Comparison of Early Versus Delayed Rehabilitation Following ACL Reconstruction
Background: Anterior cruciate ligament (ACL) injury is a common orthopedic condition affecting physically active individuals and often results in knee instability, reduced functional capacity and impaired quality of life. Postoperative rehabilitation plays a crucial role in recovery following ACL reconstruction. However, the optimal timing of rehabilitation initiation remains controversial, particularly in resource-limited settings such as Bangladesh. This study aimed to compare the functional outcomes and postoperative complications between early and delayed rehabilitation following ACL reconstruction. Methods: This comparative observational study was conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January to December 2021. A total of 60 patients undergoing primary unilateral arthroscopic ACL reconstruction were enrolled and divided equally into early rehabilitation (n=30) and delayed rehabilitation (n=30) groups. Functional outcomes were assessed using IKDC, Lysholm, Tegner activity, VAS pain scores, knee range of motion and postoperative stability tests. Statistical analysis was performed using SPSS version 25.0. Results: Baseline characteristics were comparable between the groups. At six months, the early rehabilitation group demonstrated significantly higher IKDC scores (84.6±6.8 vs 78.2±7.5; p=0.001), Lysholm scores (89.1±5.9 vs 82.7±6.7; p<0.001), Tegner activity scores (6.2±1.1 vs 5.4±1.0; p=0.006) and greater knee flexion range of motion (132.4±7.1° vs 125.8±8.3°; p=0.002). Lower VAS pain scores and fewer postoperative complications were also observed in the early rehabilitation group. Conclusion: Early rehabilitation following ACL reconstruction resulted in better functional recovery and lower complication rates than delayed rehabilitation.
ACL reconstruction, rehabilitation, early mobilization, knee function.
Dr. Md. Imamur Rashid, Prof. Dr. M.A. Shakoor, Dr. Nadia Rahman, Dr. Mohammad Golam Nobi, Dr. Mohammadullah
Predictors of Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study
Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in neonates with high death and morbidity. Aim: This study aimed to recognize demographic, laboratory, and clinical predictors related to the need for surgical management in neonates with NEC. Methods: This retrospective observational study was conducted on 200 patients over a three-year period in a tertiary neonatal intensive care unit. Neonates diagnosed with NEC (Bell’s stage II or III) were included and divided into surgical and conservative management groups. Results: A total of 200 neonates with NEC have been involved; 45 required surgical intervention, and 155 were managed conservatively. Neonates in the surgical group had significantly lower gestational age and birth weight (p under 0.001). Severe clinical features, including abdominal distension, abdominal rigidity, weak bowel sounds, poor mental reaction, tachycardia, and advanced Bell’s stage, were significantly more prevalent in the surgical group (p below 0.05). Multivariate analysis recognized CRP and lactate as independent predictors of surgical intervention, while higher gestational age, absolute lymphocyte count, and white blood cell count were protective. ROC analysis showed good predictive accuracy for CRP (AUC = 0.792). Conclusion: Prematurity, low birth weight, severe clinical presentation, and elevated inflammatory and metabolic markers are strongly associated with surgical NEC. CRP, in particular, is a reliable predictor and can aid in early recognition of high-risk neonates, facilitating timely surgical decision-making and improved outcomes.
Necrotizing enterocolitis; Surgical intervention; C-reactive protein; Neonates.
Hatem W Alsherbiny, Tharwat Hussein, Hasan A Adly, Alsayed M Othman MD, Taha Sobhy Taha, Reda Alkady
Workplace Violence Against Nurses and Its Association With Job Satisfaction and Turnover Intention
Workplace violence (WPV) directed towards nurses is one of the most serious health issues worldwide, having far-reaching consequences for healthcare provision, nurses’ well-being, and organizations’ internal functioning. This literature review presents a state-of-the-art research in terms of current evidence obtained in recent years (2020–2024) regarding prevalence, causes, and outcomes of workplace violence directed toward nurses, especially concerning its connection with nurses' job satisfaction and turnover intention. Based on systematic reviews, meta-analysis, and large cross-sectional studies conducted in different geographical regions such as Ethiopia, China, USA, and the UK, this paper shows that workplace violence affects from 43.4% to 89.6% of nurses according to the type and settings. In addition, the presented results show that job satisfaction acts as an important mediating variable explaining the link between workplace psychological violence and turnover intention, accounting for 43.97% of the total effect. According to hierarchical regression analysis, workplace violence contributes 32.5% of turnover intention variance when controlling demographic variables. The obtained results emphasize the necessity to implement evidence-based organizational changes, policy reforms, and culture changes in order to prevent nurses’ violence-related injuries and improve their satisfaction, thereby alleviating the problem of worldwide nursing shortage due to nurse turnover.
Workplace Violence, Nurses, Job Satisfaction, Turnover Intention, Healthcare, Occupational Safety, Nursing Retention.
Deema Fuad Abdullah Haneef, Jebreen Omayrah Almarashi, Razaz Hussain Bajal, Ghazal Ahmed farajallh Al- thalabi ,Alaa Abdullah Al Subhi, Tariq Ahmed Abdullah Alzahrani, Khalid Abdulrahman alzahrani
Large Language Models for Automated Healthcare Data Dictionary Generation and Maintenance
Data dictionaries enable consistent and reliable communication within and between healthcare organizations but are often incomplete, inconsistent, outdated, or poorly maintained. A methodology harnessing large language models (LLMs) facilitates the automated inception, augmentation, and upkeep of data dictionaries and associated artifacts throughout their lifecycle. Experimental results on an end-to-end data dictionary generation pipeline highlight considerable improvements in artifact quality, with specific categories prepared at least an order of magnitude faster than by human expert contributors. The approach addresses two crucial yet largely neglected aspects of data dictionary governance: the identification of new attributes within hospital information systems and the assessment of impact from proposed changes. In healthcare, data dictionaries describe the information content supported by a system. These dictionaries help facilitate interoperability and data-sharing by formally documenting core knowledge (such as metadata about entities and attributes), by enabling data sharing in an external dataset against which new datasets can be validated, and by providing domain knowledge about external datasets for data fusion, data integration, and machine learning. Nevertheless, many platforms do not have data dictionaries of any kind, and the quality of those that do is often poor. Poor-quality data dictionaries suffer from a range of problems, including incompleteness, inconsistency, outdated content, and lack of audit trails for historical queries. Poor-quality (and missing) data dictionaries also impact data governance by slowing down and increasing the risk in aspects such as the identification of privacy-sensitive fields, the preparation of new data-sharing contracts, and impact assessments for schema changes.
Healthcare Data Dictionaries, LLM-Based Data Governance, Automated Metadata Management, Data Dictionary Automation, Healthcare Data Interoperability, Metadata Quality Improvement, Schema Change Impact Analysis, Data Governance Frameworks, Clinical Data Standardization, Intelligent Data Documentation
Bindu Madhavi Mangalampalli, Sasi Kumar Kolla
Deep Vein Thrombosis and Pulmonary Embolism: A Shared Postoperative Concern in Prolonged Immobilised Patients
Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a major preventable cause of morbidity and mortality among postoperative and prolonged immobilized patients. Despite advances in surgical care, anesthesia, and anticoagulant therapy, VTE continues to be a significant global health challenge. Postoperative immobility, endothelial injury, and hypercoagulability—collectively known as Virchow’s triad—remain the cornerstone mechanisms driving thrombus formation. Surgical stress, tissue trauma, and prolonged bed rest further exacerbate venous stasis and clot propagation. Clinically, DVT often presents with unilateral leg swelling and pain, while PE manifests with dyspnea, chest pain, or hemodynamic instability, although many cases remain asymptomatic until complications arise. Early diagnosis through clinical scoring systems, D-dimer assays, ultrasonography, and computed tomography pulmonary angiography is crucial to prevent fatal outcomes. Preventive strategies, including pharmacologic prophylaxis with heparins or direct oral anticoagulants, mechanical compression, and early mobilization, have proven highly effective. However, variations in clinical practice, underdiagnosis, and inadequate adherence to prophylactic protocols persist, particularly in resource-limited settings. Future research should emphasize risk-based individualized prevention, development of national guidelines, and incorporation of artificial intelligence for improved prediction and early detection. A multidisciplinary approach integrating clinicians, nurses, and physiotherapists is essential to minimize postoperative VTE burden and improve patient outcomes.
Venous thromboembolism, Deep vein thrombosis, Pulmonary embolism, Postoperative immobility, Prophylaxis.
Dr Prithvansh Malhotra, Dr RK Shinde, Dr Pooja Batra, Dr Muskaan Singhal, Dr Jaideep Reddy R
Role of Barbed Sutures in Gynaecological Laparoscopic Surgery - Evidence and Implementation
Barbed sutures have emerged as a significant advancement in gynecological laparoscopic surgery, offering a knotless and efficient alternative to conventional suturing techniques. Their unique self-anchoring mechanism ensures continuous tension distribution, eliminates the need for intracorporeal knots, and simplifies suturing in confined pelvic spaces. Over the past decade, numerous clinical and comparative studies have demonstrated that barbed sutures reduce operative and suturing times, minimize blood loss, and improve surgical ergonomics without increasing complication rates. Their use has been widely adopted in procedures such as total laparoscopic hysterectomy, laparoscopic myomectomy, and pelvic organ prolapse repair, where consistent tissue approximation and hemostasis are critical. The safety profile of barbed sutures is well established, with reported complications such as bowel obstruction or suture extrusion being rare and largely preventable through proper surgical technique. Additionally, barbed sutures contribute to improved cost-effectiveness by reducing operative duration, anesthesia time, and hospital resource utilization. In India, adoption is steadily increasing, driven by favorable outcomes and growing surgeon familiarity, though barriers such as cost and limited training remain. Despite strong evidence supporting their clinical utility, research gaps persist regarding long-term fertility outcomes, uterine scar integrity, and region-specific cost analyses. Future studies should focus on multicentric, randomized trials and standardized training protocols to optimize safety and implementation. Overall, barbed sutures represent a practical, safe, and efficient innovation that aligns with the goals of modern minimally invasive gynecologic surgery.
Barbed sutures, Gynecological laparoscopy, Hysterectomy, Myomectomy, Surgical efficiency.
Dr Muskaan Singhal, Dr Poonam Bhojwani, Dr Karuna Puri
Unexplained Iron‑Deficiency Anemia Attributable To Hookworm Infection: A Decade of Case Reports In Asia
Iron-deficiency anemia (IDA) remains a major public health concern, with hookworm infection a significant yet often overlooked contributor, particularly in Asia. Hookworms (Ancylostoma duodenale, Necator americanus, and Ancylostoma ceylanicum) cause chronic intestinal blood loss, leading to progressive microcytic anemia, fatigue, and pallor. Susceptible populations include children, the elderly, and individuals with comorbidities or nutritional deficiencies. Diagnosis is challenging due to nonspecific symptoms and low sensitivity of routine stool microscopy, often resulting in misdiagnosis as nutritional anemia or other chronic conditions. Case reports highlight the utility of endoscopy and molecular assays in detecting low-burden or occult infections. Treatment with anthelmintics, iron supplementation, transfusion, and nutritional support results in favorable hematological recovery. This scoping review maps published case reports in Asia (2015–2025), summarizing patient characteristics, diagnostic approaches, species identified, and treatment outcomes. Findings emphasize the need for heightened clinical awareness, comprehensive diagnostic strategies, and preventive measures to reduce the burden of hookworm-associated anemia.
Hookworm, Iron-Deficiency Anemia, Ancylostoma, Necator, Asia.
Mark Ericson B. Baladad, Josephine C. Milan
Crystal Engineering of Pharmaceutical Cocrystals: Emerging Strategies for Drug Solubility, Stability and Bioavailability Enhancement
Pharmaceutical cocrystals have emerged as a promising crystal engineering strategy for improving the physicochemical and biopharmaceutical limitations of active pharmaceutical ingredients (APIs). In recent years, cocrystallization has gained significant attention in pharmaceutical research due to its ability to enhance solubility, dissolution rate, stability, permeability, bioavailability, and mechanical properties without altering the pharmacological activity of the drug molecule. This review comprehensively discusses the fundamental principles, classification, and preparation techniques of pharmaceutical cocrystals, including solvent evaporation, grinding, slurry conversion, hot melt extrusion, and supercritical fluid methods. The article further highlights the role of intermolecular interactions such as hydrogen bonding, π–π stacking, and van der Waals forces in cocrystal formation and stabilization. Various characterization techniques including Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), and nuclear magnetic resonance (NMR) are also summarized. Special emphasis is placed on the recent advancements of pharmaceutical cocrystals in improving therapeutic performance in oncology, antimicrobial therapy, and poorly water-soluble drugs. Additionally, regulatory perspectives, patent opportunities, industrial challenges, and future prospects associated with cocrystal-based formulations are critically analyzed. Overall, pharmaceutical cocrystals represent a versatile and innovative platform for modern drug development and offer substantial potential for enhancing drug efficacy, patient compliance, and formulation performance in advanced pharmaceutical applications.
Isoflavone, Cocrystal, Daidzein, Solvent Evaporation, Solubility Enhancement.
Preet Kaur, Dr. Manju Pandey, Dr. Brijesh Singh
Early Postoperative Outcomes of De Vega Versus Ring Tricuspid Annuloplasty in Patients Undergoing Mitral Valve Replacement
Background: Patients having mitral valve replacement (MVR) frequently have functional tricuspid regurgitation (TR), which is linked to poor postoperative results if treatment is not received. The relative effectiveness and safety of two popular surgical methods for tricuspid annuloplasty, De Vega semicircular suture annuloplasty and prosthetic ring annuloplasty, are still being compared. Objectives: This study aimed to compare the early clinical and echocardiographic outcomes of De Vega suture annuloplasty versus prosthetic ring annuloplasty in patients with moderate-to-severe functional TR undergoing concomitant MVR. Methods: A prospective comparative cohort study was conducted at Shebein Elkom Teaching Hospital and the National Heart Institute. Sixty adult patients with moderate-to-severe functional TR scheduled for MVR were enrolled and equally divided into two groups: Group A (De Vega group, n = 30) underwent De Vega semicircular suture annuloplasty, and Group B (Ring group, n = 30) underwent prosthetic rigid or semi-rigid ring annuloplasty. Results: Intraoperative characteristics — including CPB time (p = 0.742), aortic cross-clamp time (71.8 ± 10.4 vs. 68.3 ± 9.7 min; p = 0.186), and total procedure time (p = 0.553) — were comparable between groups. Both groups demonstrated significant improvements in EF (p = 0.003) and significant reductions in PAP postoperatively, with no statistically significant difference between groups (p = 0.248 and p = 0.368, respectively). Postoperative TR severity distribution was similar between groups (mild TR: 56.7% vs. 60.0%; p = 0.807). ICU stay was comparable (4.8 ± 1.7 vs. 4.1 ± 1.2 days; p = 0.085). No statistically significant differences were observed in postoperative complications, including prolonged intubation, tracheostomy, IABP use, ECMO requirement, or need for dialysis. Thirty-day mortality was 6.7% in the De Vega group and 10.0% in the ring group (p = 1.0). Conclusion: Both De Vega suture annuloplasty and prosthetic ring annuloplasty yielded comparable early postoperative outcomes in patients with functional TR undergoing MVR, including equivalent improvements in EF and PAP, similar TR severity grades, and comparable complication and mortality rates. While ring annuloplasty demonstrated a numerical trend toward greater hemodynamic improvement, the differences did not reach statistical significance in this early follow-up period. Long-term studies are warranted to determine whether differences in TR recurrence and durability emerge between the two techniques over time.
Tricuspid regurgitation; De Vega annuloplasty; ring annuloplasty; mitral valve replacement; functional tricuspid regurgitation; tricuspid valve repair; pulmonary artery pressure; ejection fraction..
Mohamed Abdallah, Islam Ebeid, Mazin Essam Eldin Ali, Eslam Elshafey, Sarah Mubarak Ibrahim
Leadership Styles and Their Influence on Healthcare Staff Performance and Patient Outcomes: A Comprehensive Analysis
The role of proper leadership in the healthcare environment has become a highly important factor of clinical performance, organizational success, and employee health. The paper is a comprehensive review of how different leadership styles, namely transformational, transactional, servant, autocratic, and laissez-faire, relate to the direct impact on healthcare workers performance, morale, and patient outcomes. Based on recent empirical research and systematic reviews and meta-analyses published in 2020-2026, the current paper will synthesize both quantitative and qualitative data to assess the efficacy of leadership. The results show that transformational and servant leadership styles are most likely to be linked to increased job satisfaction, decreased burnout, and high-quality patient safety cultures. On the other hand, autocratic and laissez-faire are associated with high medical errors, employee turnover and psychological distress. Transactional leadership is contextually useful, especially in highly risky, protocol-based units such as intensive care units. The article concludes that healthcare organizations should move beyond traditional, clinical based, and expertise based promotions to developed leadership development initiatives to promote adaptive, transformational, and servant leadership abilities to help them navigate the maze of modern healthcare delivery.
Leadership Styles, Healthcare Management, Transformational Leadership, Servant Leadership, Patient Outcomes, Staff Burnout, Job Satisfaction.
Amani Mohammed M Bujud, Ghadah Abdulhadi Ahmed, Maram Yousef Shalabi
Bayan Saleh Binmahfouz, Abrar Khalid Hambishi
Diagnostic Approaches for Detecting Metallo-β-Lactamase–Producing Gram-Negative Bacteria: A Review of MALDI-TOF Mass Spectrometry, Culture Methods, and Emerging Machine Learning Applications
Metallo-β-lactamase (MBL)–producing Gram-negative bacteria represent a major challenge to global healthcare due to their ability to confer resistance to carbapenems, often leaving limited therapeutic options. Early and accurate detection of these organisms is essential for appropriate antimicrobial therapy, infection control, and antimicrobial stewardship. Conventional culture-based and phenotypic methods remain widely used but are limited by prolonged turnaround times, subjective interpretation, and variable diagnostic performance. Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has emerged as a rapid tool for bacterial identification and has recently been adapted for functional detection of antimicrobial resistance through modified carbapenem hydrolysis assays. In parallel, machine learning approaches applied to MALDI-TOF spectral data have shown promising results in automating and enhancing resistance detection. This review critically summarizes current diagnostic approaches for MBL detection, compares their diagnostic performance, and discusses the evolving role of machine learning–assisted MALDI-TOF MS in routine clinical microbiology. Key challenges, standardization issues, and future research directions are also highlighted to support clinical translation.
Metallo-β-lactamase; MALDI-TOF MS; Gram-negative bacteria; Carbapenem resistance; Machine learning; Diagnostic accuracy.
A Comprehensive Systematic Review of Effect of Extracorporeal Shockwave Therapy on the Pain, Functional Capacity and Quality of Life in Patients with Chronic Low Back Pain
Introduction: Chronic low back pain (CLBP) is a prevalent and debilitating condition with significant socioeconomic impact, often refractory to conventional treatments. Extracorporeal shockwave therapy (ESWT) has emerged as a promising non-invasive modality, but its overall efficacy, optimal protocols, and comparative effectiveness for CLBP require comprehensive synthesis (Çelik, Altan & Ökmen, 2019; Yue et al., 2021). Methods: A systematic review of 67 studies, including randomized controlled trials (RCTs) was conducted. Studies involving adult patients with CLBP (≥12 weeks) receiving ESWT as a primary intervention were included. Data on pain (VAS, NRS), functional capacity (ODI, Roland-Morris), quality of life (SF-36, HADS), safety, and protocol parameters (type, energy, pulses) were extracted and synthesized (Liu et al., 2023; Wu et al., 2023). Results: ESWT demonstrated statistically and clinically significant reductions in pain intensity (e.g., VAS MD = -1.14 to -2.37) and improvements in functional disability (e.g., ODI MD = -6.01 to -14.10), with benefits sustained up to 12 months in some studies (Nedelka et al., 2025; Rajfur et al., 2022). Quality of life, particularly physical domains and depression scores, also improved (Çelik, Altan & Ökmen, 2019; Han et al., 2015). ESWT showed a favorable safety profile with mostly minor, transient adverse events. Comparative effectiveness varied: ESWT was superior to conventional physical therapy and sham, comparable to laser therapy, but sometimes less effective than manual therapies like Maitland mobilization or mechanical traction in specific contexts (Ejaz et al., 2024; Kızıltaş et al., 2022). Discussion: The therapeutic effects of ESWT are mediated by biological mechanisms including neovascularization, tissue regeneration, and pain gate modulation. Outcome heterogeneity is explained by variations in ESWT protocols (focused vs. radial, energy density), patient selection (specific vs. non-specific CLBP), and the presence of co-interventions like exercise. Focused ESWT with moderate energy (0.15-0.35 mJ/mm²) targeting identifiable pain generators (e.g., myofascial trigger points, facet joints) within a multimodal rehabilitation framework appears most effective (Sun et al., 2022; Ferdinandov, 2024). Conclusion: ESWT is an effective, safe, and non-invasive therapeutic option for CLBP, providing meaningful relief in pain, function, and quality of life. It is best applied as part of a multimodal strategy for patients with identifiable musculoskeletal pain generators who have not responded to first-line treatments. Future research should standardize protocols and focus on long-term outcomes and cost-effectiveness.
Extracorporeal Shockwave Therapy, Chronic Low Back Pain, Pain Management, Functional Capacity, Rehabilitation, Non-invasive Treatment.
Tivalen Dwirara Anggraini, Rene Rizaldi Pradnasurya
Explainable Machine Learning Framework for Early Heart Disease Detection Using SMOTE and SHAP
Cardiovascular diseases (CVDs) remain the leading cause of death globally, creating a persistent need for early screening tools that are both accurate and clinically interpretable.1 This study presents an end-to-end, explainable machine learning framework for binary heart disease prediction using a structured clinical dataset derived from the UCI Heart Disease benchmark, where published experiments commonly use a 14-variable subset and focus on distinguishing presence versus absence of disease.2 To strengthen reliability and reduce bias, the pipeline integrates stratified train–test splitting, feature scaling for scale-sensitive learners, and Synthetic Minority Over-sampling Technique (SMOTE) to address potential class imbalance in the training split.3 Multiple models are compared, including Logistic Regression, Naïve Bayes, KNN, SVM, Decision Tree, Random Forest, Gradient Boosting, AdaBoost, Extra Trees, XGBoost, and MLP. Performance is evaluated using accuracy, precision, recall, F1-score, and ROC-AUC, with 5-fold cross-validation to estimate generalization stability. On the held-out test set, Extra Trees achieved the highest ROC-AUC (90.80%), while SVM obtained the highest accuracy (83.61%). Cross-validation ranked Random Forest (mean ROC-AUC ≈ 90.06%) and AdaBoost (≈ 89.95%) as top performers, and GridSearchCV further optimized Extra Trees to a best cross-validated ROC-AUC of 0.912. Finally, explainability is provided through SHAP, which attributes predictions to clinically meaningful features, supporting transparent decision support rather than black-box output.4
Heart Disease Prediction, Machine Learning, Explainable AI, SHAP, SMOTE, Classification Models, Healthcare Analytics, Cross-Validation, Hyperparameter Tuning, Clinical Decision Support.
Mahfuz Islam Khan Jabed, Muhammad Imran, Abdul Ali Khan, Mohiuddin Mehedi, Ashraful Islam, Rahat Pervez
Peri-Coronary Epicardial Adipose Tissue and Coronary Artery Calcification as Markers of Atherosclerotic Burden in Postmenopausal Women
Background: Peri-coronary epicardial adipose tissue (EAT) may play a role in coronary atherosclerosis via localized inflammatory and paracrine mechanisms. This study sought to evaluate the correlation between peri-coronary epicardial adipose tissue, coronary artery calcification, coronary atherosclerotic lesions, and cardiovascular risk factors in post-menopausal women. Method: This study involved 200 post-menopausal women with suspected coronary artery disease. All participants underwent clinical evaluation, laboratory tests, coronary artery calcium (CAC) scoring, and multislice computed tomography coronary angiography. The thickness of peri-coronary EAT was assessed surrounding the left main, LAD, LCX, and RCA. Based on MSCT results, patients were put into two groups: a coronary lesion group and a control group. Result: There were coronary lesions in 140 women. Cases with coronary lesions had CAC scores that were much higher than those of the controls (219.64±345.55 vs. 111.5±301.33; p=0.028). There was a big difference between the patient group and the control group in peri-coronary EAT around LAD, LCX, and RCA. However, there was no big difference in LM EAT. EAT around LAD, LCX, and RCA was strongly linked to significant CAC, dyslipidemia, and a positive family history, but not to age, obesity, smoking, high blood pressure, or diabetes. Conclusion: In post-menopausal women, peri-coronary EAT had a positive correlation with CAC and coronary atherosclerotic lesions. It was also linked to certain cardiovascular risk factors, especially dyslipidemia and family history. This suggests that peri-coronary EAT could be a useful imaging marker for the burden of coronary atherosclerosis.
Epicardial adipose tissue; coronary artery calcification; multislice computed tomography; coronary artery disease; post-menopausal women.
Mohamed R Badran, Islam Ebeid, Rehab Mahmoud Al-Ashry
Delay in Diagnosis and Treatment of Breast Cancer among the Patients Attending a Public and Private Hospital
Background: Breast cancer is the most common malignancy and the leading cause of cancer-related mortality among women worldwide. Delay in diagnosis and treatment is associated with advanced stage at presentation and poor prognosis. Methods: A cross-sectional study was conducted among 236 women with diagnosed breast cancer attending a public hospital (National Institute of Cancer Research and Hospital, NICRH) and a private hospital (Ahsania Mission Cancer Hospital). Participants were selected using purposive sampling. Data were collected through face‑to‑face interviews using a pretested semi‑structured questionnaire. Delays were categorized as patient delay, diagnosis delay, treatment delay, system delay, and total delay. Associations were assessed using Pearson's chi‑square test. Results: Mean age of participants was 45.42±8.52 years; 41.5% had primary education, 89.8% were housewives, and 22.5% had a monthly family income of 6000–10,000 BDT. Most (66.5%) resided in urban areas. More than half of the respondents experienced patient delay (mean 4.5 months). Mean treatment delay was 2.10±2.30 months (nearly half of respondents), diagnosis delay 1.6±1.96 months (nearly half), system delay 3.80±4.00 months (nearly two‑thirds), and total delay 7.58±6.65 months (nearly two‑thirds). When comparing public vs. private hospital, statistically significant differences were observed for treatment delay (p=0.004), diagnosis delay (p=0.004), and system delay (p<0.001); all delays were longer in the public hospital. Multiple factors contributed to delays, and total delay showed a highly significant association with the responsible factors. Conclusion: Delays in breast cancer diagnosis and treatment are substantial, particularly in public hospital settings. Public health education, reliable referral pathways, health system strengthening, and screening programs are needed to reduce the burden of delayed presentation.
Breast Cancer, Diagnostic Delay, Treatment Delay, Public Hospital, Private Hospital, Bangladesh.
Afsana Zerin Shakila, Most Sultana Afroz, Md. Ahashan Habib, Nadiya Pasha, Nusrat Ahmed, Nayma Sharoary Jahan, Sayda Tanjina Pervin, Anaya Nur Mou
Impact of Postoperative Cognitive Dysfunction after Cardiac Surgery on Midterm Outcomes and Mortality
Background: Postoperative cognitive dysfunction (POCD) that is a common neurological side effect after cardiac surgery, is becoming more widely acknowledged as a possible marker of adverse outcomes. But its effect on mortality and midterm results is still unclear, especially in developing countries. Aim of the Study: To investigate the impact of POCD on midterm clinical outcomes and mortality following cardiac surgery. Patients and Methods: This prospective observational cohort study was conducted on 200 adult patients undergoing cardiac surgery at the National Heart Institute, Cairo, Egypt, and Shebein Elkom Teaching Hospital, Menoufia. Patients were categorized into POCD and non-POCD groups based on postoperative cognitive assessment using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Results: Postoperatively, MMSE scores were significantly lower in the POCD group compared to the non-POCD group. Patients with POCD had significantly prolonged ICU stays and total hospital stays. The incidence of postoperative complications was significantly higher in the POCD group. Functional dependence, as assessed by Activities of Daily Living (ADL), was also significantly more prevalent among POCD patients. Regarding mortality outcomes, although mortality at 1 week and 1 month were higher in the POCD group, it did not reach statistically significant difference. While at 1 year the POCD group showed a significantly higher mortality rate (9.0% vs 1.0%, p = 0.019). Conclusion: POCD is associated with adverse postoperative outcomes following cardiac surgery, including increased complications, prolonged hospitalization, greater functional dependence, and higher midterm mortality. Early identification and targeted management of POCD may improve patient outcomes and reduce postoperative morbidity and mortality.
Cognitive dysfunction; POCD; cardiac surgery; mortality.
Mohamed Abdallah, Sarah Mubarak Ibrahim, Shymaa Mamdouh Mohamed Abdu, Eslam Elshafey, Mazin Essam Eldin Ali
Secure Multi-Party Computation for Medical Data Protection
The growing digitization of healthcare systems has greatly enhanced the accessibility and efficiency of medical data and diagnosis. Nevertheless, it has also posed significant issues concerning the privacy of data, its security, and compliance with regulations. When stored or processed in centralized systems, sensitive patient data, such as clinical history and diagnostic history, is extremely susceptible to breaches. Historical healthcare machine learning models typically involve combining data from several institutions, which is a serious privacy concern. Secure Multi-Party Computation (SMPC) has become one of the promising cryptographic paradigms that help to cooperatively compute functions on the data of multiple parties without disclosing the sensitive information. This paper introduces a privacy-preserving machine learning model with SMPC to predict heart diseases. The suggested system enables the distributed healthcare institutions to collaboratively train predictive models without providing raw patient information. To test the framework, a heart disease dataset with more than 1000 records of patients was used. Random Forest and Gradient Boosting machine learning models were tested in a simulated SMPC setting. The findings show that the suggested solution has high predictive accuracy and guarantees high levels of data confidentiality. Gradient Boosting attained 88% accuracy, which is better than random forest. The results indicate that SMPC combined with machine learning is able to resolve privacy issues in healthcare analytics without drastically deteriorating the performance of the model. This study serves as part of the expanding body of privacy-sensitive AI and emphasizes the promise of SMPC in privacy-sensitive medical data sharing and collaborative medical research.
Secure Multi-Party Computation, Healthcare Data Privacy, Machine Learning, Heart Disease Prediction, Cryptography, Privacy-Preserving Systems
K M Nazmul Hasan, Md Mahbubur Rahman Akash, Md Mashfiqur Rahman, Shimanto Haque, Imamul Haque Suhag, Md Ismail Jobi Ullah, Dr Sifat Sanjida Basher
Machine-Learning–Based Prediction of Drug Resistance Genes in Human Cancer Cell Lines
Background: The problem of drug resistance has continued to be a formidable issue in the treatment of cancer, and in most instances, the patient turns out to fail in therapy and subsequently dies. The latest achievements in machine learning (ML) and high-throughput data in the biological realm have created new opportunities in predicting the drug resistance genes in human cancer cell lines. The combination of computational needs and cancer genomics and multi-omics data will have the potential to improve prediction accuracy and facilitate personalized cancer treatment. Objective: The overall aim of the conducted research was to investigate the effectiveness of machine learning-based methods in predicting drug resistance genes in human cancer cell lines and study how machine learning familiarity, cancer genomics background, and multi-omics combination impact the predictive results. Methodology: The research design employed was quantitative, which relied on the use of questionnaire-based data in finding the answer to the research question that involved 210 participants with background data in bioinformatics, computer science, biotechnology, and molecular biology. The statistical tests included a normality test, a reliability and validity test, an Independent Samples t -test, a One-Way ANOVA, a Kruskal-Wallis test, a Chi-Square Test of Independence, a Pearson correlation, and a multiple linear regression test. The data analysis was done to identify relationships, group variations, and predictive effects among major study variables. Results: The findings were that the data were distributed normally, reliable, and valid. The statistical tests were used to provide an inference that found significant variations in machine learning familiarity between genders, the level of education, and the field of study. The use of human cancer cell line datasets was also significantly related to machine learning familiarity. The results of Pearson correlation showed moderate to strong positive correlations between machine learning familiarity, cancer genomics knowledge, multi-omics integration, and the impact of personalized therapy. The use of regression analysis revealed that all of the independent variables significantly and positively impacted the prediction of drug resistance, with the largest impact being observed in multi-omics integration. Conclusion: The results of the research paper prove that machine learning-based strategies, to which specialized skills in cancer genomics are added, and multi-omics information sets are integrated, contribute to predicting drug resistance genes in human cancer cells a great deal. Such findings emphasize the relevance of cross-functional learning and elevated computational analysis to promote accuracy in oncology and individualized treatment of cancer.
Machine Learning, Drug Resistance Genes, Cancer Cell Lines, Cancer Genomics, Multi-omics Integration, Personalized Cancer Therapy, Bioinformatics.
Elton Bicalho do Carmo, Lincoln Junior Bicalho, Saima Akter Shikha, Tania Yeasmin, Daniel Benniah John, Mehedi Hasan Pritom, Momtaz Akter Mitu, Nure Alam Howlader, Md Refat Hossain, Md. Maniruzzaman
Free LIMA Graft with Proximal Aortic Anastomosis for Intraoperative Proximal LIMA Injury: Short- and Mid-Term Outcomes of a Conduit-Preserving Salvage Strategy
Background: The left internal mammary artery (LIMA) is the gold-standard conduit for left anterior descending (LAD) coronary revascularization. Proximal LIMA injury during harvest is a rare but technically challenging complication that may result in loss of the optimal arterial conduit. We evaluated the feasibility, safety, and short- to mid-term outcomes of a conduit-preserving salvage strategy using free LIMA grafting with proximal anastomosis to the ascending aorta. Methods: A retrospective analysis of a prospectively maintained multicenter registry was conducted across four high-volume cardiac centers between January 2018 and December 2021. Patients undergoing coronary artery bypass grafting (CABG) complicated by intraoperative proximal LIMA injury (≥50% transection, critical stenosis, or pedicle avulsion) were included. Salvage was performed by converting the LIMA into a free graft, with proximal anastomosis to the ascending aorta and distal anastomosis to the LAD. Intraoperative graft flow was assessed using transit-time flowmetry (TTFM). Primary endpoints were 30-day major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, myocardial infarction, stroke, or repeat revascularization) and graft patency at follow-up. Graft patency was assessed using MSCT coronary angiography at 12 months or during follow-up when feasible and graded according to the Fitzgibbon classification (A: excellent; B: <50% stenosis; O: occlusion or ≥50% stenosis). Outcomes were compared with a 1:1 propensity-matched cohort (n=52) undergoing standard in-situ LIMA-to-LAD grafting, matched for age, sex, LVEF, diabetes, redo status, and graft number. Kaplan–Meier survival analysis and Cox proportional hazards regression were used for comparative outcomes. Results: Fifty-two patients underwent attempted LIMA salvage. Technical success, defined as satisfactory intraoperative flow by TTFM, was achieved in 50 patients (96.2%). Mean age was 64.2 ± 8.1 years, and 78.8% were male. The 30-day MACCE rate was 9.6% (5/52), including mortality in 3.8% (n=2), non-fatal myocardial infarction in 3.8% (n=2), and stroke in 1.9% (n=1); no repeat revascularization occurred within 30 days. MSCT coronary angiography follow-up was available in 48 of 50 successfully treated patients (96.0%) at a mean follow-up of 26.4 ± 4.2 months (range 18–38); the remaining two patients were excluded due to pre-existing renal dysfunction precluding contrast administration. Overall graft patency (Fitzgibbon grade A or B) was 93.4% (45/48), with perfect patency (grade A) in 89.6% (43/48). Compared with the propensity-matched in-situ LIMA cohort, all-cause mortality did not differ significantly (adjusted hazard ratio 1.07, 95% CI 0.89–1.29; p = 0.51). The study was not powered to demonstrate equivalence between groups. Conclusions: Conversion of an injured LIMA to a free graft with proximal anastomosis to the ascending aorta is a feasible and effective conduit-preserving salvage strategy. It provides favorable short- to mid-term patency and acceptable clinical outcomes compared with standard in-situ LIMA grafting. This technique may be considered in selected intraoperative injury scenarios when anatomically feasible to preserve arterial revascularization options.
Coronary artery bypass grafting; left internal mammary artery; conduit injury; free LIMA graft; MSCT coronary angiography; surgical salvage technique.
Mahmoud Zayed, Mohammed Farahat Helmey, Tarek Mohamed Afifi, Badr Fayed
Essential Skills of Dental Assistants in Handling Dental Materials
The research work focused on exploring the dental assistants’ skills in handling dental materials from various domains such as knowledge, skills, infection control, communication, problem-solving, time management, confidence, and barriers. The study conducted using descriptive statistics, ANOVA, and correlation analysis showed that dental assistants possessed strong skills in knowledge (M = 4.10), skills (M = 4.01), infection control (M = 4.16), and communication (M = 4.16), and strongest in problem-solving (M = 3.93), confidence (M = 3.89. The lowest value was assigned to challenges and barriers (M = 3.61), dealing with systemic barriers such as optimized work load and new material adaptation. The one-way ANOVA analysis resulted in significant association of knowledge (p = 0.028), infection control (p = 0.002), and communication skills (p = 0.001) with demographic variables; meanwhile, there was a borderline association of skills with demographic variables (p = 0.053). The correlation analysis demonstrated that years of experience had a significant inverse relation with problem-solving, confidence, and barriers; meanwhile, type of work setting showed significant positive association with knowledge, skills, teamwork, time management, and confidence. The research work thus emphasizes and supports the net advantageous role of dental assistants in focusing efficiency and occupational safety associated with adaptation and orientation of dental assistants with dental materials and technology.
: Dental assistants; Dental materials; Competency; Infection control; Communication; Teamwork; Occupational safety; ANOVA; Correlation; Professional development How to Cite: Eman Abdullah Al Jumah,Marwah Mohammed
Eman Abdullah Al Jumah, Marwah Mohammed Alruwaijeh, FATIMAH ABDULLH AlAli
Health Equity and Digital Disparities in Cancer Screening and Cardiovascular Care Across Socioeconomic and Ethnic Groups: A Systematic Review
Background: The current disparity in breast screening and cardiac care has been one of the major health concerns in the world. Preventive services, timely diagnosis and evidence-based interventions continue to be dependent on socioeconomic status (SES) and ethnicity. These gaps are significant to comprehend so as to craft interventions that have the potential of contributing to health equity. Objectives: This is to undertake a systematic review and synthesis of evidence on disparities in cancer screening (breast, colorectal, cervical), and cardiovascular care (hypertension control, lipid management and revascularization) according to socioeconomic and ethnic categories and the strategies that have been demonstrated to reduce these disparities. Methods: A review of the system was conducted in compliance with PRISMA 2020. Four databases (PubMed, Scopus, Web of Science, and Google Scholar) were searched to identify those articles which were published after January 2010 and until March 2023. The eligible studies were adults (18 years or older) who were stratified by SES and / or ethnicity, and reported the outcomes of screening rates or cardiovascular prevention or therapeutic care. Two independent reviewers screened, extracted and quality-assessed studies, using the NewcastleOttawa Scale of observational designs and Cochrane RoB 2 tool of trials. Random-effects pooling was applied where appropriate and quantitative and qualitative methods of synthesis were utilized. Results: Two hundred and eighty-eight studies were eligible with 112,450 patients. Cancer screening: The low-income and minority groups had a 2035% lower uptake of mammography and colorectal screening (RR = 0.72 95% CI 0.660.79). These included barriers of cost, poor health literacy and distrust of healthcare systems. Cardiovascular care: Socioeconomically disadvantaged and ethnic minority populations had reduced blood pressure management (OR = 0.67; 95% CI 0.610.74) and reduced statin-use and revascularization (RR = 0.82; 95% CI 740.91). Patient engagement: There is a high positive correlation between patient engagement and improved outcomes (r = 0.69). The programs were culturally tailored by use of education and orientation, which increased screening and adherence to medication. Confidence and system preparedness: The low trust levels (2.7/5 vs. 3.9/5) in the underprivileged groups were the indicators of structural barriers and discrimination. Conclusion: Cancer screening and cardiovascular care differences exist in socioeconomic and ethnic groups, which are major and persistent. It has been shown that community-based outreach, culturally competent navigation and policy-level expansion of insurance may be effective solutions to addressing these gaps. Equity measures and intersectional analysis and long term follow up should be employed as the methods of standardizing follow up in future studies when evaluating sustainable impact is required.
Health equity; cancer screening disparity; cardiovascular care disparity; socioeconomic status; ethnicity; patient engagement; healthcare trust; PRISMA systematical review.
Abdullah Al Kium, Sumi Sarker, Saima Akter Shikha, Md Ahnaf Tajwar Kamal, Mahfuz Islam Khan Jabed, Nawfat Kamal Munifa, Momtaz Akter Mitu, Mehedi Hasan Pritom, Farmina Sharmin, Daniel Benniah John
Designing Intelligent Healthcare Ecosystems through Adaptive Data Integration and Autonomous Learning Systems
An intelligent healthcare ecosystem comprises an interconnected and mutually supportive network of healthcare stakeholders and functions aimed at improving healthcare quality and accessibility while reducing costs. Intelligent healthcare ecosystems provide continuous learning by integrating data from heterogeneous sources, such as electronic health records, wearables, and patient-reported outcomes, and feeding the data into automated decision-support systems that learn from real-world evidence. Intelligent healthcare ecosystems can be assembled in an incremental manner, with targeted investments in the development of trustworthy adaptive data integration utilities and autonomous learning systems that can deliver value independently while scaling up and maturing. Research on the development of intelligent healthcare ecosystems is particularly timely as cross-industry stakeholders prepare for the deployment of 5G networks and the Internet of Things. The adaptability and performance of intelligent healthcare ecosystems can be enhanced by focussing on clinical decision-support and clinical risk stratification capabilities that change the conduct and treatment of care, thereby producing clinical outcomes that enhance the day-to-day activities of healthcare caregivers. Enabling a shift in the conduct of care reduces the pressure on healthcare systems and the cost of care delivery. Adaptive data integration utilities and autonomous learning systems designed specifically for healthcare permit a more flexible approach to practical realisation of intelligent healthcare ecosystems, supporting incremental integration effort and enabling an agile response to changing business needs.
Intelligent Healthcare Systems,Adaptive Data Integration,Autonomous Learning Systems,AI in Healthcare,Healthcare Data Interoperability,Machine Learning in Medicine,Smart Healthcare Ecosystems,Clinical Decision Support Systems,Healthcare Analytics,Predictive Healthcare Modeling,Digital Health Transformation,Big Data in Healthcare,Personalized Medicine,Health Information Systems,AI-driven Patient Care..
Bindu Madhavi Mangalampalli, Sasi Kumar Kolla, Velangani Divya Vardhan Kumar Bandi, Uday Surendra Yandamuri, Dr. P.R. Sudha Rani
Secondary Causes of Obesity in Children: A Systematic Review and Meta-Analysis
Background: Secondary causes account for a clinically insignificant minority of childhood obesity; however, prevalence estimates, diagnostic yields, and management outcomes across specific etiological subtypes have not been quantitatively synthesized from primary study data. Objectives: To conduct a systematic review and meta-analysis of primary studies examining the prevalence, clinical features, diagnostic approaches, and management outcomes of secondary causes of obesity in children and adolescents aged 0–18 years. Methods: PubMed/MEDLINE, Web of Science, Scopus, and Embase were searched from January 2000 to December 2025. Only primary studies (cohort studies, randomized controlled trials, cross-sectional studies, clinical trials, and case series with ≥5 patients) were included. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using ROBINS-I for observational studies and Cochrane RoB 2 for the RCT. Random-effects meta-analyses were performed for outcomes reported in ≥2 studies, and heterogeneity was quantified using I² and Cochran’s Q. Publication bias was assessed using Egger’s test with k≥3. Results: Twelve primary studies (N > 3,000 children) met the inclusion criteria. The meta-analysis demonstrated a pooled MC4R deficiency prevalence of 3.6% (95% CI 2.1–5.4%; I²=41%) among children with severe early-onset obesity. Next-generation sequencing yielded a genetic diagnosis in 9.5% (95% CI 7.2–12.1%; I²=28%). Growth hormone therapy in Prader-Willi syndrome significantly reduced body mass index SDS (pooled MD −0.82; 95% CI −1.14 to −0.50; I²=19%). Hypothalamic obesity developed in 42.5% (95% CI 27.1–58.7%; I²=67%) of children following craniopharyngioma treatment. Leptin/leptin-receptor replacement therapy produced marked weight reduction (pooled MD −8.4 kg; 95% CI −12.1 to −4.7; I²=0%). The risk of bias was low in four studies and moderate in eight. Conclusions: This meta-analysis provides precise pooled estimates for the prevalence and treatment effects of major secondary obesity subtypes in children. Growth hormone therapy in PWS achieves consistent, clinically meaningful BMI SDS reduction. Genetic testing in children with severe early-onset obesity yields a diagnosis in approximately 1 in 10 children. Future adequately powered RCTs are urgently needed to evaluate hypothalamic obesity and novel targeted pharmacotherapies.
childhood obesity; secondary obesity; monogenic obesity; Prader-Willi syndrome; hypothalamic obesity; meta-analysis; systematic review; growth hormone; ROBINS-I; MC4R.
Majed M. AlSaleh, Abdullah Saeed, Bander A. Alasmari, Mohammed Y. Asiri(0000-0001-9013-7964), Mohammed Althabbahi, Ayed A. Shati, Mozoun D. Alahmari, Ahmed Albishri, Meteb A. Albraik
Thoracoscopic sympathectomy for treatment of primary palmar hyperhidrosis: Single versus multiple levels division
Background: Palmar hyperhidrosis is a disorder of excessive eccrine gland activity affecting the palms with an estimated prevalence of approximately 2.8%. Endoscopic thoracic sympathectomy (ETS) remains the definitive therapeutic intervention for refractory palmar hyperhidrosis, performed either through multi-level interruption of the sympathetic chain (T2–T5) or targeted single-level division at T3 or T4, the latter demonstrating a reduced incidence of postoperative complications. Methods: This multicentric study employed a descriptive design with both prospective and retrospective components and was conducted between (June 2021) to (June 2023). A total of 45 patients with primary palmar hyperhidrosis underwent endoscopic thoracoscopic sympathectomy (ETS). Patients were followed for a mean duration of 6 months and were assessed for improvement in palmar sweating, postoperative pain, the occurrence of postoperative complications, and overall quality of life. Results: All patients showed an improvement for their 1ry palmar hyperhidrosis, with a significant difference in favor of the single-level cut. Compensatory hyperhidrosis was recorded in all cases of group A (100%) and in 6 cases of group B (40%) and 1 case of group C (6.7%). 2 (13.3%) cases of group B and 6 (40%) cases in group C showed recurrence of 1ry palmar hyperhidrosis, but less severe than the original condition. Patients’ satisfaction with improvement in quality of life was recorded starting from the first postoperative evaluation, but without a difference between the 3 groups. Conclusion: Both techniques were effective for handling palmar hyperhidrosis with a high grade of patients’ satisfaction. Single-level division carries more advantages in the form of less incidence of post-operative pain, short operative time, with fewer incidences of post-operative complications.
Palmar hyperhidrosis, Compensatory hyperhidrosis, Endoscopic thoracic sympathectomy (ETS), Sympathectomy.
Esayed Elmokadem, M.D; Hazem Ali Essa Ali Sheashia, M.D; Mazin Essam Eldin Ali, M.D; Mohamed F. Younis, MD; Ahmed Beheiry, M.D; Mohammed Siam, M.D; Mohamed F. Elfaresy, M.D
Emerging Applications of Wearable Devices and Remote Monitoring Technologies In Cardiovascular Disease Prevention and Management: A Systematic Review
Background: CVDs are the leading cause of mortality worldwide and they have been a burden to healthcare systems in terms of late diagnosis and lack of long-term monitoring interventions. New technologies in wearable technologies such as smartwatches, ECG patches, cuffless blood pressure monitoring, and heart-failure remote-sensing platforms have also brought new possibilities of continuous and real-time cardiovascular monitoring. Improved with the help of artificial intelligence (AI) and machinelearning- based algorithms, the devices will provide a more accurate interpretation of physiological patterns and can enhance the field of early detection, risk stratification, and clinical management. This system review is an inquiry into the emerging evidence of wearable and remote monitoring in the prevention and management of major cardiovascular conditions. Objectives: This review aims to assess the quality of: diagnosis, clinical utility, and methodology of modern wearable devices and remote monitoring technologies to determine their use in atrial fibrillation, hypertension, heart failure, and other cardiovascular diseases. Methods: The systematized search was performed according to the principles of PRISMA 2020 in relation to eight large databases between January 2008 and February 2024. The studies had to meet the following criteria: they had to evaluate wearable or remote monitoring technologies and provide cardiovascular-related diagnostic or clinical outcomes. Data that were extracted comprised sample features, the type of device, performance indicators, AI implementation, and validation methods. The risk of bias was evaluated with the help of ROBINS-I and QUADAS-2. Narrative and quantitative syntheses were conducted and pooled accuracy estimates, forest plots, as well as, correlation analyses to interpret device performance and methodological patterns were used. Results: There were 58,740 participants that were included in 42 studies. The analysis has indicated that wearable devices possess great diagnostic potential, especially the devices that detect atrial fibrillation by the use of PPG- and ECG-based technologies, which had high sensitivity and specificity. Cuffless blood pressure devices demonstrated average accuracy, whereas heart-failure remote devices were always able to decrease hospitalization or give an early warning of decompensation. Signal processing with AI added value helped in enhancing the quality of diagnostic accuracy in several types of devices. There were also methodological weaknesses, though, since a smaller portion of the studies were external validation, and the problem of calibration of the devices was rather common. Correlation tests showed that the greater the sample size and the number of multi-sensor devices a higher the diagnostic accuracy and external validity. Conclusion: The use of wearable devices and remote monitoring technologies has a lot of potential to revolutionize the process of cardiovascular disease detection and continuous management. Smartwatches, ECG patches and heart-failure monitoring systems have already shown clinically meaningful consequences, and the use of AI is still continuing to expand the level of accuracy or predictive ability of the devices. However, discrepancies in validation procedures, calibration difficulties of blood pressure in equipments, and study-to-study heterogeneity means that more standardization and stringent clinical testing is required, before a wide clinical integration is attained. To achieve the full potential of wearable cardiovascular technologies in preventative and personalized medicine, it will be crucial to persist in research in multi-sensor systems, transparent AI models, and limited clinical trials on a large scale.
Wearable; remote monitoring; heart diseases; atrial fibrillation; hypertension; heart failure; artificial intelligence; photoplethysmography; ECG patches; digital health.
Abdullah Al Kium, Shakila Azad, Md Mahamudul Hasan, Aktaruzzaman Azad, Md Mahamudul Islam, Momtaz Akter Mitu, Mohammed Tanjim Uddin Chowdhury, Mehedi Hasan Pritom
Extraction, Standardization, and Phytochemical Characterization of Bioactive Compounds from Emblica officinalis, Ocimum sanctum, and Tinospora cordifolia
Background: Emblica officinalis (fruit), Ocimum sanctum (leaves), and Tinospora cordifolia (leaves) are well-known medicinal plants used in traditional systems of medicine. Scientific standardization and characterization of their bioactive constituents are essential to validate their therapeutic potential and to ensure the quality, safety, and consistency of plant-based formulations. Methods: Authentic plant materials were collected and subjected to quality control and standardization tests, including determination of moisture content, foreign matter, total ash, acid-insoluble ash, and extractive values. Phytochemical screening was conducted to identify major classes of secondary metabolites. Chromatographic analyses using thin-layer chromatography (TLC) and high-performance thin-layer chromatography (HPTLC) were performed to profile phytoconstituents. Bioactive compounds were isolated through column chromatography and characterized using spectroscopic techniques such as UV–visible spectroscopy, infrared spectroscopy, nuclear magnetic resonance, and mass spectrometry. Main Findings: Phytochemical analysis revealed the presence of flavonoids, alkaloids, terpenoids, steroids, tannins, and phenolic compounds in the plant extracts. TLC and HPTLC analyses showed multiple Rf values, indicating chemical diversity within the extracts. Column chromatography led to the isolation of rutin from Emblica officinalis, stigmasterol from Ocimum sanctum, and a flavonoid compound from Tinospora cordifolia. Spectroscopic data confirmed the structural identity of these bioactive constituents. Conclusion: The study successfully standardized and characterized Emblica officinalis, Ocimum sanctum, and Tinospora cordifolia, confirming the presence of important bioactive phytoconstituents. The isolation and spectroscopic identification of key compounds support the medicinal relevance of these plants and provide a scientific basis for their use in herbal formulations and further pharmacological research.
Emblica officinalis (Amla), Ocimum sanctum (Tulsi), Tinospora cardifolia, spectral characterization.
The Unmeasured Ischemic Burden of Non-Cardiac Surgery: A Systematic Review of Postoperative Myocardial Injury
Background: Myocardial injury after non-cardiac surgery (MINS) is increasingly recognized as a major contributor to postoperative morbidity and mortality. Despite its impact, MINS remains grossly under-diagnosed because the majority of affected patients are asymptomatic, and routine postoperative troponin surveillance is rarely performed outside specialized centers. Over the past decade, evidence has accumulated regarding its definition, mechanisms, clinical outcomes, and potential treatment approaches, yet clinical implementation remains limited. Objective: To systematically review contemporary evidence (2010–2023) on the definition, detection, prognosis, surveillance strategies, and therapeutic approaches for MINS, with emphasis on the persistent lack of awareness and poor implementation of guideline-recommended monitoring. Methods: Following PRISMA-2020 guidelines, a systematic search was performed in PubMed/Medline and major cardiology and perioperative guideline sources. Eligible evidence included randomized trials, prospective cohorts, and expert guidelines discussing postoperative myocardial injury. Due to significant heterogeneity across assays, endpoints, and patient populations, a narrative synthesis was conducted. Results: Across large prospective cohorts, MINS is common and associated with a substantially increased risk of 30-day and 1-year mortality. Most cases have no ischemic symptoms, and diagnosis relies solely on troponin measurement. Clinical guidelines from AHA (2021) and ESC (2022) recommend postoperative troponin testing for 48–72 hours in high-risk surgical patients; however, adoption remains limited. The MANAGE randomized trial provides the strongest therapeutic evidence to date, suggesting that dabigatran may reduce major vascular events in carefully selected MINS patients. Observational data reinforce the prognostic significance of even small troponin elevations.
Faisal Makki, Syed Fouzaan Albeez, Hasan Ali Ahmed, Altaf Khan, Amjad Khan, Layaan Zainab Mohammed, Faaleha Heba Fakruddin, Ahmed Mirza Zafar Baig, Yahiya Khan, Bilal Abdul Qayyum, Ammara Naseem
Study of Incidence, Risk Factors, With Special Reference To Role Of Anemia In The Development Of Retinopathy Of Prematurity
Background: ROP, or Retinopathy of Prematurity, is a major cause of avoidable childhood blindness, especially in infants born prematurely or with low birth weights. For prompt diagnosis and treatment, early risk factor identification is crucial. Methods: To ascertain the incidence and risk variables linked to ROP, a prospective hospital-based study was carried out at SCB Medical College and SVPPGIP, Cuttack, between September 2015 and September 2017. A total of 374 newborns who met the screening requirements were assessed. A total of 124 newborns were included in the final analysis after completing follow-up exams. Risk factors for mothers, newborns, and clinicians were evaluated. Results: ROP was present in 27.4% of cases overall. ROP development was substantially correlated with lower birth weight and gestational age. Infants with birth weights under 1000 g and gestational ages under 28 weeks had a greater incidence. Prolonged oxygen therapy, apnea, respiratory distress syndrome, and blood transfusion were significant newborn risk factors. Term infants with known risk factors also showed signs of ROP. ROP newborns had decreased mean hemoglobin levels, however anemia by itself was not determined to be a risk factor. While some patients showed spontaneous regression, the majority of cases were Stage I or II ROP, and severe cases needed surgery or laser therapy. Conclusion: ROP is still a serious health risk for low birth weight and preterm babies. It can also happen to term babies who have risk factors. Significant factors include blood transfusions, oxygen therapy, birth weight, gestational age, and respiratory issues. Early screening, increased provider awareness, and organized follow-up programs are necessary to guarantee prompt treatment and lessen the incidence of avoidable pediatric blindness.
Pediatric Blindness, Retinopathy of Prematurity, Infant, Respiratory Issues, Gestational Age.
Parasite contamination impact on nutritional and phytochemical composition of Gongronema latifolium, Ocimum gratissimum and Piper guineense leaves
Background: Consumption of raw vegetables has been implicated in the transmission of parasites. And as such the cultivation as well as harvesting should be done properly in order to avoid contamination. Objective: The impact of parasite contamination on the phytochemical and nutritional composition of commonly consumed Nigeria vegetables (Gongronema latifolium. Ocimum gratissimum and Piper guineense) were determined to ascertain the extent contamination can influence beneficial potential of these vegetables which are sometimes consumed raw. Methods: Both qualitative and quantitative techniques were used to assess the phytochemical and nutritional composition of these vegetables both when contaminted or not. The parasites present in the contaminated samples were also determined through floatation method and examining under the microscope. Results: Results showed that parasite contamination had a noticeable impact on the phytochemical contents of the studied vegetables. Alkaloids, flavonoids, saponin, tannin and phenol were slightly present in the contaminated leaves of G. latifolium and O . gratissimum but were in reasonable amount in non- contaminated. Dry matter was high in both contaminated and non-contaminated (88.72%) and (89.32%) in G. latifolium , (89.52%) and (89.72%) in O . gratissimum and (89.40%) and (88.40%) in P . guineense. Fat was low in both contaminated and non-contaminated (1.70%) and (1.50%) in G. latifolium , (1.90%) and (1.70%) in O . gratissimum , (1.82%) and (1.67%) in P . guineense leaf. Parasites such as Entamoeba histolytica, Giardia lamblia, Cryptosporidium spp, Strongyloides spp, Toxocara spp. were identified in all the contaminated vegetables. Conclusion: Parasites such as nematodes and protozoa have the capability to consume or degrade proteins in the vegetables which could be the reason for noticeable reduction of proteins in the contaminated samples.. Hence, parasite contamination is capable of affecting the nutritional and phytochemical content of vegetables negatively and undermines the beneficial use of vegetables in amelioration and prevention of diseases.
*Stella Ngozi Nmezi, Magnus Chinwendu Nwoko, Venatius Chiamaka Ubah,, John Luka, Ogechukwu Eucharia Okwueze, Jane Chinaza. Okoro.
Postpartum Depression in a Tertiary Maternity Service in Dhaka, Bangladesh: Prevalence, Risk Factors, Comorbid Anxiety, and Care Cascade — A Hospital-Based Observational Study (2024–2025)
Background: Postpartum depression (PPD) affects approximately 17% of women globally but reaches substantially higher rates in Bangladesh, where estimates range from 22% to 60% depending on the setting and screening threshold. Despite recommendations for routine screening, the care cascade from positive screening to sustained treatment in Bangladeshi tertiary hospitals remains poorly characterised. Methods: This hospital-based observational study was conducted at a tertiary maternity service affiliated with Bangladesh Medical University, Dhaka, during 2024–2025. A total of 1,200 postpartum women were screened using the validated Bangla Edinburgh Postnatal Depression Scale (EPDS; primary), the Patient Health Questionnaire-9 (PHQ-9), and the Generalised Anxiety Disorder scale (GAD-7) at 4–12 weeks postpartum. The study comprised (A) a cross-sectional prevalence and risk-factor component at first postpartum contact and (B) a prospective follow-up cohort for symptom trajectories and care cascade evaluation. Binary PPD was defined as EPDS ≥10 (primary) and ≥13 (sensitivity analysis). Multivariable logistic regression identified independent risk factors. The care cascade was quantified as proportions progressing through sequential steps from positive screen to treatment engagement. Reporting followed STROBE guidelines. Results: Among 1,200 women (mean age 26.1 ± 4.6 years), the prevalence of PPD was 38.9% (95% CI: 36.2–41.7) at EPDS ≥10 and 16.8% (95% CI: 14.8–19.1) at EPDS ≥13. PHQ-9 ≥10 prevalence was 22.8% (95% CI: 20.5–25.3); postpartum anxiety (GAD-7 ≥10) was 9.2% (95% CI: 7.7–10.9). In multivariable analysis, the strongest independent predictors of PPD were prior depression/anxiety (aOR 11.61, 95% CI: 6.92–19.47), comorbid anxiety (aOR 9.50, 95% CI: 4.89–18.47), intimate partner violence (aOR 3.64, 95% CI: 2.69–4.93), emergency caesarean section (aOR 3.33, 95% CI: 2.26–4.90), unplanned pregnancy (aOR 3.19, 95% CI: 2.37–4.29), sleep problems (aOR 2.48, 95% CI: 1.85–3.33), and NICU admission (aOR 2.02, 95% CI: 1.36–3.02). Among screen-positive women, 69.6% received counselling, 50.3% were offered referral, but only 20.1% attended at least one mental health appointment. Cohen's kappa for EPDS ≥10 versus PHQ-9 ≥10 agreement was 0.498 (moderate). Conclusions: PPD is highly prevalent in this urban tertiary-hospital population with substantial care-cascade attrition. Integration of routine EPDS screening into postnatal and immunisation clinic contacts, combined with on-site counselling and structured referral pathways, is urgently needed.
Postpartum Depression; Edinburgh Postnatal Depression Scale; Bangladesh; prevalence; risk factors; care cascade; screening; mental health services; anxiety; intimate partner violence.
Dr. Sabrin Khan Mou, Dr. Asma Ul Hosna, Zahid Hossain Faisal, Dr. Khandaker Morshedul Alam Azad, Santu Das, Dr. Md. Nazrul Islam, Dr. Shaila Ahmed Munia, Siam Ashraf