Comparative Study between Surgical Management and Venoplasty with Stenting in Cases of Recurrent Venous Hypertension in Hemodialysis Patient.
Background: Recurrent venous hypertension due to central venous stenosis or occlusion is a common complication in hemodialysis patients, often resulting from previous central venous catheterization. Endovascular treatments like balloon angioplasty and stenting offer initial relief but suffer from high recurrence rates, while surgical interventions provide alternative solutions when endovascular therapy fails. Objective: to compare short-term outcomes between venoplasty with stenting and surgical management in recurrent venous hypertension secondary to central venous occlusion among hemodialysis patients. Patients and Methods: This prospective randomized trial was conducted on 40 patients with recurrent venous hypertension, assigned to receive either endovascular stenting or surgical bypass. Clinical and imaging assessments were performed, with patency and symptom resolution evaluated at 1, 3 and 6 months. Results: Postoperative arm circumference showed a significantly greater reduction in the surgical group (P=0.003), with both groups having significant within-group decreases (P<0.001) and no baseline differences (P=0.390). Similarly, forearm circumference reduction was significantly greater in the surgical group (P<0.001), with significant decreases in both groups post-intervention (P<0.001) and comparable preoperative measurements (P=0.201). Intraoperative venography findings differed significantly between groups (P=0.004), indicating more severe lesions in the surgical group, Procedure duration was significantly longer in the surgical group (P<0.001). Conclusion: Surgical venous drainage provided superior primary patency and more effective early resolution of limb swelling compared to venoplas ty with stenting, despite longer operative time. Both interventions are effective in maintaining dialysis access, however venoplasty is safer compared to surgical venous drainage which is associated with higher 30-days mortality rate.
Surgical Management, Venoplasty, Recurrent Venous Hypertension, Hemodialysis Patient.
Moataz Ashraf Saleh, Abdelrahman Magdi Ahmad, Yasser Mohamed Elsayed Rezk Barakat, Ayman Abdelfattah Mohamed, Mohamed Abdelsalam Rizk, Mohamed Ismail Mohamed
Primary Anastomosis After Left Colectomy in Emergency Cases: Clinical Trial.
Background: Colorectal cancer ranks as the third most prevalent cancer globally and the second leading cause of cancer-related deaths. Obstruction, a common complication in advanced cases, often necessitates emergency surgical intervention. Traditional multi-stage procedures such as Hartmann’s operation are widely used but carry significant morbidity and impact on quality of life. Objective: to assess the results of primary anastomosis after left colectomy for obstructing mass in emergency cases regarding early post operative complications like surgical site infection, ileus, incidence of leakage, restoration of bowel movement, hospital stay and rate of readmission within one month from the time of intervention. Patients and Methods: This one-arm clinical trial was conducted at Ain Shams University Hospitals over 12 months, involving 37 patients with obstructing left colon masses. All underwent left colectomy with primary hand-sewn anastomosis. Patients were carefully selected based on intraoperative findings (good vascularity, absence of sepsis or perforation). Data were collected on postoperative recovery, complications, and hospital stay. Results: Anastomotic leakage occurred in 3 patients (8.1%), surgical site infections in 7 patients (18.9%), ileus in 5 patients (13.5%), and readmissions in 3 patients (8.1%). Bowel movement was restored in 86.5% of patients within three days. Mean hospital stay was 7.2 ± 1.2 days. No perioperative mortality was recorded. Conclusion: Primary anastomosis after emergency left colectomy is a safe and viable option in selected patients. When performed by experienced surgeons and guided by strict intraoperative criteria, it offers favorable short-term outcomes and avoids the need for stoma formation.
Acute abdomen; Colectomy; Colon carcinoma; Emergency surgery; Left-sided large bowel obstruction; Primary anastomosis.
Asmaa Ali Zaki, Tarek Youssef Ahmed, Ahmed Aly Khalil, Ibrahim Magid Abdel Maksoud
Interprofessional Competency Management and Its Effect on Clinical Quality Across Healthcare Disciplines
IPE and collaborative practice have emerged as essential imperatives in modern healthcare delivery systems due to increased complexity of patient care needs and recognition that optimal outcomes require coordinated efforts across professional disciplines. This state-of-the-art review examines the systematic management of interprofessional competencies and analyzes their documented effects on clinical quality across diverse healthcare disciplines and practice settings. Using critical review and synthesis, this study explores established competency frameworks including the Canadian Interprofessional Health Collaborative framework, the Interprofessional Education Collaborative core competencies, and the Curtin University interprofessional capability framework. The review further investigates educational interventions employed to develop collaborative practice competencies, including both traditional in-person approaches and innovative virtual modalities that gained prominence during the COVID-19 pandemic. These findings suggest that formally structured, theoretically-informed interprofessional competency development programs significantly improve collaborative practice capabilities, attitudes towards teamwork, and understanding of role and communication among students and practitioners of health professions. Evidence of effectiveness also seems to occur when educational interventions have been tailored to various delivery modalities such as simulation-based learning, clinical placement, telehealth experiences, and hybrid events that combine both virtual and in-person elements. Challenges abounding, however, are considerable in their complexity at a practical, implementational level, including organizational issues, resource limitations, scheduling complexity, faculty development issues, and assessment challenges. Additionally, whereas proximal outcomes suggest a positive trend, it is difficult to create a direct causal link between interprofessional competency development and health outcomes. This represents a critical design issue. The article concluded interprofessional competency management with sustained institutional commitment, evidence-based pedagogies, a policy environment conducive to this activity, and on-going research into its long-term impact on clinical quality and patient outcomes of care.
Interprofessional Education, Collaborative Practice, Competency Frameworks, Clinical Quality, Healthcare Education.
Aisha Mohmmad Alshmaly, Noof Hussain Almobasher, Aqilah Makki Al Dubisi, Layla Maki Aldobisy, Huda Mustafa Alhawsawi, Saadah Abdulsattar Awjan, Zainab Mohammed Alqouraiaan, Nada Omar Alnahdi, Walaa Yahia Hadadi, Sameera Faleh Al Azmi, Enas Abdulrahman Alghamdi
Genetic and Secondary Causes of Obesity Among Adults in Saudi Arabia: A Systematic Review
Background: Prevalence of obesity in Saudi Arabia is above 35% among the adult population, making it a major burden on public health. Lifestyle factors such as diet and physical activity are clearly involved, however secondary causes of obesity, such as endocrine disorders, drugs and genetic factors are still not well studied in this population. This systematic review was conducted to pool evidence for the rates and patterns of secondary causes of obesity in adults from the Saudi Arabian region. Methods: Methods We performed a systematic review following the PRISMA 2020 statement. The search was conducted in PubMed and Cochrane databases to identify studies reporting secondary causes of obesity in adults in Saudi Arabia without date or language restrictions. Two reviewers independently screened articles, extracted data and assessed quality using relevant risk of bias tools. The primary results were the frequency of endocrine causes of (hypothyroidism, polycystic ovary syndrome [PCOS], Cushing’s syndrome), drug-induced obesity and genetic aetiologias. Secondary results were the diagnostic criteria adopted, and distribution patterns according to demographic subgroups. Results: Out of 1,247 records identified, 30 were assessed for full-text review and 7 studies were included (n=1,063 participants). Neither studies on Cushing's syndrome nor on drug-related obesity as secondary causes were identified. Five studies previously investigated genetic factors (n=750), mainly focusing on obesity-related polymorphisms in the FTO, MC4R, BDNF and ACE genes. In PCOS, FTO rs17817449 and rs1421085 were significantly associated with obesity (p<0.05). Strong associations with obesity were also observed for MC4R variants rs12970134 and rs17782313 (OR=1.348 and OR=1.364, p=0.002, respectively). The largest effect was detected for the BDNF variant rs10767664 (OR=1.923, p=0.00072). PCOS was studied in 4 (n=439) studies; these studies examined genetic and metabolic factors rather than prevalence. Only one study discussed hypothyroidism, evaluating remission after bariatric surgery but without records of baseline prevalence. Meta-analysis was not feasible due to major methodological heterogeneity and incomplete reporting. Quality assessment, Type of analysis. Most of the studies showed moderate to high risk of bias, with the majority of bias arising from small sample sizes, non population-based sampling and insufficient control for confounding. Conclusions: This systematic review exposes a challenge of secondary causes of obesity in SA adults that the current evidence is insufficient to address and further high-quality research is needed. Although markers of genetic susceptibility show interesting associations, in particular for FTO, MC4R and BDNF variants, population-based studies on the prevalence of endocrine disorders and drug-related obesity virtually do not exist. The absence of screening data for hypothyroidism, Cushing’s syndrome, and drug-induced obesity is a major void in clinical knowledge. Recommendations for future research Population-based studies using uniform diagnostic criteria should be given priority in order to serve as basis for screening recommendations and for clinical practice in Saudi Arabia.
Obesity; Saudi Arabia; secondary causes; hypothyroidism; polycystic ovary syndrome; genetic polymorphisms; medication-induced obesity; Systematic review.
Majed AlSaleh, Saeed AlAhmari, Abdullah Saeed, Mohammed Yahya Asiri, Meteb AlBraik, Mohammed Jahlan, Bander Alasmari, Khaled Abdullatef Alaseeri
A Comprehensive Review of the Anesthetic Management of Patients with Pulmonary Hypertension Undergoing Cardiac Surgery
Background: Pulmonary hypertension (PH) represents a formidable challenge in perioperative medicine, particularly in the context of cardiac surgery, where elevated pulmonary vascular resistance predisposes to right ventricular dysfunction, difficulty in weaning from cardiopulmonary bypass, and increased postoperative morbidity and mortality. Main body of the abstract: Optimal management requires an integrative strategy encompassing vigilant monitoring, ventilatory adjustments, pharmacologic interventions, and preparedness for mechanical circulatory support. In recent years, attention has focused on the use of inhaled milrinone as a selective pulmonary vasodilator with potential advantages over systemic administration. This review synthesizes evidence from randomized controlled trials, meta-analyses, observational studies, and case reports (2010-2025) to evaluate the role of inhaled and intravenous milrinone, situating these within the broader framework of anesthetic and perioperative management of PH. Inhaled milrinone demonstrates theoretical and mechanistic benefits, including selective pulmonary vasodilation, preservation of systemic vascular resistance, and facilitation of separation from cardiopulmonary bypass, with some studies reporting reductions in extubation time and intensive care unit stay. However, comparative trials remain limited in size, heterogeneity of dosing regimens and timing persists, and definitive improvements in major outcomes such as survival have not been demonstrated. Conclusion: Inhaled milrinone should not be considered a standalone therapy but rather one element of a multimodal strategy that integrates preoperative optimization, invasive and echocardiographic monitoring, careful anesthetic induction, tailored hemodynamic support, and postoperative vigilance. Future large-scale randomized studies are needed to clarify optimal dosing, comparative effectiveness against other pulmonary vasodilators, and long-term outcomes.
Pulmonary hypertension, right ventricular dysfunction, cardiac surgery, perioperative management, anesthetic strategies.
Mycotic External Iliac Artery Aneurysm in a Child with Rheumatic Heart Disease and Infective Endocarditis
Background: Mycotic aneurysms of the peripheral arteries are rare in children, especially in association with infective endocarditis (IE) secondary to rheumatic heart disease (RHD). Only a few cases of RHD with peripheral mycotic aneurysms have been reported in the literature, with none in the pediatric age group. Case Presentation: We report a 10-year-old girl with known RHD and infective endocarditis who presented with acute onset left calf pain. Clinical evaluation and CT angiography revealed non-opacification of the left external iliac artery (EIA) with focal aneurysmal dilation suspicious for a mycotic aneurysm. Surgical exploration revealed a left EIA mycotic aneurysm requiring proximal and distal ligation and common iliac artery (CIA) to common femoral artery (CFA) bypass using autologous great saphenous vein. Conclusion: This case highlights a rare but serious vascular complication of infective endocarditis in children. Early recognition and prompt surgical intervention can prevent limb loss and mortality.
K Jeyachandran, Venu S, Sritharan N, Ramya, Sakthinesh
A Study to Assess The Effect Of Music Therapy On Selected Parameters Among Patients Who Have Undergone Cardiac Surgery In Selected Hospitals In Mumbai
Introduction: Postoperative cardiac surgery patients frequently experience physiological instability due to surgical stress responses, leading to increased complications and delayed recovery. Music therapy is a simple, non-pharmacological intervention known to modulate autonomic nervous system activity. This study aimed to evaluate the effectiveness of structured music therapy on selected physiological parameters among postoperative cardiac surgery patients during recovery. Materials and Methods: A quasi-experimental pretest–posttest control group design was adopted among thirty postoperative cardiac surgery patients in a tertiary cardiac hospital. Fifteen patients received binaural music therapy twice daily for seven consecutive days, while the control group received routine postoperative care. Physiological parameters including blood pressure, pulse rate, and respiratory rate were recorded and analyzed using appropriate statistical tests. Results: Post-intervention findings demonstrated statistically significant reductions in systolic and diastolic blood pressure, pulse rate, and respiratory rate in the experimental group compared with the control group. Day-wise analysis revealed progressive physiological stabilization from Day one to Day seven. Baseline measurements showed no statistically significant differences between the experimental and control groups. Discussion: The results indicate that music therapy effectively modulates autonomic responses, contributing to improved cardiovascular and respiratory stability following cardiac surgery. Repeated exposure to music therapy produced cumulative therapeutic benefits beyond routine postoperative care. These findings support existing evidence that music-based interventions are safe, low-cost adjuncts that enhance holistic recovery in postoperative cardiac patients. Conclusion: Music therapy is an effective, non-invasive adjunct in postoperative cardiac surgery care, producing significant improvements in vital physiological parameters. Its simplicity, safety, and ease of implementation support clinical applicability. Integrating music therapy into routine postoperative protocols may enhance physiological stabilization, recovery, patient comfort, and overall patient-centered outcomes in contemporary cardiac care settings..
Autonomic modulation; Cardiac surgery; Music therapy; Non-pharmacological intervention; Physiological parameters; Postoperative care.
Ms. Tejaswini Mohan Dudhawadkar, Dr. Nancy Fernandes Pereira,
Duration-Dependent Effects of Auditory Music Stimulation on Physiological and Behavioural Parameters in Wistar Rats
Auditory stimulation has been reported to influence physiological arousal and behavioural performance; however, experimental evidence regarding the effects of music exposure duration remains limited. The present study evaluated the effects of different durations of instrumental auditory music exposure on selected physiological and behavioural parameters in Wistar rats. Adult Wistar rats were allocated to four experimental groups (n = 16 per group) and exposed to instrumental music for 10, 30, or 60 minutes. Body weight and body temperature were recorded before and after exposure. Behavioural assessment included spatial learning and memory using the Morris Water Maze test and social behaviour using a helping behaviour paradigm. Pre- and post-exposure values were compared using appropriate parametric or non-parametric statistical tests. Music exposure did not alter body weight at any exposure duration. Body temperature increased significantly following exposure in all groups, with greater changes observed after 30- and 60-minute exposure compared with 10 minutes. Spatial learning performance improved significantly following exposure across all durations, as indicated by reduced escape latency in the Morris Water Maze, with no significant differences among exposure durations. Social behaviour showed duration-dependent effects, with significant improvement following 10-minute exposure, while longer exposure durations did not produce consistent changes. These findings demonstrate that auditory music exposure induces measurable changes in physiological arousal and behaviour in rats, and that exposure duration is an important determinant of behavioural outcomes. The results provide experimental evidence relevant to the study of auditory modulation of physiological and behavioural responses.
Bridging Diagnostic Medicine and Social Care: Integrating Medical Laboratory Services with Social Work to Advance Patient-Centered Outcomes
Medical laboratory services are fundamental to clinical decision-making; however, their effectiveness is frequently influenced by social determinants that affect patients’ ability to access, understand, and act upon diagnostic information. This narrative review examines the integration of medical laboratory services with social work support as a patient-centered approach to improving health outcomes across diverse healthcare settings. A structured literature review was conducted across major scientific databases to identify studies published between 2010 and 2024 addressing laboratory-based care, social work interventions, and interdisciplinary collaboration. Evidence suggests that coordinated laboratory–social work models enhance patient understanding of laboratory results, reduce diagnostic-related anxiety, improve adherence to chronic disease monitoring, and strengthen continuity of care. Social work interventions were particularly effective in addressing barriers related to health literacy, financial constraints, transportation challenges, and psychosocial stress, thereby facilitating timely diagnostic follow-up and promoting equitable access to laboratory services. Interdisciplinary collaboration further supported improved communication among healthcare professionals and earlier detection of disease-related complications. Overall, this review highlights the importance of integrating social work support within laboratory-centered care pathways to address social determinants of health and advance patient-centered outcomes. Healthcare systems are encouraged to adopt interdisciplinary frameworks that align diagnostic excellence with social support services to enhance the quality, equity, and effectiveness of care.
Medical laboratory services, social work, social determinants of health, patient-centered diagnostics, integrated care models, health literacy, chronic disease monitoring
Mohammed Almish, Elmoeiz Ali Elnagi Mohammed, Saeed Saleh Al-Wadai, Ahmed Mohamed Alahmadi, Mohammed Saad Ali AlAladhbaa, Mohammed Ali Mohammed Algarni, Mofareh Soliman Alharisi, Fahad Mashwal, Sattam Mohammed Al-Basili, Faisal Abdullah M Alamri,
Healthcare Accessibility Among Tribal Women in Jhabua District, Madhya Pradesh: Challenges and Interventions
Healthcare accessibility remains a critical concern for tribal populations in India, particularly for women residing in remote and socio-economically disadvantaged areas. This study investigates the barriers to healthcare access among tribal women in the Jhabua District of Madhya Pradesh, evaluates the effectiveness of existing interventions, and proposes context-specific strategies to improve service delivery. A mixed-method approach was employed, combining quantitative data from 300 tribal women collected through structured questionnaires and qualitative insights from focus group discussions with community leaders, ASHA workers, and healthcare providers. Secondary data were drawn from NFHS-5, Census 2011, and government health reports. The findings reveal that 68% of women were illiterate, and 72% lived below the poverty line, while 60% of households were located over 5 km from the nearest health facility, underscoring the impact of socio-economic and geographic constraints. Cultural preferences for traditional healers, financial barriers, and systemic inefficiencies—including shortage of medical personnel, irregular medicine supply, and absenteeism—further limit healthcare utilization. Consequently, 65% of women reported home deliveries, only 35% received all recommended antenatal check-ups, and immunization coverage stood at 52%, below the state average. Existing interventions, such as ASHA outreach, Janani Suraksha Yojana, and free immunization programs, demonstrated partial success but were hindered by implementation gaps and limited cultural adaptation. The study highlights the need for holistic, culturally sensitive, and community-driven approaches. Recommended strategies include establishing mobile health clinics, integrating traditional healers into health promotion campaigns, strengthening financial incentives and ASHA programs, and implementing targeted health education initiatives. Addressing these multi-dimensional barriers is essential for improving maternal and child health outcomes and promoting equitable healthcare access among tribal women.
Tribal women, Healthcare accessibility, Jhabua District, Maternal health, Cultural barriers, Health interventions.
QT Interval Prolongation Associated with High-Dose Azithromycin Therapy: A Clinical Pharmacology-Ba
Background: Azithromycin is a widely used macrolide antibiotic with a favorable safety profile; however, emerging data suggest it may induce QT interval prolongation, particularly at high doses and in vulnerable populations. This study evaluates the electrophysiological effects of high-dose azithromycin therapy and explores clinical and pharmacokinetic predictors of QTc prolongation. Methods: A multicenter, prospective, observational study was done in 180 hospitalized adults taking azithromycin 1 g/day, on infectious indications. ECGs were recorded in ser12-leads to determine the change in QTc on the basis of Bazett and Fridericia corrections. Lab data, comorbidity and co-administered medications were recorded. Exposure-response model pharmacokinetic sampling was conducted on 60 patients. Statistical analysis was done in form of paired t-tests, logistic regression and correlation. Results: The mean QTc rose dramatically in the course of the therapy (Bazett: 423.6 +- 21.4 ms to 448.2 +- 29.1 ms, p < 0.001). QTc [?]500 ms was found in 6.7% of patients and 11.7% of them had DQTc [?]60 ms. Women, hypokalemia, and chronic kidney disease and concomitant QT-prolonging medications were all important predictors of QTc [?]500 ms. Pharmacokinetic analysis found a small relationship between the plasma azithromycin concentrations and the QTc change (r = 0.28, p = 0.046). Conclusion: High-dose azithromycin is associated with dose- and risk-dependent QTc prolongation, often reversible and manageable with appropriate monitoring. Clinical vigilance, including baseline ECGs and electrolyte correction, is essential to mitigate arrhythmic risk, particularly in high-risk patients.
Azithromycin; QTc interval; QT prolongation; macrolide antibiotics; cardiac safety; torsades de pointes; high-dose therapy; pharmacokinetics; ECG monitoring; arrhythmia risk.
Mohammed Awadh M. Alanazi, Nawwarah Hakami, Abdulghani Alshehri, Wardah Hakami, Hussain Hakami, Wassan Mohammed Qattan, Jihad Majed A. Alhakami, Khaled Aljabr, Ashwaq Nasser Qumayri, Emad Alkathiry, Shatha Abujarrah, Sarah Alotaibi, Nuwayyir Alaboush, Zainab Alshawaf, Fahad Alfaifi, Najla Alkebsi
ICU-Acquired Weakness: From Neuro-Metabolic Injury to Long-Term Cognitive-Motor Deficits A Neurocritical Perspective
Background: Intensive Care Unit–acquired weakness (ICU-AW), encompassing Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM), is a debilitating neuromuscular syndrome resulting from systemic inflammation and metabolic dysregulation. From a neurocritical standpoint, ICU-AW is one component of Post-Intensive Care Syndrome (PICS), strongly correlated with persistent cognitive and psychiatric dysfunction. Despite decades of investigation, the lack of validated, actionable diagnostic criteria and targeted neuroprotective therapies represents a major failure in critical care. Objective: To critically synthesise and evaluate the progress (2014–2025) in understanding the brain-nerve-muscle axis injury in ICU-AW, assessing the clinical translational potential of molecular diagnostics, and outlining the intractable challenges in resolving the long-term cognitive-motor deficits from a neurocritical perspective. Methods: This is a definitive narrative review integrating high-impact systematic reviews, consensus statements, and prospective observational cohorts that focused on the neurophysiological, molecular, and long-term functional outcomes of ICU-AW. The selection prioritized literature that defined paradigm shifts in diagnostics, mechanisms, and the link between CIP/CIM and global PICS outcomes. Results: Neurocritical advances confirm that systemic inflammation (driven by cytokines like IL-6) and acute metabolic stress induce profound mitochondrial dysfunction in both peripheral nerves and myofibres. Novel biomarkers, particularly Growth Differentiation Factor-15 (GDF-15), have emerged as highly sensitive predictors of both muscle atrophy and poor survival, suggesting a role in risk stratification. Furthermore, electrophysiological differentiation of CIP from CIM remains the cornerstone of peripheral prognostication. Critically, the long-term literature unambiguously demonstrates that ICU-AW significantly contributes to the chronic cognitive and psychiatric morbidity of PICS, yet rehabilitation models remain largely physical-centric, failing to integrate the neurocognitive deficits. Conclusion: ICU-AW represents a complex neuro-metabolic failure that acts as a powerful predictor for the global burden of PICS. The immediate clinical imperative is the validation and integration of biomarker panels and advanced neurophysiological techniques to facilitate precision neuro-rehabilitation that simultaneously targets both the peripheral neuromuscular deficit and the persistent central cognitive impairment.
ICU-acquired weakness, critical illness polyneuropathy, critical illness myopathy, neurocritical care, Post-Intensive Care Syndrome (PICS), GDF-15, neuroinflammation, targeted rehabilitation. Summary of ICU-Acquired Weakness from a Neurocritical Perspective.
Razan Abdulkarim Khaled Alkhani, Mohamed Najm Aldeen Alameen Abdalrahman, Abdulrahman Bin Saeed, Abdullah Saeed, Amany Elsayed Ahmed Elhadidi, Raghad Emad Mohamad Alhalabi, Abd Alkader Ahmed Jafer Chardoub, Ebimisan Eyiwumi Adebiyi
Advancements in 3D Bioprinting for Organ Regeneration and Transplantation
Three-dimensional (3D) bioprinting has evolved into a sophisticated biofabrication platform capable of engineering functional tissues and, ultimately, transplantable organs. As global demand for donor organs continues to outpace supply, bioprinting offers a disruptive pathway to generate patient-specific biological constructs that replicate the structural, biochemical, and mechanical characteristics of native organs. This paper synthesizes current scientific advancements, emerging methodologies, and translational challenges in 3D bioprinting for organ regeneration and transplantation. Recent breakthroughs in bioprinting technologies—including high-precision microextrusion systems, digital light processing (DLP)-based stereolithography, and laser-assisted bioprinting—have substantially increased spatial accuracy, print fidelity, and cell viability during fabrication. Parallel innovations in bioink engineering have accelerated the field: next-generation composite hydrogels, decellularized extracellular matrix (dECM)–derived bioinks, and induced pluripotent stem cell (iPSC)-laden formulations now enable improved cell differentiation, tissue maturation, and microenvironmental mimicry. The development of programmable bioinks and shear-thinning biomaterials further enhances printability and the ability to fabricate heterogeneous, multi-material tissues. One of the most transformative advancements is the integration of vascularization strategies. Techniques such as sacrificial bioink templating, coaxial nozzle printing, endothelial cell co-culture, and angiogenic factor gradients have improved perfusability and nutrient transport in thick constructs—an essential prerequisite for printing functional organs. Progress is also evident in the bioprinting of organ-specific architectures, including hepatic lobule analogs, nephron-inspired renal constructs, contractile cardiac patches, tracheal grafts, and corneal stromal equivalents. These engineered tissues demonstrate increasing physiological relevance in preclinical models. Beyond therapeutic applications, bioprinted systems are revolutionizing drug toxicity testing, disease modeling, and personalized medicine by providing human-relevant, reproducible, and ethically sustainable platforms. Despite these advancements, significant barriers remain, including long-term tissue integration, immune modulation, large-scale biomanufacturing, and regulatory standardization. The convergence of artificial intelligence, multi-omics data, advanced biomaterials, and automated bioprinting systems is expected to accelerate the transition of bioprinted organs from laboratory prototypes to clinically viable solutions. Overall, this review critically evaluates the state-of-the-art and outlines future research directions needed to realize fully functional, transplant-ready bioprinted organs capable of addressing the global organ shortage crisis.
3D bioprinting; biomanufacturing; organ regeneration; organ transplantation; tissue engineering; biofabrication; stereolithography; laser-assisted bioprinting; digital light processing; sacrificial bioinks; coaxial printing; biomimetic biomedical engineering.
Aarthi Pradhan, Dr.T.Deborah paripuranam, Dr. Rajesh Balakrishna Jadhav, Prof. Ram Babu, Dr.Aarthi.P, Dr.Bhavya.S,
Advanced Dementia End‐of‐Life Assessment measures: A systematic Review
Background: Advanced dementia is a terminal condition characterised by profound cognitive decline, other significant and progressive symptoms, yet there is no consensus on which end‑of‑life assessment measures best capture all symptoms in this population. This study aims to identify and synthesise end‑of‑life assessment measures used in people with advanced dementia and to evaluate their measurement properties and clinical feasibility for nursing practice. Methods: This systematic review adhered to PRISMA 2020 and COSMIN guidance for measurement instruments. PubMed, ScienceDirect, Embase and the Cochrane Library were searched for peer‑reviewed quantitative studies from 2016 to 2025 using terms related to advanced or severe dementia, end of life or palliative care, and assessment or measurement. Ten studies met the inclusion criteria and were charted in a review matrix; because of heterogeneity in designs, settings and outcomes, findings were synthesised narratively across four domains: global end‑of‑life and prognostic measures, cognitive tools, behavioural pain scales and documentation‑based assessments. Results: The included studies showed that multidomain tools (EoLCAD, CADEOLD, SMEOLD, SWCEOLD) and the ADEPT prognostic score generally have acceptable internal consistency and basic construct validity but only modest prognostic discrimination and limited evidence on responsiveness. SIRS offers a brief severe‑stage cognitive assessment with minimal floor effects, while behavioural pain measures (PAINAD, PAINAD‑K, PATCIE) demonstrate good reliability, although PAINAD may partly reflect general distress in acute settings. Conclusion: The combination of end‑of‑life tool, SIRS and a behavioural pain scale is suggested to be more reliable than depending a single measure, but further COSMIN‑informed validation and implementation research is needed to improve end‑of‑life assessment in advanced dementia.
Advanced dementia, Assessment, End of life, Measurement.
Faten Ahmed Ibrahim Shab, Ebtisam Mohammed Alhindi, Nurah Abdulrahman Aldehaim, Waleed Mousa Salem Alfaifi , Mohammed Fahad H Alanazi
The Comprehensive Systematic Review of Efficacy of Minimally Invasive Techniques in Neurotrauma Surgery
Introduction: Neurotrauma, encompassing traumatic brain injury (TBI) and spinal trauma, represents a leading cause of global mortality and disability. Traditional open surgical approaches, while effective, are associated with significant morbidity. The advent of minimally invasive surgical (MIS) techniques promises to reduce surgical trauma while maintaining or improving clinical outcomes (Sahuquillo & Dennis, 2019). Methods: This comprehensive systematic review screened and analyzed 80 studies published between 2001 and 2025, including randomized controlled trials, cohort studies, and meta-analyses. The review focused on patients with acute neurotrauma requiring surgical intervention, comparing MIS techniques (e.g., endoscopic surgery, percutaneous fixation, stereotactic puncture, decompressive craniectomy variants) against traditional open surgery or conservative management. Data extraction covered study characteristics, techniques, clinical outcomes (mortality, functional scores), operative outcomes, and complications (Danfeng Zhang et al., 2017). Results: MIS techniques demonstrated significant and consistent benefits. For intracranial trauma, decompressive craniectomy (DC) reduced mortality by 34-41% compared to medical therapy (Risk Ratio [RR] 0.57-0.66). Cisternostomy showed superior mortality outcomes (Odds Ratio [OR] 0.348). Endoscopic evacuation for intracerebral hemorrhage (ICH) improved functional independence (RR 1.62) and achieved higher hematoma evacuation rates (84-87%). For spinal trauma, MIS approaches significantly reduced blood loss (mean difference -155 to -200 mL), postoperative pain, and hospital length of stay (mean reduction 3.34 days) while achieving equivalent radiological outcomes (Wei Zhang et al., 2016; Mohammad Daher et al., 2025). Discussion: The efficacy of MIS is context-specific. DC robustly reduces mortality but with a nuanced effect on functional recovery, heavily influenced by age and timing. Endoscopic techniques for ICH provide superior outcomes. In spinal trauma, MIS offers clear perioperative advantages. The evidence highlights a trade-off between the robust mortality benefit of certain invasive decompressions and the superior functional recovery and reduced morbidity associated with less invasive evacuation techniques. Conclusion: Minimally invasive techniques in neurotrauma surgery provide substantial benefits, including reduced mortality, improved functional recovery, decreased perioperative morbidity, and shorter hospital stays. The choice of technique must be individualized based on pathology, injury severity, patient age, and surgical expertise. Future research should focus on standardized outcome measures, long-term functional assessments, and cost-effectiveness analyses.
Minimally Invasive Surgery; Neurotrauma; Traumatic Brain Injury; Spinal Trauma; Decompressive Craniectomy; Endoscopic Surgery; Systematic Review.
Muhammad Fadel Asyhar, Muhammad Fadli, Muh. Raif Risqullah, Abdul Syukur Kuddus, Muhammad Yatsrib Semme,
Preventing Infection in the Intensive Care Unit (ICU): The Role of Medication Management and Use (MMU)
Healthcare-associated infections (HAIs) remain a major cause of morbidity, mortality, prolonged hospitalization, and increased healthcare costs in Intensive Care Units (ICUs). Critically ill patients are particularly vulnerable due to invasive procedures, immunosuppression, prolonged antibiotic exposure, and complex medication regimens. Effective Medication Management and Use (MMU) systems play a pivotal role in preventing ICU-acquired infections by ensuring safe, appropriate, and evidence-based use of antimicrobial and supportive medications. This paper explores the role of MMU in infection prevention in the ICU, highlighting antimicrobial stewardship, medication safety, interdisciplinary collaboration, and adherence to international standards. Practical strategies, challenges, and measurable outcomes are discussed.
ICU, Infection Prevention, Medication Management and Use, MMU, Antimicrobial Stewardship, Patient Safety.
Muhammad almalki, Mohammed Alolayan, Talal AlNahas, Sharaf Hasan Sharaf Muathin, Ahmed Masad Alzaidi, Thamer Abdullah Althobaiti, Rana Omar A Alghunaim
Prediction of Prostate Cancer by Using Data Mining Techniques with Artificial Neural Network
The idea is to explore the potential of using machine learning algorithms in predicting prostate cancer. The estimation models of prostate cancer should be made appropriately to increase the chance of prostate cancer survival. Prostate-cancer is a highly prevalent cancerous disease in men. Therefore, recognition of prostate-cancer as early as possible is needed and essential so that practitioners can establish probable outcomes and set effective strategies to treat the patients. The dataset used was the original database with 76,683 records of patients. The data were acquired from the National Cancer Institute (NCI). The number of patients after processing, cleaning, and eliminating duplicate data stands at 36,159. The data for the produced artificial neural network (ANN) was provided through the selection of data attributes, e.g., depending on the patient's age and the levels of PSA. We used a methodology that divided the data into 70% training and 30% test and validation sets, respectively. AUC and ROC curves are applied to evaluate the experimental outcomes of the proposed model. An ROC curve is a standard method of illustrating the performance of a binary classifier in terms of its accurate positive and false positive rates over a threshold range. The AUC provides a point of reference, giving a single number to represent the overall performance. Our in-depth ANN, educated by means of scaled conjugate convergence feed-forward backpropagation, achieved 91.50% in the overall confusion matrix. The best validation is 0.0644 at measure 26, the gradient is 0.0151 at measure 32, and the validation check is six at measure 32. ANN was close in predicting prostate cancer and did not use a biopsy. Nevertheless, we believe that ANN performance is insufficient for application in clinical practice. This paper observed that prostate cancer can be effectively predicted using machine learning methods. Nevertheless, incorporating more variables, including life factors that are suitable to estimate prostate-cancer, could also be a good alternative that would enable the ANN to perform better.
Machine Learning; Artificial Neural Networks; Prostate Cancer; Prostate Specific Antigen.
Mohammad Hassan Osman Abdalraheem, Alfadil Ahmed Hamdan, Mohand Tahar Kechadi
Evaluation of Orthodontic Force Magnitude on Root Resorption: A Clinical and Radiographic Study
Objectives: To evaluate the effect of orthodontic force magnitude on external apical root resorption (EARR) using clinical and radiographic outcomes. Materials and Methods: A prospective, parallel-group study was conducted at a university dental hospital in Riyadh, Saudi Arabia. Sixty-six patients were allocated to light (25–50 g), moderate (75–100 g), or heavy (150–200 g) continuous forces delivered by nickel–titanium closed-coil springs for three months. Imaging at baseline (T0) and follow-up (T1) used cone-beam computed tomography when ethically justified or standardized periapical radiographs. The primary endpoint was change in CEJ–apex root length (mm); secondary endpoints included Malmgren index grades, pain scores, and adverse events. Results: Groups were comparable at baseline. Mean EARR (Δ root length, mm ± SD) increased with force: light 0.29 ± 0.18, moderate 0.49 ± 0.24, heavy 0.83 ± 0.31. One-way ANOVA was significant (F(2,63)=26.43, p<0.001); Bonferroni-adjusted comparisons confirmed heavy > moderate > light (all p≤0.03). Clinically relevant shortening (≥2.0 mm) occurred in 0%, 4.5%, and 9.1% of participants, respectively. Malmgren grades shifted toward 2–3 with heavier forces. In mixed-effects models, force magnitude was the strongest predictor (βmoderate=+0.19 mm, 95% CI 0.09–0.30; βheavy=+0.52 mm, 95% CI 0.40–0.64), and pointed apical morphology independently increased risk (+0.18 mm, 95% CI 0.07–0.28). Conclusions: Heavier continuous forces substantially increase EARR, while light forces produce minimal, clinically insignificant changes. Treatment should prioritize light to moderate, well-calibrated forces and risk-stratified radiographic monitoring. Clinical Significance: Standardized periapicals suffice for routine surveillance; CBCT should be reserved for equivocal or high-risk cases where three-dimensional assessment will alter management.
Orthodontic force magnitude; External apical root resorption; Cone-beam computed tomography; Malmgren index; Nickel–titanium coil springs; Periodontal ligament; Hyalinization; Mixed-effects modeling; Clinical radiography; Saudi Arabia.
Abdulaziz Alzowayed, HANIN MAJED ALAHMADI, Hamad Meshal Alajmi, Abdulrahman Abdulaziz Al Saadoun, Mohammad Faye Alsultan, Amal Majrashi, ABDULLAH MOHAMMED ALMUWAINIE, Jumana Mohammed Mandurah, ALMA ABDULRAHMAN ALOUFI, Dr.Majid Salman Al-Otaibi, Zahraa Abbas Almosharaf
Enhancing Husband Support System for Fertile Age Couples (Pus) Predisposed to High-Risk Pregnancy and Husbands of High-Risk Pregnant Women in The Prevention of High-Risk Pregnancy
Background: Support system / husband's support to wives classified as Fertile Age Couples (PUS) predisposed to high-risk pregnancy is highly needed so that high-risk pregnancy in the wife does not occur. However, in reality, it is found that husbands do not provide support to their wives, even expecting the wife to get pregnant again even though the wife is already ≥ 35 years old, the youngest child is ≥ 5 years old, already has 4 children, and has experienced abortion. Objective: The objective of this research is to investigate how the support system / support provided by husbands to wives predisposed to high-risk pregnancy and to strive so that husbands can provide full support to wives predisposed to high-risk pregnancy to not get pregnant again. Materials and Methods: This research was conducted in Aceh Besar by conducting direct interviews and discussions with husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy, husbands of high-risk pregnant women, Fertile Age Couples (PUS) predisposed to high-risk pregnancy, high-risk pregnant women, Posyandu cadres, village midwives, and the head of the Community Health Center (Puskesmas). The details of respondents are as follows: Husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy as many as 4 people, husbands of high-risk pregnant women as many as 4 people, Fertile Age Couples (PUS) predisposed to high-risk pregnancy as many as 4 people, high-risk pregnant women as many as 4 people, Posyandu cadres as many as 4 people, village midwives as many as 4 people, and the head of Puskesmas as many as 4 people. The sources for interviews and discussions came from 4 (four) sub-districts in Aceh Besar Regency, namely: Lembah Seulawah Sub-district, Kuta Cot Glei Sub-district, Darul Imarah Sub-district, Baitussalam Sub-district within the time span of June 17 to July 31, 2025. The interview and discussion content was about the support system / husband's support for the prevention of high-risk pregnancy to wives predisposed to high-risk pregnancy. Results: From the interview results with husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy, husbands of high-risk pregnant women, Fertile Age Couples (PUS) predisposed to high-risk pregnancy, high-risk pregnant women, Posyandu cadres, village midwives, and the head of Puskesmas, it was found that husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy do not receive support from their husbands in efforts to prevent high-risk pregnancy, husbands tell their wives that: in the past women gave birth at ages 40-50, they were healthy, a husband of a Fertile Age Couple (PUS) said: he still wants his wife to get pregnant again because he wants to add a daughter since currently the family has 1 daughter and 3 sons. Another husband of a high-risk pregnant woman said: that he still wants his wife to get pregnant again, because he considers age, sustenance to be the destiny of Allah SWT. Discussion: Husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy and husbands of high-risk pregnant women should understand the impact of high-risk pregnancy and can provide support to their wives so that the wife is not classified as having a high-risk pregnancy. To realize this, there is a need to increase the capacity/knowledge of husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy regarding high-risk pregnancy and the impact of high-risk pregnancy on both the mother and the fetus. Conclusion: So far, the support system / support from husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy and husbands of high-risk pregnant women towards efforts to prevent high-risk pregnancy for their wives is very lacking. Husbands still think that in the past women gave birth at ages 40-50 and were healthy, then still want to add a daughter even though the family already has 1 daughter and 3 sons, and still hold the view that age, sustenance is the destiny from Allah SWT. So that husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy and husbands of high-risk pregnant women can provide a support system / support to their wives to not get pregnant and be classified as high-risk pregnancy, it is necessary to increase the capacity/knowledge of husbands about the prevention of high-risk pregnancy. For this, it is hoped that cadres and village midwives can provide maximum education to husbands of Fertile Age Couples (PUS) predisposed to high-risk pregnancy regarding high-risk pregnancy and the impact that will occur on the mother and fetus.
Husband Support System, Prevention of High-Risk Pregnancy, Education, Capacity/Knowledge Enhancement.
Rosnidawati, Darmawati, Cut Meurah Yeni, Umar Muksin
Pediatric Meningiomatosis: A Rare Radiological Case Report
Meningiomatosis is defined as the presence of multiple synchronous meningiomas arising at separate intracranial or spinal locations in the absence of prior cranial irradiation. While meningiomas represent one of the most common extra-axial intracranial tumors in adults, they are rare in children, accounting for less than 3% of pediatric central nervous system tumors. Pediatric meningiomatosis is exceedingly uncommon, with only sporadic cases reported, and its true incidence remains unknown. Diagnosis relies primarily on neuroimaging, with magnetic resonance imaging (MRI) serving as the modality of choice. Typical MRI features include multiple well-defined extra-axial masses that are isointense to gray matter on T1-weighted images, iso- to hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and demonstrate strong, usually homogeneous contrast enhancement with broad-based dural attachment and dural tail signs. Diffusion-weighted imaging generally shows no significant diffusion restriction, supporting a benign etiology. We report a rare case of pediatric meningiomatosis in which MRI revealed multiple characteristic extra-axial enhancing lesions, subsequently confirmed by histopathological examination as World Health Organization grade I meningioma.
Pediatric meningiomatosis; Magnetic resonance imaging.
Harry Galuh Nugraha, Anggi Harvia Kusumawardani, Hermin Aminah Usman
Biological Studies and Impacts of Aldimines and Ketimines in the Medicinal Field
Nitrogen-containing compounds remain foundational in medicinal chemistry, with imines—particularly aldimines and Ketimines—offering unique structural and biochemical significance. Defined by the imine bond (C=N), these molecules combine chemical versatility with biological adaptability, enabling their participation in both enzymatic processes and synthetic pharmacology. Aldimines, central intermediates in pyridoxal phosphate–dependent enzyme catalysis, are indispensable to amino acid metabolism and neurotransmitter biosynthesis. Ketimines, though less common in nature, contribute structural stability and functional mimicry, rendering them valuable in artificial biocatalysts and drug design. Together, they exemplify the dual role of imines as both reactive intermediates and pharmacophores. Their biomedical relevance extends further through Schiff bases and metal–imine complexes, which demonstrate antimicrobial, anticancer, and anti-inflammatory activity while also serving as key intermediates in heterocyclic drug synthesis. Theoretical frameworks such as Schiff base catalysis, enamine–imine tautomerism, and Werner’s coordination theory explain the reactivity, stability, and bioactivity of these compounds, while advances in computational chemistry have illuminated their binding dynamics with biological targets. This interplay of structural chemistry and pharmacological innovation situates aldimines and Ketimines at the intersection of organic synthesis, enzymology, and therapeutic development. As contemporary medicine confronts challenges such as antimicrobial resistance and cancer therapy, imine chemistry offers promising solutions. The following study explores these compounds in depth, tracing their structural foundations, biochemical functions, and translational potential in modern drug discovery, thereby underscoring their enduring relevance to the evolution of medicinal science
Medicinal chemistry, aldimine, aldehyde, imine bond, Ketimines, biochemistry, molecules.
Dr. Kumar Gaurav Jain, Dr. Sandeep Kumar, Dr. Archana Chaudhary , Amrita Kumari , Parveen , Navtej Kaur, Dr. Loveneet Kaur, Dr. Ron Kemprai
Molecular Mechanism of Red Ginger Ethanol Extract (Zingiber officinale var. rubrum) through Ovarian Cell Flow Cytometry Results: MDA, NF-ҝβ and Blood Glucose Levels as a Protector Against Polycystic Ovary Syndrome (PCOS) in Rattus norvegicus Rats
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5–21% of women of reproductive age. Insulin resistance is present in 50–75% of cases, resulting in a 35–40% reduction in insulin sensitivity compared to healthy women. Mareta’s study reported that 92.2% of 249 women with PCOS were obese, with infertility rates of 61–89.6%, and an 8.5-fold higher risk of infertility compared to women without PCOS. In experimental models, intraperitoneal administration of 100 mg/kg body weight of testosterone propionate elevates testosterone levels, induces ovarian inflammation, and disrupts the balance between protective and damaging cellular factors, leading to PCOS. This investigation endeavored to appraise the influence of red ginger (Zingiber officinale var. rubrum) ethanol extract on ovarian cellular flow-cytometric parameters—MDA, NF-κB, and glycemic indices—in mitigating the onset of polycystic ovary syndrome (PCOS) in Rattus norvegicus. In this laboratory experiment, a randomized post-test–only control group framework was utilized to examine ovarian cell MDA and NF-κB expression through flow cytometry, as well as blood glucose concentrations. Thirty Rattus norvegicus subjects were randomly assigned to five groups: K1 (negative control), K2 (positive control), P1 (200 mg/kg BW), P2 (400 mg/kg BW), and P3 (800 mg/kg BW). Treatment groups received red ginger extract for three days, followed by 21 days of combined extract and testosterone propionate (100 mg/kg BW, intraperitoneally). On day 22, rats were euthanized, and blood and ovarian tissues were collected. Ethical approval was obtained from Universitas Airlangga (No. 2.KEH.59.04.2025). Flow cytometry analysis of ovarian cells demonstrated that treatment with red ginger extract significantly reduced MDA and NF-κB expression, as well as blood glucose levels, compared to the positive control group. All treatment groups (P1, P2, and P3) showed significant improvements, with p = 0.001 for each parameter. One-way ANOVA confirmed these findings, indicating highly significant differences among groups (p = 0.001). The ethanol extract derived from red ginger (Zingiber officinale var. rubrum) was shown to diminish MDA and NF-κB expression in ovarian cells and to decrease blood glucose levels, suggesting its potential as a protective agent against polycystic ovary syndrome (PCOS).
Ethanol Extract of Red Ginger, Ovarian Cell Flow Cytometry Results, Testosterone Propionate
Siti Mudrikatin, Reny I'tishom, Jusak Nugraha, Rochmah Kurnijasanti, Sri A. Sujarwo, Budi Prasetyo
John Keats and Shiv Kumar Batalvi: A Hair-Thickness Difference inTheir Poetic Thoughts
Keats’s poetry was more sensuous than Batalvi’s. Batalvi longed for an early ‘Death', though he would not want to die an ‘Easy Death’ while Keats was passionate about life and wanted to live more, though sadly, it was not to be. His death was so painful that his last sentence was "Thank God, it has come”. Keats did talk philosophically both about the mortal and the immortal deaths, but wished an easy death for himself; perhaps he had already consumed his quota of pains and miseries from the then incurable disease tuberculosis. Keats was a poet of his age, his own social, cultural, and medical milieu. He was also, more than ever, perhaps, a poet of ours, a poet of frustration,fear, and even of hope, but Batalvi was hell-bent on pain and frustration and always waiting for death; forget about hope. Yes, Keats stands an inch taller than Batalvi as he went through dreadful agonies with threatening symptoms of the disease, and it looked as if the whole universe had conspired to give him pains. However, Keats had borne it with such fortitude and determination as if he had nothing to do with the pain. If Keats had more share of pain in life, Batalvi kept sorrows alive and took them to the last limit in his heart. Batalvi sent a cordial invitation to death, which loved him and kissed him passionately.
Sant Singh Sekhon, Fanny Brawne Luna, Ode to Nightingale, Romanticism.
John Keats and Shiv Kumar Batalvi: Kings of Melancholy and Separation
Writing sensuous poetry in two different languages, both poets speak of agony, pain, sorrow, and despair in human lives, conveying a strong relationship between love, beauty, and truth, with beauty being transient. Sufferings, the feelings of intense pains, drowning sorrows, and miserable failures in their love- lives did affect their literary works, but for the better as both wanted to give their best; perhaps aware of the paucities of times allotted to them by the Almighty as they were born for transcended imagination in their poetries. Their handsomeness proved that beauty is short-lived. The ‘Lady-luck’ did smile on both, but alas! Both lost it.
Amrita Pritam, Fanny Brawne Luna, Ode to Nightingale, Romanticism.
Effectiveness of Lung-Protective Ventilation Strategies on Clinical Outcomes in Adult Patients with Acute Respiratory Distress Syndrome: A Systematic Review
Acute Respiratory Distress Syndrome (ARDS) is a severe form of hypoxemic respiratory failure frequently encountered in intensive care units and is associated with high morbidity and mortality. Mechanical Ventilation remains a cornerstone of ARDS management; however, inappropriate ventilatory settings can exacerbate lung injury through ventilator-induced lung injury. Lung-protective ventilation strategies have been introduced to minimize alveolar overdistension and cyclic atelectasis. This systematic review evaluates the effectiveness of lung-protective mechanical Ventilation compared with conventional Ventilation in adult ICU patients with ARDS. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2010 and 2025, in accordance with PRISMA 2020 guidelines. Randomized controlled trials and observational studies reporting mortality, ventilator-free days, duration of mechanical Ventilation, or ICU length of stay were included. Following screening and quality assessment, 28 studies met the inclusion criteria. Of the included studies, 15 were randomized controlled trials and 13 observational studies, with risk of bias assessed using the Cochrane Risk of Bias Tool and Newcastle–Ottawa Scale. The findings demonstrate that lung-protective Ventilation is consistently associated with reduced mortality, increased ventilator-free days, and shorter mechanical Ventilation duration. At the same time, effects on ICU length of stay were variable. Overall, the evidence supports lung-protective Ventilation as a standard of care in the management of adult ARDS.
Adel Hussain Farhan Alghamdi, Farhan Mayouf Ghadeer Alruwaili, Dhafer Mohammed Abdulrahman Alqarni, Noor Abdullah Fraj Alkhaldi, Yousef Jadaan Hanian Albudayri, Waleed Hejji Tayil Almutairi, Emad Mohammed muidh alotaibi, Ahmed Ayidh Samran Almutairi, Saee
Investigation of the Gene Expression of APOAI and Gene Variants in ABCAI Gene in Type 2 Diabetic Pakistani Patients with and without Dyslipidemia.
Objective: To determine the APOAI gene expression and genetic variations in ABCAI gene in type two diabetes mellitus (T2DM) patients with and without dyslipidemia and association with HDL-C profile. Methodology: A cross sectional analytical study was conducted on ninety subjects; comprised of diabetic dyslipidemics, diabetics without dyslipidemia and healthy subjects, who were randomly selected. RNA and genomic DNA were isolated from human peripheral blood samples. The APOAI gene and ABCAI gene were amplified through polymerase chain reactions. APOAI gene RNA expression analysis on real time PCR and relative quantification via ∆∆CT method were carried out. DNA sequencing of ABCAI gene was performed and analyzed using BioEdit 7.9 biological software for detection of genetic mutations. Results: The mRNA abundance of APOAI gene was found changed in diseased groups compared to control. The expression of APOAI was 5.3fold changed in diabetic dyslipidemia group and 6.9fold changed in diabetic group compared to control group. There was no genetic variation found in Exon-4 of the ABCAI gene and DNA sequence was in normal pattern. Conclusion: The normalized expression of APOAI gene in diabetic dyslipidemia and diabetic group was up-regulated compared to the control group and the underlying cause might be diabetes.
Apolipoprotein I gene, ATP- binding cassette transporter I (ABCAI) gene, Dyslipidemia, Type 2 Diabetes Mellitus, High Density Lipoprotein (HDL-C)
Zara Khalid Khan, Amir Rashid, Asifa Majeed
Evaluation of Pedicled Descending Branch Latissimus Dorsi Mini Flap as an Immediate Reconstructive Technique Post Conservative Breast Surgery Regarding Cosmetic and Oncological Outcomes.
Background: Oncoplastic surgery combines tissue displacement or volume replacement to improve aesthetics after partial mastectomy. It is now favored over mastectomy, especially for large volume defects, when followed by radiation. This study aimed to evaluate the use of the latissimus dorsi muscle mini-flap (LDMF) as a volume replacement technique for large breast defects following wide local removal in various quadrants of the breast and to assess its effectiveness in terms of aesthetic results, procedure-related complications, case satisfaction, and oncologic safety, including the flap’s ability to tolerate postoperative radiotherapy. Patients and methods: This is a prospective cohort study including 25 cases who were admitted at Ain Shams University Hospitals within one year, from April 2023 until March 2024. It was conducted on patients undergoing breast-conservative surgery. Patients with early breast cancer were enrolled and assigned either to neoadjuvant chemotherapy or to upfront surgery and immediate oncoplastic reconstruction according to the MDT evaluation of the cases. This is followed by close monitoring to outcomes in follow up visits. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were the methods used to assess the quality of life and the cosmetic outcome, respectively. Range of motion (ROMs) of bilateral shoulders was assessed by disabilities of the arm, shoulder and hand (DASH) questionnaire. Moreover, Vas (visual assessment score) and sensory preservation questionnaire were given for all participants. Three surgeon assessment questionnaire was given to doctors who were not involved in the surgery. Thereafter, data including operative time, early postoperative complications and aesthetic evaluation scores were collected and analyzed using appropriate computer based statistical methods. Results: Of the 25 candidates, sixteen patients (64%) had N1 disease, seventeen (68%) were estrogen receptor–positive, six (24%) were HERII-positive and two (10%) were triple negative. Sixteen patients (32%) received neoadjuvant chemotherapy, of which five (62.5%) had good pathological response, ten (62.5%) had poor response and one (0.06%) had no response. Eventually, Nine (56.25%) patient had upfront surgery, WLE (wide local excision) with SLN (sentinal lymph node) and immediate reconstruction, as their tumor was T1N0M0 with a pathology molecular subtype luminal A or their tumor size in relation to breast cup size was large. Of the sixteen patients who took neoadjuvant chemotherapy five had underwent targeted axillary therapy with SLN successful in three (60%) and conversion to ALND (axillary lymph node dissection) in two (40%). The other eleven patients (68%) underwent WLE and ALND with WBRT (whole breast radiation). On the postoperative follow up visits, it was seen that the body image perception and nausea/vomiting score were significantly satisfying postoperatively whereas physical function score was not satisfying among the patients having shoulder pain and stiffness. Of the 25 patients, three (12%) had difficulty to resume to their daily activities and pain in shoulder. This was recorded during the 1-month follow-up; however, in the 3-month later visit none complained any difficulty in returning to their work (p=0.074). The mean operative time was 177 minutes, including the time needed for WLE and frozen section analysis. No significant relation between operative time in minutes and shoulder stiffness after angle of 150 degrees. Negative correlation between operative time and sensory preservation score (p=0.045). The median sensory preservation score was 8.00, with a range from 7.00 to 9.00; the median VAS score was 8.00, with a range from 8.00 to 9.00; and the median three-surgeon assessment score was 9.00, with a range from 8.00 to 9.00. Three patients (12%) had a complain of shoulder pain at side of operation. Of the 25 participants, five (20%) had wound infection and other 5 (20%) had seroma. Later on, wound infection was treated by antibiotics and daily dressing. Consequently, it wasn’t recorded in the 1-month follow up visit, which was statistically significant (P=0.018). Minor bleeding was recorded postoperatively in one (0.04%) patient. Adjuvant radiotherapy showed no affection to flap viability. Conclusion: The LDMF as a volume replacement procedure post BCS (brest conservative surgery) offers an effective and safe oncoplastic option for early breast cancer patients particularly those with lateral breast tissue masses, post chemotherapy, weather was with good response or poor one, and patients with large defects left behind after removal of masses with size range of two to five centimeters in small to average sized breasts. Our study revealed manageable minimal postoperative complications, good patient satisfaction scores and agreeable cosmetic outcomes throughout the follow-up visits. Longer operative time affected patient’s sensory recovery but improved surgeon ratings. Larger studies are needed to validate results and reduce complications.
Breast Surgery, Oncoplastic, LDMF, Partial lateral mastectomy
Hossam Abdelrahman Abdelrahman Yassin Elkaialy, Ashraf Abdelmoghny Mostafa, Ahmed Gamal Elden Othman, Dina Mohamed Hanafy, Mohamed Hamdy Zaid
The Critical Role of Antidotes in the Emergency Management of Poisoning: A Comprehensive Review of Mechanisms, Clinical Applications, and Strategic Stockpiling
Poisoning, whether accidental or intentional, remains a significant global cause of morbidity and mortality. The emergency management of poisoning is multifaceted, relying on decontamination, supportive care, and the timely administration of specific antidotes where available. This paper provides a comprehensive review of the role of antidotes in clinical toxicology. We define antidotes as therapeutic agents that counteract the effects of a poison through mechanisms such as receptor blockade, chelation, metabolic enhancement, or antibody-antigen neutralization. While fewer than 5% of poison exposures require an antidote, their appropriate use is life-saving and organ-sparing in critical scenarios. This review details the pharmacology of key antidotes, their evidence-based applications, and the logistical challenges of maintaining antidote availability. We emphasize the integration of antidote therapy within a holistic resuscitation framework and discuss future directions, including the development of novel broad-spectrum agents and the implications of precision medicine in toxicology.
Antidote, Poisoning, Toxicology, Emergency Medicine, Overdose, Naloxone, N-Acetylcysteine, Antidote Stockpiling.
Abdulaziz Fahad Abdulaziz Alfehaid, ALI ABDULKARIM A ALMUTIQ, Aladl, Abdulrahman Sulaiman Abdulrahman, Mohammed Alhathloul, Rahaf Saad Alshahrani, Fahed Mamdouh Alanazi
Phenotypic profiling of Carbapenem drug resistant Pseudomonas species in a tertiary care hospital in Tamilnadu
Background: Pseudomonas aeruginosa, an opportunistic pathogen, is a leading cause of healthcare-associated infections, particularly in immunocompromised individuals. The emergence of carbapenem-resistant strains poses major therapeutic and infection control challenges. Identifying carbapenem resistance through reliable phenotypic methods is essential for guiding infection control and antimicrobial stewardship. Aim and Objectives: To characterize carbapenem-resistant Pseudomonas isolates from various clinical specimens using standard phenotypic methods and to assess specimen-specific resistance patterns for optimizing antibiotic use and diagnostic accuracy. Materials and Methods: A cross-sectional study was conducted from May to October 2024 at a tertiary care hospital. A total of 100 Pseudomonas isolates from blood, pus, urine, wound swabs, respiratory secretions, cerebrospinal fluid, and other sterile body fluids were tested. Identification was done by standard biochemical tests, and antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion following CLSI 2021 guidelines. Carbapenem resistance was confirmed using imipenem and meropenem discs, and results were validated by the VITEK automated system. Results: Out of 100 isolates, 10% and 9% showed resistance to imipenem and meropenem respectively with a collective carbapenem resistance of 10%. Pus specimens displayed the highest resistance (28% IPM, 24% MRP; p < 0.05), while isolates from blood, respiratory, and CSF samples remained fully susceptible. VITEK confirmed all isolates as carbapenem-sensitive, revealing complete discordance (κ = 0.00) with disc diffusion. Conclusion: Most Pseudomonas isolates retain high susceptibility to multiple antibiotic classes. Carbapenem resistance was limited, emphasizing confirmatory testing, specimen-specific surveillance, and antimicrobial stewardship to prevent resistance escalation.
Pseudomonas aeruginosa, Drug Resistance, Phenotyping, Carbapenems.
B K Padmavathi, Ishwaryalakshmi R, Mathavi S, A V Raghavendra Rao, Reena Rajan
Quality of life, Management, and Psychological Well-Being of Patients with Obesity in the Aseer Region, Saudi Arabia: A Cross-Sectional Study
Introduction: Obesity emerges as a global health issue that creates substantial physical impacts while affecting psychological states and social dynamics. Aim of Work: This research aims to examine life quality and mental health status alongside obesity control strategies in individuals who have body mass index values greater than 25 kg/m² in the Aseer region of Saudi Arabia by assessing various demographic characteristics. Methods: The research included 100 adult participants who were aged 18 or older and had a BMI above 25 kg/m². The participants filled out an anonymous survey that contained demographic information along with BMI categories and psychological evaluation sections which included the Beck Depression Inventory (BDI), Bulimia Test (BULIT) and WHO Quality of Life Assessment (WHOQOL) as well as a body dissatisfaction checklist. The statistical analysis done through SPSS 26 version incorporated descriptive statistics along with chi-square tests, ANOVA, and correlation analysis. Results: The majority of participants were female (83.1%) and 71.5% possessed either a university or postgraduate degree. BMI revealed statistically significant relationships with gender (p = 0.008), education level (p = 0.012), age (p < 0.001) and employment status (p = 0.04). The study revealed BMI increased with age (r = .443, p < 0.001) and healthcare visits (r = .177, p = 0.020) but did not relate to physical activity. BMI showed a strong relationship with pain and discomfort because the two variables had a significant correlation of .231 (p = 0.002) but autonomy was negatively correlated at -0.218 (p = 0.004). Self-acceptance presented a negative correlation of -0.153 (p = 0.045). Conclusion: The effects of obesity on quality of life and psychological well-being primarily manifest through pain experiences and self-image problems as well as restrictions on personal independence. The research results show obesity treatment requires solutions which tackle physical health alongside emotional health needs. Future studies must conduct long-term research to both confirm cause-and-effect relationships and evaluate the successful implementation of obesity intervention approaches which enhance health results.
Obesity, Quality of Life, Psychological Well-being, Health-Related Quality of Life (HRQoL), Body Mass Index (BMI), Aseer Region, Saudi Arabia..
Reem Jaber Suhluli, Lamia Hassan Aseery, Abdulrahman Nasser Alhooti, Saleh Mubarak Aldawsari, Mujahid Fahad Aldakhil, Arwa saeed alasmari, Hamza Mohammed Aleid, Lobna aldawalibi, Faisal nasser mohammed qahl