Missouri medicine最新文献

{"title":"The Making of a Physician and Politician.","authors":"George J Hruza","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"307-311"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kratom in Clinical Practice: What Physicians Need to Know.","authors":"Mark Gold, Nicole Avena","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Kratom use is increasingly encountered in clinical practice, yet products marketed under this name encompass markedly different substances with distinct pharmacologic and risk profiles. Kratom leaf (Mitragyna speciosa) contains a complex mixture of alkaloids, primarily mitragynine, with serving size dependent stimulant and sedative effects, whereas many modern products labeled as kratom contain concentrated, semi-synthetic, or synthetic alkaloids, particularly 7-hydroxymitragynine (7-OH), with substantially greater opioid-like potency. This review summarizes the pharmacology, clinical effects, and safety data related to natural kratom leaf, contrasts these findings with evidence on high-potency alkaloid products, and examines limitations in adverse event surveillance resulting from exposure misclassification and polysubstance use. Clinical and toxicologic data suggest that severe acute harms attributed to \"kratom\" disproportionately involve concentrated alkaloid formulations rather than whole-leaf products. Guidance is provided to assist physicians in screening, counseling, and documentation, emphasizing the importance of distinguishing product type to support risk assessment, harm reduction, and patient safety.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"292-297"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myeloablative Matched Sibling Donor Hematopoietic Stem Cell Transplantation as a Curative Treatment for Congenital Erythropoietic Porphyria: A Cohort Study from Low-Middle Income Country.","authors":"Aamir Aslam Awan, Tariq Azam Khattak, Muhammad Shah Miran, Tariq Ghafoor, Raheel Iftikhar, Ammara Iftikhar, Haider Nisar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Congenital Erythropoeitic Porphyria is extremely rare autosomal recessive disorder caused by deficiency of uroporphyrin synthase III deficiency, leading to accumulation of toxic precursors of Heme biosynthesis. Severe Phenotypes present in neonatal period with reddish brown colored urine followed by photosensitivity and erythrodontia. Allogenic hematopoietic stem cell transplant is the only curative option. We retrospectively analyzed 4 patients (2 males , 2 females) with clinically and biochemically confirmed Congenital Erythropoeitic Porphyria who underwent fully matched sibling donor hematopoietic stem cell transplant with myeloablative conditioning Busulphan (Bu) and Cyclophosphamide (Cy) at the Armed Forces Bone Marrow Transplant Centre Pakistan from 2020 to 2025. These four transplants were performed at a centre with over 550 transplants during this period, highlighting the extreme rarity of disease even within a high volume transplant centre. Median Age of onset of symptoms was five days (range 2-15), median age of diagnosis was 27 months (range12-72) and median age of hematopoietic transplant was 100.5 months (range 54-126). All patients received myeloablative conditioning (Bu^16mg/kg, Cy^160-200mg/kg). Peri-transplant period was complicated by febrile neutropenia and mucositis. Neutrophil engraftment was achieved at a median of Day+16 (range 14-18) and platelet engraftment at median of Day+21 (range 18-21). At a median follow up of 240 days (range 116-2555), all patients were alive, transfusion independent with complete resolution of photosensitivity. Additionally, serum and urine porphyrin levels became normal in all patients. This cohort, though very small supports the efficacy of early myeloablative Hematopoietic stem cell transplant with matched sibling donors to prevent irreversible tissue damage and significantly improve clinical outcomes.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"368-372"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Patients, One Plan: Redesigning Transitions of Care in High-Risk Pregnancy with Mom-Baby Dyadic Models.","authors":"Johana Mejias-Beck, Kaitlin Wittler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Maternal and neonatal care in the United States (US) is often delivered separately, creating gaps during the critical transition from hospital to home. Fragmented maternal and neonatal care contributes to missed postpartum visits, delayed recognition of complications, and suboptimal outcomes, particularly in high-risk populations. Mom-Baby dyad care models integrate transitions of care by approaching the mother and infant as a single care unit. Evidence from high-risk obstetric populations, including patients with preeclampsia, gestational diabetes, and infants requiring NICU care, suggests that dyadic care approaches are associated with improved care continuity, earlier identification of complications, and enhanced engagement in postpartum care.17 Implementing structured, coordinated Mom-Baby Dyad care has the potential to reduce disparities and improve patient-centered outcomes in vulnerable populations.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 4","pages":"322-326"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"As Rural Hospitals Close, Here's What Integration Has Made Possible in Jefferson City.","authors":"Randall Haight","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 3","pages":"223-224"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Artificial Intelligence in Acute Ischemic Stroke Care: A Narrative Review.","authors":"Hunter Brooks, Zuri St Julien, Ibrahim A Bhatti, Balint Otvos, Camilo Gomez, Adnan I Qureshi, Farhan Siddiq","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute ischemic stroke remains a leading cause of death and disability; despite time-dependent reperfusion therapies, delays in recognition, imaging interpretation, triage, and specialist access still limit timely treatment. This narrative review outlines how artificial intelligence (AI) may reduce bottlenecks across the stroke pathway. Prehospital tools include dispatcher decision support, consumer wearables, mobile assessment apps, and portable diagnostics may improve early detection and destination selection. In-hospital, AI increasingly assists neuroimaging and workflow, including intracranial hemorrhage detection, automated ASPECTS scoring, large vessel occlusion identification, and perfusion-based estimation of tissue salvageability, often shortening notification and process times. We also discuss AI-enabled risk stratification, systems-of-care coordination, and emerging uses of generative AI for documentation and communication. Key limitations include domain shift, incomplete external validation, bias and equity risks, limited explainability, alert fatigue, integration challenges, and evolving regulatory accountability. Future priorities include multimodal models, prospective implementation-focused trials, and deployment-ready solutions for diverse real-world settings.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 3","pages":"234-242"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotics in Cerebrovascular Disease: The Final Frontier.","authors":"Ibrahim A Bhatti, Hunter Brooks, Fareed Jumah, Balint Otvos, Camilo Gomez, Adnan I Qureshi, Farhan Siddiq","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cerebrovascular disease remains a leading cause of global mortality. While endovascular therapies like mechanical thrombectomy and aneurysm coiling have revolutionized management, manual techniques are limited by operator fatigue, tremor, and occupational radiation exposure. This review examines the current state of robotics in neuroendovascular surgery. FDA-approved systems demonstrate safety and technical feasibility, achieving high success rates (94-100%) in aneurysm coiling and carotid stenting while significantly reducing operator radiation exposure (60-80%). In ischemic stroke, preclinical and recent clinical milestones, including the first fully remote, in-human diagnostic angiogram and transcontinental thrombectomy simulations, validate the feasibility of long-distance tele-interventions. Robotics in cerebrovascular management is rapidly evolving from a novel adjunct to clinical reality. Although challenges regarding cost, haptic feedback, and training persist, next-generation platforms integrating artificial intelligence and magnetic navigation hold the potential to overcome these barriers, establishing remote telerobotic networks to expand access to time-critical stroke care.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 3","pages":"228-233"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Food-First Prescription for Cognitive Longevity.","authors":"Max Lugavere","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 3","pages":"192-199"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Concepts in the Management of Cerebral Aneurysms.","authors":"Camilo R Gomez, Balint Otvos, Kimberley Pfeiffer, Farhan Siddiq, Michael R Chicoine, Adnan I Qureshi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cerebral aneurysms represent a heterogeneous group of vascular lesions whose clinical behavior ranges from incidental, asymptomatic findings to catastrophic aneurysmal subarachnoid hemorrhage. Despite major advances in neuroimaging, microsurgical technique, and endovascular technology, the management of both ruptured and unruptured cerebral aneurysms remains complex and highly individualized. This review examines current concepts in aneurysm pathobiology, natural history, risk stratification, and contemporary treatment strategies, emphasizing durable clinical principles that transcend evolving technology. Particular attention is given to the balance between conservative surveillance and intervention in unruptured aneurysms, as well as the time-critical priorities, complications, and neurocritical care considerations in ruptured aneurysms. The relative roles of microsurgical and endovascular therapies are discussed through the lens of long-term durability, retreatment risk, and patientspecific anatomy. Ultimately, optimal outcomes depend less on any single technique than on disciplined clinical judgment, longitudinal thinking, and true interdisciplinary collaboration within experienced neurovascular centers.</p>","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 3","pages":"243-247"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"My Full Circle Journey and Why Communication, Mentorship, and Service Matter So Deeply.","authors":"Ravi Johar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74203,"journal":{"name":"Missouri medicine","volume":"123 3","pages":"219-222"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}