Anorectal fistulas remain one of the most challenging conditions in colorectal surgery and require precise anatomical knowledge for successful management. This comprehensive review synthesizes the current evidence on the anatomical foundations of fistula development and treatment, particularly focusing on the cryptoglandular hypothesis and its clinical implications. A systematic analysis of the recent literature has examined the relationship between anatomical structures and fistula formation, classification systems, diagnostic modalities, and therapeutic approaches. The review revealed that anatomical considerations fundamentally influence treatment outcomes, with modern imaging techniques achieving up to 98% accuracy in delineating fistula anatomy. Key findings demonstrate that surgical success rates vary significantly based on anatomical complexity: 92–97% for simple fistulas versus 40–95% for complex cases using sphincter-sparing techniques. Emerging minimally invasive approaches and regenerative therapies, including mesenchymal stem cells, show promising results with 50–60% healing rates in complex cases. Special considerations are needed for complex cases such as Crohn's disease-related and rectovaginal fistulas. This review provides surgeons with an evidence-based framework for selecting optimal treatment strategies based on anatomical considerations, emphasizing the importance of preserving the anal sphincter function while achieving complete fistula eradication. Integrating advanced imaging, surgical techniques, and emerging therapies offers new possibilities for improving patient outcomes. This review aimed to bridge the gap between anatomical knowledge and practical surgical application, enhance clinical decision-making, and improve patient outcomes in anorectal fistula management.

The increasing incidence of hypospadias and cryptorchidism, coupled with the widespread presence of endocrine-disrupting chemicals (EDCs), has raised concerns about the potential impact of these environmental factors on male urogenital development. This systematic review and meta-analysis aims to evaluate the association between maternal exposure to various EDCs and the risk of hypospadias and cryptorchidism. We conducted a comprehensive search of PubMed, Scopus, Web of Science, and Cochrane databases from inception until May 2024. We included case-control and cohort studies that examined the association between maternal EDC exposure and hypospadias or cryptorchidism, reporting adjusted odds ratios (aOR) or crude odds ratios (cOR). Data were extracted and pooled using a random effects model, and heterogeneity was assessed using the Q test and I-square statistics. The risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS). A total of 48 studies were included in the systematic review, with 46 studies included in the meta-analysis. The pooled analysis revealed a significant association between maternal EDC exposure and an increased risk of hypospadias (aOR = 1.26, 95% CI: 1.18–1.35, p < 0.0001) and cryptorchidism (aOR = 1.37, 95% CI: 1.19–1.57, p < 0.001). Subgroup analyses showed that exposure to pesticides, phthalates, alkyl phenolic compounds (ALKs), and heavy metals significantly increased the risk of hypospadias. In contrast, polychlorinated biphenyls (PCBs) did not show a significant association. Significant associations were found with pesticide and PCB exposure for cryptorchidism, but not with phthalate, ALK, or heavy metal exposure. Maternal exposure to certain EDCs is associated with an increased risk of hypospadias and cryptorchidism in male children. These findings underscore the importance of addressing environmental and occupational exposures during pregnancy to mitigate potential risks. Further research is needed to elucidate the mechanisms by which EDCs affect urogenital development and to develop effective interventions to reduce exposure among vulnerable populations.

Background: Rapid advances in dental medicine necessitate a shift from traditional educational paradigms to competency-based education (CBE), which emphasizes the acquisition of specific clinical and professional skills. Aim: This study examines the implementation and effectiveness of CBE in Sudanese dental schools by comparing four curriculum models—discipline-based, hybrid, integrated, and community-based. Methods: A convergent parallel mixed-method design was employed to collect quantitative data through structured surveys and qualitative data via semi-structured interviews with students, faculty, and dental practitioners. Descriptive statistical analyses and thematic analyses were used to assess competency achievement across eight domains and to evaluate stakeholder perceptions. Results: Quantitative findings revealed robust competency attainment in the knowledge base domain, while practice management skills were significantly lacking across several models. Notably, the integrated curriculum at Ribat University achieved high scores in both communication and practice management, contrasting with gaps observed in discipline-based and hybrid models. Qualitative insights underscored the need for improved management training and stronger interdisciplinary integration. Conclusions: CBE frameworks in Sudanese dental education effectively foster essential competencies; however, targeted curricular enhancements—particularly in practice management—are required to better prepare graduates for contemporary dental practice.

Background: Congenital heart diseases are among the most common birth defects, significantly impacting infant health. Recent evidence suggests that exposure to endocrine-disrupting chemicals may contribute to the incidence of congenital heart diseases. This study systematically reviews and analyzes the association between maternal endocrine-disrupting chemicals exposure and congenital heart diseases. Methodology: This systematic review and meta-analysis followed the Cochrane Handbook and PRISMA guidelines. We included studies assessing the link between maternal exposure to various endocrine-disrupting chemicals and the incidence of congenital heart diseases without restricting the study design or exposure assessment methods. Data were extracted from four databases, including PubMed, Scopus, Web of Science, and Cochrane Library, up to June 2024. Quality assessment of observational studies was conducted using the Newcastle–Ottawa Scale. Statistical analysis was performed using RevMan software version 5.3, presenting results as odds ratios with 95% confidence intervals. Results: Fifty-nine studies were included in the meta-analysis. The pooled analysis revealed a significant association between maternal endocrine-disrupting chemical exposure and the incidence of congenital heart diseases when measured using human samples (odds ratio = 1.63, 95% confidence interval [1.35–1.97], p < 0.00001). Notably, exposure to heavy metals, polycyclic aromatic hydrocarbons, and perfluoroalkyl compounds was strongly associated with congenital heart diseases. However, non-sample-based methods showed no significant overall correlation (odds ratio = 1.08, 95% confidence interval [0.93–1.26], p = 0.30), except for housing renovation compounds, which were linked to a higher incidence of congenital heart diseases. Conclusions: Maternal exposure to specific endocrine-disrupting chemicals, particularly heavy metals and polycyclic aromatic hydrocarbons, significantly increases the risk of congenital heart diseases. These findings underscore the need for preventive measures to reduce endocrine-disrupting chemicals exposure during pregnancy and further research to elucidate the underlying mechanisms.

Objective: Accurate localization of epileptogenic foci remains of significant importance for surgical planning in drug‐resistant epilepsy. Multiple neuroimaging modalities are available; however, their comparative diagnostic performance lacks comparative detailed synthesis. This systematic review aimed to evaluate and compare the diagnostic accuracy of structural MRI, PET imaging, SPECT/SISCOM, and combined multimodal strategies for epileptogenic focus localization. Methods: We conducted a systematic review following PRISMA 2020 guidelines, searching PubMed, Scopus, Google Scholar, Cochrane Library, and Web of Science databases up to May 30, 2025. Studies evaluating the diagnostic performance of neuroimaging modalities for epilepsy focus localization with surgical correlation were included. Data extraction focused on sensitivity, specificity, and clinical manner. Quality assessment used QUADAS‐2 criteria. Results: Fifteen studies included a total of 1157 patients that met inclusion criteria. Combined multimodal strategies integrating two or more imaging modalities demonstrated the highest diagnostic performance (sensitivity 82–100%), followed by structural MRI in lesional epilepsy (72–100% sensitivity). PET imaging showed consistent performance across clinical contexts (33–89% sensitivity), while SPECT/SISCOM exhibited variable results (33–83% sensitivity). Strong complementarity existed between MRI and PET (85% concordance), with context‐dependent optimization for lesional versus non‐lesional epilepsy. Significance: Combined multimodal neuroimaging provides superior diagnostic performance for epileptogenic focus localization. Clinical context significantly impacts the modality selection, with MRI prioritized in lesional cases and functional imaging essential for MRI‐negative epilepsy. These findings support evidence‐based imaging protocols for surgical epilepsy evaluation. Plain Language Summary: This systematic review evaluated which brain imaging techniques are best for finding the exact location where seizures start in people with drug‐resistant epilepsy who need surgery. The researchers analyzed 15 studies involving 1157 patients. They found that using multiple imaging techniques together (combining structural and functional imaging) provides the most accurate results, with success rates of 82–100%. Standard MRI scans work very well (72–100% accuracy) when there is a visible brain abnormality causing seizures. However, for patients whose MRI looks normal, additional functional imaging techniques like PET or SPECT scans are crucial, achieving 63–89% accuracy. The study shows that the best imaging approach depends on the individual patient's situation: MRI should be used first when a brain lesion is suspected, but functional imaging becomes essential when MRI does not show anything abnormal. These findings help doctors choose the right combination of imaging tests for each patient to improve surgical planning and outcomes.

Background: The surgery on the craniocervical junction is associated with complex techniques that endanger the vertebral artery (VA), especially if there are some anatomical variations present, thereby increasing the risk of vascular injury, particularly during cervical decompression or instrumentation. Case Description: A case of a 60-year-old female with progressive myelopathy and craniocervical junction malformation is presented. Key preoperative imaging findings included basilar invagination, C1 assimilation, and os odontoideum, along with VA anomalies such as a tortuous, hypoplastic left VA arising anomalously from the aortic arch and a right VA with a V2 segment forming a high-riding medial loop into the C2 vertebral body. The surgical procedure was performed through a posterior approach using C-arm fluoroscopy, Doppler ultrasound, and intraoperative neurophysiologic monitoring, which achieved adequate deformity fixation and anterior decompression. Conclusion: Computed tomography angiography is the gold standard for assessing the preoperative VA anatomy at the craniocervical junction. Intraoperative Doppler ultrasound is invaluable because it minimizes the risk of sudden accidental injury to VAs in cases with abnormal anatomies.