The journal aims to popularize multidisciplinary articles and papers by Junior Researchers (students, masters, etc.). The Association does not accept the responsibility of the editor for the articles published on the Portal. Journal DOI: https://doi.org/10.52340/jr Google Scholar IF - 1.68 (2023-2024) E-ISSN: 2667-9779
Endovascular Versus Surgical Management of Intracranial Pseudoaneurysms: A Comparative Review
Intracranial pseudoaneurysms (IPAs) are uncommon cerebral lesions that are quite difficult to treat because they have high rates of rupture and deaths. This narrative review provides a comparison between the surgical and endovascular modalities of treatment of IPAs, paying attention to efficacy, durability, application, and safety. There was traditionally the gold standard of a definitive cure and that is open surgery; even clipping, trapping with bypass, and that old standard of wrapping. The methods, however, are physiologically challenging and they have high morbidity. Less invasive alternatives endovascularly include coiling, parent artery occlusion, and flow diversion which has the benefit of leaving the parent artery intact in greater than 90% of cases. Surgical trapping and bypass are the most definitive treatment, have high occlusion rates and low recurrence, and necessitate parent sacrifice. Endovascular reconstructive techniques are instant remedial and protect the parent vessel, but the long-term resilience is variable. Flow diversion is promising with rates of complete occlusion but increases risks of delayed thrombosis, and rupture. Higher morbidity and mortality are linked to surgical management because of craniotomy and repair of vessels, and endovascular complications are mostly thromboembolic and ischemic stroke. The variables taken into consideration to select a model of treatment include: the patient (age, comorbidities, neurological status), the aneurysm (location, size, morphology) and institutional (expertise, resources). IPAs are rare; most of the available evidence is retrospective in nature and prone to selection bias, as well as heterogeneity in recording. It should be multidisciplinary and tailored to the patient and would use an endovascular intervention with surgery only in more complex cases or those refractories to endovascular management. It is important to develop quality improvement programs and coordinate partnerships between endovascular experts and neurosurgeons in order to maximize patient outcomes.
Navigating the Neurological Adverse Effects of Cancer Immunotherapy: Challenges and Opportunities
The development of cancer immunotherapy has redefined how cancer is treated and further, patients will employ immunotherapy to cure cancer by targeting cancerous cells. Nevertheless, neural irAEs have also appeared as this new line of defense; a result of this novel treatment approach. The goal of this narrative review is to present a comprehensive overview of cancer immunotherapy with an emphasis on immune checkpoint inhibitors (ICIs), chimeric antigen receptor (CAR) T-cell-based therapies, and bispecific T-cell engagers (BiTEs), including description of the adverse neurological consequences related to these cancer immunotherapies. Electronic databases such as PubMed, Google Scholar, and Web of Science as well as qualitative synthesis of literature were used to conduct the literature search and synthesis of the literature. Neurological irAEs may involve the: peripheral nervous system, (PNS), the central nervous system (CNS), the neuromuscular junction, and the autonomic nervous system. The occurrence and the timing of these complications is different based on type of immunotherapy and personal risk factors. Pathophysiology Immune dysregulation, autoimmunity and neuroinflammation are believed to contribute to the pathophysiology of neurological irAEs. They also have heterogeneous clinical presentations which may complicate diagnosis and may overlap with other conditions. Treatments options comprise withdrawals of immunotherapy and immunosuppressive therapy with corticosteroids as well as further immunomodulatory agents, in severe or defiant cases. Oncologists, neurologists, and other medical workers should collaborate on multidisciplinary terms to provide the highest quality of assistance to the patient. All the patients have full recovery, but some patients develop persistent neurological deficits or even die. Future studies need to be directed to clarify the working mechanisms, determine prescriptive markers, and evidence-based treatment guidelines to enhance patient safety and outcome. With the future of cancer immunotherapy shaping up, there has been a need to better understand the associated neurological complications in order to treat patients and further the potential of the entire field.
Neuroimmunology of Autoimmune Encephalitis: From Antibody-Mediated Pathogenesis to Multidisciplinary Care
The complex neuroinflammatory disease known as autoimmune encephalitis (AE) is typified by the generation of autoantibodies that target different central nervous system receptors, proteins, and ion channels. In this review, neuroimmunology of AE is considered, and special attention will be paid to how it is caused, presented in clinical cases, diagnosed, and treated. The most common forms of AE are anti-NMDAR, LGI1 and CASPR2 encephalitis which are all associated with the different autoantibodies and clinical presentation. In paraneoplastic AE, there is the expression of non-paraneoplastic factors, post-infectious factors and mimicry of specific molecular entities that stimulate autoantibody production. The clinical manifestations of AE include a wide variety of manifestations that can include mental disorders, cognition decline, epileptic disorders, movement, and autonomic dysfunction. The multi-disciplinary diagnosis is achieved through neuroimaging, electroencephalography, cerebro spinal fluid analysis and autoantibody testing of which the autoantibody testing is the gold standard. Also, Corticosteroids, intravenous immunoglobulins, and plasmapheresis are the first-line immunotherapies of AE; second-line agents are cyclophosphamide and rituximab, which are applied in cases of refractory disease. Immunotherapy needs to be initiated in an early manner so as to achieve better outcomes and prevent relapses. Crucial part of management is tumor removal when there is suitability. To assist patients with regard to quality of life and care, behavioral support, relapse prevention, and long-term monitoring operations are necessary. Since not all patients can obtain complete recovery of their cognitive and motor capacities, this retraces the importance of further developing research and standardizing practices, which is necessary to enhance knowledge and improvement of AE, which cannot be completed without constant research and development of antibody panels. Patient centered care, clinical awareness, and multi-disciplinary care are important in maximizing the outcomes of affected individuals due to this complex neuroimmunological disorder.
Hyperglycemia and Accelerated Cognitive Decline in Early Alzheimer’s Disease: A Review of Hippocampal Atrophy and Neuronal Apoptosis Markers
Background: Alzheimer’s disease (AD) is a leading cause of dementia worldwide, imposing an immense social and economic burden. Growing evidence suggests that metabolic dysfunction, particularly chronic hyperglycemia, contributes to neurodegeneration. This review synthesized findings from longitudinal cohort studies to examine the effect of hyperglycemia on cognitive decline, hippocampal atrophy, and neuronal apoptosis in early AD. Methods: A comprehensive literature review of studies published between 2005–2025 was conducted using PubMed, Scopus, and ScienceDirect. Search terms included 'hyperglycemia', 'Alzheimer’s disease', 'hippocampal atrophy', and 'neuronal apoptosis'. Inclusion criteria were longitudinal cohort studies with patients aged 55–75 diagnosed with early AD (NIA-AA criteria). Data extraction included cognitive outcomes (MMSE, MoCA, Logical Memory Test), MRI-based hippocampal volumetry, and biomarkers (caspase-3, Bax/Bcl-2 ratio). Quality assessment was performed using PRISMA guidelines and Newcastle-Ottawa scales. Results: Across included studies, hyperglycemic patients consistently showed accelerated cognitive decline, greater hippocampal volume loss, and higher apoptotic marker expression compared with normoglycemic patients. Evidence from neuroimaging confirmed progressive hippocampal atrophy in hyperglycemia groups. Biomarker analyses highlighted dysregulation of Bax/Bcl-2 balance and caspase-3 activation, suggesting a direct mechanistic link between glucose dysregulation and neuronal apoptosis. Clinical studies also reported that elevated HbA1c was associated with increased dementia risk and faster progression. Conclusion: Chronic hyperglycemia may act not only as a comorbidity but as a mechanistic driver of AD pathology. These findings emphasize the importance of strict glycemic monitoring and interventions as preventive and therapeutic strategies in early AD.
The Role of Immune Checkpoint Inhibitors in the Treatment of Glioblastoma: A literature Review of Current Evidence
Background: Immune checkpoint inhibitors (ICIs) have shown promise in the treatment of many cancers but have faced many challenges in treating glioblastoma (GBM) due to the tumor’s unique immune microenvironment. Methods: This literature review was conducted to explore the role of ICIs in GBM, focusing on PD-1 and PD-L1 inhibitors, and their potential in combination therapies. Studies were retrieved from PubMed, Web of Science, and a total of 26 articles were included for data extraction after applying inclusion and exclusion criteria. Results: ICIs in GBM has demonstrated limited clinical benefit despite the strong biological rationale. Large phase III trials showed that PD-1 inhibition with agents like nivolumab has not improved overall or progression-free survival, largely due to the tumor heterogeneity, immunosuppressive tumor microenvironment, and low tumor mutational burden. CTLA-4 inhibitors like ipilimumab and tremelimumab have shown limited efficacy as monotherapy, though combination or salvage strategies following failure of PD-1 showed some results, particularly in replication-repair–deficient or hypermutated gliomas. Standard chemoradiotherapy with temozolomide remains the standard of treatment, with MGMT promoter methylation as the strongest predictive biomarker. Adn PD-L2 remains underexplored as a target. Conclusion: Overall, the evidence shows that monotherapy with ICIs is insufficient in GBM, and future approaches for these agents will require case-studied patient selection, combination strategies, and integration with existing standard therapies.
Noninvasive Neuromodulation for Acute and Subacute Stroke management and Rehabilitation
Stroke is a leading cause of death and disability worldwide, leaving many survivors with long-term motor, cognitive, and functional deficits. Conventional treatments like thrombolysis and antiplatelet therapy reduce immediate damage but do not repair neural tissue. Noninvasive neuromodulation (NN) offers a promising approach for early stroke rehabilitation by using electricity, magnetism, ultrasound, or vagal stimulation to enhance neuroplasticity and reorganize neural networks. Techniques using ultrasonic, electrical, magnetic waves and vagal nerve stimulation have shown benefits in improving motor control, posture, swallowing, cognition, mood, and pain. Combining NN with rehabilitation exercises appears to maximize recovery by modulating cortical excitability and connectivity. Despite promising results, current studies are small and protocols vary, highlighting the need for larger, standardized trials. Overall, NN is a safe, adaptable, and effective tool that can significantly improve outcomes in stroke rehabilitation.
Management of Status Epilepticus in the Prehospital setting
Status epilepticus (SE) is a time sensitive neurological emergency that requires rapid recognition and intervention to prevent long-term complications. This review explores current evidence and best practices for the prehospital and emergency department management of SE, focusing on early recognition, diagnostic tools, and pharmacologic strategies. Literature was sourced from PubMed using predefined keywords and inclusion criteria, emphasizing studies published within the last decade. The review highlights the challenges in prehospital care, particularly delays in treatment due to difficulties with intravenous access and underutilization of alternative drug delivery routes. Benzodiazepines (BZDs) remain the first-line therapy, with intramuscular midazolam emerging as a practical option when Intravenous (IV) access is not available. Non-IV routes such as Intranasal (IN) and buccal administration offer similar efficacy and are increasingly supported for prehospital use. Point-of-care EEG (PocEEG) shows promise in improving diagnosis, especially for non-convulsive status epilepticus (NCSE), though its adoption remains limited. Key gaps include lack of rapid diagnostic tools in the field, restricted availability of second-line agents, and underdosing due to fear of respiratory depression. Future directions should focus on protocol optimization, expanding access to non-invasive rescue therapies, and integrating diagnostic innovations into emergency systems. Effective prehospital SE management depends on timely seizure control using the most accessible route, coupled with system-wide efforts to reduce treatment delays and improve patient outcomes.
Examining the Role of the Mirror Neuron System in Social Anxiety Disorder and Borderline Personality Disorder: Pathophysiological Insights and Treatment Perspectives
Social Anxiety Disorder (SAD) and Borderline Personality Disorder (BPD) both involve serious social and emotional impairments, though their origins and clinical features differ. SAD is characterized by a persistent fear of social judgment, while BPD stems from early relational trauma and is marked by emotional instability and impulsivity. Both disorders show disrupted social cognition and hypersensitivity to rejection. Emerging evidence points to dysfunction in the mirror neuron system (MNS), This network that we possess allows us to interpret the actions, intentions, and feelings of other people by reflecting them in our brain. Research shows people with SAD often have reduced activity in core MNS areas like the inferior frontal gyrus and inferior parietal lobule, especially during tasks involving emotional recognition or social observation. These deficits may explain common SAD symptoms such as the like for social withdrawal, fear of evaluation, and trouble learning from social interactions. In BPD, the picture is less clear. Some studies suggest disrupted MNS function, but inconsistent methods and limited comparative data make it hard to draw solid conclusions. Still, both disorders involve altered brain connectivity in regions tied to emotional regulation and social processing, like the amygdala and prefrontal cortex. That matters, especially during adolescence when the MNS is still developing and social vulnerability peaks. Promising treatments are now starting to emerge, like neurofeedback, transcranial magnetic stimulation, and action observation therapy all show early signs of boosting MNS activity and improving social functioning. These tools, combined with cognitive or dialectical behavior therapies, could lead to a more tailored, neuroscience-informed care. Even better, spotting MNS problems early might help prevent full-blown disorders later. And in short, the MNS may be a key player in both SAD and BPD. But to unlock its full potential, we need better methods, more diverse samples, and long-term studies that track how these brain patterns change over time and how we can use them to heal.
Rare Diseases Worldwide and in Georgia: Screening, Diagnosis and Care Challenges
Rare diseases (RDs) affect fewer than one in 2,000 individuals but collectively impact over 300 million people worldwide. Despite their diversity, these conditions share common challenges, including delayed diagnosis, limited treatment options, and psychosocial burden. Ultra-rare diseases - those affecting fewer than one in 50,000 individuals - pose additional difficulties due to their extreme rarity and limited clinical expertise. Current estimates suggest that 3.5–5.9% of the global population lives with RDs, which positions these conditions as a major public health issue rather than isolated clinical rarities. Newborn screening programs in several countries have shown that early detection of conditions such as severe combined immunodeficiency (SCID) can enable timely, life-saving interventions. Adenosine deaminase (ADA) deficiency, a genetic cause of SCID, illustrates how survival depends considerably on prompt diagnosis. While challenges remain, including gaps in screening, long delays in diagnosis, or even undiagnosed conditions, limited access to care and lack of effective treatments. Georgia has contributed to this global effort through studies on Alport syndrome, artificial intelligence in rare bone disease diagnostics, and case reports of ultra-rare disorders. these achievements demonstrate the potential of local research to strengthen both national and international rare disease initiatives.
THE SCIENTIFIC DISCOURSE ON INNOVATIVE PERSPECTIVES REGARDING THE ROLE OF FAMILY DENTISTS IN PRIMARY DENTAL CARE AND PUBLIC HEALTH: CHALLENGES, EVIDENCE AND FUTURE DIRECTIONS GLOBALLY
Family dentists occupy a pivotal position in modern healthcare systems, serving not only as primary providers of oral health services but also as critical contributors to the wider spectrum of public health. Traditionally, their role has been confined to the prevention, diagnosis, and treatment of common dental conditions; however, evolving evidence highlights that family dentistry extends far beyond the operatory, linking oral health directly with systemic well-being, quality of life, and population health outcomes. This paper explores innovative perspectives on the global role of family dentists in primary dental care and public health, with an emphasis on challenges, evidence, and future directions that underscore their expanding significance. At the core of family dentistry lies the continuity of care across all age groups, which uniquely positions these practitioners as long-term guardians of oral health. Evidence shows that routine preventive interventions delivered in primary dental care settings can reduce the burden of oral diseases that remain among the most prevalent worldwide, such as caries, periodontitis, and oral cancers. Yet, the impact of family dentists transcends clinical practice. By adopting a biopsychosocial framework, they become central actors in health promotion campaigns, community-based prevention programs, and multidisciplinary collaborations that address the social determinants of health. Their frequent contact with patients allows them to engage in early detection of systemic conditions with oral manifestations, such as diabetes, cardiovascular diseases, and autoimmune disorders, thereby reinforcing the bidirectional relationship between oral and general health. Despite this potential, significant challenges hinder the full integration of family dentists into public health infrastructures globally. These include inequitable access to primary dental care, disparities in workforce distribution between urban and rural areas, limited inclusion of oral health in national healthcare policies, and underfunded public health initiatives. Furthermore, cultural, socioeconomic, and political barriers exacerbate inequalities in oral health outcomes, particularly in low- and middle-income countries where dental care remains predominantly treatment-oriented rather than preventive. Addressing these challenges requires systemic innovations, including policy reforms that recognize oral health as integral to overall health, investment in preventive strategies, and incorporation of family dentists into interprofessional healthcare models. Emerging evidence supports the transformative role of family dentists in population health through school-based oral health education, tele-dentistry services in underserved regions, community water fluoridation advocacy, and participation in vaccination or screening campaigns for oral and systemic diseases. The adoption of digital health technologies, artificial intelligence, and data-driven public health surveillance further expands their potential to contribute to early diagnosis, personalized care, and large-scale health monitoring. These innovations, combined with a growing global awareness of oral health’s relevance to noncommunicable diseases, point toward a future in which family dentists act not merely as service providers but as public health leaders. The family dentists are uniquely positioned to bridge the gap between individual clinical practice and collective health promotion. By reimagining their role within the broader framework of primary care and global public health, and by addressing structural barriers, family dentistry can evolve into a cornerstone of sustainable healthcare systems. This paradigm shift requires international cooperation, research-driven policies, and innovative models of practice that place oral health at the heart of public health strategies worldwide.
Developmental Anomalies of the Visual System
Congenital anomalies of the visual system represent a diverse group of pathologies arising from dysgenesis occurring at various stages of embryogenesis. These disorders involve morphological changes in the eyeball, its individual structures (cornea, lens, iris, retina, optic nerve), and accessory ocular organs. Severe forms include microphthalmia, anophthalmia, and cyclopia, which significantly or completely impair visual function, whereas milder anomalies—such as heterochromia, polycoria, ptosis, congenital cataract, coloboma, aniridia, and others—cause relatively minor visual impairment or may be limited to cosmetic or aesthetic defects. Early diagnosis and detailed anatomical and morphological knowledge of visual system anomalies are essential for effective clinical management and preservation of visual function.
Artificial Intelligence Integration with Advanced MRI Biomarkers for Early and Differential Diagnosis of HSV Encephalitis
Herpes simplex virus of the brain (HSE) is a life-threatening neurological emergency which is characterized by high morbidity and mortality unless early diagnosed and treated. Recognition promptly is essential, because the mortality rate in untreated cases is about 70 percent whereas antiviral therapy decreases the death rate to 10-20 per cent in populations/patients treated and prevents long term neurological-cognitive sequelae. Developed magnetic resonance imaging (MRI) has been the key in the early detection of the HSE and the use of sequences like diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), and T2-weighted imaging has been found to be of high sensitivity and specificity. The lesions tend to be restricted to medial temporal lobes and limbic structures although extratemporal and bihemispheric damages have been reported. These imaging biomarkers can distinguish other pathologies, like neoplasm and cerebro vascular event, and can be employed to distinguish between HSE and autoimmune encephalitis (AE), which can both share similar clinical and radiologic phenotypes. The most recent advances in artificial intelligence (AI), which include classical machine learning (CML) and deep learning (DL) have shown significant potential to increase diagnostic accuracy. The presence of AI in combination with multi-sequence MRI allows automatic lesion detection, increased pattern recognition, and better classification between HSE, AE, and gliomas. Imaging with clinical and laboratory data such as cerebral things of analysis, serological marker and patient demographics have shown a better performance in diagnosis compared to the diagnostic performance of experienced radiologists and could predict functional outcome and cognitive recovery. However, a few issues restrict the use of multicenter imaging, such as inconsistent image schemes, small sample sizes, and technical demands of sophisticated imaging techniques like pseudo continuous arterial spin labeling (pCASL). Standardization of imaging workflows, larger multicenter and prospective validation studies must determine the reproducibility, generalization and clinical utility of imaging workflows. Synergistic use of high-tech MRI biomarkers with AI-related analytics is a perspective of early and differentiated diagnosis of HSE. These combined methods can help significantly improve patient outcomes and decrease the HSE-related burden of neurological morbidity because of timely antiviral intervention and individualized long-term care.
The Impact of Intraoperative Monitoring on Spinal Cord Surgery Outcomes: A Comprehensive Review
Intraoperative neurophysiological monitoring (IONM) is an important method used in spinal surgery, which is aimed at the maintenance of the functional integrity of the nervous system, in particular, the spinal cord and its neural structures. This is a narrative review that focuses on the effect of IONM on postoperative neurological outcomes. The search was conducted in electronic databases covering the studies published in the last five years (2015 to 2025) and included the following study types: clinical studies, observational studies, systematic reviews, and key case series; all studies were excluded based on the following criterion: animal study, non-spinal surgeries, and lack of outcome data. It has been shown that IONM is an important way of improving the safety of spinal surgery, especially in high-risk surgery like intramedullary or extramedullary tumor resections, cervical myelopathy, and corrections to spinal deformities. IONM can help prevent postoperative complications and enhance recovery by enabling surgical teams to act in time to prevent neurological compromise, which results in postoperative complications and death. Multimodal monitoring Multimodal monitoring, which includes somatosensory evoked potential (SSEPs), motor evoked potential (MEPs), electromyography (EMG), and D-wave recording, provides a complete real-time evaluation of both sensory and motor pathways and has been shown to be particularly useful in complicated situations. IONM is based on the presence of qualified personnel and effective communication between surgeons and anesthesiologists and monitoring specialists during operations. Possible shortcomings are the absence of false negatives, inconsistency in sensitivity between different pathologies and the requirement of specific equipment and training. However, systematic reviews indicate that the routine use of IONM in the high-complexity spinal surgery procedures is cost-effective, decreases complications, reoperation, and the expenses of healthcare in the long run. The more advanced technologies, standardization of protocols and the wide availability of trained personnel are likely to increase IONM utility even more. IONM is a required precaution in spinal surgery today that allows anesthetists to identify and avert neural injury early in the course of surgery and enhances the patient’s safety and future neurological performance.
Emerging Therapeutics and Precision Critical Care in Aneurysmal Subarachnoid Hemorrhage
Aneurysmal subarachnoid hemorrhage (aSAH) is a serious neurological emergency that has a high rate of morbidity and mortality. The management of aSAH is still difficult despite improvements in neurocritical care, especially when it comes to avoiding and treating complications like cerebral vasospasm and delayed cerebral ischemia (DCI). This review examines new treatments and how precision critical care can help patients with aSAH achieve better results.Oral and intravenous nimodipine has been promising in the reduction of DCI and better neurological outcomes. But the fluctuating outcomes of other medications, including clazosentan, fasudil and cilostazol make it necessary to conduct more research. Examples of precision critical care approaches that could be used to offer individualized treatment according to the needs of individual patients include advanced imaging, biomarker-guided care and multimodal neuromonitoring. The approaches enable the anticipation of the risk of DCI, early identification of secondary brain injury, and optimization of the blood pressure and fluid balance. Some of the barriers to the implementation of precision critical care include patient variability, medical costs, the need to have certain infrastructure and knowledge. Some of the ways in which AI-assisted tools, better imaging techniques, assessment tools to identify genetic risks and new biomarkers will be applied in the management of aSAH are the future directions. In order to bridge the evidence to clinical practice gap and ensure that advanced therapies are available and affordable to a large group of patients, multicenter research programs and investments in healthcare are essential and scavenging incremental improvement of survival and long-term neurological recovery for aSAH patients is possible by adopting state-of-the-art technology and precision medicine approaches.
Advances in Wound Closure Techniques: Integrating Functional Preservation and Aesthetic Outcomes
Wound closure is a cornerstone of surgical practice, extending from acute management to complex reconstructive procedures, with implications for tissue healing, infection prevention, and long-term patient satisfaction. Traditional suturing techniques, including interrupted and continuous methods, remain foundational, offering flexibility in tension management and cosmesis. Recent innovations such as subcuticular suturing with absorbable monofilaments, barbed sutures, and cyanoacrylate tissue adhesives have demonstrated improved operative efficiency, reduced complication rates, and superior short-term aesthetic outcomes. Negative pressure wound therapy and closed incision negative pressure therapy further enhance healing in high-risk patients, minimizing surgical site complications and optimizing scar quality. Scar management strategies, particularly for hypertrophic scars and keloids, increasingly employ multimodal approaches combining conservative measures, intralesional corticosteroids, 5-fluorouracil, and emerging agents like botulinum toxin A to achieve functional and cosmetic restoration. At the reconstructive level, advancements in microvascular anastomosis, including coupling devices, have improved efficiency and reliability in free tissue transfer, although patient- and procedure-specific considerations remain critical. Collectively, these developments reflect a paradigm shift: wound closure is no longer solely a mechanical task, but a deliberate process aimed at preserving tissue function, optimizing aesthetic outcomes, and enhancing overall patient-centered care. Future practice will likely focus on personalized approaches that integrate novel suture technologies, advanced wound therapies, and targeted scar modulation to achieve optimal surgical outcomes.
The Role of Gut Microbiota Alterations in Modulating Neuroinflammation and Disease Progression in Alzheimer’s and Parkinson’s Disease
Background: Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the two leading neurodegenerative disorders worldwide. Growing evidence highlights gut microbiota dysbiosis as a critical factor influencing neuroinflammation, pathological protein aggregation, and clinical progression. Objective: To synthesise current evidence on the role of gut microbiota alterations in modulating neuroinflammation and disease progression in AD and PD. Methods: A narrative review was conducted, integrating data from human observational studies, meta-analyses, animal models, and interventional trials. Microbial taxa shifts, metabolite changes, and mechanistic pathways were systematically examined. Results: Both AD and PD are characterised by reduced microbial diversity, depletion of short-chain fatty acid–producing bacteria, and enrichment of pro-inflammatory taxa. In PD, dysbiosis strongly correlates with α-synuclein aggregation, gastrointestinal prodromes, and motor dysfunction. In AD, altered tryptophan metabolism, amyloid deposition, and tau pathology have been linked to microbial and metabolic disturbances. Animal models provide causal evidence, while human studies remain largely associative. Early interventions such as dietary modulation, probiotics, and fecal microbiota transplantation show promise, but long-term neurological benefits are unproven. Conclusion: Gut microbiota dysbiosis emerges as both a potential biomarker and therapeutic target in AD and PD. Although mechanistic insights are compelling, robust longitudinal studies and well-powered clinical trials are needed to establish causality and evaluate the translational potential of microbiome-targeted therapies.
Sensory Restoration in Post-Mastectomy Breast Reconstruction
Breast reconstruction after mastectomy has traditionally focused on aesthetics and donor site safety, with little attention to sensory recovery. Loss of breast sensation, including tactile and erogenous, negatively impacts patient satisfaction, Quality of life (QoL), and psychosocial well-being. This review summarizes current evidence on sensory restoration techniques, including flap neurotization, nipple-areola complex (NAC) reinnervation, and grafting strategies. Neurotized autologous flaps consistently show superior sensory outcomes compared to non-innervated flaps and implant-based reconstruction. Techniques like TNR improve NAC and peripheral breast sensation, while careful surgical planning, including donor nerve choice and pedicle selection, enhances recovery. Despite strong evidence supporting these approaches, routine adoption is limited by heterogeneity in technique, lack of standardized outcome measures, small study sizes, added operative time, costs, and technical complexity. Future work should focus on larger prospective trials, standardized sensory assessments, and integration of microsurgical, pharmacologic, and bioengineered strategies. Incorporating sensory restoration into ERAS protocols and exploring novel methods may help make it a standard part of post-mastectomy breast reconstruction.
Comprehensive Review of MPox: Critical Evaluation of Outbreak Trends, Clinical Manifestations, and Therapeutic Approaches
The monkeypox virus (MPV) is the cause of monkeypox, a zoonotic viral illness that has become a major worldwide health issue because of its changing epidemiology, increased human-to-human transmission, and potential for large-scale outbreaks. The disease has mostly been endemic in Central and West Africa since it was first discovered in humans in 1970. The recent epidemics in 2022 and 2024, however, highlight how urgently a thorough grasp of its clinical presentations, diagnostic techniques, and treatment measures is needed. The severity of this illness varies according to the host's immune status, although it usually manifests as fever, lymphadenopathy, and a progressive rash. Immunocompromised people are more susceptible to serious side effects, such as bacterial superinfections, pneumonia, and encephalitis, even though the majority of cases resolve on their own. Men who have sex with men (MSM) were the majority of those infected by the 2022 outbreak, indicating possible sexual transmission. The primary methods of diagnosis are histopathological analysis and polymerase chain reaction (PCR)--based testing that targets conserved MPV genes. Vaccination programs and antiviral medications are essential for controlling outbreaks. The reappearance of monkeypox calls for better public health preparedness, faster diagnostic capabilities, and more surveillance. Future studies should concentrate on tailored antiviral treatments, next-generation vaccinations, and novel diagnostic techniques based on nanotechnology. To minimize future outbreaks and keep monkeypox from becoming a persistent worldwide danger, a coordinated, interdisciplinary strategy is essential.
Neuroimaging Biomarkers of Suicide Risk: A Narrative Review of Cross-Disorder Evidence and Clinical Implications
Suicide is recognized as a deliberate act of self-destruction. A major share of deaths worldwide continues to be caused by suicide, despite a decline in its global rates since 1990. Suicide is commonly associated with psychiatric and chronic medical disorders. Suicide risk is poorly predicted by current clinical assessments. Recently, neuroimaging methods have been increasingly used to identify biological markers. Underlying neural abnormalities linked with suicidal behavior are thought to be reflected by these markers. The present review was performed to summarize cross-disorder evidence on neuroimaging biomarkers of suicide risk. Their possible clinical applications were also discussed. A structured literature search was performed in PubMed, Scopus, Web of Science, and APA PsycInfo for studies published from 2015 to 2025. Studies involving in-vivo neuroimaging techniques such as MRI, fMRI, DTI, PET, and MRS were included. Clear measures of suicidal ideation, attempts, or suicide death were required. Relevant data were extracted and organized thematically across structural, functional, and molecular categories. Findings were synthesized narratively. Overlapping and disorder-specific neural signatures were identified. Consistent evidence was observed for reduced gray and white matter volumes in the ventromedial and dorsolateral prefrontal cortex, anterior cingulate cortex, insula, hippocampus, amygdala, and thalamus. Altered connectivity between prefrontal control regions and limbic emotion centers was frequently detected. Disruptions in default mode, salience, and executive control networks were also found. Irregularities in serotonergic and dopaminergic activity were shown by PET findings. These irregularities were related to impulsivity and mood dysregulation. These abnormalities were found across several psychiatric disorders. Suicide vulnerability is indicated to potentially arise from shared fronto-limbic dysfunction, rather than disorder-specific pathology. Research is constrained by small samples, methodological differences, and cross-sectional designs. Larger, longitudinal, and multimodal studies are needed in future work. Support from AI and machine learning is required. Prediction accuracy will be improved, and individualized prevention strategies will be enabled. Suicide prevention is potentially transformed into a more precise, brain-based clinical practice by the early detection of neural biomarkers.
Congenital Hand Anomalies: Neural Adaptation After Surgical Reconstruction
Congenital hand anomalies, such as syndactyly, amniotic band syndrome (ABS), and congenital amelia, significantly modify hand structure, compromise functional abilities, and contribute to altered organization within the central nervous system. Reconstructive surgery seeks not only to restore anatomical form and fine motor capacity but also to facilitate the reintegration of reconstructed digits into existing cortical representations. Postoperative neural adaptation is primarily mediated through use-dependent plasticity, with magnetoencephalography studies demonstrating that somatosensory cortical maps can reorganize rapidly, even in mature brains. Timely surgical intervention leverages enhanced developmental plasticity, promoting more effective incorporation of reconstructed digits into functional sensorimotor pathways, whereas severe or complex anomalies may restrict the degree of achievable cortical reorganization. Advanced microsurgical techniques, including staged reconstructions and vascularized toe-to-hand transfers for ABS, offer sensate and functionally robust units that support both anatomical restoration and neuroplastic recovery. Structured postoperative rehabilitation further strengthens these adaptive cortical processes, underscoring the essential relationship between surgical technique, neural mechanisms, and functional outcomes. This review integrates current evidence on congenital hand anomalies, emphasizing cortical adaptation, postoperative function, and the translational relevance of surgical timing, operative strategy, and rehabilitation protocols.
Impact of Excessive Screen Time on the Misdiagnosis of Attention-Deficit/Hyperactivity Disorder in School-Aged Children
Over the past several decades, the reported prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) has increased markedly, prompting concern regarding potential overdiagnosis and misdiagnosis in school-aged children. This trend has coincided with a substantial rise in children’s engagement with digital media and screen-based technologies. An expanding body of evidence links excessive screen exposure to behavioural patterns, including inattention, impulsivity, hyperactivity, emotional dysregulation, and sleep disturbances, that closely parallel core ADHD symptomatology. Given this overlap, screen-related behavioural changes may be erroneously interpreted as ADHD during clinical evaluations, particularly when contextual and environmental contributors are insufficiently assessed. This review paper examines the degree to which excessive screen time may influence diagnostic inaccuracies, drawing on findings from longitudinal studies, cross-sectional analyses, systematic reviews, and neurodevelopmental research. Current literature indicates that elevated screen use can produce situational, transient, or reversible attention deficits that risk being misclassified as chronic ADHD symptoms in both clinical and educational settings. Furthermore, several studies highlight the potential for diagnostic bias when teachers or caregivers attribute behavioural concerns to ADHD without adequately considering alternative explanations such as heavy digital media use, poor sleep quality, or sensory overstimulation. Overall, existing research underscores a notable association between high levels of screen exposure and ADHD-like behaviours, suggesting that excessive screen time may contribute to diagnostic ambiguity and inflated ADHD prevalence estimates. These findings reinforce the need to strengthen diagnostic procedures by incorporating comprehensive evaluations of digital media habits, sleep patterns, and environmental influences to reduce the risk of misdiagnosis and prevent unwarranted treatment. A deeper understanding of the interplay between screen use and ADHD-like presentations is essential for ensuring diagnostic accuracy and guiding appropriate interventions for school-aged children.
Lifestyle and Pharmacological Interventions for Metabolic Dysfunction-Associated Fatty Liver Disease: A Systematic Review
Background & aim: Metabolic Dysfunction-Associated Fatty Liver Disease, a common condition linked to the global epidemics of obesity and type 2 diabetes, is a major health concern. The condition can progress from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, and hepatocellular carcinoma. Currently, there is no universal cure and disease prevention strategies are the primary focus. The main treatment approaches are lifestyle changes and pharmacological interventions. The aim of the study was to compare these two strategies, assessing their mechanisms, efficacy, safety and clinical utility. Methods: The systematic review was conducted by combining and evaluating data from range of peer-reviewed scientific publications, including clinical trials, systematic reviews and meta-analyses, comprising a total of 10 studies and 1987 patients. The data was categorized using two primary treatment modalities: Lifestyle changes (interventions like weight loss, specific dietary patterns and physical activity) and pharmacological interventions (Pioglitazone, Liraglutide (GLP1 agonist) and Vitamin E). Each approach was evaluated for its ability to improve liver histology, reduce liver fat and resolve MASH. Results & Conclusion: Lifestyle interventions, particularly structured dietary modifications and regular physical activity, consistently demonstrated significant reductions in hepatic steatosis, improvement in insulin sensitivity, and, in some cases, regression of fibrosis. Pharmacological agents such as pioglitazone, vitamin E, and GLP-1 receptor agonists provided histological and metabolic benefits, with pioglitazone improving fibrosis, vitamin E reducing oxidative stress and inflammation, and GLP-1 agonists contributing to weight loss and metabolic improvement. While pharmacological agents offer targeted benefits, lifestyle interventions proved more sustainable and broadly effective across populations.