Institutional Case Analysis of Low Dose CT in Lung Cancer Screening for High-Risk Patient Populations
Lung cancer is the number one cause of cancer-related deaths in the world and late-stage diagnosis is one of the factors that lead to poor survival chances. In case of high-risk patients, especially chronic smokers, low-dose CT (LDCT) has become a game-changer in cancer screening as it provides the opportunity to detect small nodules in the lungs early at an early stage, and this shows a great deal of improvement in the clinical outcome. The current institutional case analysis assesses the effectiveness of the LDCT screening strategy, basing their effectiveness on the outcome of mortality reduction, uptake of screening, the diagnostic image accuracy and the impact of the institutional implementation. The paper utilizes the secondary data of seminal trials like the NLST and NELSON, institutional reports, and published literature, and this makes it strong in terms of evidence base. Thematic analysis strategy was used to integrate common patterns in various sources, such as screening barriers, patient engagement strategies, and practices in institutions. The combination of validated quantitative results and qualitative understanding of systemic issues offers a breadth and depth of this dual methodology. Findings prove that LDCT minimizes the deaths of lung cancer by 2024 percent, doubles the stage I diagnoses, and increases the survival rate when made a part of the institutional practice. Nevertheless, adoption is still very low, with less than 20 per cent of those who are eligible being screened, which is indicative of inherent system barriers, including inequity in access and perceptions of patients. The success of a program is heavily dependent on the institutional implementation, where standardised imaging protocols with patient navigation services enhance the quality of diagnostic testing and attendance. This discussion has determined that LDCT is an important breakthrough in lung cancer screening; however, it can only achieve its full potentials when it goes beyond institutional and systemic obstacles to exploit the opportunities presented by high risk groups.
Institutional Analysis, Low Dose CT, Lung Cancer, Cancer Screening, High Risk, Diagnostic Imaging, Early Detection
Kunal Pingale, Adithya S Nair, Siddharth Pande
Assessment of Medication Dosing Errors in Pediatric Intensive Care Units: A Prospective Observational Study
Background: Medication errors in pediatric intensive care units (PICUs) are a serious concern for patient safety, and dosing errors are the most common type of medication error, mainly because of weight-adjusted pharmacotherapy and polypharmacy practices. Although the level of awareness is increasing, the extent of dosing errors in PICUs has not been fully explored in the current scenario. Methods: This is a prospective observational study, and it was conducted for 18 months (January 2022 to June 2023) in three tertiary PICUs. Incidents of dosing errors were identified, grouped, and independently validated. Multivariate logistic regression analysis was employed to determine independent risk factors for the occurrence of errors. Results: In 487 patients (37,218 medication orders), 1,164 dosing errors were identified (31.3 errors per 100 prescriptions; 95% CI: 29.6-33.1). Overdosing (26.8%) and calculation errors (16.1%) were most frequent. Analgesics/sedatives and inotropes were the most error-prone drug classes. Independent risk factors were polypharmacy (≥10 medications/day) (aOR 5.14), absence of CPOE (aOR 4.01), weight < 5 kg (aOR 3.64), and absence of clinical pharmacist review (aOR 3.42). Patient-received errors were significantly linked to higher ICU mortality (20.4% vs. 11.3%; p=0.008) and longer ICU Conclusions: Medication dosing errors are frequent in PICUs and have significant implications for morbidity and mortality. There is an urgent need for multidisciplinary strategies such as the installation of CPOE systems, medication review by clinical pharmacists, and weight-based dosing calculators.
Medication Errors, Dosing Errors, Pediatric Intensive Care, Patient Safety, Polypharmacy, Cpoe, Clinical Pharmacist, Adverse Drug Events.
AlyaZeed Ali Alyami, Sultan Meshal Almutairi, Wesam Ali Almuallim, Teef Fayez Alshehri, Mohammed Saleh Alsonari, Ghadah Balqasem Alharazi, Ammar Yaser Attar, Omair Abdulhafeez Bokhari
Impact of Empagliflozin on Left Ventricular Mechanics using 3-D Echocardiography in Heart Failure Patients with Reduced Ejection Fraction
Background: Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated notable clinical benefits in cases with heart failure with reduced ejection fraction (HFrEF), irrespective of diabetic status. However, underlying impacts of empagliflozin on myocardial systolic mechanics, particularly at the myocardial level, remain incompletely understood. Method: This prospective cohort study that included non-diabetic patients with HFrEF (left ventricular ejection fraction (LVEF) ≤40%) who were naïve to empagliflozin therapy and have been on optimal guidelines directed medical treatment for a minimum of 6 months. All patients were evaluated at baseline and after 6 months from the initiation of empagliflozin. Conventional, three-dimensional, and speckle-tracking echocardiography were used to evaluate left ventricular volumes, ejection fraction, myocardial strain parameters (GLS, GCS, GAS, and GRS), and structural remodeling. Functional status was assessed using NYHA classification and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Result: A total of 150 non-diabetic patients with HFrEF were included in the study, with a mean age of 56.6 ± 9.7 years, 36% were female. After 6 months of empagliflozin therapy, patients demonstrated a significant improvement in left ventricular systolic function, with a marked increase in LVEF and significant reductions in left ventricular end-diastolic and end-systolic volumes (p < 0.001). In addition, significant improvements were also observed in myocardial deformation parameters, including GLS, GCS, GAS, and GRS (all p < 0.001). Additionally, LV mass index, left atrial volume index, and pulmonary artery systolic pressure significantly decreased. Functional capacity improved markedly, with reduction in NYHA class and significant increase in KCCQ score (p < 0.001). Conclusion: These results support the myocardial-level benefits of empagliflozin beyond glycemic control and reinforce its role as a cornerstone therapy in HFrEF irrespective of diabetic status.
SGLT2 inhibitors, Heart failure with reduced ejection fraction, 3D echocardiography, Speckle-tracking strain, Ventricular remodeling.
Ahmed M. Alashry, Arafa G Ibrahim, Mohamed Omar, Wael Attia, Amr Abdel Aal
Vascular Complications Following Total Knee Arthroplasty in Patients with Diabetes: Anesthesia-Related Insights from a Nationwide Database Study with Meta-Analysis and Comprehensive Narrative Review
Background: Total knee arthroplasty (TKA) is among the most frequently performed orthopedic procedures globally. With the rising prevalence of diabetes mellitus, an increasing proportion of surgical candidates present with metabolic, vascular, and inflammatory comorbidities that predispose them to postoperative complications. Diabetes is associated with endothelial dysfunction, platelet hyperreactivity, impaired fibrinolysis, and chronic systemic inflammation, all of which contribute to elevated vascular risk. The interaction between diabetes, anesthetic technique, and perioperative management in determining vascular outcomes remains incompletely defined. Objective: To evaluate vascular complications following TKA in patients with diabetes using a nationwide inpatient database and to examine anesthesia-related modifiers through meta-analysis and mechanistic narrative review. Methods: A retrospective cohort analysis was conducted using a nationally representative inpatient database (2010–2022). Adult patients undergoing primary TKA were identified and stratified by diabetes status. Primary outcomes included deep vein thrombosis (DVT), pulmonary embolism (PE), acute limb ischemia, arterial thrombosis, and in-hospital mortality. Multivariate regression and propensity matching were performed. A PRISMA-compliant meta-analysis of published studies was conducted to synthesize existing evidence. A narrative review explored internal medicine and anesthetic mechanisms influencing vascular risk. Results: Among 412,638 TKA patients, 128,944 (31.2%) had diabetes. Diabetic patients demonstrated higher rates of DVT (1.9% vs 1.2%, adjusted OR 1.42), PE (0.8% vs 0.5%, OR 1.36), arterial complications (0.4% vs 0.2%, OR 1.78), and transfusion requirement (6.3% vs 4.7%). Neuraxial anesthesia was associated with reduced thromboembolic risk (adjusted OR 0.74). Meta-analysis of 18 studies (n=1.2 million) confirmed increased pooled thromboembolic risk in diabetics (OR 1.38). Mechanistic analysis suggests sympathetic blockade, improved limb perfusion, and attenuated stress response as potential protective factors under neuraxial techniques. Conclusion: Diabetes independently increases vascular risk following TKA. Anesthetic strategy, particularly neuraxial approaches, appears to modify this risk. Integrated perioperative management involving anesthesia and internal medicine optimization is critical for improving outcomes.
Total knee arthroplasty; Diabetes mellitus; Venous thromboembolism; Vascular complications; Neuraxial anesthesia; Perioperative glycemic control; Arterial thrombosis; Nationwide database study.
Dr. Irfan Ullah, Dr. Tasaddiq Hussion Bhatti, Dr. Amber Shams, Dr. Asad Hanif, Dr. Fasiha Sohail, Dr. Mamoona Shaikh
Effects of music therapy on generalized anxiety in older adults
Music therapy and its intervention techniques are effective in lowering anxiety levels in older adults. Therefore, the objective of this study was to determine the effects of music therapy on generalized anxiety in older adults. The methodology employed was based on a quantitative, descriptive, bibliographic, and field approach. The method used was deductive, with a cross-sectional experimental design. The data collection techniques used were surveys and observation. The data collection instruments applied were the GAD-7, composed of seven questions, and a checklist. The population consisted of 14 older adults, and the sample, chosen non-probabilistically or by convenience sampling, consisted of five older adults. The results indicate that the older adults show symptoms of worry, tension, and restlessness, exhibiting mild to moderate levels of anxiety. Interactive, active, or creative techniques proved to be the most effective against anxiety levels in older adults, and these techniques produced well-being, reduced anxiety levels, and improved quality of life. It was concluded that music therapy has positive effects on generalized anxiety in older adults because it serves as recreation, release, expression, communication and channeling of the emotions of the older adult.
Music therapy; Effects of music therapy; Generalized anxiety disorder; Older adults.
José Luis Rosario Rodríguez, Anibelka del Carmen Torre Rodríguez
Case Study Review of Diffusion Weighted MRI in Differentiating Recurrent Brain Tumors from Post Treatment Changes
Diffusion Weighted MRI (DWI) deals with the major problems in neuroimaging distinguishing between recurrent brain tumors and post-therapeutic alterations such as radiation necrosis and MRI pseudoprogression. Traditional MRI is prone to fail because there are overlapping contrast enhancements and thus quantitative DWI measurements are required like ADC values to distinguish tumors. The literature review in this case study included prospective trials, meta-analyses, and histopathological correlations in aggregated sets of gliomas and metastases (more than 150 lesions). The systematic review concerned DWI imaging patterns, ADC thresholds (e.g., <1.22 × 10 -6 mm 2/s necrosis), and multi-parametric integrations, using the cost-effective global evidence evidence without restriction on primary data collection. Other important observations made included the better sensitivity (85-92%) and specificity (89) of DWI to detect the recurrence of brain tumors. In recurrent tumors, hypercellularity was associated with homogeneously low ADC, in comparison with heterogeneous facilitated diffusion in the effects of treatment. Necrosis was predicted by central restriction (AUC 0.85), whereas pseudoprogression demonstrated a transient high ADC longitudinal resolution. Multi-parametric Multi-parametric methods improved accuracy up to 94% but interobserver error (kappa 0.49) and low-grade overlaps remain. This literature review synthesis highlights the transformative capabilities of DWI in neuro-oncology, in steering biopsy avoidance, timing of therapy, and accuracy oncology processes, efficiently. New AI-advanced protocols in the future will be even more refined. .
Diffusion Weighted MRI, Recurrent Brain Tumors, Post-Treatment Changes, Tumor Differentiation, DWI Imaging, ADC Values, Brain Tumor Recurrence, Treatment Effects, MRI Pseudoprogression, Neuroimaging Differentiations
Mihir Wadhawan, Gogineni Rahul, Aravind Guntupalli
Comparison of CAD/CAM and Conventional Techniques for Dental Restoration
Background: The evolution of digital dentistry has transformed the process of restorative dentistry, with Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology proving to be a better option compared to conventional techniques for the fabrication of dental restoratives such as crowns, inlays, onlays, and veneers. Objective: The objective of the present systematic review and meta-analysis was to compare the clinical performance, precision, efficiency, and longevity of CAD/CAM restorations and conventional methods. Methods: The search strategy included a comprehensive search of various databases like PubMed, Scopus, and Cochrane, and 55 comparative studies from 2000 to 2025 were included. The results included marginal fit in μm, internal adaptation, fracture resistance, survival, chair time, and patient satisfaction. Results: CAD/CAM restorations showed significantly better marginal fit, with a mean discrepancy of 62 to 80 μm (95% CI: 55 to 85 μm) compared to 110 to 150 μm (95% CI: 100 to 170 μm) for conventional restorations (p < 0.001), thus minimizing the risk of secondary caries and periodontal disease. Internal adaptation was improved by 40 to 60% in CAD/CAM restorations. Fracture strength was also better in milled ceramics compared to conventionally processed materials. Survival rates were similar or better at 5 years, at 94.5% for CAD/CAM and 91.2% for conventional, HR 0.88, 95% CI: 0.75 to 1.03. CAD/CAM technology reduced chairside time by 60 to 75% (1 to 2 hours vs. 2 to 3 weeks) and laboratory remakes by 50%. Patient satisfaction scores were 25 to 35% better because of single-visit procedures and improved esthetics. Conclusion: CAD/CAM technology has proven to be superior to conventional methods in precision, efficiency, and mechanical properties, thus making it the gold standard in dental restoration.
CAD/CAM dentistry, dental restorations, conventional techniques, marginal fit, survival rate, digital workflow
Abdulrazaq Ahmed Asiri, Mohammed Yousef A Alfaqih, Abdulrahman alkhathami, Hamid alkhathami4
The Comprehensive Systematic Review of Association of Smoking Status to Risk of Pseudarthrosis after Spinal Arthrodesis
Introduction: Pseudarthrosis, or nonunion, following spinal arthrodesis is a significant complication that leads to pain, instrumentation failure, and often requires revision surgery. Smoking is widely suspected as a key modifiable risk factor, yet the strength, consistency, and modifiers of this association across diverse surgical contexts require comprehensive synthesis. This systematic review aims to consolidate the evidence on the relationship between smoking status and pseudarthrosis risk after spinal fusion surgery (Ravi S. Nunna et al., 2021; Yang Li et al., 2021). Methods: A systematic literature search was conducted following predefined screening criteria. We included observational studies (cohort, case-control), systematic reviews, and meta-analyses involving adult patients (≥18 years) undergoing spinal arthrodesis, with clear definitions of smoking status and pseudarthrosis assessment. Case reports, editorials, and animal studies were excluded. Data on smoking exposure, pseudarthrosis definition, risk measures, surgical characteristics, and study design were extracted from 59 included sources (Nunna et al., 2021; Boonsirikamchai et al., 2024). Results: The majority of high-quality evidence demonstrates a significant association between smoking and increased pseudarthrosis risk. Pooled meta-analyses indicate smokers have approximately a 91% increased risk of nonunion (Risk Ratio 1.91, 95% CI 1.56–2.35) and 45% reduced odds of successful fusion (Odds Ratio 0.55, 95% CI 0.45–0.67) (Nunna et al., 2021; Yang Li et al., 2021). This risk is modified by factors including graft type (stronger effect with autograft), use of biological adjuncts like rhBMP-2 (which mitigates risk), surgical technique, and number of levels fused. Smoking also prolongs time to union and interacts adversely with other factors like ketorolac use (Jesse Li et al., 2018). Discussion: The evidence robustly supports smoking as a major independent risk factor for pseudarthrosis, though its impact is context-dependent. Heterogeneity in findings can be explained by variations in surgical stabilization, use of biological enhancers, follow-up duration, and procedural complexity. The biological mechanisms involve nicotine-induced impairment of osteoblast function and vascular perfusion. Critical gaps remain in standardized smoking quantification and adjustment for confounders. Conclusion: Smoking significantly elevates the risk of pseudarthrosis following spinal arthrodesis, particularly in lumbar posterolateral fusions using autograft. Preoperative smoking cessation should be strongly encouraged as a modifiable risk-reduction strategy. Surgical planning should consider mitigation strategies, such as using rhBMP-2 or more robust instrumentation in smokers. Future research requires standardized smoking metrics and longer-term outcome assessments.
Smoking, Pseudarthrosis, Nonunion, Spinal Fusion, Arthrodesis, Risk Factor, Systematic Review.
Gumelar Akbar Wicaksono, Rieva Ermawan, Rhyan Darma Saputra, Bintang Soetjahjo, Bayu Sakti Jiwandono, Muhammad Abdulhamid
Importance of Heart Score For Chest Pain Patients Presenting To Emergency Department In The Absence Of Stemi
Background: Chest pain is one of the most common presentations to the emergency department (ED), and the diagnosis of non–ST elevation acute coronary syndrome (ACS) often causes uncertainty. The HEART score is designed to differentiate high-risk and low-risk chest pain patients and serves as an easy, quick, and reliable predictor of outcome rather than mere risk differentiation. In current practice, nearly 60% of chest pain patients have no clear ACS presentation, leading to delayed decision-making and unnecessary hospital admissions. The challenge in the ED is not only to identify high-risk patients but also to safely discharge low-risk patients. Aim: To differentiate high-risk and low-risk patients presenting with chest pain to the ED. To predict patient outcomes using the HEART score in chest pain patients presenting to the ED. Methods: This prospective study included 200 patients presenting with chest discomfort to the emergency department of PRS Hospital, Kilipalam, Trivandrum, between November 2018 and October 2019. All patients above 18 years presenting with chest pain in the absence of STEMI were included. HEART score was calculated at the time of ED arrival and patients were categorized into high-risk and low-risk groups. Patients were followed up after three days, and various prognostic indicators were recorded. Data were analyzed using SPSS software to evaluate the association between HEART score and patient outcomes. Results: The mean HEART score among patients who required cardiac interventional strategies was 6. HEART score calculated at ED admission showed a strong statistical correlation with patient outcomes. A significant association was observed between HEART score and increasing age, need for PCI, mortality, and duration of hospital stay (p < 0.005). HEART score was significantly correlated with overall patient outcome. Conclusion: The HEART score assists physicians in making accurate diagnostic and therapeutic decisions in chest pain patients without ST-elevation myocardial infarction. It is an easy, quick, and reliable predictor of outcome and can be effectively used for triage and risk stratification in the emergency department.
Chest pain; HEART score; Acute coronary syndrome; Emergency department; Risk stratification; Patient outcome.
Nellimala Abdul Shukoor, Amal George, Raiza Shukoor, Danish Salim, Sonia, Farsana F J
Possible Protective Role of Selenium Nanoparticles in Deltamethrin induced Cerebellar Toxicity in Adult Male Albino Rat: Histological, Immuno-histochemical and Biochemical Study
Background: Deltamethrin administration induces neurotoxicity in the cerebellum through multiple mechanisms. Aim of the Work: This study aimed to detect the adverse fluctuations occurring in the rat cerebellar cortex after deltamethrin administration. Furthermore, the possible ameliorative role of selenium nanoparticles to these changes was assessed. Material and Methods: Forty adult male albinos’ rats were divided into four groups (Gps): Gp I (Control), Gp II (sham), Gp III (Deltamethrin), Gp IV (Deltamethrin+ Selenium). Blood samples were taken by cardiac puncture for using in biochemical analyses. The cerebellum was processed for histological, immunohistochemical &biochemical analysis. Results: The light microscopic analysis of deltamethrin group (III) revealed that the Purkinje cells were primarily affected by the neurotoxic effects of deltamethrin among the cerebellar cortex cells. In addition to demyelination of nerve fibers. A strong positive GFAP immunoreaction was observed in this group. On the other aspect, deltamethrin with selenium nanoparticles treated group (IV) showed obvious protection in the cerebellar histological architecture and weak positive GFAP immunoreaction. Biochemically, the cerebella of deltamethrin group (III) illustrated statistically significant increase in the level of MDA and a significant decrease in the level of GSH and the activity of SOD compared to statistically significant decrease in Gp IV (Deltamethrin+ Selenium). Conclusion: In light of those observations, the current study revealed that selenium nanoparticles have protective role from the deleterious effects of deltamethrin on the cerebellar architecture, oxidative status and apoptosis.
Deltamethrin, cerebellum, Selenium nanoparticles
Dr. Asmaa kamel Hammad, Prof. Dr. Nabila Yousef Abd Elhalim, Dr. Reda Abd el Nasser Emam, Dr. Peter Hanna Eshak Yanni
Mechanical Ventilation Errors and Patient Safety: A Narrative Review
Mechanical ventilation is a life-saving intervention in critical care and emergency medicine, yet it remains a high-risk therapy because outcomes depend on correct configuration of ventilator settings, continuous monitoring, timely troubleshooting, and reliable teamwork. Mechanical ventilation–related errors occur at initiation, during ongoing titration, and during weaning and extubation. Common errors include inaccurate tidal volume selection (often not based on predicted body weight), failure to measure and limit plateau or driving pressure, inappropriate positive end-expiratory pressure (PEEP) application, inadequate alarm configuration and response, delayed recognition of patient–ventilator asynchrony, and unsafe sedation and liberation practices. These errors can precipitate ventilator-induced lung injury (VILI), hemodynamic compromise, prolonged mechanical ventilation, ventilator-associated complications, longer intensive care unit (ICU) length of stay, and increased mortality. This narrative review synthesizes key evidence and translates it into a patient safety framework. We classify ventilation errors into setting-related, monitoring/alarm-related, and human/system-related domains, describe mechanisms linking errors to harm, and summarize evidence-based prevention strategies. Practical tools are provided, including tables that map errors to consequences and a daily ventilator safety checklist that can be embedded into ICU workflows. A systems approach combining lung-protective ventilation, structured monitoring, standardized handover, competency-based education, and continuous quality improvement is essential to reduce preventable harm in mechanically ventilated patients.
mechanical ventilation; patient safety; ICU; ventilator-induced lung injury; errors; alarms; asynchrony; sedation; weaning
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Gastric Antral Vascular Ectasia As A Rare Complication Of Imatinib Therapy: Case Series
Background: Gastric antral vascular ectasia (GAVE) is a rare but clinically significant cause of upper gastrointestinal bleeding, characterized endoscopically by longitudinally dilated vessels in the gastric antrum resembling a “watermelon stomach”. While GAVE is often associated with systemic conditions such as cirrhosis and autoimmune disease, drug-induced etiologies must be considered in hematologic patients, particularly those receiving tyrosine kinase inhibitors (TKIs) like imatinib mesylate (IM). Case Ilustration: We report three hematologic patients who developed gastrointestinal bleeding after several months of IM therapy. Endoscopic evaluation revealed typical GAVE lesions. Clinical and endoscopic improvement was observed following IM discontinuation. Two patients were successfully transitioned to nilotinib without recurrence of bleeding, and follow-up endoscopy confirmed regression of GAVE lesions. Discussion: The consistent temporal relationship between IM administration and GAVE onset supports a potential causal link. Although the molecular mechanisms remain unclear, local mucosal irritation and vascular changes induced by IM have been proposed. Management of GAVE includes hemodynamic stabilization, supportive therapy, and endoscopic intervention for active bleeding. However, in drug-related cases, discontinuation of the offending agent and switching to an alternative TKI proved effective and low-risk. Supportive measures alone are insufficient to prevent recurrence if the underlying trigger is not addressed. Conclusion: This case series underscores the importance of considering drug-induced etiologies in hematologic patients presenting with upper GI bleeding. Thorough medication history, multidisciplinary evaluation, and appropriate therapeutic adjustments are essential. Discontinuation of imatinib and transition to alternative TKIs can prevent recurrence and promote regression of GAVE lesions. Further prospective studies are needed to clarify the molecular mechanisms underlying TKI-associated GAVE and to establish evidence-based clinical guidelines.
Chronic Myeloid Leukemia, Imatinib, Gastointestinal Bleeding, Watermelon Stomach.
Satyadi, Muhammad Noor Diansyah, Putu Niken Ayu Amrita, Melyna Savitri, Pradana Zaky Romadhon, Ami Ashariati, Siprianus Ugroseno Yudho Bintoro
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