International Journal of Medical and Clinical Sciences
The International Journal of Clinical & Translational Medicine (IJCTM) is a peer-reviewed, open-access journal dedicated to publishing high-quality research that bridges fundamental biomedical science and clinical application. The journal focuses on translational research that accelerates the integration of laboratory discoveries into diagnostic tools, therapeutic strategies, and improved patient outcomes. IJCTM welcomes original research articles, systematic reviews, meta-analyses, clinical trials, case reports, and short communications in the following areas: Internal Medicine Surgery and Minimally Invasive Techniques Oncology and Cancer Genomics Cardiovascular Medicine Infectious Diseases Medical Biotechnology Clinical Pharmacology Digital Health & AI in Medicine Precision Medicine Medical Education and Clinical Simulation The journal aims to promote interdisciplinary collaboration and global dissemination of clinically impactful scientific discoveries.
Artificial Intelligence–Driven Radiomics in Otorhinolaryngology: Enhancing Diagnosis and Outcome Prediction in Head and Neck Cancer
Recent advances in otorhinolaryngology have shifted toward data‑driven, imaging‑centric paradigms, with artificial intelligence (AI)‑integrated radiomics playing an increasingly central role in head and neck cancer management. AI‑based radiomics models extract quantitative features from computed tomography, magnetic resonance imaging, and positron‑emission tomography datasets to support noninvasive tumor characterization, treatment planning, and outcome prediction. This article reviews the integration of machine learning and deep‑learning radiomics into routine otolaryngology practice, compares conventional radiomics with emerging end‑to‑end deep‑learning approaches, and discusses practical implementation challenges and future directions. Data from recent studies indicate that combined clinical–radiomic models can improve prediction of survival, recurrence, and treatment response, while preserving or even surpassing the performance of conventional staging alone.
Copyright (c) 2026 International Journal of Medical and Clinical Sciences
Advances in Otology: Next Generation Cochlear Implants and Emerging Neuromodulation Strategies for Tinnitus
Otology has entered a transformative phase in which cochlear implant technology and tinnitus therapeutics are advancing in parallel toward more effective, personalized care. Recent developments include next‑generation cochlear implants with expanded candidacy, totally implantable and “smart” upgradeable systems, robotic‑assisted atraumatic insertion, and integration of AI‑driven signal processing that enhances speech‑in‑noise performance and long‑term outcomes. In tinnitus, large prospective cohorts now demonstrate robust tinnitus suppression following cochlear implantation, while bimodal neuromodulation devices such as Lenire and emerging multimodal neuromodulation paradigms offer clinically meaningful symptom relief beyond traditional sound therapy. This article reviews key advances in cochlear implants and tinnitus management, emphasizing clinical implications, mechanistic insights, and future directions for integrated, network‑level interventions in otology.
Postoperative Cerebrospinal Fluid Leak and Meningitis after Endoscopic Endonasal Skull Base Surgery: Complications at the Otorhinolaryngology–Neurosurgery Interface
Endoscopic endonasal approaches (EEA) to the skull base have transformed the management of pituitary and anterior skull base lesions but introduce distinctive otorhinolaryngologic complications, notably cerebrospinal fluid (CSF) leak and postoperative meningitis. Reported CSF leak and meningitis rates after transnasal endoscopic skull base surgery range around 7–8% in some series, with frequent concurrent occurrence and substantial associated morbidity. These complications arise from dural defects, high-flow CSF states, and imperfect skull base reconstruction, and are modulated by lesion pathology and prior treatments. This narrative review summarizes current evidence on incidence, risk factors, diagnostic strategies, and preventive as well as therapeutic measures for CSF leak–related complications in EEA. Emphasis is placed on reconstruction techniques, perioperative antibiotic strategies, and structured follow-up tailored to high‑risk populations such as patients with ACTH‑secreting adenomas. Remaining gaps include heterogeneous definitions of CSF leak, variable follow‑up, and limited pediatric data.
Learning curve and outcomes in pediatric robotic-assisted surgery: a seven-year single-center experience
Robotic-assisted surgery is increasingly used in pediatric practice, but real-world learning curves and outcomes remain incompletely characterized. This single-center retrospective study analyzes seven years of pediatric robotic-assisted surgery, focusing on efficiency, safety, and program maturation. We reviewed 105 procedures performed between 2017 and 2024, extracting docking time, operative time, conversion rate, complications, and length of stay. Median docking time decreased from 45 to 15 minutes, and operative time also significantly shortened over time, illustrating a robust learning curve. The conversion rate was 0.9%, postoperative complications 1.8% (Clavien 3b), and median hospitalization two days. Compared with historical pediatric laparoscopic cohorts from the literature, robotic-assisted surgery demonstrated comparable or lower complication rates with progressive gains in efficiency. Our findings support robotic-assisted surgery as a safe and effective option in specialized pediatric centers, provided structured training and volume consolidation are achieved.
Virtual Simulation versus Mannequin‑Based Training in Medical Education: Implications for Hand Hygiene and Infection Prevention
Virtual simulation has rapidly emerged as a flexible and scalable modality in medical and nursing education, yet its comparative effectiveness against mannequin‑based and standardized‑patient training remains debated. This narrative review synthesizes recent randomized and quasi‑experimental evidence on clinical competence, learner experience, and downstream hygiene‑related behaviors, with a focus on hand hygiene and infection prevention. A recent meta‑analysis including 27 randomized trials found no significant differences between virtual simulation and mannequin or real‑person simulations for knowledge, procedural skills, clinical reasoning, or communication, although nursing participants showed superior procedural skill acquisition with virtual platforms. Simulation‑based training in general improves clinical performance, decision‑making, and confidence compared with traditional lectures,. In parallel, multilevel, theory‑driven interventions—including feedback, reminders, and participatory training—are the most effective strategies to increase hand hygiene compliance among healthcare workers, suggesting that simulation could be embedded into such frameworks. Integrating virtual simulation into infection‑prevention curricula may offer cost‑effective, high‑fidelity education without compromising learning outcomes.
Surgical Operations Powered by Robotic Technology: Present Realities and Future Horizons
Robotic-assisted surgery has evolved from experimental telemanipulation systems into a mainstream component of modern operative care across urology, gynecology, general surgery, thoracic surgery, and beyond Contemporary platforms integrate articulated instruments, high-definition three-dimensional visualization, and increasingly intelligent software to enhance precision, ergonomics, and minimally invasive access. Evidence suggests that robotic approaches can reduce blood loss, shorten hospitalization, and lower complication rates in selected procedures, although cost and equitable access remain significant constraints. Emerging trends include AI-enabled decision support, digital twins, haptic feedback, miniaturized and task-specific robots, and ultra-low-latency connectivity for tele-surgery, which together may shift surgery from manual craft to data-rich, semi-autonomous intervention At the same time, the ethical landscape is growing more complex, with questions about liability, transparency, surgeon autonomy, and dependency on proprietary platforms. This article reviews the current state of robotic-assisted surgery, highlights key innovations and clinical applications, and discusses future trajectories, challenges, and ethical considerations shaping the next generation of surgical robotics.
Medical complications following procedures in otorhinolaryngology: patterns, mechanisms, and management
Otorhinolaryngologic surgery encompasses a heterogeneous group of procedures in anatomically constrained regions adjacent to critical neurovascular and aerodigestive structures, predisposing patients to distinctive postoperative complications. This narrative review synthesizes contemporary evidence on common and clinically significant complications after thyroid surgery, endoscopic sinus and skull base surgery, airway and laryngeal procedures, otologic and cochlear implantation, and aesthetic or functional nasal surgery. Early complications such as hemorrhage, airway compromise, hypocalcemia, cerebrospinal fluid (CSF) leak, orbital injury, and infectious sequelae are contrasted with late events including persistent vocal fold paralysis, chronic hypoparathyroidism, device failure, and olfactory dysfunction. Risk factors span patient-related (age, comorbidity, obstructive sleep apnea), disease-related (extent, prior surgery, malignancy), and procedure- or surgeon-related determinants (approach, case volume, technology use). Prevention relies on meticulous anatomical planning, standardized perioperative protocols, and early recognition of sentinel signs. Management strategies—from conservative observation to urgent reoperation or multidisciplinary salvage—are outlined with emphasis on functional and quality-of-life outcomes. Future directions include enhanced recovery pathways and data-driven risk stratification to individualize perioperative care in otorhinolaryngology.
Medicine, Medical Education, and Hygiene: Interwoven Pillars of Modern Public Health
Modern medicine increasingly depends on a robust foundation of medical education and rigorous hygiene practices to safeguard public health. Recent trends show that artificial intelligence, simulation‑based learning, and community‑engaged training are reshaping how future clinicians are prepared. At the same time, smart textiles, antimicrobial coatings, and digital monitoring tools are transforming hygiene in healthcare and everyday environments. Integrating infection‑prevention principles early and repeatedly into medical curricula strengthens both clinical competence and patient safety. This article explores how advances in medicine, evolving educational models, and cutting‑edge hygiene innovations interact to build more resilient, equitable, and sustainable health systems.
Artificial intelligence in medical emergencies: what clinical trials are starting to show
Artificial intelligence (AI) is rapidly entering emergency medicine, promising faster triage, more accurate diagnosis, and better allocation of scarce resources. Yet its real benefit depends on clinical trials rather than technical performance alone. This article synthesizes prospective and randomized studies summarized in Cochrane‑indexed and Cochrane‑searching systematic reviews, alongside individual emergency department (ED) and prehospital trials, to examine how AI performs in real emergency settings. We focus on AI‑driven triage, clinical decision support, and prehospital risk prediction, highlighting effects on response times, diagnostic accuracy, and patient outcomes. Across trials, AI tools frequently outperform traditional triage scores and standard decision support on accuracy‑related metrics, but gains in hard clinical outcomes are modest and context‑dependent. Methodological heterogeneity, limited randomization, and workflow integration issues temper current enthusiasm. Overall, AI appears most promising as an adjunct that accelerates and standardizes decision‑making rather than as an autonomous system, underscoring the need for larger, pragmatic trials.
Odontogenic Maxillary Sinusitis: A Borderland Disease Between Dentistry and Otorhinolaryngology
Odontogenic maxillary sinusitis (OMS) is one of the most clinically relevant intersections between dentistry and otorhinolaryngology, yet it remains frequently underdiagnosed and mismanaged. OMS accounts for a substantial proportion of unilateral maxillary sinusitis and often arises as a complication of caries, apical periodontitis, tooth extraction, endodontic therapy, dental implants, or maxillary sinus grafting The resulting sinonasal disease may present primarily to ear, nose, and throat (ENT) clinics, where the dental source is easily overlooked without systematic dental assessment and appropriate imaging This narrative review summarizes contemporary evidence on epidemiology, etiopathogenesis, clinical and radiologic features, and multidisciplinary management of OMS, with emphasis on coordination between dentists and otorhinolaryngologists. Awareness of characteristic unilateral symptoms, radiologic patterns, and typical dental foci is critical to avoid treatment failure after isolated sinus surgery and to optimize outcomes through combined dental and endoscopic sinus interventions
Layered Shields: Multiscale Prevention of Seasonal Viral Diseases
Seasonal viral diseases such as influenza, respiratory syncytial virus, rhinovirus, and seasonal coronaviruses remain leading causes of morbidity, mortality, and health‑system strain worldwide, despite the experience gained during the COVID‑19 pandemic. Prevention now demands an integrated, “layered shields” strategy that combines vaccines, antivirals, non‑pharmaceutical interventions, environmental measures, and host‑directed approaches tailored to risk groups and settings This narrative review synthesizes emerging evidence on climatic and behavioral drivers of seasonality, host–virus–environment interactions, and scalable interventions from community to long‑term care and hospital settings We highlight how immunization, respiratory hygiene, ventilation, and early outbreak detection can be orchestrated into anticipatory preparedness cycles rather than reactive outbreak responses Finally, we outline research priorities for optimizing vaccination schedules, leveraging digital surveillance, and mitigating complications through host‑directed prevention in vulnerable populations such as children, older adults, and immunocompromised patients
Postoperative Complications and Recovery after Surgical Procedures: A 10 Year PRISMA Based Systematic Review
This systematic review synthesizes evidence from the past decade on the most common postoperative complications across surgical specialties and their impact on recovery, following PRISMA methodology. Across 2016–2025, general postoperative complication rates in large cohorts ranged around 20%, with bleeding, surgical site infection (SSI), pulmonary and cardiac events, and postoperative delirium emerging as dominant entities affecting early outcomes. SSIs occurred in roughly 10–25% of patients in high‑risk settings and were frequently driven by multidrug‑resistant Gram‑negative organisms, substantially prolonging length of stay and impairing wound recovery. Multiple studies highlighted that cascades of complications significantly increase mortality, with mortality after any complication reaching almost sixfold that of uncomplicated cases. Recovery trajectories were strongly influenced by preoperative risk profile, procedure complexity, perioperative care, and follow‑up intensity, with structured infection prevention and early mobilization associated with improved functional recovery. Future work should standardize complication reporting and recovery metrics to enable high‑quality meta‑analysis, particularly in low‑ and middle‑income countries where data remain scarce.
Effectiveness of Simulation-Based Learning on Nursing OSCE Performance Among Medical Students: A Quasi-Experimental Multi-Center Study in Uzbekistan
Background: Simulation-based learning (SBL) has emerged as a transformative approach in medical education, yet evidence from Central Asian institutions remains limited. This study aimed to evaluate the effectiveness of SBL on nursing Objective Structured Clinical Examination (OSCE) performance, student satisfaction, and self-confidence among medical students in Uzbekistan. Methods: A quasi-experimental study with a non-equivalent control group design was conducted across three medical institutes: Fergana Medical Institute of Public Health (FMIOPH; experimental group, n=156), Andijan State Medical Institute (ASMI; control group 1, n=170), and Bukhara State Medical Institute (BSMI; control group 2, n=190). All 516 participants were physically and mentally healthy. The experimental group received structured SBL integrated into the nursing curriculum, while control groups followed conventional teaching. OSCE scores, satisfaction, and self-confidence were assessed. Results: FMIOPH students achieved a significantly higher mean OSCE score (84.6±6.2) compared with ASMI (72.3±8.5) and BSMI (69.8±9.1) (F=196.42, p<0.001). Notably, 82.1% of FMIOPH students scored ≥80%, compared with 31.8% at ASMI and 24.7% at BSMI (χ²=131.56, p<0.001). Satisfaction (4.32±0.51 vs. 3.64±0.73 and 3.51±0.78) and self-confidence (4.18±0.55 vs. 3.42±0.69 and 3.31±0.74) were also significantly higher in the experimental group (p<0.001). Conclusion: SBL significantly enhances nursing OSCE performance, satisfaction, and self-confidence among medical students. These findings support the integration of simulation-based methodologies into nursing education curricula across medical institutions in Uzbekistan and similar settings.
Internationalisation, Evidence-Based Practice, and Persistent Gaps in Uzbek Medical Education: A Systematic Narrative Review
Uzbekistan, a Central Asian nation of ~36 million people, has substantially reconfigured its medical education system since the Soviet era, with reforms accelerating after 2010 under successive presidential administrations. This systematic review synthesises English-language and grey literature on post-2010 medical education reforms in Uzbekistan. A structured search of major bibliographic databases and institutional repositories (2015–2025) identified 825 records, of which 66 studies and policy documents met inclusion criteria following PRISMA 2020 procedures. Five key domains emerged: (1) structural and policy reforms driven by presidential decrees, notably Decree UP-5590 (2018); (2) transformation of undergraduate curricula from Soviet-legacy specialist training toward competency- and outcome-based frameworks; (3) persistent gaps in evidence-based medicine and research methodology training; (4) challenges in postgraduate and continuous professional development systems, including fragmented continuing medical education; and (5) internationalisation, reflected in rising foreign student enrolment and partial adoption of international accreditation standards. Prominent contributors to this literature include Asadov, Aripov, Ahmedov, Rechel, and Muratalieva. Despite visible progress toward an internationally oriented, competency-focused model, implementation remains constrained by corruption in admissions, brain drain, and underfunding. The pace of evidence-based reform lags behind policy ambition, underscoring the need for rigorous outcome evaluations, sustained faculty development, and accreditation efforts aligned with World Federation for Medical Education standards.
Preventive Medicine in Cardiovascular Diseases: Integrating Post Surgical Care and Somatic Disorders such as Tachycardia
Preventive medicine in cardiovascular diseases has transformed clinical outcomes by targeting modifiable risk factors across primary, secondary, and tertiary prevention, yet cardiovascular disease remains the leading global cause of death despite effective therapies. This article reviews contemporary strategies spanning lifestyle interventions, pharmacologic prevention, and structured post‑procedural care, and contrasts their impact in patients with structural cardiovascular disease after surgery and those with somatic rhythm disorders such as tachycardia. Using illustrative datasets, we apply chi‑square tests and logistic regression to compare event rates and risk reduction across preventive strategies, highlighting differential benefits in coronary artery disease, heart failure, and atrial and ventricular tachyarrhythmias. The narrative emphasizes guideline‑directed lipid and blood pressure management, cardiac rehabilitation, and rhythm control, and concludes with practice‑oriented recommendations for integrated, lifelong prevention.
AI-Enhanced Pediatric Robotic and Image-Guided Surgery: Integrating Surgical Data Science and Oncology-Driven Bioinformatics
Artificial intelligence has rapidly entered pediatric perioperative care, spanning diagnostics, surgical planning, robotic-assisted procedures, and postoperative surveillance, yet translation into routine practice remains fragmented compared with adult surgery –. This narrative review synthesizes current evidence on AI-enabled pediatric robotic and image-guided surgery, integrating developments from surgical data science, computer vision, and oncology-focused bioinformatics –,. We highlight clinical use-cases, including AI-assisted preoperative risk stratification, intraoperative navigation, automated pathology, and precision oncology decision support, and contrast them with non-AI robotic programs that rely predominantly on human expertise and ergonomics. While early outcome data suggest at least comparable safety and efficiency, the field faces pediatric-specific barriers such as small, heterogeneous datasets, regulatory constraints, and limited pediatric robotic platforms. Future work must prioritize multi-institutional data sharing, explainable models, and pragmatic trials embedded in pediatric surgical pathways to move from proof-of-concept tools toward trustworthy hybrid human–AI systems.
The Impact of Sport Participation on Mental Health and Physical Fitness Among Medical Students: A Comparative Study of ASMI and FMIOPH Students
Background: Medical education is globally recognised as one of the most psychologically demanding academic environments. Students frequently report elevated rates of burnout, anxiety, and depression, often linked to sedentary lifestyles and inadequate self-care strategies. Regular physical activity and sport participation have demonstrated associations with improved mental wellbeing, yet structured comparisons between institutions with differing sporting cultures remain scarce. Objective: To compare mental health outcomes, physical fitness, sleep quality, stress levels, and academic performance between medical students at Al-Sham Medical Institute (ASMI) and the Faculty of Medicine of the Institute of Postgraduate Healthcare (FMIOPH). Methods: A cross-sectional study was conducted with 178 medical students (89 per institution). Validated tools including the GHQ-12, PSS-10, DASS-21, and Pittsburgh Sleep Quality Index were used to assess outcomes. Independent samples t-tests and chi-squared analyses were applied. Results: ASMI students demonstrated significantly higher physical fitness scores (72.4 ± 9.2 vs. 58.1 ± 11.4, p<0.001), better mental health scores (68.9 ± 10.7 vs. 54.2 ± 12.3, p<0.001), lower perceived stress, and superior academic performance. Sport participation rates were markedly higher at ASMI (68.5% vs. 32.6%, p<0.001). Conclusion: Regular sport participation is strongly associated with improved mental health, reduced stress, better sleep, and higher academic achievement among medical students. Institutions should embed structured physical activity programmes into the medical curriculum.
Recompensation Oriented Management of Chronic Liver Diseases in the Era of Metabolic and Viral Therapies
Chronic liver diseases encompass a spectrum from asymptomatic hepatic injury to cirrhosis with life‑threatening decompensation, and they now rank among the leading global causes of morbidity and mortality. Their etiological profile is rapidly shifting from viral hepatitis toward metabolic dysfunction–associated steatotic liver disease, alcohol‑related liver disease, and complex multimorbidity, while modern antivirals have transformed outcomes in viral hepatitis. Effective management integrates etiologic cure or control, prevention and treatment of portal hypertension and hepatocellular carcinoma, optimization of nutrition and sarcopenia, and timely referral for liver transplantation. Recent guidance emphasizes risk‑stratified surveillance, non‑invasive staging, and multidisciplinary, patient‑centered care to prevent progression and to promote “recompensation” even after decompensation. This narrative review summarizes contemporary concepts in epidemiology, pathophysiology, diagnosis, and comprehensive management of chronic liver diseases across compensated and decompensated stages, highlighting practical approaches applicable to everyday clinical practice.
Oxidative Stress–Inflammation–Fibrosis Axis in Chronic Liver Diseases
Chronic liver diseases share converging biochemical processes driven by oxidative stress, innate immune activation, and maladaptive wound‑healing, culminating in fibrosis and cirrhosis. Reactive oxygen species generated by mitochondrial dysfunction, cytochrome P450 enzymes, and NADPH oxidases modify lipids and proteins, triggering hepatocyte injury and death with release of danger signals and lipid peroxidation products that amplify inflammatory cascades. Pattern‑recognition receptors activate NF‑κB and NLRP3 inflammasomes, promoting cytokine production, pyroptosis, and recruitment of immune cells that further perpetuate oxidative damage and inflammation. These events synergistically activate hepatic stellate cells and portal fibroblasts, driving extracellular matrix deposition, architectural distortion, and ultimately portal hypertension and liver failure. Understanding this oxidative stress–inflammation–fibrosis axis offers an integrated framework to link biochemical markers with molecular pathogenesis and to identify therapeutic targets aimed at interrupting profibrogenic signaling.
Biochemical Orchestration of Viral Infections: From Cellular Entry to Host Metabolic Reprogramming
Viral infections are driven by tightly coordinated biochemical interactions between invading virions and host cells that determine tissue tropism, replication efficiency, and clinical outcome. This article synthesizes current knowledge on major biochemical processes underlying viral infection, from attachment and entry through genome replication, assembly, and egress, with an emphasis on host–virus interplay at the levels of signaling, cell death regulation, and metabolic reprogramming. We discuss receptor engagement, endocytosis and fusion mechanisms, innate immune sensing via pattern-recognition receptors, and downstream interferon signaling and cytokine responses. We then examine how viruses manipulate apoptotic and pyroptotic pathways and remodel host metabolism, including glycolysis, nucleotide biosynthesis, and lipid synthesis, to support replication while evading innate immunity. Finally, we highlight emerging therapeutic strategies that target host metabolic and signaling nodes rather than viral proteins alone, offering broad-spectrum antiviral potential.
Blending Active, Digital, and Simulation-Based Strategies to Teach Therapeutics in Undergraduate Medical Education: An Integrative Review
Modern therapeutics education increasingly relies on active and technology-enhanced methods to prepare undergraduates for safe, rational prescribing and complex treatment decisions. This narrative review synthesizes contemporary evidence on five trending instructional strategies in undergraduate medical therapeutics: problem-based learning, team-based learning, flipped classrooms, simulation-based and virtual patient learning, and structured rational-prescribing curricula such as those inspired by the WHO Guide to Good Prescribing. Recent reviews and pilot studies suggest that active formats, especially flipped and simulation-based designs, outperform traditional lectures in knowledge gains, clinical reasoning, and learner satisfaction, while virtual reality environments appear particularly promising for communication and decision making in therapeutic encounters. Integration of these methods with updated clinical pharmacology and prescribing curricula can close persistent gaps in prescribing competence. Based on current data, we propose a hybrid “Therapeutics Decision-Making Pathway” that sequences case-based, team-based, flipped, and simulation components around a longitudinal prescribing framework to achieve more reliable transfer of therapeutic knowledge to practice.
RNA‑Based Therapeutics: From Molecular Biology to Disease‑Targeted Medicine
RNA‑based therapeutics have emerged as a transformative platform at the intersection of medical biology and human disease. By harnessing messenger RNA, small interfering RNA, antisense oligonucleotides, CRISPR‑associated systems, and aptamers, these modalities can precisely modulate gene expression from the genome to the proteome. This article reviews the molecular foundations of RNA‑based drugs, their mechanisms in oncology, cardiovascular disease, genetic disorders, and infections, and how they reshape the concept of “druggable” targets. A short methods section outlines contemporary in silico, in vitro, and in vivo approaches, and a descriptive Results section is illustrated with a horizontal barplot comparing the number of disease categories targeted by each RNA‑based modality. The growing integration of RNA biology into clinical pipelines underscores a paradigm shift toward highly specific, programmable therapies that mirror the complexity of human disease.
Biochemical Crosstalk Between Diabetes Mellitus and Atherosclerosis: From Hyperglycemia to Plaque Rupture
Diabetes mellitus and atherosclerosis are tightly linked chronic diseases driven by intersecting biochemical pathways centered on hyperglycemia, dyslipidemia, oxidative stress, and inflammation. Insulin resistance and β‑cell failure in type 2 diabetes promote sustained hyperglycemia, which activates polyol and hexosamine pathways, protein kinase C, and the formation of advanced glycation end products (AGEs). These alterations impair endothelial function, modify lipoproteins, and amplify oxidative stress. Atherosclerosis, once viewed as simple lipid storage, is now recognized as an inflammatory disease in which modified low‑density lipoprotein (LDL), foam‑cell formation, and cytokine networks drive plaque initiation and progression. Hyperglycemia accelerates atherogenesis through glycation and oxidation of LDL, engagement of the AGE–RAGE axis, mitochondrial dysfunction, and activation of NLRP3‑ and NF‑κB‑mediated inflammatory cascades. This review summarizes the biochemical basis of diabetes and atherosclerosis and illustrates, with a barplot, the relative contribution of key pathways to vascular injury.
Therapeutic Impact of Oral and Intravenous Antivirals on COVID-19 Outcomes in Clinical Trials
Antiviral drugs remain central to the management of COVID-19, particularly for high‑risk patients at risk of progression to severe disease. This article reviews the therapeutic effects of three key agents—nirmatrelvir/ritonavir, molnupiravir, and remdesivir—drawing mainly on randomized controlled trials and large real‑world effectiveness studies conducted during the pre‑Omicron and Omicron eras. Early placebo‑controlled trials in largely unvaccinated populations infected with ancestral or Delta variants showed substantial relative risk reductions in hospitalization or death, whereas later studies in highly immune populations reported attenuated or null benefits. The mechanisms of action, trial design features, and evolving viral and host factors are examined to contextualize the changing effect sizes. A comparative bar plot and tabular summary illustrate differences in trial settings, endpoints, and approximate risk reduction. The article highlights persistent benefit of nirmatrelvir/ritonavir in selected high‑risk groups, more modest and uncertain effects for molnupiravir, and important but context‑dependent benefit of remdesivir, underscoring the need for ongoing reassessment of antiviral deployment as SARS‑CoV‑2 and population immunity continue to evolve.
Transforming Internal Medicine Training for Hospital and Community Care in the 2020s
Internal medicine faces increasing complexity due to aging populations, multimorbidity, and expanding care transitions between hospital and community settings. This article reviews contemporary internal medicine residency curricula and the evolving interface between hospitalists and outpatient internists, highlighting implications for training and service design. Structured inpatient and ambulatory curricula now emphasize intensive exposure to general wards, critical care, geriatrics, oncology, and longitudinal continuity clinics, supported by formal teaching in communication, evidence-based medicine, and quality improvement. The rapid expansion of hospital medicine has created distinct roles: hospitalists focus on high-acuity, short-term inpatient management and care transitions, whereas clinic-based internists provide long-term, comprehensive care across settings. Aligning postgraduate training with these practice patterns requires clearer competency frameworks, explicit transition-of-care skills, and longitudinal ambulatory experience. This narrative review outlines current models and proposes practical directions for optimizing internal medicine education to support safe, efficient, and patient‑centered care across the continuum.
Harnessing clinical artificial intelligence to combat physician burnout and accelerate research productivity
Clinical workloads and research demands are escalating worldwide, contributing to unprecedented levels of physician burnout and time pressure on medical researchers. This narrative review synthesizes recent evidence on how artificial intelligence (AI), particularly large language models (LLMs), can reduce administrative burden, support clinical decision-making, and augment biomedical research workflows. AI scribes and documentation tools have demonstrated substantial reductions in burnout odds and improvements in perceived job satisfaction by decreasing time spent in electronic health records and enabling clinicians to re-focus on direct patient care. In parallel, LLMs are transforming medical writing, literature synthesis, coding, and data analysis, although concerns persist regarding factual reliability, bias, privacy, and overreliance. This article proposes a pragmatic framework for integrating AI into routine clinical practice and research, emphasizing governance, validation, and human‑in‑the‑loop oversight. By aligning technological deployment with workflow realities, professional values, and ethical safeguards, AI can evolve from a source of hype to an actionable co‑worker, helping clinicians and scientists reclaim time for complex decision-making, innovation, and human connection.
Contemporary treatment options for diabetes mellitus: current challenges and emerging future perspectives
Diabetes mellitus requires multifaceted management integrating lifestyle, pharmacologic, and technological interventions across heterogeneous patient populations. This narrative review summarizes current treatment options for type 1 and type 2 diabetes, focusing on lifestyle modification, established glucose‑lowering agents, and diabetes technologies such as continuous glucose monitoring and automated insulin delivery. It then highlights newer disease‑modifying drug classes, including sodium–glucose cotransporter‑2 inhibitors, glucagon‑like peptide‑1 receptor agonists, and next‑generation dual and triple incretin agonists, alongside advances in precision medicine and digital health. Persistent challenges—such as residual cardiovascular and renal risk, obesity, hypoglycemia, therapeutic inertia, health‑system constraints, and inequitable access—are discussed in the context of global prevalence and resource variability. Finally, the article outlines future perspectives, including mechanistically rational combination therapies, precision diabetes medicine, and artificial intelligence–enabled decision support. Together, these developments aim to shift diabetes care from glucose‑centric control toward holistic, individualized risk reduction and complication prevention.
Methodology for Developing the Communicative and Ethical Competencies of Students in Teaching Palliative Oncology: A Comparative Institutional Study
The integration of communicative and ethical competencies into palliative oncology curricula remains a globally recognized challenge, particularly in Central Asian medical institutions. This study evaluated the effectiveness of an enhanced, multi-modal pedagogical methodology at the Fergana Medical Institute of Public Health (FMIOPH) compared with the conventional curriculum delivered at Andijan State Medical Institute (ASMI). A total of 134 mentally and physically healthy 5th-year students from FMIOPH constituted the intervention group, matched against an equivalent cohort at ASMI studying under an identical 5-year faculty structure. The intervention integrated structured role-play, case-based ethical reasoning, and supervised real-patient consultations into the standard oncology curriculum. Assessment outcomes across three modalities — case-based assessments, written tests, and real patient evaluations — demonstrated that FMIOPH students scored approximately 20% higher than their ASMI counterparts. Independent samples t-tests confirmed statistical significance across all three domains (p < 0.001), with large effect sizes (Cohen's d > 1.3). These findings indicate that structured communicative and ethical training materially improves competency outcomes in palliative oncology education.
EARLY EMERGENCY INTERVENTIONS FOR ACUTE HEART FAILURE: BRIDGING PREHOSPITAL CARE AND ICU OUTCOMES
Acute heart failure and its life‑threatening phenotypes, such as cardiogenic pulmonary edema and cardiogenic shock, remain leading causes of emergency department admission and in‑hospital mortality. Timely recognition and structured emergency aids—from lay bystander actions through prehospital care to early in‑hospital interventions—substantially modify prognosis by limiting hypoxic injury and preventing multiorgan failure. This article synthesizes contemporary evidence and guideline‑aligned practices on airway and breathing support, rapid hemodynamic assessment, vasodilators, diuretics, inotropes, vasopressors, and early revascularization strategies. Particular emphasis is placed on prehospital initiation of therapy, including non‑invasive ventilation and nitrates in hypertensive pulmonary edema, alongside early treatment of reversible triggers such as acute coronary syndromes and arrhythmias. The narrative highlights practical decision points relevant to emergency physicians, intensivists, and paramedics, and concludes with an integrated algorithm that links community recognition with definitive hospital therapies to improve survival and functional outcomes in acute heart failure.
Harnessing the Pediatric Gut–Lung Axis: Microbiome-Guided Strategies Against Childhood Respiratory Disease
The microbiota–gut–lung axis is emerging as a crucial regulator of pediatric respiratory health, reshaping concepts of susceptibility, disease course, and therapy in childhood respiratory infections. Evidence links gut dysbiosis with increased risk and severity of pediatric respiratory tract infections, mediated through altered mucosal immunity and microbial metabolites such as short-chain fatty acids. This article overviews mechanistic insights into gut–lung crosstalk in children and critically appraises microbiome-targeted strategies, including diet modulation, probiotics, synbiotics, fecal microbiota transplantation, and live biotherapeutics. Special emphasis is placed on precision approaches that integrate multi-omics profiling to stratify patients and design tailored interventions. Remaining challenges include heterogeneous clinical data, regulatory uncertainty, and limited studies in low- and middle-income settings. Thoughtful translation of these concepts could transform prevention and treatment of pediatric respiratory diseases by moving from pathogen-centered to ecosystem-centered care.