Rambam Maimonides Medical Journal最新文献

As clinicians progress in their careers, they are often tasked with projects and responsibilities that require additional education, knowledge, and training in leadership and management. In the past, they were expected to pick up these skills along the way; current expectations, however, are different. Today, several avenues are available to clinicians to acquire and refine these competencies. This narrative review provides a structured overview of the education and training available-both with and without formal credentials-and outlines potential opportunities and pathways for developing leadership and management skills, particularly among critical care physicians.

Background: Cardiovascular disease is the leading global cause of death, with lifestyle and sociodemographic factors playing key roles in cardiovascular risk (CVR).

Objective: This two-phase study assessed the associations of alcohol intake, Mediterranean diet adherence, physical activity, and sociodemographic variables with CVR-as measured by the Registre Gironí del Cor (REGICOR) function and Systematic COronary Risk Evaluation 2 (SCORE2) algorithm-in a large cohort of Spanish workers (Phase 1). A secondary aim was to examine CVR trends from 2010 to 2020 (Phase 2).

Methods: A two-phase study was conducted: a cross-sectional analysis of 139,634 workers (Phase 1) and a longitudinal follow-up of 40,431 participants (Phase 2). Anthropometric, clinical, biochemical, and behavioral data were collected using standardized procedures. Multinomial logistic regression was used to evaluate associations.

Results: Phase 1 results showed a higher CVR associated with male sex, older age, lower education, manual labor, smoking, physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption. In Phase 2, CVR increased over the decade, especially among smokers, sedentary individuals, and those with lower education.

Conclusions: Both modifiable behaviors and structural determinants significantly influence CVR. Preventive strategies should integrate lifestyle promotion with measures to reduce social inequalities, with targeted actions for vulnerable groups.

Background: Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers.

Materials and methods: As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann-Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters.

Results: All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow.

Conclusion: This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.

Traditional coronary artery disease (CAD) risk scores offer limited precision, often failing to capture the complex, multifactorial nature of the disease. The proliferation of multimodal data from imaging, genomics, electronic health records (EHRs), and wearables offers a transformative opportunity for more individualized risk prediction. This narrative review systematically maps and critically evaluates the landscape of multimodal data fusion for CAD risk prediction. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we synthesized 39 empirical studies published from 2009 to 2025 to identify key methodological patterns, informatics challenges, and future directions. Our synthesis reveals consistent methodological patterns: (1) integrating imaging biomarkers (e.g. coronary computed tomography angiography, coronary artery calcium scoring) with clinical data robustly enhances risk discrimination and reclassification; (2) adding polygenic risk scores provides incremental value, typically via late-fusion models; and (3) leveraging longitudinal EHR data with machine learning captures dynamic risk trajectories, outperforming static scores. Advanced machine learning architectures, particularly deep and graph neural networks, are pivotal for enabling automated feature extraction and modeling complex cross-modal interactions. Despite these advances, significant informatics hurdles persist, including data heterogeneity, algorithmic bias, the need for robust external validation, and challenges in clinical workflow integration. Multimodal data fusion is a cornerstone of precision cardiology, but realizing its clinical potential requires a concerted focus on developing fair, interpretable, and scalable methodological frameworks to translate complex data into improved patient outcomes.

Background: Sarcopenia and frailty are multi-factorial conditions, but few studies have examined their prevalence among older adults with diabetes in the Indian subcontinent. This study aimed to estimate prevalence of sarcopenia and frailty in ambulatory patients ≥65 years with type 2 diabetes mellitus (T2DM).

Methods: Sarcopenia was assessed utilizing the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Frailty was assessed using the Fried Frailty phenotype criteria. The study enrolled ambulatory participants aged 65 years and above with T2DM visiting the outpatient clinic. Patients with degenerative or inflammatory arthritis of the lower limbs, disabling cerebrovascular accidents, Alzheimer's disease or other cognitive impairment, as well as those with chronic obstructive pulmonary disease, chronic liver disease, or chronic kidney disease were excluded from the study.

Results: Among the 100 outpatients meeting the inclusion criteria, sarcopenia was present in 30% (including 17% with severe sarcopenia). Frailty was present in 27%, pre-frailty in 59%, and 14% were classified as robust.

Conclusion: This study demonstrated a high prevalence of both sarcopenia and frailty among older adults with T2DM. Routine screening for these conditions may facilitate early identification and intervention in this high-risk population.

Introduction: Pulp stones (PS) are incidental, mostly asymptomatic, radiographic findings that may hinder endodontic therapy. They are observed as radiopaque aggregates within coronal or radicular pulp tissue on intraoral periapical, bite-wing, panoramic radiographs and cone-beam computed tomography images. This study aimed to evaluate PS prevalence in patients with cardiovascular disease (CVD), diabetes mellitus (DM), and chronic periodontitis (CP) as compared with controls, as a function of age and sex.

Material and methods: This cross-sectional study included 200 subjects: 50 healthy controls, and 50 patients each with CVD, DM, and CP. All participants underwent digital panoramic radiograph (orthopantomogram) (OPG) evaluation for the presence/absence, number, and location of PS.

Results: Significant differences in PS prevalence were observed among the groups (P<0.01), with CVD patients showing the highest prevalence. Older individuals (>50 years) and first molars were most frequently affected. The maxillary arch showed a significantly higher prevalence than the mandible (odds ratio [OR]=1.45; 95% CI 1.22-1.72). The strongest risk factor was CVD (OR=7.38; 95% CI 5.20-10.47), followed by DM (OR=4.18; 95% CI 2.91-5.99) and CP (OR=4.16; 95% CI 2.88-6.00). Age was significantly associated with PS, while sex showed no association.

Conclusion: The presence of PS, even among healthy controls, may serve as an adjunctive radiographic marker and could also alert dental practitioners to the possibility of underlying systemic disease.

Background: An odontogenic keratocyst is presently considered a cyst by the 2017 World Health Organization (WHO) classification, even though, at times, it shows highly aggressive behavior and a high recurrence rate. Ki-67 is a protein associated with the proliferative activity of the intrinsic cell populations. In tumors, Ki-67 is associated with tumor aggressiveness. This study aimed to compare the Ki-67 expression rates of odontogenic keratocysts to those of other odontogenic cysts and normal mucosa.

Materials and methods: A retrospective cross-sectional study was conducted using pathology samples retrieved from the archives of a tertiary care center to evaluate Ki-67 expression. Histopathologically confirmed cases of odontogenic keratocysts, radicular cysts, dentigerous cysts, and ameloblastomas were selected. The standardized immunohistochemistry streptavidin-biotin detection system HRP-DAB method was employed for analysis.

Results: All the odontogenic keratocysts pathology samples demonstrated some degree of Ki-67 expression: mild, moderate, and severe Ki-67 expressions were identified in 26.7%, 53.3%, and 20.0% of the samples, respectively. Compared to the odontogenic keratocyst samples, the samples from dentigerous cysts, periapical cysts, ameloblastomas, and normal mucosa demonstrated no Ki-67 expression in 33.3%-66.7% of the samples, mild expression in 13.3%-40.0%, moderate expression in 0%-33.3%, and severe expression in none of the samples (P<0.001).

Conclusions: Ki-67 was either moderately or severely overexpressed in the majority of odontogenic keratocyst samples. The 2017 WHO classification, which reclassifies keratocystic odontogenic tumors as cysts, conflicts with our findings.

Background: Parental caregivers of children with special needs manage their child's daily tasks, taking on responsibilities such as making health and financial decisions, assisting with routine activities, and ensuring their safety from self-harm. The level of a child's disability determines the amount of time and effort a caregiver must invest, with higher disability levels meaning greater dependency and thus requiring greater support. While rewarding, caregiving may also be highly demanding. The parental caregiver's physical and mental health can decline due to stress, potentially leading to anxiety and depression, and may worsen pre-existing conditions. This research aimed to provide insights into the psychological well-being of parental caregivers, shedding light on their challenges and needs for better support and intervention.

Methods: This study examined the psychological health of parental caregivers of special needs children at a special education school in Puducherry, India. Following an orientation program, 66 parental caregivers volunteered and provided informed consent to participate. The mean age of the parents was 38.4 years (±6.6). Demographic details were collected, and psychological parameters were assessed using standardized scales: Zarit Burden Interview-Caregiver Burden Scale (ZBI-CBS), Depression Anxiety Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life-brief form (WHOQOL-BREF).

Results: The study findings revealed that most parents experienced caregiver burden and poor sleep quality, consistent with previous studies. Specifically, 93.9% of parents had poor sleep, while 84.8% reported caregiver burden. Additionally, 89.4% of the parents experienced depression, 89.4% have anxiety, and 86.4% have stress. Quality of life was low across all domains.

Conclusion: The stress of managing their child's needs can negatively impact parental caregivers' physical and psychological health. Providing counseling and promoting healthy lifestyle choices can significantly enhance caregivers' overall well-being.