Most Viewed Articles

Sagittal split osteotomy (SSO) of the mandible is still an important part of orthognathic surgery, but “bad split” fractures that happen during the surgery are still a big problem. This report describes a rare case of bilateral bad split associated with highly compact mandibular bone (D1–D2 type) in a 53-year-old male undergoing mandibular advancement. The bone was too hard for the piezoelectric and rotary tools to work, and there was very little bleeding. This caused fractures in the cortex and lingual. Postoperative computed tomography confirmed the presence of highly dense bone, correlated with delayed healing and recurrence. Consistent pre-surgical CT scanning for an assessment of the density of the mandibular bone can provide essential information about the potential risk of the osteotomy procedure in the patient. Performing a careful bone quality and density examination pre-operatively will allow the surgeons to select the most appropriate instruments and surgical techniques that will fit the patient’s individual anatomy. Such a point escalates to being very significant when dealing with the geriatric population, as bone density increase can not only alter the fracture behavior but also the recovery process during and after surgery. The inclusion of regular CT-based bone density evaluations into the preoperative routine not only facilitates the anticipation of surgical difficulties but also results in safer and more efficient osteotomies.

Prolactin (PRL), a hormone traditionally associated with lactation, has been increasingly recognized for its significant role in the immune system. This paper explores the multifaceted functions of PRL, particularly its contribution to immunosuppressive and corticosteroid drug unresponsiveness, commonly referred to as drug resistance. Hyperprolactinemia has been observed in various autoimmune diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren’s syndrome (SS), and multiple sclerosis (MS). The association between PRL and these diseases is partly explained by the proximity of the PRL gene to the HLA-DBR1 region on chromosome 6, suggesting a genetic link to autoimmune pathogenesis. Furthermore, PRL’s interaction with immune cells, including T-cells, B-cells, and macrophages, as well as its production by these cells, underscores its role in modulating immune responses. This paper hypothesizes that hyperprolactinemia contributes significantly to the resistance to immunosuppressive and corticosteroid therapy frequently observed in autoimmune diseases. The mechanisms involve PRL’s interference with corticosteroid receptor signaling pathways, STAT5 pathways, and the IL-2 receptor pathways, leading to diminished anti-inflammatory effects. Furthermore, PRL is involved in PRL/JAK2 interactions, activation of the Ras/Raf/MAP kinase pathways, as well as the pathways involving the Src family of kinases (e.g, Fyn) and SHP2, IRS-1, and PI-3 kinase activation. In vitro and animal studies further support the immunomodulatory effects of PRL, demonstrating its ability to alter lymphocyte sensitivity to corticosteroids and immunosuppressive drugs. This comprehensive review aims to elucidate the complex interplay between PRL and the immune system, highlighting the potential for targeting PRL pathways in the treatment of autoimmune diseases and overcoming drug resistance.

Depression, trauma, and anxiety disorders continue to be predominant causes of global disability, with typical therapies proving to be only marginally successful. Heart Rate Variability Biofeedback (HRVB) offers patients a self-regulation method that improves the flexibility of the autonomic nerve system via resonance breathing. Clinical research shows that training can significantly lower symptoms of sadness and PTSD, with improvements shown after 4 to 8 weeks. HRVB is inexpensive, non-invasive, and scalable, making it a promising supplementary therapy in psychiatry. Subsequent study ought to inform its incorporation into clinical protocols.

Background: Employee performance appraisal is essential for improving healthcare service delivery through systematic staff evaluation. In the health sector, effective appraisals support decision-making and professional development.Objective: This study aims to map and categorize existing employee performance appraisal methods in the health system using a scoping review approach.Methods: This scoping review was conducted using the JBI 2024 protocol. Articles published up to December 2024 were identified through four databases: PubMed, Scopus, Web of Science, and Google Scholar. The keywords used were “Personnel appraisal,” “Health workers,” and “Health workforce.” The inclusion criteria focused on studies assessing employee appraisal methods in health systems.Results: Of the 1,245 articles initially identified, 18 met the inclusion criteria. Appraisal methods were classified into traditional and modern categories. Traditional methods included ranking, critical incidents, and graphic rating scales. Modern approaches involved 360-degree feedback, Management by Objectives (MBO), and Behaviorally Anchored Rating Scales (BARS).Conclusion: No single appraisal method suits all healthcare environments. A hybrid approach tailored to organizational context and job roles is recommended. Emphasis should be placed on objective evaluation, customization, and the degree of scientific connection between the evaluator and the evaluated person to improve performance outcomes.