Citations

Background Educational conferences play a crucial role in advancing global health by addressing challenges in diverse settings and fostering bidirectional knowledge exchange. Many new healthcare providers in Ghana lack hands-on experience in life-saving emergency skills, which is further compounded by limited resources and inadequate infrastructure. This highlights the need for targeted educational initiatives. Methods This paper describes a 3-day conference, the Young Doctors Conference, hosted by a non-governmental organization and aimed at improving emergency care skills for early-career healthcare professionals in Ghana. The conference includes interactive sessions on basic life support, newborn resuscitation, obstetric emergencies, point-of-care ultrasound, and communication case studies. An observational study was done using anonymous surveys that were conducted over four years to assess participants’ experiences and the conference’s impact. Results A total of 95 new physicians responded (out of 127), with over 90% reporting being ‘very satisfied’ with the conference. Common descriptors included “high quality,” “useful,” and “inspirational.” Furthermore, 100% of participants rated the quality of the conference as ‘very high’ or ‘high’. Basic life support training significantly increased comfort in managing cardiac arrest and breathing difficulties, while newborn resuscitation improved confidence in caring for critically ill infants. Additionally, 100% of participants stated they were ‘likely’ or ‘highly likely’ to attend again. Conclusions The Young Doctors Conference has been highly rated as an effective initiative in advancing emergency care communication and education. It serves as a valuable model for similar programs in other resource-limited settings, improving skills, communication, and confidence among early-career healthcare professionals. These findings highlight the need for ongoing hands-on education within Ghana’s healthcare system and how partnerships can fill these gaps. Future research is needed to examine long-term outcomes of this conference.

Abstract Background Distinguishing physiological cardiac adaptation from pathological remodeling in endurance athletes is challenging. While the athletic heart typically demonstrates balanced biventricular enlargement, extreme exercise may rarely trigger disproportionate right ventricular (RV) changes that challenge diagnostic classification. Case Summary A 47-year-old male ultra-endurance athlete presented with exertional symptoms three months after recovery from a pulmonary embolism (PE). Initial post-PE echocardiography was normal. After resuming extreme training, he developed severe RV dilation (basal diameter 5.7 cm on echocardiography; RV volume index 92 cc/m² on cardiac magnetic resonance imaging) disproportionate to the left ventricle, with preserved systolic function and no late gadolinium enhancement. Cardiopulmonary exercise testing revealed significant chronotropic incompetence with below-expected peak oxygen uptake for his elite training status. Symptoms and ventricular ectopy improved with detraining, but severe RV dilation persisted. Evaluation excluded arrhythmogenic cardiomyopathy and significant pulmonary vascular sequelae. Discussion This case illustrates disproportionate RV remodeling precipitated by the resumption of extreme exercise in a susceptible athlete post-PE. The temporal dissociation from the PE and absence of residual clot burden implicate exercise-related hemodynamic stress as the primary driver, challenging the boundary between physiological adaptation and maladaptation. These findings highlight a potential maladaptive response to extreme exercise, possibly potentiated by a prior vascular insult, and underscore the value of integrated functional assessment and monitored detraining in athletes with borderline findings.

Abstract Vitamin C has been long recognized as an important nutrient for skeletal biology, historically attributed to its role in collagen synthesis and connective tissue integrity. Recent studies, however, reveal vitamin C as a critical epigenetic regulator of cellular differentiation. As a required cofactor for α-ketoglutarate-dependent dioxygenases, vitamin C controls the enzymatic activity of a broad array of histone and DNA demethylases, thereby modulating chromatin accessibility and driving cell-specific gene expression. This review provides a novel, integrated perspective that directly links vitamin C’s epigenetic functions to osteogenesis and skeletal health, highlighting experimental evidence that redefines its role beyond collagen maturation and antioxidant defense, and elucidating its sex-dimorphic effects. Importantly, inadequate vitamin C status remains widespread across diverse socioeconomic groups even in Western countries, with low vitamin C intake associated to higher risk of osteoporosis and fractures in the elderly. Viewed through the dual lenses of epigenetic-mechanistic function and clinical relevance, vitamin C emerges as a central epigenetic determinant of skeletal health and a safe, low-cost, and scalable adjuvant to complement current bone therapies. Integrating nutrient epidemiology, clinical data and epigenetic-mechanistic insights may enable targeted interventions to enhance skeletal resilience, particularly in vulnerable populations.

Abstract Background and Aims Upadacitinib (UPA)—an oral, reversible selective Janus kinase inhibitor—has a favorable benefit–risk profile for patients with Crohn’s disease (CD) and ulcerative colitis (UC). We evaluated the benefit–risk of UPA in select subgroups with CD or UC. Methods Patients were randomized to UPA 45 mg (UPA45) once daily (QD) or placebo (PBO) induction for 12 (CD: U-EXCEED, U-EXCEL) or 8 weeks (UC: U-ACHIEVE, U-ACCOMPLISH). Clinical responders were re-randomized to QD UPA 15 mg (UPA15), UPA 30 mg (UPA30), or PBO for 52-week maintenance (CD: U-ENDURE; UC: U-ACHIEVE). This exploratory post hoc analysis assessed efficacy and safety outcomes (adverse events of special interest [AESIs]: serious infections, major adverse cardiovascular [CV] events, malignancies, and venous thromboembolic events) by CV risk, prior treatment failure, and age. Results This analysis included 1021 patients with CD and 1097 with UC during induction, and 673 with CD and 746 with UC during maintenance. Improved efficacy outcomes comparable to the overall study populations were observed with UPA versus PBO across subgroups. Patients receiving UPA30 generally showed numerically higher rates of improvements versus UPA15. AESI rates were generally comparable between UPA and PBO across subgroups except for numerically higher rates of herpes zoster and serious infections in CD with UPA. Conclusions UPA resulted in consistent benefit versus placebo across CV risk, prior treatment failure, and age subgroups. No treatment differences were seen in AESIs across subgroups except herpes zoster and serious infections, reinforcing the favorable benefit–risk profile for UPA in CD and UC seen in the overall study populations. Clinical trial numbers NCT02819635, NCT03653026, NCT03345836, NCT03345849, NCT03345823

Abstract Introduction There are limited data on the impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) on the risk of recurrent pouchitis after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC). Methods A retrospective cohort study was conducted in the TriNetX Research Network in adult patients with obesity and IPAA for UC with a history of pouchitis in whom a GLP-1RA was initiated compared to those patients in whom a GLP-1RA was not initiated. The primary outcome was the risk of recurrent pouchitis within 12 months. The secondary outcomes were mean number of antibiotic prescriptions, anti-diarrheal medication use, Crohns-like disease of pouch (CLDP), and pouch excision. One-to-one propensity score matching was performed. Results We identified 43 UC-IPAA patients with obesity and history of pouchitis (mean age 51.7 ± 14.7 years, mean body mass index [BMI] 34.4 ± 6 kg/m2, 60.4% female). After propensity score matching, the GLP-1RA cohort had a significantly decreased risk of recurrent pouchitis (26.3% vs 52.6%; adjusted odds ratio [aOR], 0.32; 95% CI, 0.12-0.84) compared to the control cohort. Mean antibiotic prescriptions were numerically lower in the GLP-1RA cohort (2 vs 4.4, P = .16). Anti-diarrheal medication use was lower in the GLP-1RA cohort (18.4% vs 47.3%; aOR, 0.23; 95% CI, 0.07-0.67). There was no difference in the risk of CLDP. Zero patients required pouch excision in both cohorts. Conclusion Our study in a small cohort of patients with UC-IPAA and obesity with a history of pouchitis showed that GLP-1RA use was associated with decreased risk of recurrent pouchitis and anti-diarrheal medication use.

Artificial intelligence (AI) is increasingly shaping pediatric spine care, leveraging its rapid advancements in healthcare to improve efficiency, accuracy, and disease understanding. Moreover, machine learning and deep learning excel at detecting complex patterns. This holds promise in processing spinal deformity data, with the potential to surpass traditional statistical methods in predictive accuracy. Challenges persist, however, including unclear clinical implementation guidelines, limited model transparency, and ethical concerns surrounding data privacy and bias. Small sample sizes and the need for larger, diverse datasets further complicate integration. In order to realize AI’s transformative potential in pediatric spine care, these critical obstacles must be addressed for effective and ethical clinical adoption. This review examines the role of AI through applications such as image sorting, surgical outcome prediction, forecasting of spinal curve progression, and vertebral volumetric analysis using deep reasoning. It also explores possible intraoperative contributions from AI, including robotics and optimized screw trajectory planning, and the potential of large language models in clinical practice.

ABSTRACT The American Board of Dermatology (ABD) Continuing Certification Program (CCP) for board‐certified dermatologists helps advance its vision, which includes quarterly web‐based knowledge assessments. In 2022, the ABD began a review of gaps in knowledge assessment, practice improvement reporting, and areas of educational interest. The American Board of Medical Specialties directed member boards to share frequently occurring deficits with specialty societies to identify and prioritize gaps. This report summarizes pediatric dermatology findings from this review.