Journal of Advances in Medicine and Medical Research

A Proposed Minimum Photographic Documentation Framework for Oral and Maxillofacial Surgery

Apurva Apurva — 2026-06-06

Background: Clinical photography is an essential but inconsistently standardised tool in oral and maxillofacial surgery, providing objective documentation of facial and intraoral structures for diagnosis, treatment planning, follow-up, education, and medico-legal record keeping.

Aims: To propose a minimum photographic documentation framework for oral and maxillofacial surgery that addresses clinical assessment, outcome reporting, consent, storage and publication use.

Study Design: Policy paper based on narrative synthesis of published literature.

Place and Duration of Study: Not applicable; no clinical or institutional data collection was performed.

Methodology: A narrative literature search was performed using PubMed and manual screening of reference lists from relevant articles. Search terms included clinical photography, medical photography, cranio-maxillo-facial photography, oral and maxillofacial surgery, orthognathic photography, cleft photography, intraoral photography, smartphone clinical photography, patient consent, image storage and three-dimensional imaging. Peer-reviewed articles directly relevant to technical, clinical, ethical or reporting aspects of photographic documentation were prioritised. The evidence was synthesised into a practical minimum framework for routine oral and maxillofacial practice.

Results: Photographic documentation supports diagnosis, treatment planning, serial comparison, teaching, audit, research and medicolegal records. Variation in head position, camera distance, lighting, background, facial expression, occlusion, intraoral technique, image labelling, consent and storage can reduce reliability. Non-standardised images may distort perceived facial form, dental display, lesion size and surgical outcome.

Conclusion: Oral and maxillofacial units should adopt minimum photographic documentation standards that integrate reproducible image acquisition, use-specific consent, secure storage, reliable retrieval and controlled use for clinical care, teaching, audit, research and publication.

Assessment of Systemic Immune-Inflammation Index (SII) and Systemic Inflammatory Response Index (SIRI) in Patients Undergoing Bariatric Surgery

Nuriye Esen Bulut — 2026-05-29

Background: Obesity became an important health problem in last years. It’s relation with many inflammatory markers and indexes were studied.

Aim: The present study aimed to analyze the role of Systemic Immune Inflammation Index (SII) and Systemic Inflammatory Response Index (SIRI) in bariatric surgery.

Materials and Methods: Single-center, observational, cross-sectional, and retrospective study was carried out. Data about demographics, comorbidities, excess weight loss (EWL), as well as body mass index (BMI) , laboratory results, and inflammatory markers including platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR) were recorded preoperatively and postoperatively at 1^st, 6^th, 12^th and 24^th months. The SII and SIRI values also calculated preoperatively and at 1^st, 6^th, 12^th and 24^th months after surgery.

Results :A total of 149 patients operated on by a single surgeon were studied. The mean age of the patients was 36.77±11.39 (18-66). When we compare the preoperative and postoperative values of SII and SIRI, all values were decreased after bariatric surgery.

Conclusions: Inflammatory indexes, SII and SIRI were decreased after bariatric surgery. Although there was a weak correlation between EWL and SIRI only at the postoperative 24 months, there was no clear relationship in between EWL and SII/SIRI in all other time periods.

Screen Time Duration and Its Association with Sleep Disorders in Medical Students

Rebwar Ghareeb Hama — 2026-06-05

Background: Digital device uses such as smartphones, tablets, laptops and even modern televisions are widely used by university students from all fields, and especially medical students. These electronic devices have become essential to the students’ academic and social life. Recent evidence shows that prolonged screen exposure during evening and late-night hours, might affect sleep quality negatively because of their continuous and long-term use, and leading to a poorer sleep quality. Medical students are therefore at more risk to face sleep problems due to their studying schedules that require screen-based device during their studying time.

Objectives: To describe the associations between electronic device use and sleep quality among medical students of different universities in the Kurdistan Region of Iraq.

Methods: The research was done as a questionnaire based Cross-sectional study among undergraduate medical students from different medical colleges across the Kurdistan Region of Iraq between March and April 2024. Data were collected by using an online survey distributed through Google Forms. The questionnaire included these data (sociodemographic information, sleep characteristics, and screen use pattern). Sleep characteristic measurements included bedtime, wake-up time, sleep latency, sleep duration, and subjective sleep quality. Data were analyzed using IBM SPSS Statistics version 27, and descriptive statistics and comparing the analyses were performed to explore associations between device use and sleep outcomes.

Results: With the response of total 331 medical student who participated in study from different medical colleges of Kurdistan Region of Iraq. In average their mean age was 21 years old and 59.3% of the students were female. Approximately half of the participants were in pre-clinical stages and the other half in clinical stages. About 70.7% of students reported using electronic devices before bedtime. The average sleep duration was about 7 hours per night, the mean sleep quality score was 4.05 ± 2.26 on a 10-point scale, and the mean sleep latency was 20.77 ± 8.10 minutes. Students that used electronic devices before bedtime reported slightly poorer sleep quality and longer sleep latency compared to those that did not use devices before sleep. These mentioned differences were not statistically significant even though screen use before sleep continuously was resulting in later bed times.

Conclusion: The usage of electronic screen-based devices before bedtime is highly frequent among medical students in the Kurdistan Region of Iraq. While bedtime device use showed a tendency toward poorer sleep quality, but their relationship in this study was not statistically significant. The results show the widespread relation of digital devices into student’s routines and explaining the need and necessity for further research on behavioral factors influencing sleep health among medical students.

Awareness of Hypnotherapy Practice in Malaysia among Clinical Medical Students: A Cross-sectional Study

Gauri Krishnaswamy — 2026-06-13

Background and Aims: Complementary and Alternative Medicine (CAM), particularly clinical hypnotherapy, has gained increasing recognition as an evidence-based adjunct therapy in modern healthcare. Despite its demonstrated efficacy in managing conditions such as anxiety, stress, and chronic pain, a notable “support gap” persists due to insufficient integration into medical education. This study aimed to evaluate the awareness and perceptions, knowledge levels and barriers of clinical hypnotherapy among clinical-year medical students in four Malaysian universities.

Study Design: A cross-sectional survey.

Place and Duration of Study: MAHSA University, the National Defence University of Malaysia (NDUM), Taylor’s University, and UCSI University. The duration of the study was from March 2025 till February 2026.

Methodology: A multicenter survey was conducted among 215 clinical-year medical students from four Malaysian universities. A structured 10-item questionnaire comprising five domains (demographics, awareness, attitudes, perceived barriers, and learning factors) was developed following a literature review and expert panel review. The instrument was pilot tested among 30 students and demonstrated good reliability (Cronbach's α = 0.87). The questionnaire was administered online using Google Forms. The minimum required sample size was calculated as 261 participants from a population of 810 students at a 95% confidence level and 5% margin of error. Clinical-year students who provided consent were included, while preclinical students and incomplete responses were excluded. Data were analysed using SPSS version 26.0 and summarized using descriptive statistics and Chi-square tests.

Results: Findings revealed limited formal exposure to CAM, with only 17.2% of respondents having attended related educational sessions. However, 52.1% reported awareness of hypnotherapy, largely influenced by informal sources such as social media. Students most recognized its role in anxiety and stress reduction (79.8%) and insomnia (65.8%), while fewer identified its applications in conditions such as irritable bowel syndrome. Perceptions were generally positive, particularly regarding preoperative anxiety reduction, although uncertainty remained for chronic disease management and treatment compliance. The key barriers included limited clinician awareness, patient skepticism, and perceived lack of scientific evidence. Most participants expressed interest in structured CAM education, favoring a multimodal approach integrating lectures, case discussions, and curriculum inclusion.

Conclusion(s): Awareness of hypnotherapy among medical students is moderate and formal education remains insufficient. Integrating evidence-based CAM content into medical curricula may help bridge the support gap and enhance future clinical practice.

Online Search Trends and Quality of Web-Based Information on the Relationship Between Periodontal and Cardiovascular Diseases Worldwide

Mehmet Murat TASKAN — 2026-06-13

Background: Periodontal disease is a highly prevalent chronic inflammatory condition increasingly linked to cardiovascular disease, yet the quality and accessibility of online information regarding this association remain insufficiently characterized.

Objectives: To evaluate worldwide online search behavior concerning the relationship between periodontal disease and cardiovascular disease and to assess the quality, transparency, readability, and completeness of web-based information available to lay users.

Materials and Methods: This cross-sectional infodemiological and web-content analysis used Google Trends data from January 2010 to December 2025 and assessment of 120 English-language webpages retrieved through Google searches. Google Trends data were downloaded on 15 January 2026, after the complete 2025 monthly dataset was available, and Google webpage searches were performed on 16 January 2026. Search expressions combining periodontal and cardiovascular terms were analyzed as monthly relative search volume values and summarized as annual means, quarterly means, and predefined period blocks. Website quality was evaluated using DISCERN, JAMA benchmark criteria, Health on the Net certification, readability formulas, a seven-domain content-completeness checklist, and an additional source-channel/commercial-orientation check to identify whether eligible non-medical pages were media-, social-media-, influencer-, or commerce-associated.

Results: Relative search volume increased over time for combined periodontal-cardiovascular queries, with higher mean values in 2020-2025 than in earlier periods. The overall mean relative search volume increased from 21.4 +/- 5.8 in 2010-2014 to 34.7 +/- 7.6 in 2015-2019 and 52.9 +/- 10.3 in 2020-2025. Patient-centered expressions such as "gum disease heart disease" generated higher relative search volume than technical expressions. The final webpage sample included academic/professional sources (26.7%), hospital/clinic sources (24.2%), commercial sources (20.8%), news/media sources (15.8%), and miscellaneous sources (12.5%). No standalone social-media or influencer-posted page met the eligibility criteria as a patient-facing textual webpage. Mean DISCERN score was 46.8 +/- 12.7. Only 18.3% of webpages fulfilled all four JAMA benchmarks and 14.2% displayed a HONcode seal. Academic/professional sources had higher DISCERN, JAMA, and completeness scores than commercial and news/media websites (p < 0.001). Readability was generally above the recommended patient level.

Conclusions: Worldwide online search activity related to the periodontal-cardiovascular relationship increased in relative terms during the study period. However, relative search volume reflects normalized search behavior rather than absolute public interest, disease prevalence, or clinical concern. Online information was heterogeneous in quality, transparency, completeness, and readability. These findings support the need for professionally curated, readable, and evidence-based digital resources that communicate both the importance and the limitations of current knowledge on the periodontal-cardiovascular association.

Material Innovations and Digital Advances in Telescopic Denture Prosthodontics: A Narrative Review

Ifrah Khan — 2026-05-26

Telescopic denture systems, distinguished by their double-crown construction and programmable retention, have occupied an established position in prosthodontic rehabilitation for more than a century. In recent years, the field has been reshaped by two converging developments: the emergence of high-performance biomaterials and the widespread adoption of digital fabrication technologies. This review examines the current state of evidence on material innovations—including zirconia ceramics, polyetheretherketone (PEEK), noble metal alloys, and base metal alternatives—alongside digital workflows encompassing computer-aided design and manufacturing (CAD/CAM), intraoral scanning, and additive manufacturing, as applied specifically to telescopic prosthetic systems. Searches were conducted for literature published between January 2010 and March 2026 in all primary databases, with the date range selected to ensure contemporary clinical and materials science relevance. Clinical outcomes, retentive mechanisms, biological considerations, and patient-centred measures are addressed throughout. The review identifies a trend towards increased precision, improved aesthetics, and enhanced customisation in telescopic prostheses fabricated through digital means, whilst acknowledging that the evidence base—particularly for newer materials in this specific prosthetic category—remains in a developing phase. Challenges related to material standardisation, clinical validation, cost, and practitioner expertise are discussed, and directions for future research are identified.

Comparison of Proprioceptive Neuromuscular Facilitation (PNF) and Neuromuscular Re-education (NRE) with Conventional Therapy, Home-based Exercise, and Facial Nerve Stimulation in Bell’s Palsy: A PRISMA-Based Comprehensive Systematic Review

Shyamal Koley — 2026-05-28

Background: Bell’s palsy is the most prevalent cause of acute unilateral facial paralysis and often results in functional deficits, facial asymmetry, and psychosocial impairment. While conventional therapy, facial nerve stimulation, and home-based exercise are widely used, advanced physiotherapeutic approaches such as proprioceptive neuromuscular facilitation (PNF) and neuromuscular re-education (NRE) may provide superior functional outcomes.

Objective: To systematically compare the effectiveness of PNF and NRE with conventional therapy combined with home-based exercise (HBE) and facial nerve stimulation in improving facial function, disability, and quality of life in patients with Bell’s palsy.

Methods: This review was conducted according to PRISMA 2020 guidelines. Electronic databases including PubMed, Scopus, Web of Science, PEDro, and Cochrane Library were searched for studies published between 2000 and 2026.

Results: Randomized controlled trials, cohort studies, and interventional studies involving Bell’s palsy patients receiving PNF, NRE, electrical stimulation, conventional therapy, or combinations were included. Evidence consistently suggests that PNF and NRE demonstrate greater improvements in facial symmetry, facial grading scores, disability reduction, and synkinesis management compared to conventional approaches alone. Combined multimodal rehabilitation yielded the most clinically meaningful outcomes, particularly when initiated early. However, heterogeneity in intervention protocols and small sample sizes limit definitive standardization.

Conclusion: PNF and NRE appear to offer superior rehabilitation benefits over conventional therapy and home programs alone, particularly in enhancing neuromuscular control and facial function. Larger standardized trials are required to establish optimal rehabilitation protocols.

Regenerative Dentistry and Dental Tissue Engineering: Contemporary Strategies, Biomaterials, and Clinical Applications

Rajeshwari Yadav — 2026-06-11

Regenerative dentistry represents a paradigm shift in oral healthcare, moving beyond palliative repair towards biologically driven restoration of native dental tissues. Drawing upon principles from developmental biology, materials science, and cell biology, dental tissue engineering seeks to recreate structurally and functionally competent analogues of enamel, dentine, pulp, cementum, and the periodontium. Over the past two decades, remarkable advances in scaffold fabrication, stem cell biology, growth factor delivery, and bioreactor technology have collectively accelerated progress from bench to early clinical translation. Despite this momentum, formidable challenges remain: the intrinsic complexity of tooth architecture, immune-mediated rejection of exogenous cells, poor vascularisation of engineered constructs, and the absence of standardised regulatory pathways. This review critically evaluates contemporary strategies in dental tissue engineering, with particular attention to biomaterial design, cell sourcing, signalling molecule delivery, and clinical feasibility. Scaffold-based and scaffold-free approaches are assessed alongside gene therapy, bioprinting, and cell homing strategies. The translational limitations of current models — including the gap between in vitro findings and in vivo performance — are examined in detail. Key areas of emerging consensus are identified, as are those requiring further experimental scrutiny. Regenerative endodontics, periodontal regeneration, and whole-tooth bioengineering are discussed as distinct yet interconnected domains. This review is intended to serve clinicians, bioengineers, and researchers seeking a rigorous, current synthesis of the field, and to highlight priority directions for future investigation.

Decoding Pancreatic Tumorigenesis: Molecular Origins, Microenvironmental Complexity, and the Future of Early Detection

Nazmi Özer — 2026-06-20

Pancreatic cancer remains one of the most lethal malignancies worldwide, mainly because diagnosis commonly occurs at advanced stages, tumour biology is aggressive, and responses to conventional therapies are limited. Pancreatic ductal adenocarcinoma (PDAC), which represents approximately 90% of pancreatic cancers, is characterised by complex genomic alterations, metabolic reprogramming, dense stromal architecture, and an immunosuppressive tumour microenvironment. Current evidence supports a multistep model of pancreatic tumorigenesis in which driver mutations, tumour suppressor gene inactivation, precursor lesions, and environmental and metabolic risk factors interact during disease initiation and progression. However, the earliest molecular events that initiate malignant transformation, and the mechanisms determining whether precursor lesions progress to invasive cancer, remain incompletely understood.

This review synthesises current knowledge on the molecular and genetic basis of pancreatic cancer, hereditary predisposition, precursor lesions, environmental and metabolic risk factors, tumour microenvironmental interactions, and emerging diagnostic and therapeutic approaches. Particular attention is given to pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms as precursor lesions, the contribution of KRAS, TP53, CDKN2A, and SMAD4 alterations, and the role of stromal and immune components in disease progression and treatment resistance. Recent technologies, including liquid biopsy, circulating tumour DNA analysis, artificial intelligence-assisted imaging, and multi-omics approaches, may support earlier detection and improved risk stratification. Nevertheless, no single diagnostic modality currently provides sufficient accuracy for routine early detection. Addressing unresolved questions related to tumour initiation, lesion progression, immune evasion, and therapeutic resistance will be essential for improving screening strategies, identifying high-risk individuals, and developing more effective targeted interventions for patients with pancreatic cancer.