Annals of Medicine and Surgery最新文献

{"title":"Unusual presentation of dermatofibrosarcoma protuberans in a young female: a rare case report and literature review.","authors":"Ankur Bhandari, Sabina Nhemafuki, Saurav Shah, Anil Mahato, Ujwal Sah, Sudikxya Basnet, Bishnu Prasad Ghimire","doi":"10.1097/MS9.0000000000005649","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005649","url":null,"abstract":"<p><strong>Introduction: </strong>Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade malignant cutaneous soft tissue sarcoma of fibroblastic origin, characterized by slow but infiltrative growth and a high propensity for local recurrence, while distant metastasis remains uncommon. The reported incidence ranges from 0.8 to 5 cases per million population per year, accounting for less than 0.1% of all malignant tumors and approximately 1% of soft tissue sarcomas.</p><p><strong>Case presentation: </strong>The author reports a case of 33-year-old woman with no known comorbidities who presented to neuro OPD with complaint of solitary, dark-brown lump, associated with occasional pain over the lateral aspect of the elbow, for 7-8 months which was expanding gradually. Further on, the histopathological report revealed DFSP; wide local excision with vascular flap with split thickness skin graft of left elbow was therefore performed.</p><p><strong>Conclusion: </strong>DFSP is a rare cutaneous sarcoma with a high risk of local recurrence but excellent overall prognosis. Presentation at the elbow is uncommon and may delay diagnosis. This case emphasizes the importance of histopathological confirmation and adequate surgical excision with appropriate reconstruction. Long-term surveillance remains essential to detect recurrence early.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6851-6855"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179184","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":"Spontaneous fistulization of a giant pancreatic pseudocyst into the duodenum following acute pancreatitis: a case report.","authors":"Bikash Kumar Shah, Adesh Kantha, Abhisekh Bhattarai","doi":"10.1097/MS9.0000000000005650","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005650","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic pseudocysts are well-recognized sequelae of pancreatitis, but giant pseudocysts (>10 cm) are uncommon and rarely resolve through spontaneous fistulization. Spontaneous internal rupture into the gastrointestinal tract happens in less than 3% of cases and typically requires surgical or endoscopic intervention.</p><p><strong>Case presentation: </strong>We report the case of a 40-year-old male with a history of alcohol use who developed a giant pancreatic pseudocyst (22 × 12 cm) following acute pancreatitis. He presented with abdominal discomfort, early satiety, and vomiting. Imaging revealed a massive cyst compressing the stomach and duodenum. Although initially managed conservatively, the patient later experienced episodes of severe abdominal pain and coffee-ground vomiting.</p><p><strong>Clinical discussion: </strong>Spontaneous internal drainage of a giant pancreatic pseudocyst into the duodenum is very rare. This case highlights the potential for non-operative management in carefully selected, clinically stable patients, despite the size of the lesion and the risk of complications.</p><p><strong>Conclusion: </strong>We describe an unusual case of a giant pancreatic pseudocyst that resolved spontaneously through cystoduodenal fistulization. Conservative management led to full recovery, underscoring the importance of individualized treatment strategies in pancreatic pseudocyst management.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6846-6850"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178917","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":"Early neonatal demise from vein of Galen aneurysmal malformation in a low-resource setting: a case report in Ghana.","authors":"Ruth Agyekum, Richeal Shola Makinde, Kwaku Doffour-Dapaah, Jeff Osei-Agyapong, Kwabena Onwona-Agyeman, Alhassan Dasana Andani","doi":"10.1097/MS9.0000000000005569","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005569","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6786-6791"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178925","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":"Electrolyte disturbance profiles and associated factors in Somali patients with heart failure.","authors":"Said Abdirahman Ahmed, Abdullahi Mohamed Hassan Fujeyra, Isaak Mohamed Osman, Ahmed Shafie Aden, Mohamed Omar Hassan, Ahmed Elmi Abdi, Mohamud Mire Waberi, Mohamed Abdullahi Mohamud, Yahye Abukar Sabrie, Mohamed Sheikh Hassan, Rahma Yusuf Haji Mohamud, Abdijalil Abdullahi Ali, Ishak Ahmed Abdi, Abdinafic Mohamud Hussein, Usama Hassan Hussein, Kowthar Ismail Hashi, Ali Jimale Mohamed, Mehmet Zafer Aydin, Feyza Aksu, Osman Farah Dahir","doi":"10.1097/MS9.0000000000005364","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005364","url":null,"abstract":"<p><strong>Background: </strong>Electrolyte disturbances are frequent yet under-monitored complications of heart failure (HF), contributing to arrhythmias, prolonged hospitalization, and increased mortality. Data from Somalia remain scarce, despite the growing HF burden.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted among 369 adult HF patients admitted to Mogadishu Somali-Turkish Training and Research Hospital between January 2023 and January 2025. Demographic, clinical, and laboratory data were analyzed using IBM SPSS Statistics v29. Electrolyte disturbances were classified by standard cut-offs, and associations with clinical variables were tested using Chi-square and Pearson correlation analyses.</p><p><strong>Results: </strong>The mean age was 60.1 ± 15.2 years, and 43.6% were female. The mean ejection fraction was 31.3 ± 8.0% (range 10-45%), with most patients having reduced EF. Hyponatremia occurred in 38.5%, hypokalemia in 17.1%, and hypomagnesemia in 16.3%. Among affected patients, severe hyponatremia was most frequent (26.8%), while hypokalemia was largely mild (73.0%). Loop-diuretic therapy was significantly associated with hyponatremia and hypokalemia (<i>P</i> < 0.05), while electrolyte levels showed no significant correlation with age or ejection fraction (|<i>r</i>| ≤ 0.14).</p><p><strong>Conclusion: </strong>Electrolyte disturbances - particularly hyponatremia and hypokalemia - are highly prevalent among Somali HF patients. These findings highlight the need for improved electrolyte monitoring in HF management in low-resource settings. Strengthening electrolyte monitoring and improving diagnostic capacity are essential for optimizing HF management in low-resource settings.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6551-6556"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178962","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":"Hybrid Explainable Deep Ensemble Framework with self-attention mechanism for early prediction of depression severity using PHQ-9 clinical and behavioral data.","authors":"Zeina T Khaleel, Sarmad S Abdullah, Majid S Jabir","doi":"10.1097/MS9.0000000000005555","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005555","url":null,"abstract":"<p><strong>Background: </strong>Depression is a major global mental health disorder that requires accurate, reliable, and interpretable prediction models to support early identification and timely intervention. This study proposes a Hybrid Explainable Deep Ensemble Framework for multiclass prediction of depression severity using PHQ-9 clinical responses and behavioral characteristics.</p><p><strong>Methods: </strong>A retrospective cross-sectional machine learning study was conducted using a dataset comprising 682 anonymized participants. Predictor variables included demographic characteristics, PHQ-9 questionnaire items, sleep quality, academic pressure, and financial pressure. A hybrid ensemble integrating TabNet, multilayer perceptron (MLP), and XGBoost was developed with a self-attention mechanism for adaptive feature weighting and a weighted soft-voting strategy for final prediction. Model performance was evaluated using five-fold stratified cross-validation and an independent test set. Accuracy, precision, recall, macro F1-score, ROC-AUC, Matthews correlation coefficient, confusion matrix analysis, and SHAP-based explainability were employed to assess predictive performance and model interpretability.</p><p><strong>Results: </strong>The proposed framework achieved an overall accuracy of 91.3%, precision of 0.907, recall of 0.898, macro F1-score of 0.902, and a macro-ROC-AUC of 0.940, outperforming the baseline machine learning models. Class-wise evaluation demonstrated the strongest performance for severe depression (F1-score = 0.934), whereas the mild depression category exhibited comparatively lower predictive performance (F1-score = 0.861) because of overlap with adjacent severity levels. Confusion matrix analysis indicated that misclassification primarily occurred between neighboring depression categories while clinically implausible predictions were rare. SHAP analysis identified sleep disturbance (PHQ-4), fatigue (PHQ-3), academic pressure, depressed mood (PHQ-2), and financial pressure as the most influential predictors. The ablation study further demonstrated that incorporating the self-attention mechanism and ensemble learning strategy improved both predictive performance and model robustness.</p><p><strong>Conclusion: </strong>The proposed Hybrid Explainable Deep Ensemble Framework combines high predictive accuracy with transparent decision-making for multiclass depression severity assessment. By integrating deep learning, ensemble learning, self-attention, and explainable artificial intelligence, the framework provides accurate and clinically interpretable predictions and represents a promising approach for future clinical decision-support systems and precision mental health screening.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6359-6373"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179007","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":"Sclerosing epithelioid fibrosarcoma of the bone: a systematic review of radiologic findings and associated clinical features.","authors":"Fatemeh Kanaani Nejad, Maryam Afshari, Alireza Keshtkar, Omid Bahrami, Amir H Hoveidaei, Janet D Conway","doi":"10.1097/MS9.0000000000005613","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005613","url":null,"abstract":"<p><strong>Background: </strong>Primary bone sclerosing epithelioid fibrosarcoma (SEF) is a rare, yet aggressive, condition associated with considerable mortality and prone to misdiagnosis or delayed diagnosis, making precise radiologic identification essential.</p><p><strong>Materials and methods: </strong>The systematic review was conducted in accordance with PRISMA standards. PubMed, Scopus, Web of Science, and Embase were searched through March 2025. The inclusion criteria consisted of English-language human studies with radiologic descriptions of primary bone SEF. Two independent reviewers conducted screening and data extraction. The risk of bias was evaluated utilizing the Joanna Briggs Institute critical appraisal tools for case reports and series.</p><p><strong>Results: </strong>Out of 190 identified papers, 18 met the inclusion criteria, describing 26 patients. The predominant findings in X-rays and computed tomography scans were lysis and destruction (88.46%), well-defined margins (81.81%), and soft tissue involvement (53.84%). magnetic resonance imaging (MRI) data revealed T1-weighted images exhibiting hypo- to isointense signals, while mixed hyper- and hypointense signals mostly characterized T2 sequences. SEF predominantly affected irregular bones (46.2%), followed by long bones (38.5%), with sclerotic rims being most prevalent in long bones (60%). Bone SEF predominantly manifested as pain alone in 40% of cases, and only 33.3% of the patients were initially classified as SEF. Accurate initial diagnosis of SEF was more frequently reported in studies that performed MRI.</p><p><strong>Conclusion: </strong>This systematic review elucidates the varied imaging features of bone SEF across several bone types. When these characteristics elicit suspicion in primary imaging, it is probably wise to prioritize MRI, and early biopsy contemplated to guarantee a timely and precise diagnosis.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6689-6695"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179108","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":"Unveiling the landscape of vancomycin in periprosthetic joint infections: a comprehensive bibliometric analysis.","authors":"Yuting Yang, Ke Lv, Hongbo Li, Aidi Zhao, Yong Ding, Jinxue Zhang","doi":"10.1097/MS9.0000000000005489","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005489","url":null,"abstract":"<p><strong>Purpose: </strong>Periprosthetic joint infection (PJI) is a devastating adverse complication after joint replacement surgery. Vancomycin is crucial in treating PJI but presents unique challenges. Despite extensive research, a comprehensive bibliometric analysis is missing. This study aims to identify key contributors, evaluate current research, and highlight major scientific issues.</p><p><strong>Methods: </strong>We retrieved studies on vancomycin and PJI from the Web of Science Core Collection database, gathering data on publications, authors, citations, publication year, H-index, references, country/region, journal, and keywords. Bibliometric and visual analyses were conducted using R-bibliometrix, VOSviewer, and CiteSpace.</p><p><strong>Results: </strong>The analysis included 451 publications from 725 institutions in 43 countries/regions from 2010 to 2025, showing a clear growth trend in annual publications. The United States contributed the most (172, 39.2%), with the Mayo Clinic leading in studies (28, 6.21%). Cao L had the highest number of publications, while Parvizi J received the most citations. The Journal of Arthroplasty was the leading journal in this field. Current research on vancomycin in PJI focuses on improving localized application and new drug delivery systems to tackle biofilm infections and antibiotic resistance. Additionally, burden management has emerged as a significant research area.</p><p><strong>Conclusion: </strong>This study summarizes publications characteristics and identifies influential countries, institutions, authors, journals, and trends related to vancomycin use in PJI. The findings offer researchers valuable insights and help clinicians improve diagnostic and therapeutic services.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6595-6605"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179169","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":"Social media's influence on rhinoplasty: the impact of digital platforms on nasal esthetics - a review.","authors":"Haidar Kanso, Hadi Salame, Amarelle Chamoun, Ibrahim Dhaini, Aya Kawssan, Clarita Al-Tawny, Fatima Mroueh, Mohamad Obeid","doi":"10.1097/MS9.0000000000005598","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005598","url":null,"abstract":"<p><p>Social media has emerged as a major influence on contemporary perceptions of beauty and cosmetic surgery, particularly among younger populations. As one of the most commonly performed esthetic procedures worldwide, rhinoplasty has been increasingly affected by the widespread use of platforms such as Instagram, Snapchat, TikTok, Facebook, and YouTube. This narrative review explores the influence of social media on rhinoplasty trends, patient motivations, expectations, psychological outcomes, and ethical considerations. Current evidence suggests that exposure to cosmetic surgery-related content, including before-and-after photographs, influencer endorsements, celebrity appearances, and filtered images, is associated with increased interest in rhinoplasty and more favorable attitudes toward cosmetic procedures. Social media also serves as an important source of information and facilitates communication between patients and surgeons, contributing to greater accessibility of esthetic services. However, repeated exposure to idealized and digitally enhanced images may contribute to unrealistic expectations, body dissatisfaction, appearance-related anxiety, and increased interest in cosmetic enhancement among susceptible individuals. Ethical concerns regarding patient confidentiality, informed consent, professionalism, and the responsible presentation of surgical outcomes have also become increasingly relevant in the digital era. While social media offers valuable opportunities for patient education and engagement, esthetic surgeons should prioritize ethical communication and realistic patient counseling. Further prospective, high-quality research is needed to better understand the long-term impact of social media on rhinoplasty decision-making and patient well-being.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6679-6682"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178873","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":"Risks of free flap reconstruction amongst smoking patients: a NSQIP analysis of 4653 patients from 2010 to 2021.","authors":"Taylor Schumann, Victoria Hodkiewicz, Christopher Kujalowicz, Parinaz Jila Siemers, Bianca Di Chiaro, Irena Helenowski, Eleanor Bucholz","doi":"10.1097/MS9.0000000000005624","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005624","url":null,"abstract":"<p><strong>Background: </strong>Microvascular free flap reconstruction for complex soft tissue defects relies on vascular perfusion for overall flap survival. Smoking has been linked to complications in postoperative wound healing due to vasoconstriction and weakened immune status. We aim to investigate the impact of smoking on postoperative complications in patients undergoing free flap reconstructive surgery.</p><p><strong>Methods: </strong>Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, adult patients (≥18 years old) undergoing microvascular free flap surgery (Current Procedural Terminology: 15 756-15 758) from 2010 to 2021 were included. Patients were excluded if they were <18 years old or if they lacked postoperative follow-up data or documented smoking status. Smokers were compared to non-smokers across demographics and postoperative complications.</p><p><strong>Results: </strong>Among 4653 free flap patients, 1202 (25.8%) were smokers. Smokers were more likely to be male, younger, non-diabetic, and have lower body mass index. After multivariable adjustment, smoking status was associated with higher odds of organ/space SSI (OR = 1.653, 95% CI: 1.068-2.558, <i>P</i> = 0.024) and wound disruption (OR = 1.597, 95% CI: 1.092-2.336, <i>P</i> = 0.016). There were no significant differences in rates of superficial or deep incisional SSIs, graft/flap failure, sepsis/septic shock, or venous thromboembolism.</p><p><strong>Conclusion: </strong>Smoking was associated with increased rates of organ/space surgical site infections and wound dehiscence, but not with flap failure in patients undergoing microvascular free flap reconstruction. These findings support the role of preoperative smoking cessation counseling and more nuanced risk stratification focused on wound-related complications rather than flap survival.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6283-6288"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179018","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":"When promotion becomes a bounty on publications: how academic reward systems shape publication behavior, with lessons from Nepal.","authors":"Naveen Gautam","doi":"10.1097/MS9.0000000000005602","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005602","url":null,"abstract":"<p><p>The criteria institutions use to appoint and promote academics shape how science is produced. Where advancement is tied tightly to publication counts, researchers respond rationally to the incentive, and publication behavior shifts toward volume. This article uses the faculty-promotion regulations of Tribhuvan University, Nepal's largest higher education institution, as a worked example of how publication-weighted criteria may reward output over scientific merit. The framework allocates the majority of open-competition marks to research publications, sets minimum article counts for promotion, fractionates credit by authorship position, and scores articles by journal tier. Such a structure illustrates a problem common across many low- and middle-income academic systems: it can encourage fragmented, lower-quality output, penalize collaborative authorship, and use journal-based metrics as surrogates for individual article quality, contrary to the San Francisco Declaration on Research Assessment. The institution's existing anti-plagiarism and anti-predatory safeguards show that meaningful reform is achievable. Drawing on DORA, the International Committee of Medical Journal Editors authorship criteria, and Committee on Publication Ethics guidance, the article argues for a phased shift toward portfolio-based assessment that rewards the quality, integrity, and relevance of scholarship rather than the counting of papers.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6380-6383"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179158","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}