %) (r:0.18 to 0.25 p < 0.05). When VDR gene polymorphism Fok1 and Apa1 alleles in the patient and control groups were examined, they were found to be similar (p > 0.05). However, when VDR gene polymorphism genotypes were analyzed in terms of vitamin D levels, no significant difference was found between Apa1 genotypes (CC, CT, TT). Regression analysis of variables which are considered to influence Vitamin D levels showed that gender and PEF are independent determinants. CONCLUSIONS: In our study, a significant relationship was found between Vitamin D levels and asthma severity, asthma control level, and respiratory functions. However, no significant effect of VDR gene polymorphism was detected on the vitamin D levels and asthma.
Proactive Prevention of Postpartum Hypothyroidism: The Critical Role of Community-Based Diet and Micronutrient Supervision.
Xu Y, Xie Q
Med Princ Pract · 2026 Jun · PMID 42378191 · Publisher ↗
Postpartum thyroiditis (PPT) is a common autoimmune sequela of pregnancy, affecting 5-10% of women, a considerable percentage of whom ultimately develop lifelong hypothyroidism. The disorder's characteristic symptoms, su...
Postpartum thyroiditis (PPT) is a common autoimmune sequela of pregnancy, affecting 5-10% of women, a considerable percentage of whom ultimately develop lifelong hypothyroidism. The disorder's characteristic symptoms, such as debilitating tiredness and cognitive impairment, are frequently misattributed to the routine challenges of new parenthood, leading to delayed diagnosis and adverse effects on maternal quality of life and newborn development. Evidence suggests that the currently utilized reactive, clinic-based model of care may be insufficient to address this significant and often overlooked public health concern.The fundamental paradigm change toward a proactive, community-based treatment strategy to secure long-term maternal thyroid health. We synthesize available evidence on PPT pathophysiology, including the post-delivery immunological rebound, and examine the potential role of diet and micronutrient supervision in both primary and secondary prevention. We detail the function of essential micronutrients, including the delicate balance of iodine, the antioxidant protection provided by selenium, and the necessity of iron for thyroid hormone production. Available data suggest that while high iodine consumption is a modifiable risk factor, dietary shortages in these and other key nutrients may significantly exacerbate thyroid dysfunction.This review outlines a comprehensive Community-Based Care (CBC) framework that transcends conventional clinical settings, advocating for the integration of telehealth with trained community health professionals to provide systematic screening, education, and professional dietary oversight. By prioritizing the identification of at-risk women and implementing consistent, personalized nutritional management, this methodology offers a robust approach to proactive prevention, thereby reducing the significant long-term burden of PPT and improving maternal health outcomes.
Cytokine Profiles in Peripheral Blood Mononuclear Cells and Neutrophils following SARS-CoV-2 Vaccination: A Study from Kuwait.
Essa S, Abdulwahab MA, Raghupathy R
Med Princ Pract · 2026 Jun · PMID 42371831 · Publisher ↗
COVID-19 continues to be associated with substantial morbidity and mortality, and understanding vaccine-induced immune regulation beyond antibody responses remains important. This study characterized cytokine profiles in...
COVID-19 continues to be associated with substantial morbidity and mortality, and understanding vaccine-induced immune regulation beyond antibody responses remains important. This study characterized cytokine profiles in peripheral blood mononuclear cells (PBMC) and neutrophils following SARS-CoV-2 vaccination with Pfizer-BioNTech (mRNA-based) and AstraZeneca (adenoviral vector-based) vaccines in Kuwait. The study included 200 adult participants: 100 unvaccinated healthy controls; 18 recipients of two Pfizer-BioNTech doses; 32 recipients of two AstraZeneca doses; and 50 recipients of a third Pfizer-BioNTech dose. Blood samples were collected at 0-2 months and 3-6 months after vaccination, and cytokines were measured in mitogen-stimulated PBMC and neutrophil culture supernatants. Both vaccine platforms induced measurable cytokine responses, but the cytokine patterns differed according to vaccine type, cell population, and time after vaccination. Pfizer-BioNTech vaccination was associated with an early Th2-skewed profile in PBMC, while AstraZeneca vaccination showed broader activation of Th1/Th2/Th17-associated cytokines. IL-6 and IL-10 decreased over time in several comparisons; however, these findings should be interpreted with caution because cytokine concentrations are dynamic and may vary with sampling time, cell type, and stimulation conditions. Overall, vaccine-induced cytokine profiles waned by 3-6 months after primary vaccination, whereas the third Pfizer-BioNTech dose enhanced several PBMC cytokine responses. These findings support the immunomodulatory effects of SARS-CoV-2 vaccines and highlight the value of booster vaccination for sustaining cellular immune responsiveness.
The Efficacy of Integrating Problem-Based Learning with the BOPPPS Six-Step Methodology in Endocrinology Clinical Instruction.
Liu T, Guo W, Chen B … +3 more , Chen P, Xia X, Li P
Med Princ Pract · 2026 Jun · PMID 42348510 · Publisher ↗
OBJECTIVES: The objectives of the study were to evaluate the efficacy of the Problem-Based Learning (PBL) with the Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary (BOPPPS) PBL-B...
OBJECTIVES: The objectives of the study were to evaluate the efficacy of the Problem-Based Learning (PBL) with the Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary (BOPPPS) PBL-BOPPPS model compared to conventional instruction in endocrinology clinical education, focusing on academic outcomes and learner satisfaction. METHODS: This is a quasi-experimental study and was conducted at the Affiliated Guangdong Second Provincial General Hospital (January 2022-September 2025). A total of 285 students were enrolled (BS Cohort: PBL-BOPPPS, n=105; TT Cohort: Conventional, n=180) please give in full and then the abbreviations in parenthesis when they appear for the first time. RESULTS: The BS cohort achieved significantly higher median scores across all evaluation components, including written exam (52 vs. 47.5, p<0.001) and total score (68 vs. 58, p<0.001). Student satisfaction was also higher in the BS cohort (median 14 vs. 13, p<0.001). Granular analysis revealed consistently higher satisfaction across all 10 items, with the largest differences in creativity, clinical thinking, interest, and communication skills. Correlation analyses demonstrated significant positive associations between academic performance and satisfaction (rs=0.433, p<0.001), attendance and exam performance (rs=0.7449, p<0.001), case-based video learning and exam performance (rs=0.5125, p<0.001), and clinical thinking with creativity (rs=0.8604, p<0.001). CONCLUSIONS: The PBL-BOPPPS model significantly improved academic performance and student satisfaction compared to conventional instruction in endocrinology clinical education. Its structured, interactive design enhanced both cognitive and affective learning outcomes, supporting its adoption in competency-based medical education.
Clinical Outcomes of Immunosuppressant drugs in Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta Analysis.
Alotaibi FM, Alrowaydan SM, Alshamlani LK … +5 more , Alomar MA, Almutairi NS, Khashwayn SA, Alshammari K, Al-Tawfiq JA
Med Princ Pract · 2026 Jun · PMID 42313698 · Publisher ↗
OBJECTIVES: To systematically evaluate the impact of immunosuppressant drugs (ISDs) use on clinical outcomes in patients with cancer treated with Immune checkpoint inhibitors (ICIs). METHODS: A systematic review and meta...
OBJECTIVES: To systematically evaluate the impact of immunosuppressant drugs (ISDs) use on clinical outcomes in patients with cancer treated with Immune checkpoint inhibitors (ICIs). METHODS: A systematic review and meta-analysis was conducted. Eligible studies reporting overall survival (OS) and/or progression-free survival (PFS), among adult cancer patients receiving ICIs stratified by the use of ISDs. RESULTS: A total of 33 studies with 34,063 patients met the inclusion criteria. Pooled analyses showed significantly worse outcomes among patients receiving ISDs during ICI therapy, with poorer OS (HR = 1.31; 95% CI: 1.10-1.56; p = 0.003) and PFS (HR = 1.39; 95% CI: 1.10-1.76; p = 0.006) compared with those who did not receive ISDs with high heterogeneity of (I² ~80-85%). In subgroup analysis, patients with non-small-cell lung cancer exhibited significantly reduced OS associated with the use of ISDs. CONCLUSIONS: The results suggest an association between ISDs use and reduced OS and PFS in patients with cancer receiving ICI treatment. These findings highlight the need for precision-based immune-related adverse events (irAE) management strategies that balance toxicity control with preservation of therapeutic benefit.
Immune Polarization in Coexisting Rheumatoid Arthritis and Asthma: Insights into Th2 Dominance and Unresolved Confounding.
Kaban N
Med Princ Pract · 2026 Jun · PMID 42284253 · Publisher ↗
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Immune Polarization in Coexisting Rheumatoid Arthritis and Asthma: Insights into Th2 Dominance and Unresolved Confounding.
Almutairi SS, Azizieh FY, Al-Herz AA … +3 more , Al-Shemary TE, Alsaber AR, Raghupathy R
Med Princ Pract · 2026 Jun · PMID 42275259 · Publisher ↗
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Quantitative Imaging of the Mandibular Condyle: Radiomics and Microarchitectural Biomarkers.
Negrete D, Borges-Oliveira AC, Alves Santos MM … +2 more , de Castro Lopes SLP, Costa ALF
Med Princ Pract · 2026 Jun · PMID 42258594 · Publisher ↗
Radiomics makes it possible to extract quantitative data from medical images, revealing details about tissue heterogeneity that are not apparent from visual evaluation alone. Conventional evaluation of temporomandibular...
Radiomics makes it possible to extract quantitative data from medical images, revealing details about tissue heterogeneity that are not apparent from visual evaluation alone. Conventional evaluation of temporomandibular joint (TMJ) imaging still primarily relies on qualitative morphological criteria that primarily detect late-stage structural alterations. This narrative review summarizes current evidence on quantitative imaging of the mandibular condyle and subchondral bone within the TMJ, with emphasis on radiomics applications using computed tomography (CT), cone-beam computed tomography (CBCT), and magnetic resonance imaging (MRI). Studies have shown that texture and morphometric features derived from CT and CBCT can reflect trabecular organization and subchondral remodelling, with some parameters validated against micro-computed tomography in experimental settings. MRI-based approaches are particularly sensitive to changes in subchondral bone marrow, especially in inflammatory and degenerative conditions, even when morphological alterations are subtle or absent. Radiomic features can detect patterns associated with joint degeneration and adaptation across imaging modalities. However, variability in acquisition protocols, segmentation methods, and limited longitudinal data still restrict their clinical application. At present, quantitative imaging should be considered a research tool that may support the development of imaging biomarkers and contribute to a better understanding of TMJ disease.
Differential Therapeutic Modulations of Adiponectin: Beneficial, Adverse, and Context-Dependent Effects in Chronic Coronary Syndromes.
Stojanović S, Petrović V, Jocić J … +5 more , Petrović D, Šarac M, Nikolić N, Simonović D, Marinković M
Med Princ Pract · 2026 May · PMID 42213633 · Publisher ↗
Different degrees of chronic metabolic inflammation and adiponectin resistance significantly contribute to the development of cardiovascular diseases and metabolic syndrome. Adiponectin is a unique pleiotropic adipokine...
Different degrees of chronic metabolic inflammation and adiponectin resistance significantly contribute to the development of cardiovascular diseases and metabolic syndrome. Adiponectin is a unique pleiotropic adipokine with anti-inflammatory, anti-atherogenic, and anti-diabetic effects. In early metabolic dysfunction, adiponectin levels increase as a compensatory response, whereas in advanced coronary disease, hypoadiponectinemia develops due to adiponectin resistance. The aim of this review is to highlight how contemporary cardiovascular therapies alter adiponectin levels and why this is clinically important for reducing low-grade systemic and vascular inflammation in chronic coronary syndromes. Evidence suggests that drug classes such as PPAR agonists, SGLT2 inhibitors, GLP-1 receptor agonists, RAAS blockers, metformin, certain statins, and fibrates may increase adiponectin levels, although effects vary by drug class and disease stage. Although adiponectin represents a promising therapeutic target for the treatment of coronary syndromes, further experimental and pharmacological research is necessary to develop drugs based on its mechanism of action.
Kluyvera infections in humans - A systematic review.
Maraki S, Mavromanolaki VE, Iliaki-Giannakoudaki E … +1 more , Kasimati A
Med Princ Pract · 2026 May · PMID 42207736 · Publisher ↗
OBJECTIVE: Kluyvera species are Gram-negative rods, catalase-positive, oxidase-negative, and glucose-fermenting members of the Enterobacteriaceae family. Although often considered saprophytic, Kluyvera can cause opportun...
OBJECTIVE: Kluyvera species are Gram-negative rods, catalase-positive, oxidase-negative, and glucose-fermenting members of the Enterobacteriaceae family. Although often considered saprophytic, Kluyvera can cause opportunistic infections, particularly in immunocompromised individuals, with severe underlying medical conditions. The objective of this study was to identify and evaluate all published cases of human infections by Kluyvera spp., through a systematic literature review. METHODS: We searched PubMed and Scopus databases for articles providing data related to the epidemiology, clinical features and microbiology of Kluyvera human infections. RESULTS: In total 73 studies provided information on 97 patients with Kluyvera infections. The mean age of the patients was 39.5 years and most (53.6%) were females. The most frequently reported types of infection were bacteremia, urinary tract infections, intra-abdominal infections and soft tissue infections, and more than half of them were community-acquired. Comorbidities were common in the majority of patients, with almost half of them being immunosuppressed. K. ascorbata was the most commonly identified species (59.8%), followed by K. cryocrescens (23.7%), K. intermedia (3.1%), and K. georgiana (1.0%). High rates of resistance were recorded for ampicillin (78.1%), 1st generation cephalosporins (52.1%), and 2nd generation cephalosporins (43.8%). Third generation cephalosporins were the most commonly used antibiotics, followed by aminoglycosides. The outcome was favorable for the majority of the patients (89.2%). The mortality rate attributed to the infection was 4.3%. CONCLUSION: Early detection of Kluyvera species is critical for effective infection control and antimicrobial stewardship, as these opportunistic pathogens are known to act as reservoirs for antibiotic resistance genes.
Epigenetic Reactivation of SOCS-3 and Inhibition of ERK1/2 Underlie Thymoquinone-Induced Apoptosis in a Chronic Myeloid Leukemia Xenograft Model.
Al-Rawashde FA, Alqaraleh M, Hasan D … +4 more , Elsayed A, Amiludin NAAM, Al-Suede FSR, Al-Jamal HAN
Med Princ Pract · 2026 May · PMID 42176292 · Publisher ↗
Aberrant DNA methylation of tumor suppressor genes (TSGs) plays a critical role in chronic myeloid leukemia (CML) pathogenesis. SOCS-3, a TSG, regulates various proliferative pathways, including MAPK signaling. Enhancing...
Aberrant DNA methylation of tumor suppressor genes (TSGs) plays a critical role in chronic myeloid leukemia (CML) pathogenesis. SOCS-3, a TSG, regulates various proliferative pathways, including MAPK signaling. Enhancing expression of TSGs through demethylation provides a potential target for cancer treatment. One of Nigella Sativa's main ingredients, thymoquinone (TQ), has proven anticancer properties. However, the mechanisms driving TQ's antileukemic influences were not entirely clarified. This research aimed to assess TQ's abilities to demethylate and re-express SOCS-3 in CML mice model. A nude mouse model of CML was established, and the apoptotic influence of TQ was identified. TQ's impact on the target gene expressions was examined using RT-qPCR, and SOCS-3 methylation was assessed by pyrosequencing. TQ's effects on ERK1/2 phosphorylation were assessed using Jess Simple Western analysis. Molecular docking of TQ's interaction with the anti-apoptotic proteins. TQ exerted a marked hypomethylating influence on SOCS-3 and reduced ERK1/2 phosphorylation level in K562-xenograft tumours. TQ also significantly upregulated Caspase-3, Caspase-9, Bim, Bax, Bak, PUMA, and Bmf and downregulated BCL-2, BCL-w, BCL-xL, MCL-1, BFL-1, Survivin, and XIAP in K562 cells. TQ also exhibited marked inhibitory properties on BFL-1, BCL-xL, MCL-1, and BCL-2. This led to growth inhibition and apoptosis of K562-tumor xenograft. These results indicate that TQ enhances CML cells' apoptosis by hypomethylating and re-expressing SOCS-3, inhibiting ERK1/2 and modulating the apoptosis-regulator gene expression and by showing consistent interaction with most of anti-apoptotic proteins, enhancing its potential as a scaffold for designing novel inhibitors to combat CML cells.
Convolutional Neural Networks in Radiology: Principles, Clinical Applications, and a Practical Framework for Radiologists.
Thompson B, Gibson J, Chapala S … +2 more , Shah A, Botchu R
Med Princ Pract · 2026 May · PMID 42172171 · Publisher ↗
Artificial intelligence is increasingly embedded within radiology workflows. In radiology, large language models may support reporting and communication tasks, while machine learning and deep learning models are increasi...
Artificial intelligence is increasingly embedded within radiology workflows. In radiology, large language models may support reporting and communication tasks, while machine learning and deep learning models are increasingly used for image classification, segmentation, and quantitative analysis. This article is an educational review and practical guide rather than an experimental study. It summarizes how convolutional neural networks work, outlines the key stages of model development and validation, and discusses how modern language models may assist with code prototyping and troubleshooting. Although these tools may reduce technical barriers, clinically useful models still require appropriate datasets, external validation, transparent reporting, governance, and human oversight. This review aims to help radiologists understand the principles, potential, and limitations of convolutional neural networks in contemporary practice.
Histopathological Analysis of Adipose-Derived Mesenchymal Stem Cells and Their Osteogenic Derivatives in Promoting Bone Regeneration in Model of Fracture Non-Union.
Maslennikov S, Danukalo M, Isachenko M … +3 more , Avramenko Y, Holovakha M, Kolesnyk Y
Med Princ Pract · 2026 May · PMID 42172169 · Publisher ↗
OBJECTIVE: To perform a histopathological analysis of the effects of mesenchymal stem cells (MSCs) and their osteogenically differentiated derivatives (Dif-MSCs) on reparative processes in bone tissue using an experiment...
OBJECTIVE: To perform a histopathological analysis of the effects of mesenchymal stem cells (MSCs) and their osteogenically differentiated derivatives (Dif-MSCs) on reparative processes in bone tissue using an experimental model of fracture nonunion. SUBJECTS AND METHODS: Fifteen male rabbits aged 3 months were randomly assigned to three groups: control with induced femoral nonunion (n=5), nonunion treated with adipose-derived MSCs (n=5), and nonunion treated with Dif-MSCs (n=5). MSCs were isolated from lipoaspirate, cultured to passage 3, and differentiated osteogenically for 4 weeks. A 5-mm bone defect was created surgically, and cells were injected into the defect zone on day 7. Animals were euthanized at 6 weeks post-injection. Bone specimens underwent fixation, decalcification, histological staining (hematoxylin-eosin and Van Gieson), and quantitative analysis of osteoblasts and osteocytes using ImageJ. Statistical analysis included one-way ANOVA and Welch's t-test. RESULTS: Macroscopic and histological evaluation revealed a gradation in regeneration: control group showed predominant fibrous tissue with immature bone and inflammation; MSCs group exhibited fibrocartilaginous callus with immature bone, bone marrow formation, and increased osteoblasts (52.0 ± 16.2 per 10 HPF vs. control 28.6 ± 7.0, p = 0.032); Dif-MSCs group demonstrated mature lamellar bone, organized osteons, mature bone marrow, and higher osteocytes (vs. MSCs, p = 0.006). ANOVA indicated trends in osteoblast increases (p = 0.092) and significant osteocyte variability (p = 0.014). CONCLUSION: Undifferentiated MSCs enhance early osteogenesis via endochondral ossification, while Dif-MSCs promote advanced maturation through mixed intramembranous and endochondral pathways, suggesting superior efficacy for treating fracture nonunion.
Neuropsychiatric adverse effects associated with the use of levetiracetam in adults: A Systematic Review and Meta-analysis.
Ramírez-Guerrero S, Gaviria-Carrillo M, Suárez Rubiano J … +8 more , Nava-Mesa MO, Mendivelso-Juya P, Olaya-Galindo MD, Pardo CE, Vargas-Cifuentes O, Bohórquez Sánchez MA, Mansilla Santamaría V, Vélez Van Meerbeke A
Med Princ Pract · 2026 May · PMID 42149799 · Publisher ↗
OBJECTIVE: Levetiracetam is a broad-spectrum anti-seizure medication (ASM) with a good safety profile; however, the occurrence of neuropsychiatric manifestations has been described in relation to its use. The aim of this...
OBJECTIVE: Levetiracetam is a broad-spectrum anti-seizure medication (ASM) with a good safety profile; however, the occurrence of neuropsychiatric manifestations has been described in relation to its use. The aim of this study is to provide an updated assessment of the neuropsychiatric adverse effects related to levetiracetam in patients aged 16 and older with epilepsy, without psychiatric comorbidity, and perform a meta-analysis comparing the occurrence of neuropsychiatric adverse effects between levetiracetam, placebo and other ASMs. METHODS: A systematic literature search was conducted in PubMed, Embase, and Web of Science. Studies published until March 14th, 2024, were included. Out of the 33 studies, 7 were randomized clinical trials comparing levetiracetam to placebo, and 4 comparing levetiracetam to other ASM, all of which were selected for further quantitative analysis. RESULTS: Somnolence was the most frequently reported NPAE (15 articles), followed by depression (11 articles). Fatigue, aggression/agitation, cognitive and memory impairment, irritability, anxiety, and behavioral changes were also commonly described. Across pooled analyses, levetiracetam‑treated patients demonstrated a significantly higher risk of somnolence/drowsiness (OR 1.61, 95% CI 1.20-2.17) and asthenia/fatigue (OR 1.48, 95% CI 1.04-2.11) compared with placebo. In contrast, a separate meta-analysis comparing levetiracetam to other ASMs, showed no significant difference for depression (OR 1.41, 95% CI 0.80-2.51). CONCLUSION: Patients treated with levetiracetam have a greater risk of developing neuropsychiatric effects, such as somnolence and fatigue, compared to placebo.
Effects of Ketogenic Diet on Behavioral, Metabolic, and Peripheral Tissue Changes in a Propylthiouracil-Induced Hypothyroidism Model.
Akkaya EC, Ilgin R, Kızıldağ S … +2 more , Argon A, Hoşgörler F
Med Princ Pract · 2026 May · PMID 42102036 · Full text
OBJECTIVE: This study aimed to evaluate whether a ketogenic diet (KD) mitigates behavioral, metabolic, and peripheral tissue alterations in a rat model of propylthiouracil (PTU)-induced hypothyroidism. SUBJECTS AND METHO...
OBJECTIVE: This study aimed to evaluate whether a ketogenic diet (KD) mitigates behavioral, metabolic, and peripheral tissue alterations in a rat model of propylthiouracil (PTU)-induced hypothyroidism. SUBJECTS AND METHODS: Adult female Sprague-Dawley rats (n = 28) were randomly assigned to control, KD, PTU, and KD+PTU groups. Hypothyroidism was induced using 0.05% PTU for 6 weeks, while KD was administered during the final 4 weeks. Behavioral testing was conducted during the final phase of the experimental period, followed by biochemical and histological analyses at the end of the 6-week protocol. Behavioral assessments included the open field, light/dark box, forced swim, and Morris water maze tests. Biochemical analyses evaluated serum free thyroxine (T4), thyroid-stimulating hormone (TSH), glucose, β-hydroxybutyrate, tumor necrosis factor alpha (TNF-α), and interleukin 10 (IL-10). Histological evaluations targeted the thyroid gland, liver, white adipose tissue (WAT), and brown adipose tissue (BAT). RESULTS: PTU significantly reduced serum free T4 levels and impaired spatial learning and mood-related behaviors. KD effectively induced nutritional ketosis and improved systemic glucose metabolism but did not reverse cognitive impairment or depressive-like behaviors associated with hypothyroidism. Histologically, KD attenuated PTU-induced hepatic inflammation, WAT dysfunction, and BAT whitening. Thyroid morphology and circulating TNF-α and IL-10 levels remained unchanged across groups. CONCLUSION: KD exerts favorable metabolic and peripheral tissue effects in PTU-induced hypothyroidism but does not rescue associated neurobehavioral deficits, likely due to persistent thyroid hormone deficiency.
Lactate, a Spearhead of Cancer Aggressiveness: Metabolic Reprogramming, Immune Suppression, and Metastatic Progression.
Luqmani YA
Med Princ Pract · 2026 May · PMID 42102033 · Full text
Reprogramming of cellular energy metabolism is a defining feature of malignancy, characterized by sustained glucose conversion to lactate under aerobic conditions. Once viewed as metabolic waste or a consequence of mitoc...
Reprogramming of cellular energy metabolism is a defining feature of malignancy, characterized by sustained glucose conversion to lactate under aerobic conditions. Once viewed as metabolic waste or a consequence of mitochondrial dysfunction, lactate is now recognized as a multifunctional metabolite that actively drives malignant progression. This review advances the concept of lactate as a spearhead of malignancy that coordinates metabolic adaptation with microenvironmental conditioning, immune suppression, epigenetic regulation, and metastatic dissemination. Beyond its role in metabolism, lactate functions through receptor-mediated signaling and histone lactylation, linking metabolic state to transcriptional programs associated with epithelial-mesenchymal transition, stemness, immune modulation, and therapeutic resistance. Lactate also reshapes the tumor microenvironment by promoting angiogenesis, stromal activation, immune suppression, and invasive behavior, including effects that cannot be explained solely by extracellular acidosis. Together, these observations support lactate as a critical effector of metastatic competence and a strategic target for disrupting multiple cancer hallmarks.
Blending AI with Expertise: A Comparative Study of Concept Maps in Anatomy Education.
Albuainain S, Alkubaisi Y, Zaqout S
Med Princ Pract · 2026 May · PMID 42102014 · Publisher ↗
OBJECTIVE: Concept maps are valuable tools in anatomy education, helping students organize complex information visually. With the rise of generative artificial intelligence (AI), tools like large language models (LLMs) a...
OBJECTIVE: Concept maps are valuable tools in anatomy education, helping students organize complex information visually. With the rise of generative artificial intelligence (AI), tools like large language models (LLMs) and large action models (LAMs) offer new opportunities to automate concept map creation. However, their effectiveness compared with human-generated maps remains unclear. METHODS: In this cross-sectional study, 74 medical students at Qatar University evaluated three concept maps-one generated by a large language model, one by a large action model, and one by a human expert. Students rated each map on clarity, structure, and scientific accuracy using Likert-scale items and selected their preferred map based on explanation, engagement, and future use. Data were analyzed using non-parametric and categorical tests. RESULTS: Human-generated maps demonstrated the highest ratings for contribution to understanding, while clarity ratings were comparable between the human-generated and large language model maps. Maps generated by the action-based model received lower ratings overall. Students consistently preferred the human-generated map across all categories, including explanation, engagement, and future use. While overall differences in categorical preferences were not statistically significant consistently, the selected pairwise comparisons showed significant differences favoring the human-generated map. CONCLUSIONS: Human-generated concept maps remain the most effective and preferred learning tool in anatomy education. Artificial intelligence models, particularly large language models, show promising potential as supportive tools but do not yet surpass expert-designed materials.
Comparing Spinal and General Anesthesia for Prone Percutaneous Nephrolithotomy: A Propensity Score-Matched Study.
Chen L, Xu D, Hou L
Med Princ Pract · 2026 May · PMID 42081437 · Publisher ↗
BACKGROUND/OBJECTIVE: Prone percutaneous nephrolithotomy (PCNL) is commonly performed under general anesthesia (GA); however, increasing evidence supports the feasibility of PCNL under spinal anesthesia (SA). This study...
BACKGROUND/OBJECTIVE: Prone percutaneous nephrolithotomy (PCNL) is commonly performed under general anesthesia (GA); however, increasing evidence supports the feasibility of PCNL under spinal anesthesia (SA). This study presents our experience with prone PCNL under SA performed by a single surgeon. The primary outcome was the incidence of postoperative complications according to the modified Clavien-Dindo classification, and the secondary outcome was the stone-free rate (SFR). METHODS: A total of 778 patients who underwent PCNL for kidney stones by a single surgeon between June 2014 and May 2023 were divided into two groups: Group GA (n=498) and Group SA (n=280). Demographic and stone characteristics, operative parameters, SFR, and complications were compared between the groups after 1:1 propensity score matching (PSM) based on age, sex, and stone burden. RESULTS: After PSM, 280 patients in Group SA were matched with 280 patients in Group GA. No significant differences were observed between the groups in terms of stone number, side, or localization. The use of intercostal access, need for multiple access tracts, and fluoroscopy time were also comparable. However, surgery duration, anesthesia duration, and hospital stay were significantly shorter in Group SA (p<0.001, p=0.04, and p<0.001, respectively). The SFR at the first evaluation and after auxiliary treatments was similar between groups. Overall postoperative complication rates did not differ significantly, and no life-threatening (Clavien-Dindo grade IV-V) complications occurred. CONCLUSIONS: Compared with GA, prone PCNL can be performed safely and effectively under SA, achieving comparable stone-free and complication rates while offering shorter operative time and hospital stay.
Self-Injury Mortality: Global Ascertainment and Prevention.
White F
Med Princ Pract · 2026 May · PMID 42081431 · Publisher ↗
The aim of this review is to explore self-injury mortality (SIM) for its utility and potential in capturing deaths due to a desire or indifference to ending one's life. Suicide deaths are underreported, and a high percen...
The aim of this review is to explore self-injury mortality (SIM) for its utility and potential in capturing deaths due to a desire or indifference to ending one's life. Suicide deaths are underreported, and a high percentage of substance use disorder deaths are misclassified as "accidental" or "undetermined." The challenge is how to plan interventions when such deaths are inadequately ascertained? Shifting the focus from suicide to SIM unmasks a hidden global crisis. Globally over 727,000 suicide deaths are reported each year. However, if adjusted for estimated underreporting and substance use disorder deaths, the actual number of people driven by a desire to escape despair by bringing one's life to an end could be more than double this. A case is argued for construction of globally applicable composite measures of self-injury mortality (SIM). To respond intelligently to suicide and self-injury prevention opportunities requires that the etiology and natural history of underlying mental disorders are understood, so that effective interventions are implemented. This is illustrated for the following disorders: anorexia nervosa, schizophrenia, bipolar disorder, major depressive disorder, gambling disorder, and substance use disorder. The keys to reducing self-injury mortality as an outcome of mental and behavioral disorders remain timely clinical intervention by informed health professionals, and supportive families and communities. Policy and service interventions to address determinants and risk factors are equally important. The ultimate enabling agent for ensuring conditions for optimal mental health must be society itself, and how it prioritizes elements within the political economy.
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