Avalon University School of Medicine

Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are standard treatments for Multivessel Coronary Artery Disease (MVD). Their long-term comparative effectiveness remains debated. A systematic review and meta-analysis of randomized and observational studies was conducted, including patients with MVD followed for ≥5 years. Data were pooled using randomor fixed-effects models, depending on the level of heterogeneity. Thirteen studies met the inclusion criteria. CABG was associated with reduced all-cause mortality (RR 0.82, 95% CI 0.72-0.91) and fewer repeat revascularizations (RR 1.98, 95% CI 1.74-2.26) compared with PCI. Stroke risk was slightly higher after CABG. Findings suggest CABG provides superior survival and event reduction in long-term follow-up, particularly in higher-risk subgroups. However, the modestly increased stroke risk highlights the need for individualized decision-making, taking into account patient comorbidities, anatomy, and surgical suitability. CABG offers long-term survival and durability advantages over PCI in MVD, while PCI remains suitable for patients with lower-risk anatomy or when surgery is contraindicated.

Myocardial bridging is a congenital coronary anomaly in which a segment of a coronary artery travels intramyocardially instead of on the epicardial surface. While often asymptomatic, myocardial bridging can occasionally result in ischemia or arrhythmias. We present the case of a 37-year-old woman with recurrent exertional chest pain and exercise-induced hypotension. Stress testing revealed mild anterior ischemia, and coronary angiography demonstrated a mid-left anterior descending myocardial bridge. Intravascular ultrasound confirmed extensive systolic compression with increased plaque burden at the bridged site. Medical therapy with vasodilators and beta-blockers was not tolerated due to adverse effects, and symptoms persisted. The patient underwent surgical unroofing of the bridged segment, which resulted in complete resolution of chest pain and improved exercise tolerance. This case highlights the role of advanced imaging in the diagnosis of MB and the importance of individualized management when medical therapy fails.

Background:Hurricane Helene introduced significant disruptions in the intravenous (IV) fluid supply chain. Ambulatory surgery centers were particularly affected, necessitating fluid conservation without compromising safety. Preoperative liquid carbohydrate loading is a promising intervention to improve outcomes while reducing IV fluid use. This study evaluated the effectiveness of liquid carbohydrate protocols during periods of resource strain.Methods:Patients from ambulatory surgery centers were divided into a liquid carbohydrate protocol group (LPG, n = 58) after Hurricane Helene and a control group (CG, n = 58) before the disaster. The LPG consumed 355 mL of Gatorade and 355 mL of water 3 hours preoperatively, whereas the CG followed standard fasting protocols. Outcomes of interest included intraoperative IV fluid use, postoperative antiemetic use, postanesthesia care unit stay length, surgical delays, and protocol adherence.Results:IV fluid intake was 1460 mL in the LPG and 1820 mL in the CG (P = 0.041). One patient in the LPG required an antiemetic versus 3 in the CG (P = 0.612). The mean postanesthesia care unit recovery time was 103 and 100 minutes in the LPG and CG, respectively (P = 0.721). There was 1 surgical delay in the CG and 6 in the LPG (P = 0.051). The compliance rate in the LPG was 58.6% and that in the CG was 98.3% (P < 0.001)Conclusions:Consuming liquid carbohydrates preoperatively reduced intraoperative IV fluid use, but did not improve nausea or recovery time. Liquid protocol patients were less compliant and had more surgical start delays. These findings suggest that liquid carbohydrate protocols may not be feasible during fluid shortages.

Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that profoundly compromises patients’ quality of life. Early and accurate diagnosis remains a clinical challenge, with voice signal analysis emerging as a promising non-invasive biomarker. Unlike the classical vowel sounds used in existing studies, we present a new PD sound dataset that includes a Turkish word "gofret" vocalized by the PD and control groups. The collected dataset was converted into images using Mel - Frequency Cepstral Coefficients (MFCCs), spectrograms, chromograms and tempograms in order to develop vision-based deep learning models from audio recordings. To mitigate data scarcity and enhance model generalizability, a suite of data augmentation strategies including frequency masking, time stretching, shifting and masking were systematically applied. In this study, alternative deep learnnig architectures were developed and their performances were compared. Quantitative evaluations, employing rigorous cross-validation protocols, demonstrated superior classification performance of spectrogram-based models with 85.6% accuracy in PD diagnosis, underscoring their robustness in capturing pathological vocal characteristics. The findings advocate for the integration of advanced augmentation techniques and multifaceted acoustic representations to bolster automated PD detection efficacy from voice data.

Background A study at Xavier University School of Medicine introduced an integrated-shared teaching model to address the challenges of medical education. This new approach combines physiology, biochemistry, and pathology into single, organ-system-based sessions, aiming to reduce content redundancy and promote a holistic understanding. This integrated model uses cognitive learning theory to improve retention. By linking subjects like physiology and pathology, it helps students form interconnected mental frameworks called schemata. This reduces cognitive load, moving beyond simple memorization to a deeper, more meaningful understanding that's easier to apply in clinical practice. MethodsThe study included 73 medical students across two cohorts (first-year MD3 and second-year MD5). It used a one-group pretest-posttest design with clinical vignette questionnaires. In addition to the integrated lectures, students participated in interactive in-class assignments, like one-line answers and flowcharts, to encourage real-time engagement and provide formative feedback. ResultsThe results showed significant improvement in learning outcomes for both groups. The first-year MD3 students’ average scores rose from 5.19 to 7.40, while the second-year MD5 students' scores increased from 2.73 to 4.87. Both results were statistically significant (p-value&lt;0.001). In-class activity scores, which averaged 4.45 for MD3 and 3.82 for MD5, confirmed high levels of student engagement and participation. Conclusions In conclusion, this integrated-shared teaching model, when combined with in-class assessments, demonstrably improves knowledge acquisition and retention in basic science medical education. By fostering interdisciplinary connections and reducing cognitive load, this method helps cultivate the critical thinking skills essential for future medical professionals.

Understanding the challenges of telehealth interventions is essential to determining their future direction in cancer pain management, as these are considered complex interventions. This systematic review aimed to identify the challenges associated with telehealthbased interventions in cancer pain management. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A systematic search was conducted from January 19 to February 2, 2022, covering the past 10 years. Databases searched included PubMed and EBSCO. Inclusion criteria were articles published in English focusing on cancer pain in patients with any cancer diagnosis. Data were extracted on participants, interventions, and outcomes, with a particular focus on challenges reported in each study. A total of 320 publications were retrieved and screened; 38 articles met the inclusion criteria. The most reported challenge was limited or slow Internet access, followed by lack of technological expertise among healthcare teams and low computer literacy. Human resource-related challenges were also frequently reported, including inadequate reimbursement mechanisms, concerns over malpractice, increased staff workload, and absence of formal organisational structures. In studies conducted after the COVID-19 pandemic, data-related issues such as data security and management were also highlighted. Telehealth is a rapidly growing technology with the potential to transform healthcare delivery. Addressing the challenges identified in this review may help guide the development and implementation of more effective telehealth interventions in cancer pain management.

This systematic review examines the safety and efficacy of ketogenic diets (KD) in multiple sclerosis (MS) management. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched five major databases through April 2025, identifying six relevant studies published between 2017 and 2024. These studies, predominantly focusing on relapsing-remitting MS, demonstrate consistent benefits of ketogenic interventions across multiple domains. Findings suggest KD normalizes gut microbiome composition, reduces pro-inflammatory markers (ALOX5, COX1, COX2), improves body composition with favorable changes in adipokines (decreased leptin, increased adiponectin), and enhances clinical outcomes, including fatigue, depression, sleep quality, and quality of life measures. Objective neurological improvements were observed in Expanded Disability Status Scale (EDSS) scores, walking ability, and manual dexterity. Adherence rates were notably high, with benefits partially persisting after intervention completion. The metabolic shift induced by ketosis may provide alternative neuronal energy substrates, reduce oxidative stress, and attenuate neuroinflammation. Despite limitations including small sample sizes and study heterogeneity, these preliminary findings suggest KDs represent a promising adjunctive approach in MS management, addressing both inflammatory and neurodegenerative components of the disease. Larger, controlled trials with longer follow-up periods are warranted to establish long-term safety and efficacy profiles.

Data sharing not applicable–no new data generated, or the article describes entirely theoretical research.