bluuebunny/crossref_metadata_2025 huggingface dataset:
Physicians to the Duke of Clarence
Authors: Wilson JB
Published: January 2025

Halliday and Beattie came from the small village of Dalton in Dumfriesshire and both became physicians to the Duke of Clarence, the King’s brother. They had interesting and varied careers and accompanied their royal patron on his frequent visits to the Continent. Halliday served in the Peninsula War and at Waterloo while Beattie became a close friend and confident of the Duke. Based on his visits to the Continent, Beattie produced a beautifully illustrated series of travel books.
Writing safe and effective prescriptions in a hospital kardex
Authors: Maxwell SRJ , Wilkinson K
Published: January 2025

Several thousand prescriptions will be dispensed each day in a typical National Health Service hospital in the UK. The success of each normally depends on a communication between one healthcare professional (usually a doctor), who has made a diagnosis and formulated a treatment plan, and a second professional (usually a nurse), who will deliver the medicine to the patient. This critical communication, or prescription, should convey all the necessary information about the dispensing of the medicine: which medicine and formulation, who it should be given to, how much, which route, how often, and for how long. Sometimes the prescription will provide discretion to the dispenser about the amount and timing, e.g. for as-required medicines. Confusion surrounding the information conveyed in the prescription accounts for many of the 40,000 serious hospital medication errors reported to the National Patient Safety Agency each year, some of which are fatal. Evidence of poor prescription writing has been documented in numerous studies of hospital prescription charts. Although most prescription errors in hospital are made by junior medical staff (because they write the majority of the prescriptions), more senior staff are also implicated, and importantly have an opportunity to lead by example. Not surprisingly, the Department of Health in the UK is taking the issue of safety related to medicines very seriously.
Medication errors
Authors: Williams DJP
Published: January 2025

Medication errors, broadly defined as any error in the prescribing, dispensing, or administration of a drug, irrespective of whether such errors lead to adverse consequences or not, are the single most preventable cause of patient harm. Medication errors may be classified according to the stage of the medication use cycle in which they occur (prescribing, dispensing, or administration) although a recent classification of medication error into mistakes, slips, or lapses has been proposed. Incidences of medication error rates vary widely, as a result of the variety of different study methods and definitions used. The majority of medication errors occur as a result of poor prescribing and often involve relatively inexperienced medical staff, who are responsible for the majority of prescribing in hospital. Electronic prescribing may help reduce the risk of prescribing errors owing to illegible handwriting, although such systems can in turn lead to further problems such as incorrect drug selection, and their effect on patient outcomes requires further study. A multidisciplinary approach to solving the problem of medication errors is required which adopts an attitude of ‘no blame’, since incident reports have often been used as instruments of punishment, thereby creating a fear of discipline. This fear may be lessened by creating an open and safe environment for detecting and reporting medication errors. Current approaches to preventing medication errors are inadequate and require a shift in emphasis to a scientific investigation of preventable patient harm.
Filaggrin and eczema
Authors: R Weller  , WHI McLean
Published: January 2025

Recent genetic findings demonstrate an important role for the epidermal protein filaggrin in the aetiology of atopic diseases, including asthma as well as eczema. Filaggrin is critical to the conversion of keratinocytes to the protein/lipid squames that compose the stratum corneum, the outermost barrier layer of the skin. In 2006, icthyosis vulgaris, a disease characterised by dry, scaly skin, was found to be a semi-dominant Mendelian condition due to mutations at two sites (R501X and 2282del4) in the filaggrin gene. An exceptionally strong association has also been shown between these two mutations and the most common distinct form of eczema, atopic dermatitis, in 12 independent European populations, with odds ratios varying between 2·8 and 13·4. No negative studies have been reported in Europe, although these two mutations are not associated with AD in three non-European cohorts. Furthermore, FLG null mutations have since been identified in European and non-European cohorts with AD. Asthma on a background of AD is related to FLG null status, but not in the absence of AD. A primary defect in skin barrier function therefore appears to underlie atopic dermatitis and asthma. Immunological changes in atopic disease are probably secondary to enhanced antigen penetration through a deficient epidermal barrier.
Marshall Hall, the reflex arc and epilepsy
Authors: Eadie MJ
Published: January 2025

Marshall Hall (1790–1857), who graduated from the University of Edinburgh’s Medical School in 1812, was considered one of the greatest physiologists of his day. He advanced knowledge in various areas of medicine, in particular elucidating the mechanism of reflex activity in 1833. Hall suggested that convulsive epileptic seizures arose from heightened activity in the afferent limb or the central component of the reflex arc. From 1838 onwards he developed the idea that reflex-mediated neck muscle spasm in seizures obstructed cerebral venous return, congested the brain and thus caused unconsciousness. Associated reflex-mediated laryngeal spasm then caused convulsing. This was the most comprehensive physiologically based explanation of the major features of the convulsive epileptic seizure then available. Hall subsequently advocated and employed tracheotomy to prevent epileptic convulsing. His idea was taken up, modified and made more acceptable by others, and for a generation was the widely acknowledged basis for interpreting epileptogenesis. However, from 1870 onwards it was superseded by John Hughlings Jackson’s accumulating evidence that epileptic seizures often arose in the cerebral cortex.
Prospects for new drugs and regimens in the treatment of tuberculosis
Authors: Cheepsattayakorn A , Cheepsattayakorn R
Published: January 2025

Since rifampicin was introduced in 1967, no novel compounds have been approved for first-line chemotherapy of tuberculosis. The inexorable rise in cases of tuberculosis worldwide, fuelled by the HIV epidemic, highlights the need for new drugs, particularly those that can shorten the duration of treatment. The World Health Organization’s Stop TB strategy considers that the present high burden of tuberculosis worldwide is related not only to the spread of HIV but also to poverty and the widening gap between rich and poor in various populations, disregard for the disease and lack of appropriate healthcare services. Clinical trials of existing agents such as methoxyfluoroquinolones (e.g. gatifloxacin and moxifloxacin), which are bactericidal and potent against organisms that are not actively multiplying, are proceeding on the basis of efficacy in models of interaction and preliminary clinical data. These may provide a stopgap, but the real breakthrough will come when novel agents with potent sterilising activity are discovered. New agents will provide opportunities to intensify regimens that could be shorter in duration as well as provide more options for the eradication of multi-drug-resistant mycobacteria.
Oesophageal cancer: current trends and management
Authors: Evans M , Crosby T
Published: January 2025

The incidence of oesophageal cancer continues to increase worldwide, particularly adenocarcinoma of the distal oesophagus and gastro-oesophageal junction. Unfortunately, overall survival rates remain disappointingly low, even in those patients who are fit for radical (curative) treatment at presentation. Surgery, with or without preoperative chemotherapy, remains the treatment of choice in the UK for those patients of adequate performance status who have potentially resectable disease. An alternative approach is chemoradiotherapy, which is associated with similar long-term survival rates, at least in patients with squamous cell carcinoma. The survival of patients with advanced disease may be prolonged by palliative chemotherapy, and there are a number of treatment modalities that may be used to relieve dysphagia; their use often reflects local availability and expertise. This review summarises the recent trends in the incidence and aetiology of oesophageal cancer and provides an up-to-date overview of its management.
The challenging diagnosis of cardiac amyloidosis
Authors: Gavin A , Coats CJ , Wallace W , Flapan AD
Published: January 2025

Cardiac amyloidosis is a rare condition. Early diagnosis allows for more effective treatment with subsequent improvements in patient quality of life and survival. There is, however, often a significant delay between the initial presentation with symptoms and the eventual diagnosis. We present seven individual cases presenting to our centre over a 12-month period for whom the final diagnosis was cardiac amyloidosis. We look at the difficulties encountered and alternative diagnoses that were considered before the eventual diagnosis of cardiac amyloidosis was made. We discuss the apparent discrepancies often encountered between the clinical signs and the results of various investigations. We review the various tests that can help the clinician to make the diagnosis in patients with suspected cardiac amyloidosis and look at the treatment options. Finally, we conclude that careful evaluation of the clinical status in the context of all available results should allow early diagnosis and treatment, thereby improving long-term prognosis.
Edinburgh doctors and their physic gardens
Authors: Doyle D
Published: January 2025

Edinburgh has had eight physic gardens on different sites since its first one was created by the Incorporation of Barbers and Surgeons in 1656. As the gardens grew in size, they evolved from herb gardens to botanic gardens with small herbaria for the supply of medical herbs. They were intended for the instruction of medical, surgical and apothecary students and, in the case of the physicians, to demonstrate the need for a physicians’ college and a pharmacopoeia. Some of the doctors in charge of them were equally famous and influential in botany as in medicine, and while Edinburgh Town Council enjoyed the fame the gardens brought to the city it was parsimonious and slow to support its botanical pioneers. The gardens are celebrated today in the Sibbald Garden within the Royal College of Physicians of Edinburgh.
Infectious diseases: problems and challenges
Authors: Robertson P
Published: January 2025

Animals and, unfortunately, medical care are responsible for many of the problems and challenges caused by infection that we currently face. The symposium’s morning session covered four zoonotic infections – Q fever, Lyme borreliosis, verotoxin-producing Escherichia coli and rabies – that will require improved interaction between physicians, microbiologists, veterinarians and public health agencies for their control. Representatives of each of these groups spoke, and the audience was similarly broad in its make-up. The afternoon session saw expert speakers discuss two difficult bugs – complicated Staphylococcus aureus bacteraemia and fungal lung infection – and the difficult clinical scenario of ensuring patients with severe sepsis receive effective initial antibiotics without fuelling antimicrobial resistance or Clostridium difficile disease. The wealth of information and experience provided should challenge anyone prescribing antimicrobial agents to reflect on and improve their own practice.
New warnings on the use of antipsychotic agents in the elderly with dementia
Authors: Mackay AVP
Published: January 2025

The use of antipsychotic drugs is common in the care of the elderly with dementia and associated behavioural problems, but until recently none of these agents had marketing authorisation for this indication. Medicines regulators have recognised this off-label use and issued warnings about the special risks posed to the elderly. The increased risk of stroke has been reflected in product information for five years, but recent attention has shifted to mortality risk. Initially confined to new-generation atypical antipsychotics in which an approximately 1.6–1.7-fold increase in mortality has been demonstrated, recent evidence points to a risk of at least similar magnitude with older-generation typical agents, prompting warnings by UK and US medicines regulators about an increased risk of death associated with the entire class, atypical and typical.
Diabetes &endocrinology: something for everyone
Authors: Pearson E
Published: January 2025

This symposium addressed new developments and controversies in diabetes and endocrinology. The practical management of hyperparathyroidism, thyroid nodules, hyperprolactinaemia and diabetes and thyroid disorders in pregnancy were all discussed. In addition to these traditional areas of endocrinology, there was a focus on the role of endocrinology in ‘non-endocrine’ specialties, namely critical care and cardiovascular disease. We learned that manipulation of the thyroid axis or local glucocorticoids can potentially be used to treat high cholesterol, atrial fibrillation or coronary stent stenosis, and that glucose lowering with insulin reduces mortality in the critically ill.
Adolescent inflammatory bowel disease: assessment, treatment and transition
Authors: Gillett PM , Rogers PM , Wilson DC
Published: January 2025

Paediatric inflammatory bowel disease (IBD) most usually evolves during adolescence, a time of great challenge. For the adolescent, the disease should be thoroughly assessed by upper gastrointestinal endoscopy and ileo-colonoscopy, preferably performed under general anaesthetic or conscious sedation, with relevant radiological examination. This will enable the determination of diagnosis, IBD subtype and extent. Growth also needs to be assessed and the effect of disease on academic and social functioning must be explored. Unlike adult IBD, there is a poor evidence base for the medical and nutritional management of adolescent IBD. However, within the UK it is common practice to use exclusive enteral nutrition rather than corticosteroids for the induction of Crohn’s remission, and to have early recourse to immunomodulation with azathioprine (and methotrexate for azathioprine/6MP intolerance or non-response) unless remission is rapidly induced and maintained. There should be close collaboration with paediatric and colorectal surgeons. Adolescents need higher relative drug doses than the literature suggests for adult IBD patients. Transition clinics are vital for adolescent care and provide a helpful source of second opinion for the paediatric gastroenterologist. Adolescents with IBD are best looked after by the paediatric gastroenterology multidisciplinary team (or in shared care with that team). In this overview we highlight these key areas of assessment, treatment and transition.
Was Maria de’ Medici a diabetic patient?
Authors: Leeuw I de
Published: January 2025

Queen Maria de’ Medici (1573–1642) died in a miserable, marasmic state. Infections, gangrene, weight loss, fatigue and respiratory problems suggest a progressive decompensation of a previously existing Type 2 diabetes. The lack of biochemical data, however, permits only circumstantial evidence of this hypothesis. The author proposes that the queen developed subclinical diabetes after the age of 45, when she became obese due to excessive eating and lack of exercise. With a clear familial predisposition, she could have become insulin resistant and chronically hyperglycaemic. The presence of an internal deviation of the left eye, visible on several late portraits, suggests a mononeuropathy of cranial nerve VI. Repeated skin infections and gangrene of the lower limbs during the last month of her life complete the clinical diagnosis. Hyperglycaemic ketosis with Kussmaul respiration without adequate treatment may have caused her death.
From surgeon-apothecary to statesman: Sun Yat-sen at the Hong Kong College of Medicine
Authors: Fu L
Published: January 2025

Despite being of peasant stock from a small village on the southern coast of China, Sun Yat-sen (1866–1925), the founder and first provisional president of the Republic of China, was exposed to Western education early in life. Educated first in Hawaii and then in the British Crown Colony of Hong Kong, he was influenced by Christianity, democracy and liberalism. It was the years of his tertiary education at the Hong Kong College of Medicine that moulded his ultimate destiny as the healer of a nation. This article examines the importance of this medical college and its two stalwarts, Sir Patrick Manson and Sir James Cantlie, in the transformation that shaped China’s modern history.
The history of ergot of rye (Claviceps purpurea) I: From antiquity to 1900
Authors: Lee MR
Published: January 2025

This article outlines the history of ergot of rye up to 1900. Ergot is a fungal disease that affects many grasses but is particularly damaging to rye. It occurs as the result of an infection by the parasitic organism Claviceps purpurea, which produces characteristic black spurs on the grass. When incorporated into grain, the ergot fungus can cause severe outbreaks of poisoning in humans called ergotism. There are two main clinical forms of toxicity, gangrenous and convulsive, where coma and death often supervene: the death rate for ergotism has been reported to be between 10 and 20 per cent in major outbreaks. Historical accounts note that ergot could accelerate labour, stop postpartum haemorrhage and inhibit lactation. At the end of the nineteenth century ergot was still regarded as a ‘glorious chemical mess’, but help would arrive in the early 1900s and the complex jigsaw would be solved.
Is routine screening for coeliac disease of value in people with type 1 diabetes?
Authors: Adamson KA , White AE , Geddes J , Frier BM , Gillett HR , Strachan MWJ
Published: January 2025

This study aimed to assess the impact of screening positive for coeliac disease on a population of adults with type 1 diabetes. Fifty-three patients were identified with a positive screen for coeliac disease, out of a population of 2,752 individuals with type 1 diabetes (minimum prevalence 1.9%). Prior to screening, 32% of patients were asymptomatic. Only a fifth of patients found no improvement in well-being with a gluten-free diet and in those who followed a strict gluten-free diet the improvement in well-being was greater (p=0.034). Screening was felt to be beneficial by 73%. The response did not relate to gluten-free diet adherence but did relate to symptom improvement (p=0.037). These data show that patients report an improvement in well-being with treatment and feel that screening for coeliac disease is beneficial.
The Residency Mess at the Royal Infirmary of Edinburgh: history and traditions
Authors: Burt RAP
Published: January 2025

For almost 250 years the Edinburgh Royal Infirmary was staffed with resident physicians and surgeons. This paper traces the history and the traditions of the Residency Mess, its inhabitants’ lives, duties and leisure activities and how these have changed over the years.
An unusual cause of obstructive jaundice
Authors: Hameed H , Sultan F , Khan YI , Hussain M , Azhar R
Published: January 2025

Cryptococcus neoformans is an opportunistic fungal infection that mainly affects immunocompromised patients with or without HIV and can only be seen infrequently in the immunocompetent host. Presentation can be with pneumonia, meningitis or widely disseminated disease. We report the case of a 65-year-old man who presented with obstructive jaundice and weight loss. He had been evaluated at another institution where surgery was offered to him for a presumed diagnosis of cholangiocarcinoma. Our evaluation revealed disseminated cryptococcal infection for which the patient received fluconazole for six months, which resulted in the resolution of his obstructive jaundice.
THE CONCENTRATION OF THUJONE IN ABSINTHE FROM VALENTIN MAGNAN’S TIME
Authors: Jean-Pierre Luauté , Dirk W Lachenmeier
Published: January 2025

The recent paper on absinthe, epileptic seizures and Valentin Magnan (Eadie MJ. Absinthe, epileptic seizures and Valentin Magnan. J R Coll Physicians Edinb 2009; 39:73-8) addresses an interesting question: can science from the 1870s be of any validity for today's view on the alcoholic beverage absinthe?

In an attempt to defend Magnan's conclusions on the responsibility of absinthe to cause epileptic seizures in humans, Eadie argues that the presence of thujone at convulsant concentrations in some of the available absinthes of Magnan's time cannot be known. We have demonstrated, however, that it can be known: not only from theoretical calculations,1 but also from chemical analyses of surviving products.2,3 The total thujone content in 21 analysed pre-ban absinthe samples ranged between 0.5 and 48.3 mg/l, whereas the average thujone content of 27.8 ± 17.1 mg/l fell within the modern Codex Alimentarius/ EU limit of 35 mg/l (derived from no-effect levels in animal experiments with an additional safety factor). We also provided evidence that thujone in bottled absinthe remains stable; therefore, our analyses of 100-year-old spirits were not confounded by significant thujone deterioration over time.3 We concluded that the scientific literature contains no proof that historic absinthe contained thujone in concentrations able to produce any of the effects experienced in the Magnan experiments conducted with pure wormwood oil. Our historical survey4 also showed that Magnan was swayed by specific anecdotal reports from which he inferred a general principle. Magnan attributed the epileptic seizures and general delirium observed in long-term absinthe drinkers to wormwood essence in absinthe in particular, rather than to alcohol in general, which is the more plausible explanation.

Another of Eadie's claims, which seems highly speculative, is that some of Magnan's patients might have had a genetic predisposition to juvenile myoclonic epilepsy (not described at the time) and thus may have been unusually vulnerable to thujone's convulsant effect. The relationship Magnan drew between absinthe and epilepsy was not restricted to a small number of drinkers, but to all of them.

In conclusion, we want to stress that while Magnan's conclusion on absinthe cannot uphold to today's standards, he is still rightly regarded as one of the fathers of French psychiatry.
The 1727 St Kilda epidemic: smallpox or chickenpox?
Authors: Stride P
Published: January 2025

An acute infectious epidemic almost eliminated the St Kilda community in 1727. An epic tale of survival in adversity followed. Contemporary records reveal atypical features, suggesting a speculative alternative.
Author’s reply
Authors: Horowitz Professor RE
Published: January 2025

I thank Professor Stuart for his comments. The discrepancies between clinical and autopsy diagnoses and the inaccuracies of death certification as cited by Cameron et al. are well known1 and bear reiteration.

The centralisation of autopsies may be a practical approach to a thorny problem. Ideally, every hospital would have a decedent affairs programme which assures a high autopsy rate; there would be a modern autopsy facility staffed by expert prosectors, supervised by knowledgeable and interested pathologists, all paid for by ‘the healthcare system’. The attending clinician would attend the autopsy and gain immediate knowledge and benefit. In most American hospitals that ideal is simply not available.

The regionalisation of autopsies in a single facility under the auspices of a medical school or medical examiner’s (coroner’s) office would optimise the utilisation of scarce resources. One university medical centre in the United States has already done this: it contracts with 23 community hospitals, both locally and up to 200 miles away. The community hospitals’ pathologists do not do autopsies, the community hospitals do not need to invest in space and personnel and these savings are passed on to the university as payment for performing the autopsy. The university thus gets sufficient numbers of autopsies for medical student and resident training, the autopsies are performed by people who are skilled and interested in doing them and there is sufficient material for research and publication, allowing the university to attract pathologists dedicated to the autopsy. With modern information and imaging systems, autopsy reporting is prompt and the distances are no problem.

Is such centralisation ideal? No! But is it a potential viable alternative? Yes! Is it a ‘ghetto of the dead’? Perhaps, but with a marquee that reads: Hic locus est ubi mors gaudet succurrere vitae (This is the place where the dead give sustenance to the living).
MORE ON THE ASSOCIATION OF GASTRIC AND COLONIC NEOPLASMS
Authors: Jolobe OMP
Published: January 2025

The report of the association of synchronous gastric polyp and colon cancer in the last Journal issue (Cooper H, Dhar A. Synchronous gastric polyp and colonic cancer. J R Coll Physicians Edinb 2009; 39:218-20) has, as its corollary, the occurrence of metastases to the stomach from primary adenocarcinoma of the colon.1 In the latter series there were five such cases, one identified by endoscopy, and four by autopsy. The five cases comprised 7% of 67 examples of primary tumours metastatic to the stomach1. The reverse scenario is exemplified by primary gastric adenocarcinoma metastasising to the colon. In the latter instance, the metastases presented as multiple colonic polyps.2 Apart from the two-way neoplastic traffic between stomach and colon1-2 colorectal cancer can also metastasise to the small bowel.3
Author’s reply
Authors: Dhar Anjan
Published: January 2025

We thank Dr Jolobe for his comments. The association of colorectal metastasis from gastric cancer has been well known for many years and the occurrence of gastric metastasis from colonic cancer is less common. But the metastatic spread of dysplastic cells from polyps in one site to the other site has not been described. Further, to attribute the development of a frank cancer at one site to the metastatic seeding of dysplastic cells from a polyp at the other site, and subsequent progression to cancer, has also not been described. Most occurrences of cancer at one site and polyp at the other have therefore to be regarded as synchronous rather than metastatic.
Obesity now: what you need to know
Authors: McGregor EC
Published: January 2025

At no time in human history has the issue of obesity and its health implications been greater. At the same time as disease processes and co-morbidities have become increasingly complex and potential treatments more sophisticated, the additional challenge of increasing numbers of critically overweight patients has arisen. Bariatric assessment and therapeutics are becoming more important. This programme was devised to cover the key areas from the genetics and demographics through the management of clinical situations where obesity is co-existent to the treatment options for obesity itself.
Online Survey Retention and Re-engagement: Learning from the COVID-19 Social Study
Authors: Bu Feifei , Cernat Alexandru , Steptoe Andrew , Fancourt Daisy
Published: January 2025

This article examines factors associated with survey attrition/retention in an online panel survey with weekly/monthly follow-ups during the COVID-19 pandemic. It also explores the effectiveness of making contact with dropout participants and factors associated with sample re-engagement, as well as motivations and barriers to maintaining survey participation. Our data consisted of over 1.2 million records from over 70,000 participants collected between March 2020 and April 2022. On average, 92.7% participants during weekly follow-ups and 95.9% during monthly follow-ups participated again in a later wave. The high retention rates, to some extent, could be attributed to a high level of altruistic motivations during a global health crisis and to the use of retention strategies to create a project community. A similar set of factors were related to both survey attrition/retention and re-engagement. However, some differences were also found, indicating the possibility of distinct decision processes.
Skin Micro-Fragments for the Management of Diabetic Foot Ulcers: A Case Series
Authors: Lázaro-Martínez José Luis , García-Madrid Marta , López-Moral Mateo , García-Morales Esther , Molines-Barroso Raúl J. , Tardáguila-García Aroa
Published: January 2025

This prospective case series evaluated the clinical outcomes of skin micro-fragment therapy in managing hard-to-heal diabetic foot ulcers (DFU). A total of ten patients with chronic DFU, who were treated in a specialized diabetic foot unit, were included in this study. The primary outcome was the wound healing rate at 12 weeks. Secondary outcomes comprised the time to complete epithelialization, wound area reduction (WAR) at 4 and 12 weeks, and the incidence of adverse events. After treatment with hy-tissue micrograft (HT-MG), 6 (60%) of patients achieved complete wound closure within 12 weeks. The mean healing time was 7.8 ± 2.4 weeks. The mean WAR at 4 and 12 weeks was 67.2% ± 23.5% and 87.5% ± 24% respectively. The procedure was well tolerated with no complications observed in the donor site such as pain or infection. No adverse effects related to the infiltration procedure at wound site were recorded with a promising wound healing rate during the follow-up period. These results suggest that HT-MG could be a safe and effective treatment option for chronic DFU, promoting noteworthy wound healing and reducing healing times. Further studies are required to confirm these findings and assess long-term outcomes.
Infection Relapse and Time-to-Healing After Conservative Surgery for Non-Acute Presentations of Diabetes-Related Forefoot Osteomyelitis: Does Site Matter?
Authors: Aragón-Sánchez Javier , Víquez-Molina Gerardo , Aragón-Hernández Javier , Rojas-Bonilla José María
Published: January 2025

Diabetes-related foot osteomyelitis (DFO) can present as an acute condition with soft tissue involvement or as a non-acute form characterized by long-standing ulcers without immediate limb-threatening features. This study evaluates infection relapse and healing times after conservative surgery in non-acute DFO, with a focus on osteomyelitis localization. A retrospective cohort of 60 patients treated for forefoot DFO without soft tissue involvement or necrosis was analyzed. Conservative surgery, defined as resection of infected bone without amputation, was performed in all cases. Postoperative antibiotic therapy was guided by bone biopsy cultures. Infection relapse was defined as new evidence of infection localized to the previously treated bone. Infection arrest was achieved in 98.3% of cases, with a recurrence rate of 10%. Relapse was significantly associated with osteomyelitis localized to the first metatarsal head, which presented a 57.1% relapse rate compared to 3.8% in other locations (OR: 34.0, 95% CI: 4.34–266, p < 0.001). Healing times were longer for the first metatarsal head, first toe, and second to fifth metatarsal heads compared to the lesser toes, but the association with the first metatarsal head lost significance when relapse was included in the analysis. This study highlights the effectiveness of conservative surgery in non-acute DFO, achieving high healing rates while preserving limb function. The findings emphasize the critical role of osteomyelitis localization, particularly the first metatarsal head, in determining relapse and healing outcomes. These results provide a basis for future research into individualized surgical strategies for high-risk anatomical sites.
Bioactive component integrated textiles: A promising source of medicine and healthcare
Authors: Ghosh Joyjit , Repon Md. Reazuddin , Pranta Arnob Dhar , Rupanty Nishat Sarmin , Khan Faizunnessa , Noor Tasneem
Published: January 2025

The healthcare industry can greatly benefit from natural colorants as bioactive component integrated textiles. These textiles are perfect for use in healthcare because they are biocompatible, have antimicrobial characteristics and are sustainable. It is an exciting new development that might replace harmful synthetic dyes with safer and more practical options for healthcare textiles. The use of bio-colorants in textiles makes them both biocompatible and antimicrobial. By facilitating quicker healing and warding off infections, these textiles further add to improved healthcare outcomes. It also helps fund research into smart clothes that can track vital signs to better care for patients. Incorporating bio-colorants into textiles is the focus of this review paper which will also examine different sources of bio-colorants and fabrication methods. In addition, the review work will discuss obstacles and future possibilities for bio-colorant technology advancement in the healthcare and textile sectors. Developing smart textiles that monitor health parameters, improving wound dressings with biocompatible and healing properties and creating antimicrobial fabrics for surgical garments and hospital linens are all potential uses for bio-colorant integrated textiles. Patients can wear these textiles to protect themselves from harmful ultraviolet rays and these materials could also find use in environmentally friendly medical supplies.
The Exposome, Social Determinants, and Environmental Pollution: Comprehensive Cardiovascular Risk in Women
Authors: Farinetti Alberto , Cocchi Camilla , Coppi Francesca , Mattioli Anna Vittoria
Published: January 2025

Cardiovascular disease (CVD) remains a significant global health concern for women, influenced by a complex interplay of social, economic, and environmental factors. This article examines cardiovascular risk through the lens of the exposome, which encompasses all environmental exposures from conception onward, including pollution, diet, and chronic stress. Social determinants such as socioeconomic status (SES), education, and stress management play crucial roles in shaping women’s cardiovascular health. Lower SES and education are associated with greater exposure to adverse living conditions, poor nutrition, and limited access to healthcare, increasing the risk of CVD. Environmental pollution, particularly air pollution and climate-related changes, further exacerbates cardiovascular risk by promoting oxidative stress and inflammation. Additionally, gender-specific factors, such as pregnancy and menopause, interact with the exposome, heightening the vulnerability of women to cardiovascular risks over their lifetime. Addressing these risk factors requires a comprehensive approach, incorporating public health strategies that focus on reducing pollution, improving food security, and mitigating social inequalities. By addressing the cumulative and interacting exposures that contribute to cardiovascular disease, especially in women, more effective prevention strategies can be developed to improve long-term health outcomes.
Short-term and long-term prognoses in AChR-Ab positive very-late-onset myasthenia gravis patients
Authors: Xie Nairong , Liu Qing , Wen Qi , Wang Yaye , Liu Haoran , Jiang Yuting , Lu Yan , Di Li , Wang Min , Zhu Wenjia , Wen Xinmei , Zhang Xuxiang , Shen Xin-Ming , Da Yuwei
Published: January 2025

Background:

Very-late-onset myasthenia gravis (VLOMG) refers to myasthenia gravis (MG) with onset at age 65 or older. Current research on VLOMG prognosis remains limited, especially regarding factors influencing outcomes.

Objectives:

To identify the clinical factors that affect the short- and long-term prognosis of MG patients with an onset age ⩾65 years.

Design:

This was a single-center, retrospective cohort study of AChR-ab positive VLOMG patients, classified into two subgroups based on age of onset: sub-very-late-onset MG (S-VLOMG, onset age ⩾65 and <75 years), and super-late-onset MG (SLOMG, onset age ⩾75 years).

Methods:

A total of 93 patients were included, including 75 in the S-VLOMG group and 18 in the SLOMG group. Clinical, therapeutic, and prognosis data were reviewed, and the Cox regression model was used to identify factors influencing short- and long-term prognosis.

Results:

Patient characteristics were well balanced between the groups. Overall, 49.5% of patients achieved minimal symptom expression (MSE) within 6 months and 86% within 24 months. There was no significant difference between the groups in the proportion achieving MSE at 6 months ( p = 0.635) or 24 months ( p = 0.714). The median time to achieve MSE was also comparable between the S-VLOMG and SLOMG groups (199.0 days vs 280.5 days, p = 0.463). Low baseline MG-ADL score and steroid therapy were associated with better short-term prognosis ( p = 0.007 and p = 0.002, respectively). For long-term prognosis, baseline bulbar and limb involvement, time to treatment initiation, and use of immunosuppressants were significant factors ( p = 0.025, p = 0.004, p = 0.025, and p < 0.0001, respectively). There were no significant differences in side effects or drug withdrawal rates between two groups.

Conclusion:

This study demonstrated that AChR-ab positive VLOMG patients have a favorable prognosis and responded well to medication, with age and comorbidities showing no significant impact.
Navigating the landscape of neoadjuvant immunotherapy for NSCLC: progress and controversies
Authors: Chen Yuzhu , Qi Fei , Sun Chenhao , Jiang Peng , Xue Xiangyu , Yang Xiaomei , Li Xiaomi , He Xin , Wang Yishuo , Zhang Tongmei
Published: January 2025

Recently, attention has increasingly centered on non-small-cell lung cancer (NSCLC) with immune checkpoint inhibitors application. Numerous clinical studies have underscored the potential of immunotherapy in treating resectable NSCLC, highlighting its role in improving patient outcomes. However, despite these promising results, there is ongoing debate regarding the efficacy of immunological combination therapy strategies, the prevalence of treatment-related side effects, the identification of predictive biomarkers, and various other challenges within the neoadjuvant context. Careful consideration is essential to maximize the benefits of immunotherapy for patients with resectable NSCLC. This article offers a detailed overview of recent advancements in neoadjuvant immunotherapy for resectable NSCLC. By examining these developments, we aim to provide new perspectives and valuable insights into the benefits and challenges of applying neoadjuvant immunotherapy in clinical settings.
Managing thrombosis risk in flow diversion: A review of antiplatelet approaches
Authors: Toma Aureliana , Essibayi Muhammed Amir , Osama Mahmoud , Karandish Alireza , Dmytriw Adam A , Altschul David
Published: January 2025

Flow diversion is a transformative approach in neurointerventional surgery for intracranial aneurysms that relies heavily on effective antiplatelet therapy. The ideal approach, including the timing of treatment, the use of dual antiplatelet therapy (DAPT), and the number of flow-diverter devices to use, remains unknown. DAPT, which combines aspirin with a thienopyridine like clopidogrel, prasugrel, or ticagrelor, is the standard regimen, balancing thromboembolic protection and hemorrhagic risk. The variable response to clopidogrel, influenced by genetic polymorphisms, necessitates personalized treatment strategies. Alternatives like prasugrel and ticagrelor provide superior efficacy in specific scenarios but require careful consideration of bleeding risks and costs. Platelet function testing plays a critical role in tailoring antiplatelet regimens for patients undergoing flow diversion for intracranial aneurysms. Special considerations were made for ruptured aneurysms, and the implications of the extensive metallic surface of flow diverters on platelet activation were noted. Emerging technologies such as drug-eluting flow diverters and reversal agents for P2Y12 inhibitors suggest a potential shift toward more refined antiplatelet strategies in the future. Personalized medication that is compatible with the stent structure and metal is essential for optimizing patient outcomes in cerebral flow diversion procedures. Ongoing research and multidisciplinary collaboration will be key in refining these strategies and enhancing the safety and efficacy of neurointerventional treatments.
Durable disease regression with copanlisib treatment in PI3K-mutated metastasizing ameloblastoma: A case report
Authors: Lynch Meghan M , Hermida-Viveiros Pedro , Stencel Sean , Knott Hannah , Al-Maryati Rusul , Obeidin Farres , Alexiev Borislav A , Abbinanti Susan , Damodaran Senthil , Agulnik Mark , Pollack Seth M
Published: January 2025

Ameloblastoma is a rare tumor arising from odontogenic cells that is benign, yet locally aggressive. Metastasizing ameloblastoma (METAM) is an ultra-rare ameloblastoma variant in which both primary and secondary tumors have histological features of benign ameloblastoma. This is a case report of a patient who presented with a jaw mass and subsequent lung metastases, later diagnosed as METAM. Initial treatments, including carboplatin, etoposide, and taxane-based chemotherapy, were ineffective. Molecular profiling revealed mutations including PIK3CA H1047R and BRAF V600E. The patient was enrolled in a tumor-agnostic trial and began treatment with copanlisib, a PI3K inhibitor, which resulted in a partial response and durable disease regression. After 76 cycles, she continues to tolerate therapy well with minimal adverse events. This case highlights the potential of targeted therapies such as copanlisib for treating METAM, providing a promising therapeutic option for patients with PIK3CA mutations.
A case of pityriasis rubra pilaris secondary to ponatinib
Authors: Nateghi Ariana , Lagacé-Thomassin Florence , Desrochers Julie
Published: January 2025

Ponatinib, a tyrosine kinase inhibitor used for chronic myeloid leukemia and acute lymphoblastic leukemia, can cause rare cutaneous side effects. In this case, a 63-year-old woman developed a pityriasis rubra pilaris-like eruption 1 month after starting the drug. The skin reaction improved with dose reduction and recurred more mildly at a lower dose. Symptomatic relief was achieved with topical tretinoin, triamcinolone, and emollients. This case underscores the importance of managing dose-dependent skin reactions while maintaining cancer therapy.
Fostering University Students’ Entrepreneurial Opportunity Identification Capability: A Systematic Literature Review
Authors: Farrokhnia Mohammadreza , Noroozi Omid , Baggen Yvette , Lans Thomas , Biemans Harm , Pittaway Luke
Published: January 2025

Fostering university students’ Opportunity Identification (OI) capability has received much attention from entrepreneurship scholars. There is, however, a lack of comprehensive understanding of “ why” some students can better identify business opportunities and “ how” their OI capability can be improved. This systematic review aims to synthesize the research findings on university students’ OI capability to answer the above questions and propose evidence-informed guidance for entrepreneurship educators when developing programs designed to enhance this key entrepreneurial capability. In this regard, 44 empirical studies (out of 945 peer-reviewed articles) on OI, dating from 2000 through 2022, were reviewed. The findings were categorized by answering five essential questions raised by the adopted teaching model framework, i.e., “why?”, “for whom?”, “for which results?”, “what?”, and “how?”. The findings indicate that students’ prior knowledge, entrepreneurial alertness, and creativity are the most influential factors in the OI process. The research found that developing students’ opportunity identification capability requires guiding them through three distinct stages, namely, triggering, idea generation, and idea evaluation, within a constructively aligned learning environment. The paper concludes by presenting several suggestions and directions for future research.
Open Medial Meniscus Centralization With Arthroscopic Root Repair
Authors: Newcomb Nicholas , Sanderford Jared , Patel Tyag , Sessums Price , Price Ryan , Curtis William , Treme Gehron , Shultz Christopher
Published: January 2025

Background:

Meniscotibial ligament disruption and medial meniscal extrusion may represent early and predisposing events contributing to medial meniscal root tears. If left untreated, these extruded tears may result in loss of medial compartment cartilage. As a result, multiple approaches have been developed to centralize the extruded meniscus.

Indications:

In this case, we present a 45-year-old man who sustained a left medial meniscal root tear with extrusion while playing tennis. Indications for root repair with meniscal centralization include extrusion >3 mm seen on magnetic resonance imaging after an acute meniscal root tear or subjective meniscal extrusion seen intraoperatively.

Technique Description:

The medial meniscal root tear is first repaired arthroscopically per surgeon preference. Then a medial incision is made along the proximal tibia and a submeniscal arthrotomy performed. Two double-loaded 3.0-mm anchors are placed along the proximal medial tibial edge. Sutures are passed in a Mason-Allen configuration through the meniscal body and capsule. Tightening of the sutures results in meniscal centralization. The root repair sutures are then tensioned and fixed along the medial proximal tibia.

Results:

Recent data have shown meniscal root repair with centralization is associated with significant improvements in pain, function, and quality of life and no significant progression of osteoarthritis.

Discussion/Conclusion:

Medial meniscal centralization can be safely performed with an open approach. An open approach may allow for more accurate anchor placement and more near-anatomic replication of meniscotibial ligaments.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Safety of steroids in severe community-acquired pneumonia
Authors: Piedepalumbo Federica Viola , Motos Ana , Blasi Francesco , Torres Antoni
Published: January 2025

The systemic use of corticosteroids for patients with severe community-acquired pneumonia (sCAP) remains controversial in clinical practice, particularly in terms of the safety profile of these drugs. This narrative review aims to analyse the available literature data concerning the safety of short-term steroid use in the treatment of sCAP, while also highlighting potential future research directions. Several trials and meta-analyses have evaluated corticosteroid therapy as an adjuvant treatment for sCAP, yielding heterogeneous results regarding its efficacy and safety. Despite the wide variability in results, it is generally accepted that steroids are not associated with a significant risk of healthcare-associated infections, gastrointestinal bleeding or acute kidney injury in patients with sCAP in the short term. Nevertheless, such drugs are linked to hyperglycaemia, necessitating regular monitoring and appropriate management. The influence of steroids on long-term outcomes and their potential risks in viral sCAP still needs to be investigated.