BACKGROUND: Alopecia areata (AA), an autoimmune disorder, represents a prevalent form of hair loss among individuals. Various therapeutic approaches exist for managing AA, with Janus kinase (JAK) inhibitors emerging as a...BACKGROUND: Alopecia areata (AA), an autoimmune disorder, represents a prevalent form of hair loss among individuals. Various therapeutic approaches exist for managing AA, with Janus kinase (JAK) inhibitors emerging as a promising treatment modality. Nonetheless, there is a paucity of rigorous studies directly comparing the efficacy of JAK inhibitors in cases of severe AA. OBJECTIVE: Evaluating the efficacy of different JAK inhibitors in the treatment of severe AA. METHOD: A comprehensive search was conducted across four databases-PubMed, Embase, Web of Science, and Cochrane Library-on February 10, 2025. Eligible studies were selected based on the PICOS framework. A Bayesian network meta-analysis was employed to extract and analyze data concerning the number of individuals achieving SALT20 and corresponding sample sizes. The relative efficacy of the interventions was evaluated using league tables and Surface Under the Cumulative Ranking values. RESULT: A total of 3866 patients with AA were included in the study, with a total of 10 interventions. Of these, the one that showed the best efficacy was deuruxolitinib_12 mg, but with wider 95% confidence intervals. Of all the JAK inhibitors, the one with significant efficacy and high precision of results was baricitinib_4 mg (OR: 2.59, 95% CI: 1.98-3.38). CONCLUSION: The efficacy of JAK inhibitors in the treatment of severe AA is definitive, and all possess a dose-dependent effect. This study provides valuable insights for clinicians in selecting appropriate pharmacological interventions for severe AA. Key messages What is already known on this topic: Alopecia areata is an autoimmune disorder characterized by patchy hair loss on the scalp. Previous studies have demonstrated that JAK inhibitors can effectively treat alopecia areata, but research comparing the efficacy of different JAK inhibitors is lacking. What this study adds: This study established a ranking of efficacy for different JAK inhibitors in treating severe alopecia areata, providing a reference for selecting clinical treatment regimens. How this study might affect research, practice, or policy: Future studies are needed to directly compare the efficacy of different JAK inhibitors in treating alopecia areata. This will provide more reliable evidence for formulating treatment regimens for alopecia areata.
Postgrad Med J
· 2026 Jun · PMID 42341167
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BACKGROUND: Diastolic dysfunction is an important early indicator of heart failure (HF) with preserved ejection fraction (HFpEF). Type 2 diabetes mellitus (T2DM) may contribute to HFpEF, as it is associated with an incre...BACKGROUND: Diastolic dysfunction is an important early indicator of heart failure (HF) with preserved ejection fraction (HFpEF). Type 2 diabetes mellitus (T2DM) may contribute to HFpEF, as it is associated with an increased risk of hospitalization and mortality. AIM: To investigate the association between diastolic dysfunction and T2DM in an adult population from Liverpool, accounting for age and sex. METHODS: A retrospective review of 493 patient records was conducted, extracting data on diastolic function status, diabetes status, age, and sex. Echocardiographic parameters were used to assess and grade diastolic function according to the 2016 ASE/EACVI recommendations. RESULTS: Diastolic dysfunction was more prevalent in type 2 diabetics (71.42%) than non-diabetic patients (43.98%) (P < .05). The odds ratio of developing diastolic dysfunction was 2.636 times higher in diabetics, with 2.56 times greater odds of a higher dysfunction grade (P < .001). Age ≥65 years was associated with 4.65 times higher odds of having diastolic dysfunction, with no significant difference between genders. CONCLUSIONS: This retrospective cohort study demonstrates a clear and statistically significant association between T2DM, advancing age and diastolic dysfunction. This association, however, should be interpreted within the context of a clinically selected population undergoing echocardiography. Due to the metabolic alterations that are associated with diabetes and the pathophysiology of HFpEF, there is a great potential for the use antidiabetic therapies as cardioprotective agents aimed at reducing HF morbidity and mortality. Considering these results, we propose incorporating diabetes into the H2FpEF score. Key messages What is already known on this topic - the development of heart failure with preserved ejection fraction (HFpEF) has long been associated with type 2 diabetes mellitus (T2DM), with the recognition of diastolic dysfunction as an early marker of disease progression. However, data describing the relationship between diabetes and diastolic dysfunction in specific local populations remains limited. What this study adds - this study provides data from a Liverpool tertiary centre showcasing significantly higher prevalence and severity of diastolic dysfunction in patients with type 2 diabetes. These findings produce locally relevant epidemiological evidence that supports the association between diabetes and diastolic dysfunction. How this study might affect research, practice or policy - the findings of this study highlight the importance of cardiovascular assessment in patients with type 2 diabetes in certain populations with a high burden of diabetes, such as Liverpool, and may support earlier identification of individuals at risk of developing HFpEF. Future research might consider incorporating T2DM into the H₂FPEF score, to improve early risk stratification.
Postgrad Med J
· 2026 Jun · PMID 42335038
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Clinical neurology is predicated on deciphering the intricate functions and dysfunctions of the nervous system. This educational review explores the fundamental principles of localization and diagnostic reasoning that ar...Clinical neurology is predicated on deciphering the intricate functions and dysfunctions of the nervous system. This educational review explores the fundamental principles of localization and diagnostic reasoning that are essential for neurological practice. We frame these principles within a philosophical context, referencing Plato's Allegory of the Cave to demonstrate the fundamentally indirect nature of neurological assessment, wherein clinical signs and symptoms reflect underlying neuronal processes. The application of the scientific method, balancing reductionist and contextualist approaches, is discussed. Bayes' Theorem is presented as a framework for probabilistic clinical reasoning. We examine the interplay between intuitive pattern recognition, analytical reasoning, and metacognition in developing diagnostic acumen. A systematic model (Symptoms → Syndrome → Anatomy → Pathology → Etiology) is described as a cornerstone for avoiding errors. Practical applications of localization are illustrated through common clinical scenarios. Finally, we highlight cognitive biases that contribute to diagnostic errors and propose strategies for mitigation.
Postgrad Med J
· 2026 Jun · PMID 42328736
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100 years ago, the main treatments for asthma were the sympathomimetic ephedrine, theophylline tablets, inhaled anticholinergics in the form of "asthma cigarettes". Together with adrenaline injections for acute exacerbat...100 years ago, the main treatments for asthma were the sympathomimetic ephedrine, theophylline tablets, inhaled anticholinergics in the form of "asthma cigarettes". Together with adrenaline injections for acute exacerbations, these treatments were all bronchodilators derived from natural products. Adrenaline injections evolved into inhaled β2-agonists as the most effective bronchodilators in asthma, whereas theophylline and inhaled anticholinergics are less useful treatments. The efficacy of desiccated adrenal glands extract, used since 1900, is likely due to steroids derived from the adrenal cortex. Corticosteroids are the most effective treatment for asthma and target the underlying eosinophilic airway inflammation. Combination inhalers of corticosteroid and long-acting β2-agonist are now the mainstay of asthma therapy. Recently, short-acting β2-agonists as relievers have been replaced by relievers containing an inhaled corticosteroid, together with a rapid onset long-acting β2-agonist formoterol (anti-inflammatory reliever). This addresses the major issue of poor adherence with inhaled corticosteroids. Poor inhaler technique is being addressed with the development of smart inhalers. In patients with severe asthma not controlled by inhaled therapy, antibodies that block cytokines involved in eosinophilic inflammation have been very effective. In the future, longer acting antibodies will simplify the treatment of these patients. New drugs are also in development for severe non-eosinophilic asthma. There have been remarkable advances in asthma therapy over the last century, although our current treatments have their origins in the therapies used in 1925.
Regmi A, Jain V, Baral S
… +2 more, Jain VK, Iyengar KP
Postgrad Med J
· 2026 Jun · PMID 42323882
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BACKGROUND AND PURPOSE: Technological innovation has played a pivotal role in shaping trauma and orthopaedic surgery. This narrative review examines the evolution of orthopaedic practice across six industrial revolutions...BACKGROUND AND PURPOSE: Technological innovation has played a pivotal role in shaping trauma and orthopaedic surgery. This narrative review examines the evolution of orthopaedic practice across six industrial revolutions, from early mechanization to contemporary artificial intelligence (AI)-driven healthcare. METHODS: A structured literature search of major databases and historical sources was performed through December 2025. RESULTS: Industry 1.0 introduced standardized surgical instrumentation and early prosthetics, while Industry 2.0 enabled radiographic imaging, aseptic techniques, and internal fixation. Industry 3.0 facilitated total joint arthroplasty, advanced cross-sectional imaging, and minimally invasive surgery. Industry 4.0 has integrated AI, robotics, and three-dimensional printing into clinical practice. Emerging paradigms of Industry 5.0 emphasize human-AI collaboration, personalized medicine, and regenerative technologies, whereas Industry 6.0 envisions autonomous surgical systems and intelligent implants. CONCLUSIONS: Understanding this technological progression provides insight into the future trajectory of precision orthopaedics and highlights the importance of interdisciplinary innovation in improving patient outcomes.
Postgrad Med J
· 2026 Jun · PMID 42319085
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BACKGROUND: Recent increases in food prices in Egypt have raised concerns about their impact on dietary patterns and household food security (FS), particularly among economically vulnerable groups, forcing families to re...BACKGROUND: Recent increases in food prices in Egypt have raised concerns about their impact on dietary patterns and household food security (FS), particularly among economically vulnerable groups, forcing families to reduce dietary diversity and nutrient intake. This may indirectly contribute to an increased risk of malnutrition and chronic diseases. AIM: To identify changes in food consumption behavior (food choices and dietary patterns) among Egyptian households following food inflation and determine the levels and predictors of food insecurity (FI). METHODS: An online cross-sectional survey of 723 Egyptian households from June to December 2024. Data was collected using a pretested structured questionnaire targeting household heads. The tool assessed sociodemographic characteristics, food consumption changes, and FS status. RESULTS: Most participants reported increased food expenditure (58.2%) with dietary shift toward cheaper carbohydrate-rich staple foods (55.2%). Reduced consumption of animal protein and dairy products was also observed. Overall, 64.6% of households experienced FI: 15.8% mild, 27.5% moderate, and 20.3% severe levels. Significant predictors of FI included female respondents (OR = 2.425, P < .001), maternal unemployment [odds ratio (OR) = 1.597, P = .018], low household income (OR = 1.774, P = .001), maternal financial responsibility (OR = 3.432, P < .001), the presence of a family member with chronic disease (OR = 1.748, P = .002), and a current smoking father (OR = 1.711, P = .004). CONCLUSION: Increased food prices lead to changes in food consumption patterns with shifts toward less nutritionally valuable foods and deprive most households of FS. Therefore, there is an urgent need for national nutrition health education programs to help households optimize the use of limited household budgets to achieve a balanced diet.
Khor Z, Rathnamalala N, Flynn R
… +1 more, Isles C
Postgrad Med J
· 2026 Jun · PMID 42287721
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BACKGROUND: Rhabdomyolysis is a potentially life-threatening consequence of muscle injury. The aim of our study was to analyse the relation between serum creatine kinase (CK), acute kidney injury (AKI), renal outcomes, a...BACKGROUND: Rhabdomyolysis is a potentially life-threatening consequence of muscle injury. The aim of our study was to analyse the relation between serum creatine kinase (CK), acute kidney injury (AKI), renal outcomes, and mortality among adults with serum CK over 1000 IU/L within 72 h of hospital admission. METHODS: Our single-centre cohort study enrolled 855 patients with serum CK over 1000 IU/L. Univariate and multivariate analyses were performed for short- and long-term mortality, based on a logistic regression model and a cox proportional hazards model, respectively. RESULTS: AKI developed in 368 of 855 patients (43%). Those with CK 5001-10 000 IU/L and over 10 000 IU/L were more likely to develop stages 2 and 3 AKI than those with lower levels of serum CK (P = .001 and P < .001, respectively). Renal replacement therapy (RRT) was required by 43 (5.0%) patients during their hospitalization, 15 of whom had pre-existing non-dialysis dependent chronic kidney disease (CKD). The requirement for RRT was greatest among those with serum CK over 5000 IU/L (P < .001). Among the 269 patients with AKI who survived at least 3 years, 235 (87.4%) had complete recovery of renal function, 26 (9.7%) had partial recovery, while 8 (3.0%) remained dialysis dependent. Complete recovery was more likely in patients with stages 1 and 2 AKI than those with stage 3 AKI (P < .018). All eight patients who remained dialysis dependent had initially presented with stage 3 AKI. For patients who were still alive 90 days after hospital admission, neither AKI or CK levels were associated with subsequent mortality. Age was the only predictor of their long-term mortality identified by multivariate analysis. CONCLUSIONS: AKI is a common but not inevitable consequence of rhabdomyolysis. Most patients with AKI have complete recovery of renal function. Serum CK predicts likelihood of more severe forms of AKI but has no discernible effect on either short- or long-term mortality. Key messages What is already known on this topic: Acute kidney injury (AKI) is a common and potentially life-threatening complication of rhabdomyolysis. Studies have shown varying results when describing relationship between serum creatine kinase (CK) and AKI. What this study adds: Our study showed an AKI incidence of 43% in patients with serum CK over 1000 IU/L. Most patients with AKI had complete recovery of their renal function. Serum CK over 5000 IU/L predicted likelihood of more severe forms of AKI, including the need for dialysis, but was not associated with either short or long-term mortality. How this study might affect research, practice, or policy: Greater awareness of the relation between serum CK and AKI should prompt preventive measures, including early rehydration and treatment of infection if present, to reduce the incidence of severe AKI.
Pillai P, Saadat S, Ward I
… +2 more, Hajibandeh S, Hajibandeh S
Postgrad Med J
· 2026 Jun · PMID 42284227
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AIMS: To evaluate comparative outcomes of artificial Intelligence (AI)-based and traditional-based teaching in medical education. METHODS: The literature search was carried out in CENTRAL, CINAHL, Web of Science, MEDLINE...AIMS: To evaluate comparative outcomes of artificial Intelligence (AI)-based and traditional-based teaching in medical education. METHODS: The literature search was carried out in CENTRAL, CINAHL, Web of Science, MEDLINE, and EMBASE to identify randomized controlled trials (RCTs) comparing AI-based versus traditional-based teachings in medical education. Estimate of effect size was determined for knowledge score, skills score, and teaching satisfaction score via fixed-effect modelling. RESULTS: Fourteen RCTs enrolling 1116 students who received AI-based teaching (n = 558) or traditional-based teaching (n = 558) were included. The use of AI-based teaching was associated with significantly higher knowledge score (standardized mean difference (SMD): 0.36, 95% CI, 0.24-0.49, P < .00001), skills score (SMD: 0.78, 95% CI, 0.57-0.99, P < .00001), and teaching satisfaction score (SMD: 0.97, 95% CI, 0.66-1.29, P < .00001) compared to the traditional-based teaching. Subgroup analyses with respect to the practical course, theoretical course, duration of course shorter or longer than 1 week were consistent with the main analyses. Meta-regression analysis demonstrated that practical course significantly increased estimate effect for knowledge score (P = .002) and skills score (P = .0001). CONCLUSIONS: Meta-analysis of best available evidence (level 1a) indicates that AI-based teaching significantly improves student's knowledge, skills, and satisfactions compared to traditional teaching. However, the available evidence may be subject to publication and reporting bias with high between-study heterogeneity. Future studies should evaluate AI-based teaching in postgraduate settings including speciality and even subspecialties trainings. Key messages What is already known on this topic: Growing evidence from randomized controlled trials demonstrated positive impact of artificial intelligence (AI) in medical education when compared to the traditional approaches. What this study adds: Meta-analysis of best available evidence (level 1a) indicates that AI-based teaching significantly improves student's knowledge, skills, and satisfactions compared to traditional teaching. How this study might affect research, practice, or policy: This study suggests that Future studies should evaluate AI-based teaching in postgraduate settings including speciality and even subspecialties trainings.
Chow M, Li AY, Quek DYJ
… +2 more, Fan EB, Sadasiv MS
Postgrad Med J
· 2026 May · PMID 42213533
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Generative AI (genAI) does not simply add another layer of decision support to medicine; it changes the environment in which clinical reasoning is performed, taught, and judged. This matters because clinical reasoning is...Generative AI (genAI) does not simply add another layer of decision support to medicine; it changes the environment in which clinical reasoning is performed, taught, and judged. This matters because clinical reasoning is not simply the production of answers, but the management of uncertainty in a particular patient: framing the problem, deciding what matters most, distinguishing between plausible alternatives, calibrating uncertainty, and revising plans as new information emerges. As large language models (LLMs) become embedded in clinical workflow, the work of reasoning is not removed but redistributed. Clinicians may do less first-pass synthesis but more verification, contextualization and judgment of machine-generated outputs. This may reduce burden, but it also increases vulnerability to anchoring, automation bias, and premature closure. The educational risk is therefore not only that AI may be wrong, but that routine answer-first use may weaken the developmental work through which adaptive expertise forms. In training, this may lead to deskilling, never-skilling, or mis-skilling unless key domains of reasoning remain visible under supervision. We argue that these include framing, weighting salient findings, discriminating between alternatives, calibrating uncertainty, and revising plans in context. In this light, one promising educational use of LLMs may be as question-prompting aids used after trainee commitment to test and deepen reasoning. The future of clinical reasoning in the age of genAI will depend less on what the machine can produce than on whether medical education preserves the conditions under which human judgment is formed.
Chuang PY, Yang TY, Huang KC
… +3 more, Tsai YH, Cheng LY, Lu YC
Postgrad Med J
· 2026 May · PMID 42213532
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BACKGROUND: Osteopenia and osteoporosis commonly affect women during the menopausal transition. The controlling nutritional status (CONUT) score, a marker of nutritional health, has been linked to various clinical outcom...BACKGROUND: Osteopenia and osteoporosis commonly affect women during the menopausal transition. The controlling nutritional status (CONUT) score, a marker of nutritional health, has been linked to various clinical outcomes, but its relationship with bone health in menopause remains unclear. This study examined associations between CONUT scores and osteopenia and osteoporosis in menopausal women. METHODS: Data from 1188 women aged 45-55 years in the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed, representing 19.5 million U.S. women. Bone mineral density (BMD) at the femur sites was assessed using dual-energy X-ray absorptiometry (DEXA), and T-scores defined osteopenia and osteoporosis. CONUT scores were derived from serum albumin, total cholesterol, and lymphocyte count. Logistic regression evaluated associations between CONUT scores and bone health outcomes, adjusting for confounders. Analyses were stratified by body mass index (BMI > 25 vs. ≤ 25 kg/m2). RESULTS: Women with higher CONUT scores (≥2) had significantly greater odds of osteopenia (adjusted odds ratio [aOR] = 1.82; 95% CI: 1.06-3.13; P = .031). No significant association was observed between CONUT scores and osteoporosis (P = .091). In BMI-stratified analysis, the association between high CONUT scores and osteopenia was stronger among women with BMI > 25 kg/m2 (aOR = 2.66; 95% CI: 1.41-5.01; P = .003). CONCLUSIONS: Poor nutritional status, as reflected by higher CONUT scores, is associated with higher likelihood of osteopenia in women undergoing menopausal transition, especially those with higher BMI. Key messages What is already known on this topic: Osteopenia and osteoporosis occur commonly in women undergoing menopausal transition. Use of controlling nutritional status (CONUT) scores to assess nutritional health, has been associated with various health outcomes, but the CONUT role in bone health during menopause has not been explored. What this study adds: This study examined the association between nutritional status, as assessed by the CONUT score, and bone health in women during the menopausal transition. The results demonstrated that poorer nutritional status was significantly associated with a higher likelihood of osteopenia, particularly among individuals with higher BMI. How this study might affect research, practice, or policy: These findings suggest that attention to nutritional status may contribute to strategies aimed at preventing early bone deterioration.