American Journal of Medical and Clinical Research & Reviews

Re-coding Leadership Legitimacy in Gendered Organizations: MAN+ as a Counter-Script to Masculinity Contest, Ideal-Worker, and Unequal Conditions of Authority

Ignacio Bonasa Alzuria — Sun, 19 Apr 2026 00:00:00 +0300

This theory-building article advances MAN+ as a counter-script for re-coding leadership legitimacy in gendered organizations. The article starts from a persistent blind spot in leadership scholarship: influential theories explain ethics, motivation, authenticity, and trust with growing sophistication, yet still under-specify the gendered conditions under which leader behaviours become recognizable as credible authority. In many organizations, leadership is tacitly authorized through a legacy masculine script that prizes invulnerability, domination, relentless work devotion, emotional restriction, and exemption from repair. Drawing together feminist organization theory, hegemonic masculinity, masculinity contest culture, ideal-worker scholarship, role congruity, status beliefs, precarious manhood, psychological safety, ethical leadership, engagement, and burnout research, the article conceptualizes these legacy scripts as legitimacy regimes rather than merely personal styles. MAN+ specifies four mutually reinforcing dimensions of an alternative script: Mindful authority, Accountable power, Nurturing standards, and Purposeful stewardship. The article makes six contributions. First, it theorizes masculinity as an organizational script operating at the interface of culture, legitimacy, and control. Second, it clarifies why legacy scripts remain sticky even when they are costly. Third, it identifies the discriminant theoretical surplus of MAN+ relative to adjacent leadership frameworks by centring the gendered recognizability of authority. Fourth, it specifies mechanisms linking counter-scripting to voice, learning, repair, inclusion, ethical restraint, and sustainable performance. Fifth, it develops propositions, moderators, and boundary conditions through which the model can be critically examined rather than normatively celebrated. Sixth, it integrates intersectional cautions and risks of managerial co-optation so the framework is not misread as either a men-centred remedy or a substitute for structural reform. The result is a more precise bridge between gender-and-organization scholarship and leadership development, offering a vocabulary for analysing how organizations might de-authorize harmful norms of strength without romanticizing care, privatizing inequality, or depoliticizing power.

Creative Arts Interventions as Adjunctive Strategies in Clinical and Occupational Medicine: Evidence, Mechanisms, Implementation, and Research Priorities

Ignacio Bonasa Alzuria — Sun, 19 Apr 2026 00:00:00 +0300

Creative arts interventions are gaining clinical credibility as adjunctive strategies in medicine, particularly in behavioral health, oncology, dementia care, pain management, palliative care, and occupational health. Their appeal lies in their low pharmacological burden, adaptability across care settings, and capacity to engage affective, cognitive, social, and physiological processes simultaneously. This narrative review synthesizes policy documents, systematic reviews, meta-analyses, selected randomized trials, and implementation-science literature relevant to visual art therapy, therapeutic art-making, music therapy, dance and movement-based interventions, and exposure to visual art in healthcare environments. The review focused on outcomes of direct clinical and service relevance: anxiety, depression, distress, pain, cognition, sleep, quality of life, burnout, feasibility, and implementation.

The strongest contemporary signals support music-based interventions for anxiety and selected pain outcomes; structured art therapy and art-making for distress and quality of life in cancer care; music-based interventions for behavioral and cognitive symptoms in dementia; and arts-based approaches for burnout-related distress among healthcare workers. Receptive exposure to visual art in healthcare environments also appears to contribute to well-being, positive distraction, and more humane care experiences. At the same time, the field remains constrained by heterogeneity of interventions, inconsistent reporting of dose and fidelity, small samples, variable comparators, and conceptual ambiguity in some reviews.

The evidence does not justify framing the arts as a universal remedy. It does support their selective integration into multidisciplinary care when interventions are well specified, aligned with clinically meaningful targets, and delivered with professional governance. Future progress depends on better terminology, stronger trial design, integration of implementation outcomes, and a more critical approach to evidence appraisal.

The Revolution of Kindness as a Vaccine for a More Humane World

Ignacio Bonasa Alzuria — Sun, 19 Apr 2026 00:00:00 +0300

Objective: To examine whether kindness can be conceptualized as a relational and institutional protective factor against loneliness, polarization, organizational exhaustion, and the erosion of social trust.

Method: An integrative review was conducted across psychology, public health, education, prosocial behaviour research, and organizational studies. The search strategy was structured, bilingual, and oriented toward high-value academic sources, prioritising reviews, meta-analyses, and widely cited empirical studies.

Results: The literature converges around five broad findings: a) kindness and prosocial action are associated with higher subjective well-being and meaning; b) social connection and supportive relationships buffer psychosocial risk and are linked to better health; c) compassionate climates improve the experience of organizations and services; d) perceived kindness in educational settings supports belonging and well-being; and e) at community level, kindness strengthens cohesion, trust, and collective response capacity.

Conclusions: Kindness should not be reduced to private sentimentality or confused with mere politeness. It can be understood as a relational infrastructure that protects dignity, regulates social threat, activates reciprocity, and sustains more humane cultures. The VACUNA model (Vincular, Acoger, Cuidar, Unir, Nutrir, Activar) is proposed as a heuristic and not-yet-validated operational framework for education, health, organizations, and community settings.

Different Equations for Combined Chronic Kidney Disease and Cardiovascular Risk

Wed, 01 Apr 2026 00:00:00 +0300

Assessment of combined risk in chronic kidney disease and cardiovascular disease requires the use of multiple complementary tools, as no single model captures all relevant outcomes. Traditional cardiovascular risk scores, such as the Framingham Risk Score and the Atherosclerotic Cardiovascular Disease Risk Estimator, incorporate factors including age, sex, cholesterol levels, blood pressure, diabetes, and smoking. However, both have important limitations in chronic kidney disease, as kidney dysfunction is either not included or only indirectly considered, leading to underestimation of cardiovascular risk. The QRISK3 model represents a more suitable alternative for this population because it directly incorporates chronic kidney disease and proteinuria, along with additional variables such as body mass index and comorbidities, resulting in more accurate cardiovascular risk prediction. For renal outcomes, the Kidney Failure Risk Equation is the most widely validated tool, using demographic and laboratory parameters to estimate progression to end stage kidney disease, although it does not predict cardiovascular events. Combined models, such as those developed by the Chronic Kidney Disease Prognosis Consortium, integrate kidney function and albuminuria to predict both mortality and cardiovascular outcomes. Similarly, the Kidney Disease Improving Global Outcomes classification system provides a practical framework by combining estimated glomerular filtration rate and albuminuria to stratify risk of progression, cardiovascular events, and death. Biomarker-based approaches incorporating natriuretic peptides and troponin further enhance prediction, particularly for heart failure. Overall, optimal management requires an integrated approach combining cardiovascular and renal risk tools to improve prognostic accuracy and guide therapy.

Antibiotic-resistant Klebsiella pneumoniae: phenotypic mechanisms and epidemiological patterns

Wed, 15 Apr 2026 00:00:00 +0300

Klebsiella pneumoniae has become a pathogen of significant clinical relevance due to the increasing prevalence of antimicrobial resistance and its remarkable ability to adapt to diverse environments. This Gram-negative bacillus is associated with both hospital-acquired and community-acquired infections and contributes to the emergence of multidrug-resistant strains. This study presents a literature review conducted through a search of the PubMed database, in which articles published during the last six years related to resistance mechanisms, virulence factors, and the epidemiology of K. pneumoniae were selected. Available evidence indicates a global increase in multidrug-resistant strains, particularly those producing β-lactamases and carbapenemases. In addition, virulence factors such as the capsule, lipopolysaccharide, fimbriae, siderophores, and biofilm formation contribute to bacterial colonization. These mechanisms limit available therapeutic options and highlight the importance of strengthening epidemiological surveillance and promoting the rational use of antibiotics.

Streptococcus anginosus Bacteremia with Hepatic Abscess After Biliary Stent Exchange in a Patient with Relapsed Lymphoma: A Case Report

Kyaw Zaw Lin, Soraya Kernizan — Sun, 05 Apr 2026 00:00:00 +0300

A 46-year-old woman with a history of relapsed and transformed lymphoma, including marginal zone lymphoma (MZL), Hodgkin lymphoma, and subsequent transformation to diffuse large B-cell lymphoma (DLBCL) with hepatic involvement, presented with Streptococcus anginosus bacteremia and suspected hepatic abscesses following recent biliary instrumentation. She had previously undergone multiple lines of therapy, most recently chimeric antigen receptor T-cell (CAR-T) therapy with axicabtagene ciloleucel in July 2025, achieving an initial complete metabolic response.

Her clinical course was complicated by chronic obstructive cholestasis requiring biliary stent placement and serial endoscopic retrograde cholangiopancreatography (ERCP) procedures. Following a recent ERCP with stent exchange and lymph node biopsy in March 2026, she presented with fever and chills and was found to have S. anginosus bacteremia. Imaging demonstrated hepatic lesions consistent with abscesses in the setting of pneumobilia and biliary stenting.

She was treated with intravenous ceftriaxone, resulting in rapid clinical and laboratory improvement, including resolution of leukocytosis and clearance of blood cultures. Although interventional radiology–guided drainage was recommended, the patient declined invasive management and opted for prolonged intravenous antibiotic therapy. She was discharged with a plan for 4–6 weeks of ceftriaxone via peripherally inserted central catheter, along with antiviral and hepatoprotective prophylaxis.

This case underscores the risk of infectious complications, including bacteremia and hepatic abscess formation, in immunocompromised patients undergoing repeated biliary interventions, and highlights the role of conservative management in select patients.