St. George's School

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive intervention for obesity, bridging the gap between conservative medical therapy and surgical bariatric procedures. ESG reduces gastric volume through endoscopic suturing, creating a tubular gastric sleevewithout gastric resection and with the preservation of native anatomy. This approach offers clinically meaningful weight loss, metabolic improvement, and a favorable safety profile while minimizing procedural risk and recovery time. This qualitative narrative review provides a comprehensive evaluation of ESG, including its historical development, procedural technique, patient selection criteria, mechanisms of action, clinical outcomes, and safety considerations. The comparative efficacy of ESG relative to established bariatric surgeries, including laparoscopicsleeve gastrectomy (LSG) and open sleeve gastrectomy (OSG), is discussed, highlighting ESG's unique balance between effectiveness and minimally invasive design. Evolving applications are also explored, including combination with pharmacologic therapy, use as a bridge to surgery for high-risk patients, and revisional strategies for weight regain after prior non-resective procedures, where preserved gastric anatomy allows safe and effective volume modification. Future directions focus on procedural refinement, optimizing patient selection, combining with adjunct therapies, and integrating into multidisciplinary obesity management. ESG represents a versatile, patient-centered tool that complements existing treatment paradigms, expands therapeutic options, and offers a practical, low-risk alternative for patients seeking minimally invasive treatment for obesity. Its growing adoption underscores its potential to play a central role in contemporary obesity management strategies.

The product information leaflet for metronidazole highlights a potential interaction with propylene glycol-containing substances, which may result in a disulfiram-like reaction. While dentists routinely advise patients to avoid alcohol during metronidazole therapy for this reason, there is limited awareness within the dental profession that e-cigarette liquids also contain propylene glycol and may pose a similar risk. This case report highlights a suspected drug interaction between metronidazole and propylene glycol from e-cigarette use, leading to a disulfiram-like reaction in a healthy 25-year-old male. Thorough history-taking and clear patient guidance regarding vaping habits are essential for the safe prescribing of metronidazole and vigilant monitoring for adverse reactions, as outlined in the practice recommendations at the end of this report.

IntroductionStroke is a major cause of global morbidity and mortality. Readability of educational material is critical for rapid clinical decision-making among healthcare professionals. UpToDate (UpToDate, Inc., Waltham, MA) is a widely used, peer-reviewed point-of-care clinical resource, while ChatGPT (OpenAI, San Francisco, CA) is an emerging AI-based educational support tool. However, a formal comparison of their linguistic accessibility has not been performed.ObjectiveTo compare the readability and linguistic complexity of educational material on stroke generated by ChatGPT (GPT-4o) versus content retrieved from UpToDate, using validated readability metrics.Design, setting, and participantsThis cross-sectional study was conducted between May 27 and June 4, 2025. ChatGPT (GPT-4o, accessed May 27, 2025) was prompted to generate educational content on stroke. A corresponding section from UpToDate (accessed May 27, 2025) was extracted. Only prose content was analyzed. Readability parameters assessed included total word count, sentence count, word/sentence ratio (average words per sentence), Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index, difficult word count, and difficult word percentage. Data were analyzed using IBM SPSS v25 (IBM Corp., Armonk, NY) and R v4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). The Mann-Whitney U test was used. P < 0.05 was considered statistically significant.ResultsUpToDate content was substantially longer (median = 2772 vs. 304 words; p = 0.008) and used more sentences (median = 134 vs. 23; p = 0.032) and difficult words (median = 857 vs. 88; p = 0.008) compared to ChatGPT. The word/sentence ratio (average words per sentence) was also higher (21.7 vs. 13.2; p = 0.008). However, no statistically significant differences were observed for FRE (p = 1.000), FKGL (p = 0.222), SMOG Index (p = 0.151), or difficult word percentage (p = 0.690).ConclusionsChatGPT produces shorter and more concise educational content on stroke while maintaining comparable readability to UpToDate. The lower linguistic density may enhance rapid orientation for trainees; however, the reduced depth indicates ChatGPT should supplement, not replace, established peer-reviewed resources. Future research should explore multiple medical topics, additional AI models, and assess the clinical applicability and accuracy of AI-generated content.

This essay explains how tiny plastic particles, called microplastics, get into bottled water. It starts with how plastic pellets used to make the bottles are often spilled into the ocean during shipping. Then, the process of manufacturing the bottles creates microplastic dust and fragments that would contaminate the water. The final steps of filling and capping the bottles, especially the act of screwing on the cap, are also major sources of these plastic particles. Storing and reusing plastic bottles makes the problem worse. Studies show that microplastics leak into the water from the bottle's inner walls, especially when bottles are reused multiple times or exposed to heat, such as in a hot car or microwave. This means that from the very beginning of making a plastic bottle to when we drink from it and reuse it, microplastics are constantly being released, creating a serious pollution problem.

Black Salve is an escharotic used in alternative medicine for the treatment of a variety of skin conditions, including benign growths and skin cancers. These products are readily available on the Internet, are unregulated, and are used by patients seeking non-surgical cures. We present a case study of a basal cell carcinoma (BCC) self-treated with this agent. The patient meticulously documented every step of treatment, providing invaluable information for medical professionals in understanding, counseling, and properly managing such clinical scenarios involving escharotic use.

[This corrects the article DOI: 10.7759/cureus.57338.].

Surgical drains remain a common adjunct in general surgery to prevent fluid collections and detect early postoperative complications. However, their routine use and timing of removal continue to generate debate. This review analyzes evidence-based criteria for drain removal, identifies complications related to prolonged use, and evaluates evolving trends in drain management across gastrointestinal, hepatobiliary, pancreatic, and abdominal wall procedures. The evidence consistently supports early drain removal typically once drainage output is <50 mL/24 h and non-bilious or non-hemorrhagic being associated with lower rates of surgical site infection, fistula formation, and hospital stay duration. Conversely, delayed removal beyond postoperative day five to seven increases the risk of infection, prolonged inflammation, and wound complications. Biochemical monitoring, particularly amylase and bilirubin levels in pancreatic and biliary drains, enables safer, individualized removal decisions. Early, criteria-based, and selective drain management integrated within Enhanced Recovery After Surgery (ERAS) frameworks improves postoperative outcomes and reduces morbidity in general surgery. These findings emphasize the importance of tailored protocols and continued refinement of evidence-driven drain removal practices.

Depression and suicidality are typically treated with a combination of medication and cognitive-behavioral therapy. However, for many individuals, especially those dealing with trauma or a loss of meaning, these approaches may not fully address the deeper layers of distress. Emerging research points to the potential value of incorporating spiritual and meaning-centered practices into psychiatric care. This case report describes a 24-year-old mixed-race woman who presented with suicidality following a sexual assault and long-standing feelings of purposelessness. After stabilization, she was referred to spiritually integrated therapy by her outpatient psychiatrist and also received support from her spiritual community. Her treatment centered on developing spiritual qualities, building a sense of purpose, and engaging in acts of service. Over time, she showed significant emotional and psychological improvement. Her case highlights how meaning-focused and spiritually informed care can support long-term healing, especially in individuals facing existential challenges.

The type I interferon (IFN) response is crucial for cells to restrict viral replication during infection. Many viruses, including human cytomegalovirus (HCMV), have evolved mechanisms to antagonise the type I IFN response. We have previously observed an increase in protein expression of certain interferon stimulated genes (ISG) when comparing the high passage HCMV strain AD169 compared to the low passage strain HCMV Merlin, suggesting that AD169 is defective in its ability to inhibit type I IFN function. To better understand HCMV interaction with the type I IFN response, we examined expression of cellular and viral proteins expressed in Merlin- and AD169- infected cells associated with IFN production and signalling. HCMV IFN antagonists expressed by both viruses had differences in amino acids throughout their protein sequences, although analysis using AlphaFold revealed no obvious differences in the total structure of these proteins. Analysis of quantitative mass spectrometry datasets showed modest differences in the expression of cellular IFN associated proteins between strains. Contrary to previously reported data, we found no obvious loss of IRF3 expression, though this may be due to experimental differences between studies. These data revealed that multiplicity of infection was an important factor in IRF3 expression. We found little or no difference in the production of IFN-β RNA between Merlin- and AD169- infected cells in RT-qPCR assays and little or no difference in replication of AD169 and Merlin in virus replication assays. Overall, these data suggest different strains of HCMV had different, albeit modest, abilities to influence the expression of type I IFN pathway proteins during infection, but this had no overall impact on the ability of different strains to produce a type I IFN or to replicate.

Quantum gyroscopes have the advantages of high precision and drift-free, and are extensively applied in high accuracy spacecraft attitude control, but it is extremely sensitive to quantum noise, zero-bias drift and nonlinear errors under complex space conditions, which directly affect the accuracy of attitude solving. According to the well-established quantum gyro error models, including the random walk model and Markov error modeling, We propose a multi-channel error physics model, which integrates the non-Gaussian error modeling, multi-scale quantum state perturbation analysis and sensor-environment interaction coupling mechanism (MCEAM-AKF). In this section we use the error propagation equation to obtain the response matrix as influenced by noise under the evolution of quantum state, not only the noise responses of device linear part but also the nonlinear terms of state transition, which is the internal state decoherence phenomenon of the device. Then a model and augmented state based adaptive Kalman filter algorithm is designed, which integrates the time-varying error covariance estimation mechanism and the multi-layer scale observation update strategy and achieves the real-time dynamic correction of the attitude angle output error. Furthermore, external reference sources (e.g., star sensors) for closed-loop joint calibration accordingly to the movements to enhance the anti-interference ability and fast convergence performance are introduced in the model. Simulation results demonstrate that the average attitude angle error of MCEAM-AKF model can be decreased by $38.2 \%$ for different orbit and disturbance scenarios.