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Background: Corticobasal syndrome (CBS) is a rare, clinically heterogeneous neurodegenerative syndrome most commonly associated with corticobasal degeneration (CBD), a 4-repeat tauopathy. CBS presents with asymmetric motor and cortical features, but diagnosis remains challenging, as clinicopathologic concordance is imperfect and other conditions such as Alzheimer's disease (AD), progressive supranuclear palsy (PSP), and frontotemporal lobar degeneration (FTLD) can present with similar phenotypes.

Case presentation: We report the case of a 55-year-old woman with a four-year history of progressive, right-sided spastic hemiparesis and rigidity. Electroneuromyography (ENMG) revealed isolated upper motor neuron (UMN) findings with no lower motor neuron (LMN) involvement. Brain MRI demonstrated cortical atrophy in perirolandic regions, and dopamine transporter (DaT) SPECT imaging revealed a marked, unilateral presynaptic dopaminergic deficit. No sensory, cerebellar, or autonomic features were observed, and levodopa challenge test yielded no benefit. FDG-PET and tau-PET imaging were not performed due to unavailability at our center.

Discussion: The marked clinical asymmetry, dopaminergic deficit strongly support a diagnosis of CBS. While CBD remains the most probable underlying pathology, differential diagnoses include PSP, AD, multiple system atrophy (MSA), idiopathic Parkinson's disease (PD), and, less likely, Mills syndrome or other UMN syndromes. Mills syndrome was considered due to asymmetric UMN findings but was excluded due to parkinsonism, cortical atrophy, and presynaptic dopaminergic loss. This case underscores the diagnostic complexity of CBS, particularly in resource-limited settings where advanced imaging tools are unavailable.

Conclusion: CBS should be considered a leading diagnosis in patients presenting with asymmetric parkinsonism, UMN findings, especially when supported by DaT-SPECT abnormalities. This case highlights the importance of comprehensive clinical evaluation and multimodal imaging in differentiating CBS from other neurodegenerative syndromes.

Background: Objective, reproducible appraisal of primary healthcare (PHC) organizational maturity is essential for steering quality, safety, and sustainability. Existing approaches (e.g., accreditation, compliance audits, single-dimension scorecards) seldom provide an integrated, development-oriented view tailored to outpatient settings.

Aim: To develop a Multilevel System for Competency Development in primary healthcare organizations (MSRK PMSP) based on the Indicator Model For Outpatient Clinic Development (IMORP) model and to assess its feasibility and applicability in urban polyclinics.

Material and methods: The IMORP model was built on aggregated data from a six-year monitoring programme (2020-2025) covering eight urban polyclinics. The framework was designed by four public-health experts and underwent external content review by two independent experts. IMORP structures organizational maturity across seven domains (workforce, quality of care, infrastructure, innovation, digitalization, finance, managerial responsiveness) with a maximum of 155 points and four maturity tiers (basic, intermediate, advanced, expert). Descriptive statistics (mean, SD, min-max) were computed. Group comparisons used the Kruskal-Wallis test with Dunn-Bonferroni post hoc procedures where applicable (α=0.05). Temporal changes within each PHC organization were evaluated using Repeated Measures ANOVA or the Friedman test, depending on data distribution.

Results: The model demonstrated clear managerial interpretability and domain-level diagnostic resolution. Clinic-level mean IMORP totals differed significantly (Kruskal-Wallis p<0.001), with representative ranges from approximately 60.0±3.3 to 105.3±8.1 points across facilities; domain-specific means typically fell within narrow bands (e.g., digitalization ≈14-15 points, SD minimal), whereas innovation remained uniformly low. Despite statistically significant between-clinic differences in total scores, all eight facilities were classified within the same maturity tier (Intermediate) according to predefined cut-offs, indicating structural heterogeneity without cross-tier transitions in the pilot phase.

Conclusions: MSRK PMSP (IMORP) offers a practical, multi-domain, maturity-levelled instrument for PHC organizations, simultaneously supporting diagnostic profiling and targeted improvement planning. A full psychometric validation is planned on a larger sample (≥35 polyclinics) to establish internal consistency, inter-rater/test-retest reliability, factor structure, and predictive validity versus clinical-economic and patient-engagement outcomes.

Introduction: In the globalized higher education landscape, international student recruitment has become a strategic priority for universities worldwide. This study examines the recruitment instruments employed in Georgia compared to five leading European countries.

Objective: To analyze and compare the effectiveness of various recruitment instruments used for international student attraction in Georgia versus the United Kingdom, Sweden, Italy, the Netherlands, and Germany.

Methods: Mixed-methods approach combining secondary data analysis from QS International Student Surveys (2022-2023, N=110,306 respondents from 194 countries) with institutional analysis of Georgian universities' recruitment practices (2015-2024). The study examines digital marketing tools, agent networks, accreditation frameworks, and institutional factors.

Result: Georgian universities demonstrate heavy reliance on educational agents as the primary recruitment channel, contrasting with European institutions' emphasis on digital marketing and brand reputation. Social media platforms show differential effectiveness by region: African students (48% online sources), Asian students (16% online sources). University websites remain the most critical information source (84% of prospective students). International accreditation (WFME, ENQA membership) and ranking presence significantly influence recruitment success.

Conclusions: While Georgia has achieved substantial growth in international student enrollment (31,486 students in 2024, representing a 20-fold increase since 2010), predominantly in medical programs (88.1% of international students), recruitment strategies differ markedly from European models. Success factors include: (1) international diploma recognition, (2) competitive tuition costs, (3) safe environment, and (4) liberal visa policies. The transition toward digital recruitment instruments is emerging but agent-mediated recruitment remains dominant.

Background: Fusobacterium nucleatum (F. nuclatum) has been recognized as a bridging pathogen within subgingival biofilms, in the same arrow, Peptidyl Arginine Deiminase 4 (PAD4), a host protein responsible for histone citrullination, confers to the neutrophil extracellular traps formation and subsequent tissue damage. Therefore, the current study aimed to explore the association of PAD4 activity and F. nucleatum prevalence in patients; with periodontal disease and evaluate their diagnostic potential role in disease progression.

Methods: Ninety participants aged from (25-55) years were categorized equally into 3 groups: (Group I) healthy controls, (Group II) patients with gingivitis, and (Group III) patients with severe periodontitis /stage III. Clinical periodontal parameters plaque index (PLI); gingival index (GI), bleeding on probing (BOP); probing pocket depth (PPD); clinical attachment loss (CAL) was recorded. Unstimulated saliva analyzed for PAD4 level using ELISA, and subgingival plaque was examined for F. nucleatum prevalence using qPCR. Data were analyzed using Kruskal-Wallis, Spearman's correlation, and ROC curves.

Results: Patients with severe periodontitis demonstrated markedly elevated salivary PAD4 levels compared with patients with gingivitis and controls (P<0.001). There was no interconnection between PAD4 and clinical parameters. On another hand, F. nucleatum counts were significantly higher in diseased groups than controls (P<0.001), demonstrating highly significant correlations with clinical periodontal parameters especially in severe periodontitis patients. ROC curve analysis revealed excellent diagnostic accuracy for PAD4 (AUC=0.98) and F. nucleatum (AUC=1.00) in discriminating between health and disease, confirming their value as reliable biomarkers for periodontal disease.

Conclusion: PAD4 overexpression together with the increased prevalence of F. nucleatum possibly crucial in the development and progression of periodontal diseases. They can act as reliable biomarkers for periodontal inflammation. Screening salivary PAD4 levels and F. nucleatum counts may facilitate early recognization of patients susceptible for periodontal disease, providing a basis for timely intervention and more precise disease monitoring.

Background: Hyperglycemia brought on by insulin resistance and decreased insulin secretion is a hallmark of type II diabetes mellitus (T2DM), a common metabolic disease. By increasing the excretion of glucose in the urine, dapagliflozin, an inhibitor of the sodium-glucose cotransporter-2 (SGLT2), lowers blood glucose levels and may have other systemic effects.

Aim: The purpose of this study was to assess how dapagliflozin affected glycemic control, thyroid function, and serum vitamin D₃ levels while looking into potential age and gender effects.

Methods: Thirty T2DM patients who had previously received metformin treatment (18 men and 12 women, ages 31 to 70) were enlisted. In addition to metformin, each participant received 10 mg of dapagliflozin daily for eight weeks. Using chemiluminescent and ELISA assays, serum levels of HbA₁c, triiodothyronine (T₃), thyroxine (T₄), thyroid-stimulating hormone (TSH), and vitamin D₃ were assessed both before and after treatment.

Results: Although, changes in T₄, TSH, and vitamin D₃ were not statistically significant, dapagliflozin significantly decreased HbA₁c and T₃ levels. While HbA₁c showed a near-borderline difference between sexes (p≈0.10) and vitamin D₃ showed a mild age-related trend (p≈0.07), neither gender nor age significantly affected any of the parameters.

Conclusion: Dapagliflozin's main effect appears to be on peripheral metabolic regulation rather than endocrine hormone synthesis, as evidenced by the fact that it successfully improved glycemic control without substantially changing thyroid or vitamin D₃ levels. Dapagliflozin's stable therapeutic profile is highlighted by the consistent biochemical responses across age and gender, which calls for additional research with bigger sample sizes and longer follow-up periods.

Background: Malignant central airway obstruction (CAO) is a critical, life-limiting complication in patients with advanced thoracic malignancies. Interventions such as bronchoscopic laser resection and airway stenting can provide rapid palliation and symptom relief, yet comparative data on survival and quality of life (QoL) remain limited.

Objective: To assess the impact of bronchoscopic laser resection and stenting on survival and health-related QoL in patients with malignant CAO, compared with conservative palliative care.

Methods: A comparative cohort study was conducted at a national pulmonary referral center. Thirteen patients underwent bronchoscopic laser resection and/or endobronchial stenting, while twelve control patients received conservative palliative care. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate mortality. Health-related QoL was measured using the EQ-5D-5L questionnaire at baseline and one-month post-intervention.

Results: Median survival in the intervention group was 9.7 weeks compared to 0.6 weeks in the control group (p<0.0001). At 25 weeks, the hazard ratio for death was 0.019 (95% CI: 0.004-0.091). The mean EQ-5D-5L score improved from 29.2±14.4 to 43.5±9.2 (p=0.0062), with the most pronounced improvements in the pain/discomfort and anxiety/depression domains.

Conclusion: Bronchoscopic laser resection and airway stenting significantly improve short-term survival and quality of life in patients with malignant CAO. These minimally invasive interventions should be considered integral components of palliative care for patients with inoperable airway obstruction.

Background: Neck pain is a common musculoskeletal condition which is becoming more common in undergraduate students due to the modification in modern lifestyle, learning methods, and the use of electronic devices.

Aim: To assess the prevalence of neck pain and its associated factors among Baghdad undergraduate students.

Materials and methods: A descriptive cross-sectional study was performed by means of a self-administered online questionnaire distributed among the undergraduate students in December 2023. GraphPad Prism was used to analyse data from 520 students.

Results: The study involved 520 college students (198 males and 322 females). The overall prevalence of neck pain was 74.23% (95% CI: 70.30-77.80%), and it was higher in females (81.37%) than in males (62.63%). Statistically significant associations were found between neck pain and gender (p<0.0001), duration of electronic device use (p<0.0001), family history of neck pain (p<0.0001), age (p=0.0036), and study position (p=0.0127).

Conclusion: Neck pain prevalence was 74.23% among undergraduate students in Baghdad, with female gender, age, prolonged electronic device use, poor study posture, and family history found as significant associated factors. Despite the methodological limitations, the findings highlight the necessity for preventive strategies that focus on ergonomic education and performing future multi-institutional studies with multivariate analysis.

Pain caused by injection is influenced by various factors including the type of anesthetic used, injection technique, needle gauge and size, injection speed, and individual patient characteristics. Technical and pharmacological advances, such as the use of modern equipment, buffering and warming solutions, or reducing pain with gels and numbing agents, aim to minimize the pain associated with injections. Investigating the factors influencing injection pain can lead to improvements in the quality of dental treatments and increase patient satisfaction. Hence, a systematic review was conducted to methodically examine the determinants affecting pain related to local anesthetic injections in the oral cavity. All stages of the study design were conducted based on the PRISMA guidelines. A comprehensive and extensive review of scientific and research article databases including PubMed, Web of Knowledge, Google Scholar, and Scopus was performed for the period from January, 2013, to January, 2024. Extracted information included authors, country, year, pain level, injection site, type of anesthetic, type of equipment used for injection, gender of patients, age of patients, factors affecting the level of pain during injection, and conclusions. The findings indicate that patients' individual characteristics, the type of substance and needle, and modern techniques and equipment like laser and microneedle patches are effective in reducing injection pain. Attention to psychological factors and the use of appropriate tools based on the injection site play a crucial role in pain management; however, some methods require further research for standardization.

Temporomandibular joint dysfunction (TMJD) represents a multifactorial disorder that extends beyond the articular complex to include neuromuscular, postural, and psychosomatic dimensions. This literature review analyzes the integration of osteopathic medicine into the multidisciplinary management of TMJD. The study explores five osteopathic models-biomechanical, neurological, metabolic-energetic, respiratory-circulatory, and behavioral-psychosocial-emphasizing their clinical significance for functional rehabilitation within the cranio-cervico-mandibular system. Evidence suggests that osteopathic manipulative treatment (OMT) significantly reduces pain, improves mandibular mobility, and restores neuromuscular balance when combined with conventional dental and physiotherapeutic modalities. However, limitations in existing research-including small sample sizes, heterogeneous methodologies, and lack of objective digital assessments-underscore the need for further randomized controlled trials employing standardized protocols and AI-based cephalometric tools to substantiate clinical outcomes.

Background To analyze the correlation between loneliness and perceived stress in the elderly, and to explore the chain mediating effect of perceived social support and a sense of meaning in life on loneliness and perceived stress. Methods Convenient cluster sampling was used to conduct a survey on 634 elderly people in Wuhu City, Anhui Province, using the UCLA Loneliness Scale (UCLA), Perceived Social Support Scale (PSSS), Meaning of Life Questionnaire (MLQ), and Perceived Stress Scale (PSS). Results Loneliness was positively correlated with perceived stress (r=0.26, P<0.01); Perceived social support was negatively correlated with loneliness and perceived stress (r=-0.28, -0.35, P<0.01). The sense of meaning in life was negatively correlated with loneliness and perceived stress (r=-0.24, -0.34, P<0.01). Perceived social support plays a mediating effect between loneliness and perceived stress. The sense of meaning in life plays a mediating effect between loneliness and perceived stress. Perceived social support and a sense of meaning in life play a chain mediating effect between loneliness and perceived stress. Conclusion The research results reveal the synergistic protective effect of psychosocial resources and cognitive evaluation factors in alleviating the impact of loneliness on stress perception, providing a theoretical basis and practical direction for mental health intervention for the elderly.