Journal of Advances in Medical and Pharmaceutical Sciences

Comparative Antimicrobial and Antibiofilm Effects of Chlorhexidine, Lactobacillus reuteri Cell-free Supernatant, and Green Tea Extract against Major Periodontopathogens: An in vitro Study

Mehmet Murat Taşkan — 2026-06-19

Background: Periodontal diseases are associated with dysbiotic biofilms, and adjunctive strategies to chlorhexidine (CHX) are being explored because repeated antiseptic use may be accompanied by undesirable effects. This controlled in vitro study compared 0.12% CHX, Lactobacillus reuteri cell-free supernatant (CFS), and catechin-rich green tea extract against Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum.

Methods: Direct antimicrobial activity was assessed by agar diffusion and broth microdilution assays, including minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) determination. Biofilm-related outcomes were evaluated by crystal violet measurement of biofilm-formation inhibition and viable-count reduction in 24-hour pre-formed biofilms after 60 minutes of exposure. Each condition included three technical replicates in three independent experimental runs. Quantitative data were analysed using two-way ANOVA followed by Tukey-adjusted pairwise comparisons.

Results: CHX produced the largest inhibition zones, lowest MIC and MBC values, and greatest viable-count reductions in mature biofilms across all tested species. Green tea extract showed the strongest non-CHX anti-biofilm profile, inhibiting biofilm biomass by 67-72% and producing intermediate log10 CFU reductions of 1.8-2.2 in pre-formed biofilms. L. reuteri CFS demonstrated moderate, species-dependent activity, with the most evident response against P. gingivalis. The main effect of agent was significant for inhibition-zone and biofilm outcomes (p < 0.001), and post hoc testing confirmed the ordered pattern CHX > green tea extract > CFS > vehicle.

Conclusions: Within this in vitro model, CHX remained the most potent comparator, whereas green tea extract and L. reuteri CFS showed adjunctive anti-biofilm activity. Further formulation, multispecies biofilm, and host-relevant studies are required before clinical extrapolation.

Thoracic Manifestations of Behçet’s Disease Excluding Cardiac Involvement: A 17-Year Retrospective Study in a Moroccan Tertiary Referral Center

Soukaina Mounsif — 2026-06-22

Background: Thoracic involvement in Behçet’s disease (BD) is uncommon but is associated with significant morbidity and mortality, mainly due to vascular complications.

Aim: This study aimed to evaluate thoracic manifestations of Behçet’s disease, excluding cardiac involvement, in patients managed at a Moroccan tertiary hospital over a 17-year period.

Methods: This retrospective single-centre study was conducted over a 17-year period (2006–2023) in the Internal Medicine Department of Ibn Rochd University Hospital, Casablanca, Morocco. Among 563 patients diagnosed with BD according to the International Study Group (1990) criteria and the International Criteria for Behçet’s Disease (2013), 58 patients presented with thoracic manifestations excluding cardiac involvement.

Results: Thoracic involvement was observed in 10.3% of cases. The mean age was 35.3 ± 10.9 years, with a male predominance (M/F ratio = 2). Haemoptysis was the most frequent symptom (44.8%). CT angiography revealed pulmonary artery aneurysms in 32.7%, pulmonary embolism in 37.9%, and superior vena cava thrombosis in 15.5%. Treatment was based on corticosteroids and immunosuppressants. The clinical course was favourable in most patients after treatment, with regression of symptoms and stabilisation of vascular lesions. However, relapses occurred in some cases, reflecting the chronic relapsing nature of the disease. Mortality was mainly related to massive haemoptysis secondary to aneurysmal rupture.

Conclusion: Thoracic manifestations of BD are predominantly vascular and determine prognosis. Early diagnosis and intensive immunosuppressive therapy are essential to improve outcomes.

Vitamin D Status and Biochemical Markers Related to Bone Health among Premenopausal Women with Obesity

Kayode Solomon Adedapo — 2026-07-03

Vitamin D is important for calcium homeostasis and skeletal health, while obesity may influence circulating vitamin D concentrations through altered metabolism and adipose tissue sequestration. This study assessed vitamin D status and selected biochemical markers related to bone health among premenopausal women with obesity. A case-control study was conducted among 120 women aged 18–40 years recruited from General Hospital Ijede, Ikorodu, Lagos State. Participants comprised 30 normal-weight controls and 90 women with obesity, categorised as mildly obese, moderately obese, and severely obese, with 30 participants in each group. Serum 25-hydroxyvitamin D, calcium, phosphorus, bone-specific alkaline phosphatase, and thyroid-stimulating hormone were analysed using standard laboratory methods. Data were analysed using analysis of variance, Pearson correlation, and chi-square tests at p ≤ 0.05. Vitamin D concentrations differed significantly across groups, with lower levels in mildly obese, moderately obese, and severely obese women than in controls. Calcium concentrations were also significantly lower among women with obesity, while phosphorus showed a modest but significant difference. Bone-specific alkaline phosphatase and thyroid-stimulating hormone did not differ significantly across groups. A significant negative correlation was observed between vitamin D and body mass index in severely obese women. Calcium deficiency was more frequent among women with obesity than among controls. These findings indicate that obesity is associated with lower vitamin D and calcium concentrations among premenopausal women, and calcium status may be important in assessing bone health in this population.

Modelling Malaria Mortality in Ghana Using Distributed Lag Nonlinear Frameworks

Francis Ayiah-Mensah — 2026-07-07

Background: Malaria mortality studies in Ghana and sub-Saharan Africa have commonly relied on traditional regression approaches or generalised additive models, which may not fully represent delayed transmission effects, nonlinear exposure-response patterns, or uncertainty in mortality estimates. This study modelled the delayed and nonlinear dynamics of malaria mortality in Ghana and examined incidence-related thresholds associated with cumulative mortality effects.

Objectives: The study applied a Distributed Lag Nonlinear Model (DLNM) to assess temporal malaria mortality dynamics in Ghana using a climate-sensitive health modelling framework that incorporated uncertainty-adjusted estimation.

Methods: An ecological time-series analysis was conducted using annual age-standardised malaria mortality and incidence data for Ghana from 1990 to 2023 obtained from the Global Burden of Disease database. DLNMs with nonlinear spline functions, distributed lag structures and inverse-variance weighting were fitted separately for males, females and the combined population. Model performance was assessed using adjusted R², deviance explained, Akaike Information Criterion and residual diagnostics.

Results: Malaria mortality and incidence declined over the study period, while mortality remained consistently higher among males. The DLNM performed well, with adjusted R² values ranging between 0.9936 and 0.9945, and deviance explained over 99.6%. Nonlinear temporal effects were observed in all sex groups (p < 0.05). Delayed mortality amplification was mainly observed at lags 2-4, with higher cumulative delayed effects among males. The maximum cumulative mortality effects occurred at incidence thresholds around 21,000 cases per 100,000 population, with the highest cumulative effect estimated for males (49.28).

Conclusions: The findings indicate that malaria mortality dynamics in Ghana are nonlinear, delayed and threshold-sensitive. The combined use of DLNM, sex-specific lag modelling and uncertainty-adjusted weighting provides a useful framework for strengthening malaria surveillance, early-warning modelling and targeted public health planning.

Beyond Palliation: Redefining the Surgical Frontier in Stage IV Non-Small Cell Lung Cancer

Swarnava Chanda — 2026-06-29

Stage IV non-small cell lung cancer (NSCLC) has long been treated as a domain for systemic therapy and palliation alone, with surgery reserved for managing complications rather than for controlling disease. That position has shifted markedly over the past decade. It is now recognised that a meaningful subset of patients present with, or evolve towards, a limited burden of metastatic disease — the so-called oligometastatic state — and this has prompted a rethink of curative-intent local therapy, including pulmonary resection, as part of multimodality management. Randomised evidence showing a survival benefit from local consolidative therapy, combined with the steady improvement of targeted agents and immune checkpoint inhibitors, has created conditions in which carefully selected patients with synchronous or metachronous oligometastatic NSCLC can achieve prolonged progression-free and overall survival after resection of the primary tumour and, in some cases, of metastatic deposits as well. This review traces how the oligometastatic concept developed, weighs the randomised and observational evidence behind surgical intervention, and works through site-specific considerations affecting the brain, adrenal gland, contralateral lung and pleura. It also looks at how surgery is being integrated with oncogene-targeted agents and immunotherapy, at the practical business of multidisciplinary patient selection, and at the emerging role of molecular and circulating biomarkers in refining who should be offered surgery. The evidence remains largely retrospective and inconsistent in how it defines oligometastasis, yet a fairly consistent signal points to durable benefit in well-selected patients, and recent consensus guidelines have begun to give the surgeon's role here a more formal footing. The review concludes that surgery in stage IV NSCLC should no longer be treated as an exception to standard practice but rather as an increasingly codified part of a biologically informed, multidisciplinary treatment strategy — while still acknowledging the real limitations of the current literature and the need for prospective, adequately powered trials.

Integrating Digital Twins and Predictive Analytics for Personalized Patient Monitoring and Care Optimization

Fidele Nsanzumukunzi — 2026-06-15

The utilisation of digital twins in conjunction with predictive analytics has seen a marked rise in its promotion for applications in personalised patient monitoring, treatment planning and service optimisation. Nevertheless, the extent to which these claims are substantiated by real-world healthcare evidence remains uncertain. To map empirical applications of these technologies and summarise their impacts and implementation constraints, a scoping review was conducted using a Population–Concept–Context framework. The review searched MEDLINE/ PubMed and Web of Science for peer-reviewed studies published in English between 2015 and 2025. Nineteen studies met the inclusion criteria, with most published after 2022. Most were clinical twins spanning cardiovascular, hepatology, diabetes, oncology, and intensive care; one addressed emergency communication operations. Imaging-anchored and hybrid physiological twins achieved the strongest patient-specific validation, while continuous-data twins improved glycaemic control, risk prediction, and therapy optimisation. Acute-care and operational twins showed feasibility and safety gains, but inconsistent effects on efficiency. Barriers clustered around fragmented data standards, missing or noisy inputs, workflow fit, clinician trust, and limited multicentre prospective trials. Predictive digital twins are transitioning from proof-of-concept to early utility. However, scalable impact will depend on interoperable data ecosystems, rigorous staged validation, and human-centred deployment with governance for safety and equity.

Neglected Heavy Metals in the Niger Delta Region of Nigeria: A Systematic Review of Toxicity, Environmental Contamination, Health Risks, and Research Gaps

Ibioku Elekima — 2026-06-26

Background: The Niger Delta region of Nigeria hosts one of the largest crude oil reserves in Africa. Decades of oil exploration and production have released a wide range of toxic heavy metals into the environment. While lead (Pb), cadmium (Cd), and nickel (Ni) have attracted considerable scientific attention, other metals, including vanadium (V), arsenic (As), barium (Ba), cobalt (Co), and manganese (Mn), remain underreported despite having well-established toxic effects in humans. This review refers to these metals collectively as neglected heavy metals.

Objective: To systematically review published evidence on the occurrence, distribution, sources, exposure pathways, and human health risks of neglected heavy metals in the Niger Delta region of Nigeria, and to identify existing research and policy gaps.

Methods: A systematic literature search was conducted across PubMed, Scopus, Google Scholar, Cochrane Library, BIOSIS, Global Health, and ScienceDirect, covering publications from 2010 to 2026. Studies reporting measured concentrations of vanadium, arsenic, barium, cobalt, or manganese in any environmental or biological matrix from the Niger Delta were eligible. Screening, data extraction, and quality assessment followed PRISMA 2020 guidelines. Thirty-eight studies met the final inclusion criteria. The initial search for neglected heavy metals in the Niger Delta identified 4,019 unique publications from Google Scholar, PubMed, Cochrane Library, BIOSIS, and Global Health. Of the 4,019 articles, 3,453 were excluded due to duplications while 513 were excluded because of lack of defined location, studies conducted outside the Niger Delta, studies focusing on mercury, lead, and chromium, among others, and studies not reported in the English language. A total of 52 full-text articles were reviewed for eligibility of which 14 records were excluded because they were systematic or mini reviews. Overall, 38 full articles were included in the study.

Results: All five neglected heavy metals were consistently detected across water, soil, sediment, seafood, food crops, and biological samples in the Niger Delta. Concentrations frequently exceeded WHO, US EPA, and Nigerian DPR regulatory thresholds. Arsenic and manganese were the most widely reported. Cobalt showed the highest pooled concentration in seafood at 4.039 mg/kg dry weight. Vanadium was confirmed as a neuropathological hazard in ecological studies. Barium was primarily linked to drilling fluid discharge. Human health risks include neurotoxicity, carcinogenicity, kidney and liver damage, and reproductive harm.

Conclusion: Neglected heavy metals represent a serious but poorly characterised public health threat in the Niger Delta. Comprehensive biomonitoring studies, stronger regulatory frameworks, and community-level health surveillance programmes are urgently needed. Scientific and policy attention must expand beyond conventionally studied metals to capture the full toxic burden facing Niger Delta communities.