Armen Muradyan

Background: Sialolithiasis is a multifactorial biomineralization disorder in which local salivary, biological, and potentially environmental factors may influence stone formation and maturation. The relationship between drinking-water mineralization and the chemical composition of salivary stones remains poorly understood. This study aimed to characterize the composition of sialoliths in an Armenian population and to explore whether long-term regional drinking-water hardness is associated with variation in their mineralization profile. Methods: Fifty submandibular sialoliths obtained from 50 patients were analyzed using atomic absorption spectroscopy, optical emission spectroscopy, flame-emission analysis, and photocolorimetric methods. Elemental concentrations were reported as oxide-equivalent weight percentages, and the organic fraction was quantified separately. The molar Ca/P ratio was calculated from CaO- and P₂O₅-equivalent concentrations. Regional drinking-water hardness data for 2018–2026 were obtained from official Armenian water-supply and regulatory sources and expressed in mmol/L. Associations with patient age, sex, geographic region, and long-term regional water hardness were evaluated using non-parametric statistical methods, with correction for multiple comparisons. Results: Calcium was the predominant individual inorganic constituent (CaO-equivalent: 31.38 ± 2.35 wt%), accompanied by P₂O₅ (15.83 ± 2.78 wt%) and a substantial organic fraction (32.09 ± 4.26 wt%). The mean molar Ca/P ratio was 2.62 ± 0.71. CaO and P₂O₅ concentrations were not significantly correlated, indicating considerable heterogeneity in calcium–phosphorus stoichiometry among stones. No significant associations were observed between major compositional parameters and patient age or sex. In contrast, CaO-equivalent content differed significantly among geographic regions (Kruskal–Wallis H = 19.88, p = 0.0058; Holm-adjusted p = 0.0409). Long-term drinking-water hardness ranged from approximately 1.04 to 9.52 mmol/L across the eight regions. At the patient-record level, greater regional water hardness was positively associated with CaO content (Spearman ρ = 0.374, p = 0.0075) and the molar Ca/P ratio (ρ = 0.364, p = 0.0093); however, these associations were attenuated after correction for multiple testing and were not statistically significant when the eight regions were analyzed as independent ecological units. Conclusions: Armenian submandibular sialoliths are chemically heterogeneous composite structures characterized by a calcium- and phosphorus-rich inorganic component and a substantial organic fraction. The significant geographic variability in calcium content and the exploratory positive relationship with regional drinking-water hardness suggest that environmental mineral exposure may contribute to variation in the biomineralization phenotype of sialoliths. However, the ecological nature of the exposure assessment and the absence of significant region-level associations preclude causal inference. Larger prospective studies integrating individual water exposure, salivary biochemistry, and phase-sensitive mineralogical analyses are warranted.

Background: Modern warfare has introduced novel mechanisms of injury, particularly drone-induced blast trauma, resulting in complex craniomaxillofacial injuries. These injuries differ substantially from typical ballistic wounds and require adapted surgical strategies. This study was conducted to evaluate the clinical characteristics, management approaches, and long-term outcomes of midfacial blast injuries. Methods: A retrospective analytical study was conducted on 41 patients with drone-induced midfacial blast injuries treated at a tertiary referral center in Armenia following the 2020 Nagorno-Karabakh War. All patients underwent surgical management after initial stabilization and were followed for 5 years. Clinical outcomes, complications, and reconstructive needs were assessed. Results: All patients presented with comminuted midfacial fractures, which were frequently associated with polytrauma (87.8%). Burns were observed in 82.9% of cases. Surgical management included radical debridement and early definitive osteosynthesis using titanium fixation systems. No cases of postoperative osteomyelitis, bone sequestration, or implant failure were observed during the 5-year follow-up period. Patients with extensive soft tissue defects, particularly nasal and lip amputations, required multiple reconstructive procedures. Long-term follow-up revealed progressive soft tissue thinning over titanium meshes, especially in the zygomatico-orbital region, necessitating secondary interventions such as lipofilling. Conclusions: Drone-induced midfacial blast injuries represent a distinct and severe form of trauma. Early definitive reconstruction following adequate debridement was associated with favorable outcomes. However, soft tissue reconstruction remains challenging and often requires staged procedures. Long-term follow-up is essential to manage delayed complications and optimize aesthetic outcomes.

Objectives The study aimed to evaluate the significant trends of advancement in the body of literature of specialty journals on molecular biological investigations of ameloblastoma (AB). Additionally, this bibliometric study sought to identify the authors, organizations, journals, and countries from emerging regions that have exerted the most significant influence on molecular biological and bioinformatics studies on AB. Novelty of study The novelty of this study lies in its comprehensive bibliometric integration of bioinformatics and molecular perspectives, offering a structured roadmap for future ameloblastoma research. Materials and methods A complete list of AB molecular biological research citations was found in Scopus. The search was restricted to papers published between 2014 and 2024, but there were no restrictions on the language or type of research studies. The study examined total citations, citation density, journal name, impact factor, journal category, quartile, published year, authors, affiliations, and study type. Results The analysis included collecting 112 publications published between 2014 and 2024. There were 95 original research papers, 6 systematic reviews, 5 case reports, 3 brief communications, and 6 systematic reviews and meta-analyses. Our analysis identifies noteworthy authors and nations that have contributed, with Brazil emerging as a leading figure in this field of study. Conclusions The research on AB, especially its biological profile, has changed significantly across the years, as can be observed by perusing the contents of the papers included here. The data from this study would help the researchers target specific objectives for future research in more relevant avenues.

The chapter delves into the transformative potential of ubiquitous Artificial Intelligence (AI) for revolutionizing healthcare in low- and middle-income countries (LMICs). It showcases numerous AI-driven benefits, such as enhanced diagnostics, tailored treatment plans, streamlined drug discovery, and overall healthcare improvement in resource-constrained settings. The discussion acknowledges the challenges and limitations of implementing AI in LMICs, including high costs, a dearth of skilled professionals, and data-related hurdles. It proposes viable solutions, such as public-private partnerships, external funding, open-source software, international collaborations, and infrastructure investments. With a focus on ethical considerations, the text underscores the significance of patient data privacy, addressing algorithmic biases and promoting global collaboration to ensure equitable access to AI-powered healthcare solutions. Inspiring real-world examples from Rwanda, Armenia, Pakistan, and India illustrate the profound impact of AI in LMIC healthcare settings. The vision of ubiquitous AI presents a unique opportunity to bridge the healthcare divide between LMICs and high-income countries, enabling proactive and preventive care while tackling global health challenges. This captivating discussion encourages readers to further explore the responsible and ethical utilization of AI’s transformative power in healthcare.

Background: Annually, approximately 200 new ovarian cancer cases are diagnosed in Armenia, which is considered an upper-middle-income country. This study aimed to summarize the survival outcomes of patients with relapsed ovarian cancer in Armenia based on the type of recurrence, risk factors, and choice of systemic treatment. Methods: This retrospective case-control study included 228 patients with relapsed ovarian cancer from three different institutions. Results: The median age of the patients was 55. The median follow-up times from relapse and primary diagnosis were 21 and 48 months, respectively. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was observed in only 18.4% (42) of patients. The median post-progression survival of the platinum-sensitive group compared to the platinum-resistant group was 54 vs. 25 months (p < 0.001), respectively, while the median survival after relapse was 25 vs. 13 months, respectively; three- and five-year post-progression survival rates in these groups were 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0.113). Conclusions: Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases affecting women, especially in developing countries with a lack of resources, where chemotherapy remains the primary available systemic treatment for the majority of patients. Low survival rates demonstrate the urgent need for more research focused on this group of patients with poor outcomes.

Background: About 200 new ovarian cancer cases per year are diagnosed in Armenia, an upper-middle-income country. This study aims to summarize the survival outcomes of relapsed ovarian cancer patients in Armenia based on the type of relapse, risk factors, and the choice of systemic treatment. Methods: A retrospective case-control study including 228 patients with relapsed ovarian cancer from 3 different institutions. Results: The median age of the patients was 55. The median follow-up from the relapse and primary diagnosis was 21 and 48 months. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was seen only in 18.4% (42) patients. Median survival of the patients starting from the primary diagnosis in the platinum-sensitive compared to the platinum-resistant group was 54 versus 25 months (p < 0.001), and median survival after relapse: was 25 versus 13 months, respectively 3- and 5-year survival in these groups were: 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0,113). Conclusions: Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases in women, especially, in developing countries with a lack of resources, where, in fact, the main available systemic treatment for the majority of patients remains chemo-therapy. Low survival rates emphasize the urgent need for more research on this group of patients with poor outcomes.