The Role of Clinical Decision Support Systems in Optimizing Anemia Management: A Systematic Review
Background: One of the most potential methods to close the gap between the evidence and practice is through the use of Clinical Decision Support Systems (CDSS) for the patient suggestions for anemia identification and treatment. This study aims to identify, synthesize, and map systematic review of the effectiveness of Clinical Decision Support Systems (CDSS) for optimal anemia management. Methods: This systematical assessment adhered to PRISMA regulations to investigate how efficient CDSS are in the management of anemia through the optimization of various healthcare settings. Numerous databased were navigated from May 2021 to December 2025 to find relevant studies. Study included 9 studies (randomized controlled trials, quasi, experimental, and observational studies) that met the criteria for inclusion. Results: A total of 3517 articles were identified; following screening, 241 reviews underwent full‐text screening, and 9 articles met the inclusion criteria and were included in this review. The analyzed studies revealed that CDSS involve in reflexive algorithms, guideline, based order sets, and AI models, have the potential to greatly raise the proper management of anemia, related laboratory test requests, lower the redundant testing and expenses, and increase the diagnostic accuracy. Conclusion: CDSS is effective in achieving efficient anemia management through the provision of support for evidence, based decision making, facilitation of test appropriateness, and reduction in resource utilization. Integrating CDSS into a workflow is effortless and choosing strategies that will result in proper engagement of clinicians in appropriate anemia management.
Anemia, Artificial Intelligence, CDSS, Clinical Decision Support Systems, Diagnostic Accuracy, Management.
Norah Abdullah Alshambari, Abeer Nawar Alotaibi, Rahaf Sumayhan Alanzi, Hanan Baker Haron Al Haossawi, Rawan Saad Faraj Aldajani Alotaibi, Shaimaa Mahmoued Mohamed, Bandar Ayash M. AL-Ruwaili, Naif Humoud Alotaib
Silent Threat: Post-Traumatic Aortic Pseudoaneurysm Causing Airway Compression and Respiratory Failure
Background: Post-traumatic aortic pseudoaneurysm is a rare but life-threatening complication of blunt chest trauma. When large, it can exert significant mass effect on adjacent structures, leading to critical complications such as airway compression and pulmonary artery obstruction. Early recognition and intervention are crucial to prevent fatal outcomes. Case Presentation: We report a case of a 17-year-old male who developed progressive dyspnea and hypoxemia over 1.5 months following a motor vehicle accident. Initial injuries included lung contusion and hemothorax, requiring mechanical ventilation and chest tube insertion. Contrast-enhanced CT revealed a large aortic arch pseudoaneurysm with a mediastinal hematoma, causing severe compression of the left main bronchus and pulmonary arteries. The resultant left lung collapse and vascular compromise led to refractory respiratory failure. Despite maximum ventilatory support, the patient remained hypoxemic, necessitating extracorporeal membrane oxygenation (ECMO) and subsequent endovascular stent graft repair. The intervention successfully relieved airway compression, leading to improved oxygenation and clinical stabilization. Conclusion: This case highlights the potential for post-traumatic aortic pseudoaneurysms to cause airway and vascular compression, mimicking pulmonary embolism and leading to respiratory failure. Prompt imaging and endovascular intervention are critical in preventing fatal outcomes. Contrast-enhanced CT with multiplanar reconstruction is invaluable in diagnosis and management planning.
Silent Threat, Post-Traumatic Aortic Pseudoaneurysm, Airway Compression, Respiratory Failure, ECMO.
Hamada Kawshty Sayed Fayed, Tarek Mohamed M. Mansour, Yasser Abd El Aal Ahmed, Doaa M Fouad, Mohamed M. El-baroudy, amaa mostafa El-kossi, Mohamed Ibrahim Abdo, Kamal SH Ibraheem, Gamal Mohamed Gamal Elsalawy, Ahmad M. Omar
Beyond the Patient: The Role of Clinical Data Managers in Mediating Human Identity in Modern Trials
Clinical Data Managers (CDMs) are in a strategic position to mediate patient identity during the vascular trial turning subjective clinical inputs into standardized data structures. CDMs in the context of data-intensive environments make essential decisions that relate to edit checks, reconciliation of the timestamps, and codification practice that forms the way trial subjects are digitally represented. The aim was to investigate the role of clinical data managers in building, transformation and de-identification of patient identity in vascular studies through data handling and standardization practices. A qualitative research design was adapted where semi-structured interviews were used among CDMs (n=10), cardiac professionals, trial coordinators, and imaging analysts in order to examine the use of identity mediation in vascular trials. The information sources were query logs, audit trails and discrepancy reports. Thematic analysis was used to determine the major patterns that include identity curation, data abstraction, and algorithmic governance. Different viewpoints were guarantees by purposive sampling. The results show that CDM in vascular trials play a significant role in shaping patient identity wherein raw clinical data (ABI values, ECG data, and imaging results) are converted into standard formats. The clinical visibility, safety evaluation, and eligibility depend on their choices in data normalization, alignment of timestamps and adverse event coding. Such identity mediation issues concerns of re-identification, algorithmic bias, and depersonalization of governance of posthuman data. The research reinstates CDM as identity mediators in vascular trials and underlines their ethical involvement in data management and suggests patient-oriented leadership to retain clinical complexity and humanity.
Clinical Data Management, Vascular Trials, Endovascular Data, Identity Curation, Clinical Data Managers, Data Standardization.
Capsaicinoids and Piperine in Cardiovascular Physiology: Autonomic, Endothelial, and Myocardial Pathways
Pepper-derived phytochemicals, particularly volatile terpenoids and pungent alkaloids from Capsicum and Piper species, have attracted increasing attention for their complex cardiovascular effects. Bioactive constituents such as capsaicinoids and piperine interact with transient receptor potential vanilloid 1 (TRPV1) channels, autonomic regulatory circuits, endothelial function, and myocardial signalling pathways, suggesting both cardioprotective potential and cardiovascular risk. This review critically synthesises current experimental, clinical, and epidemiological evidence concerning the cardiovascular actions of pepper-related volatile oils, with particular emphasis on their role in typical and atypical cardiac pain. Preclinical studies consistently demonstrate TRPV1-mediated mechanisms that may promote cardioprotection, including improved endothelial function, modulation of ischemic injury, and attenuation of adverse myocardial remodelling. In contrast, concentrated or non-dietary exposures have been associated with adverse cardiovascular effects, such as sympathetic activation, coronary vasospasm, and arrhythmogenic potential. Human evidence remains inconclusive. Case reports describe acute cardiac events following high-dose exposure to capsaicinoids or piperine-containing products, whereas population-based studies generally associate habitual dietary intake of peppers with favourable cardiovascular outcomes. Despite limited clinical validation, piperine has emerged as a promising candidate due to its anti-inflammatory, antioxidant, and metabolic effects observed in experimental models. By integrating mechanistic, translational, and clinical findings, this review highlights critical gaps in current knowledge, including the scarcity of controlled human trials, incomplete pharmacokinetic and pharmacodynamic characterisation, and the absence of systematic surveillance of adverse cardiovascular events. Finally, key priorities for future research are proposed to clarify the therapeutic potential and safety profile of pepper-derived phytochemicals in cardiovascular health and disease.
Capsicum; Piperine; Capsaicin; Volatile oils; TRPV1; Cardiovascular physiology; Chest pain; Coronary vasospasm; Cardioprotection; Pepper-induced cardiac effects; Atypical cardiac pain; Phytochemicals; Autonomic modulation; Ischemic preconditioning; Cardiovascular risk..
The Hidden Threat: Mesentric Ischemia Disguised As Simple Appendicitis - Case Report
Mesenteric ischemia is a life-threatening condition resulting from inadequate blood flow to the intestines. Its early symptoms often mimic common abdominal conditions such as acute appendicitis, leading to diagnostic delay and increased morbidity. Here we have discussed a case of 30 years male presented with Right lower Abdominal pain and Vomiting and clinically suggestive of Acute appendicitis. Initial Laboratory findings showed mild Leukocytosis, and ultrasound was nil significant. On Per Rectal Examination finger stalk stained with blood-tinged stool. The patient underwent Diagnostic laparotomy, revealing ischemic bowel segment 15 cm away from from Ileocaecal junction. Further evaluation confirmed acute mesenteric ischemia due to thrombosis of a branch of Superior mesenteric artery. Bowel resection with anastomosis was performed, and the patient had an uneventful recovery following timely intervention.
Acute mesenteric ischemia, abdominal surgery, Leukocytosis, abdominal pain, Gangrene bowel.
Dr. Ankit boora, Dr. G. Dhananjayan, Dr. G muralidharan, Dr. Hakeem sulthan z
Studying The Role Of Cytokines In Patients With Covid-19 As A Predictor Of Disease Severity
The aim of the study was to examine cytokine production, examining cytokines as predictors of disease severity in patients with COVID-19. Study materials and methods. Sixty patients with COVID-19 (30 with moderate and 30 with severe disease) hospitalized at the Zangiota 1 Specialized Hospital for the Treatment of Patients with Coronavirus Infection and 25 apparently healthy individuals were examined. The COVID-19 diagnosis was based on current protocols of the Ministry of Health of the Republic of Uzbekistan. All patients tested positive for SARS-CoV-2 using real-time PCR on a throat swab. Immunological studies were performed using the ELISA method (IL-1β, IL-6, IFN-gamma). Results and discussion. Measurement of total cytokine levels of IL-1 beta, IL-6, and IFN-gamma revealed a moderate and statistically significant increase in three cytokines (p<0.0001) in severe patients, indicating active inflammation. IFN-γ levels showed a slight increase in the severe group compared to the moderate group. Thus, total IL-1 beta and IL-6 levels showed significant heterogeneity. Early studies of COVID-19 indicated the role of proinflammatory cytokines such as IL-1 beta, IL-6, and IFN-gamma released by activated mast cells in the respiratory submucosa in exacerbating inflammation and pathogenesis. Despite the uncertainty of the therapeutic potential of IL-6 and IL-10, the observed levels of their elevation in patients with severe COVID-19 have prompted clinical researchers to explore their use as prognostic factors. Conclusions. 1. A significant increase in the cytokines IL-1 beta, IL-6, and IFN-gamma was demonstrated in both groups of patients, with a significant increase in these cytokines observed in the group of severely ill patients. It was shown that the proposed simple panel of three cytokines can be used as predictors for the rapid diagnosis of patients at higher risk of worsening the course of COVID-19 disease. IFN-γ levels showed a slight increase in the severe group compared to the moderate group. IL-1 beta and IFN-gamma levels were shown to be age-dependent, while the age-dependent relationship for IL-6 was not significant. No gender-dependent relationship was found for IL-6 levels. These studies will be key to identifying patients who are more likely to progress to severe disease and thus taking the necessary precautions.
Cytokine regulation of immunity, cytokines, interleukins, cytokine storm, immunocompetent cells, COVID-19, severity of coronavirus infection.
Kurbanova Z.Ch., Shamsutdinova M.I., Sabitkhodzhaeva S.U
Laboratory Diagnosis of Coagulation Hemostasis in Chronic Hepatitis And Liver Cirrhosis With Hcv Etiology
In HCV-associated chronic hepatitis blood coagulation system did not show significant changes before or during antiviral therapy. In HCV-associated liver cirrhosis activated partial thromboplastin time, prothrombin time, and thrombin time were prolonged, but showed improvement with AVT. Fibrinogen levels were significantly reduced by 2 times after 3 months of antiviral therapy. These findings suggest that antiviral therapy has a positive impact on coagulation parameters in liver cirrhosis.
Chronic Hepatitis, Liver Cirrhosis, Coagulation System, Antiviral Therapy, Activated Partial Thromboplastin Time, Prothrombin Time, Thrombin Time, Fibrinogen.
Nuriddinova Nodira Fakhriddin qizi, Kurbonova Zumrad Chutbayevna, Zaynutdinova Dilafruz Latibovna
Evaluation Of The Efficacy Of Antiaggregant Therapy In Covid-19
In patients with mild coronavirus infection, platelet activity and coagulation he-mostasis did not show significant changes. However, in moderate and severe cas-es, platelet aggregation and adhesion activity increased. When platelet aggregation and adhesion activity increased, treatment with a combination of acetylsalicylic ac-id and 75 mg of clopidogrel, compared to standard therapy, provided the most ef-fective correction of hemostatic changes.
Coronavirus Infection, Platelet Activity, Coagulation Hemostasis, Platelet Aggrega-tion, Platelet Adhesion, Acetylsalicylic Acid, Clopidogrel.
Kurbonova Zumrad Chutbayevna, Babadzhanova Shaira Agzamovna, Qurbanova Gavhar Chutbayevna, Nodirzhanova Zulfiaxon Nodirjon qizi
Effectiveness Of Antiplatelet Therapy In Patients With Thrombophilia Gene Mutations
In mild coronavirus infection, the significance of genetic mutations predisposing to thrombophilia was not confirmed. However, in moderate and severe cases, an un-favorable genotype of the MTHFR 677 C>T (rs1801133) gene and the MTR 5p15.31 66 A>G (rs1801394) gene was significantly more common. The high-risk homozygous mutation of thrombophilia genes was observed only in patients with severe COVID-19, with the predominant genotype being the mutant G/G genotype of the MTR 5p15.31 66 A>G (rs1801394) gene in 23 cases (67.65%). In severe coronavirus infection with a homozygous mutation, the effectiveness of antiplatelet therapy was observed in 3-4 months
Coronavirus Infection, Genetic Mutations, Thrombophilia Genes, Covid-19, Platelet Activity, Antiplatelet Therapy.
Diagnosis of Anemia In Diffuse Toxic Goitre
Diffuse toxic goitre (Graves’ disease) is often accompanied by various hematological changes, including anemia. The diagnosis of anemia in this condition is based on blood count, iron studies, and thyroid function tests. Anemia may result from increased metabolism, iron deficiency, or autoimmune mechanisms. Early detection and treatment are essential for improving the patient’s general condition and prognosis. Anemia was observed in 68.2% of patients with diffuse toxic goiter, of which 28.4% had iron deficiency anemia, 19.6% had megaloblastic anemia, 17.6% had normochromic anemia, and 34.4% had mixed anemia.
Diffuse Toxic Goiter, Iron Deficiency Anemia, Megaloblastic Anemia.
Babadzhanova Shaira Agzamovna, Qurbanova Gavhar Chutbayevna, Kurbonova Zumrad Chutbayevna, Nodirzhanova Zulfiaxon Nodirjon qizi
Features Of Vascular-Platelet And Coagulation Hemostasis In Immune Microtrombovasculitis
This article presents the results of the evaluation of vascular-platelet and coagulation hemostasis in patients with immune microtrombovasculitis.
Immune Microtrombovasculitis, Vascular-Platelet Hemostasis, Coagulation Hemostasis.
Zumrad Ch.Kurbonova, Shaira A.Babadjanova, Zulfiya S. Islamova, Nargiza B. Musayeva
Impact Of Flavonoid-Based Hypolipidemic Agents On Lipid Profile And Atherosclerosis Development In Hypercholesterolemic Rabbits
The purpose of this research was to examine modifications in the lipid profiles of experimental rabbits with experimentally induced hypercholesterolemia and to explore the connection between these lipid variations and the onset of atherosclerosis. The investigation focused on analyzing the blood levels of total cholesterol, triglycerides, low-density lipoproteins (LDL), and high-density lipoproteins (HDL) in rabbits, highlighting their contribution to the pathophysiology of atherosclerosis. Rabbits with hypercholesterolemia demonstrated marked elevations in total cholesterol and triglyceride levels, accompanied by diminished HDL levels, factors that promote the formation of atherosclerotic lesions. The study established that flavonoid-rich formulations successfully restore lipid balance by suppressing atherogenic lipoprotein levels and enhancing HDL concentrations, thus offering potential applications in preventing and managing cardiovascular conditions.
Elevated Blood Cholesterol, Arterial Plaque Formation, Blood Fat Composition, Plant-Derived Polyphenols, Serum Cholesterol, Fatty Acid Esters, Heart And Vessel Disorders.
Kurbonova Z.Ch., Saidov A.B., Sayfutdinova Z.A., Akhmedova D.B., Tairova G.B.
The effect of local instillation of tranexamic acid on the gallbladder bed after laparoscopic cholecystectomy on the risk of postoperative bleeding: a randomized controlled study
Introduction: Bleeding during laparoscopic cholecystectomy can occur from the gallbladder bed, especially if there is difficulty during the dissection due to acute inflammation. The bleeding is usually minor from the small arteries running between the gall bladder and its bed. Tranexamic acid (TXA) is a drug that used topical and parenteral to decrease the bleeding during cardiac and spine, and trauma surgeries. It has antifibrinolytic effect by inhibiting degradation of blood clot and also probably degradation of platelet aggregation. We hypothesized that the local instillation of TXA in the gall bladder bed after laparoscopic cholecystectomy can decrease the bleeding in the form of decrease in the haematocrit and haemoglobin levels in the drain after surgery. Objective: to evaluate the efficacy of local instillation of TXA in the gallbladder bed in reducing postoperative bleeding following difficult laparoscopic cholecystectomy. Methods: This randomized double-blinded clinical study involved 80 adult patients treated at our university institution from December 2021 to January 2024. The patients were categorized into two groups. Group A consisted of 40 patients who, after achieving meticulous hemostasis of the bleeding points in the liver bed, received 500 mg of TXA dissolved in 20 ml of normal saline locally in the liver bed. Group B, also comprising 40 patients, underwent the same hemostatic procedure until no significant bleeding was observed, followed by the instillation of 20 ml of normal saline in the gall bladder bed. In both groups, the drain was occluded for one hour. Drain output was measured, and the haematocrit and haemoglobin levels of the drain fluid were evaluated at 6 hours and 24 hours. The haemoglobin level was compared to preoperative levels. Postoperative complications were documented. Results: 80 patients were eligible and after excluding 20 patients that were easy dissection of the gallbladder without potential risk of bleeding, so sixty patients were the scope of the study and divided into two groups. No serious bleeding was observed in any case, and hemoglobin and hematocrit levels in the drain were assessed at 6 and 24 hours’ post-procedure. In the TXA group, there was significant decrease in the 6h hematocrit concentration in the drain from 7.59±3.09 % to 5.76±2.88 % (P= 0.0213), and also hemoglobin decreased in the drain from 2.29±1.48 gm/dl to 11.21± 1.09 gm/dl (P=0.002), but these differences were not significant after 24 hours. Additionally, there was statistically insignificant difference between the two groups regarding the preoperative and 6 hours’ postoperative hemoglobin concentration in blood (P=0.521 and 0.710, respectively). Conclusion: The local administration of Tranexamic acid in the gallbladder bed following dissection may serve as an effective method to enhance hemostasis in the operative field, improve laparoscopic visibility, and reduce the likelihood of conversion to open surgery.
Tranexamic acid; laparoscopic cholecystectomy; postoperative bleeding; topical hemostasis; randomized controlled trial; gallbladder bed.
Ahmed Amer, Elghamry E. Elghamry, Ahmed Swelam, Gamal I. Moussa, Sameh Ahmed, Sherif Elgarf
Negative Pressure Wound Therapy with Partial Closure for Surgical Site Infections Following Spinal Surgery: A Prospective Case Series
Background: Deep surgical site infections (SSIs) following spinal surgery remain a major postoperative challenge, particularly when associated with instrumentation and extensive soft-tissue dissection. Negative Pressure Wound Therapy (NPWT) has shown promise in managing complex wounds, but evidence on its use combined with partial wound closure in spinal SSIs is limited. This study evaluates the effectiveness of NPWT with partial closure and identifies factors influencing wound healing duration. Methods: A prospective observational study was conducted at a tertiary care centre from July 2016 to April 2022. Sixteen patients (16–70 years) with deep SSIs and wound gaping after thoracic or lumbar open spinal surgery were included. All patients underwent surgical debridement, partial wound closure, and NPWT at –125 mmHg with dressing changes every 5–7 days. Demographic variables, wound characteristics, NPWT duration, number of dressing changes and healing time were recorded. The primary outcome was time to complete wound healing. Statistical significance was set at p ≤ 0.05. Results: The mean patient age was 51.1 ± 12.6 years, with males comprising 69%. The mean healing time was 10.2 ± 2.8 weeks. Patients with comorbidities had significantly longer healing durations (11.4 ± 2.9 vs. 9.0 ± 1.7 weeks; p = 0.027). Larger wound size was also associated with delayed healing (p = 0.035). No major NPWT-related complications were observed. Conclusion: NPWT with partial wound closure is a safe and effective strategy for managing deep SSIs after spinal surgery. Comorbidities and larger wound size significantly prolong healing, emphasizing the need for individualized wound management strategies.
Spinal surgery, Surgical site infection, Negative pressure wound therapy, Partial wound closure, Wound healing, Debridement.
Mahesh M, Ravikumar TV, BM Santhan Kumar Reddy
Inequalities in Out-of-Pocket Expenditure for Vascular Healthcare Services in Eastern Uttar Pradesh
Background & Objectives: This study rigorously examines the magnitude and factors influencing inequities in out-of-pocket expenditure (OOP) for vascular healthcare services in Eastern Uttar Pradesh. Vascular diseases necessitating expensive diagnostics, medical management, and surgical or endovascular interventions frequently impose a considerable financial burden on households. The main goal is to find out how much more people spend on vascular care out of pocket and what social, economic, and health system factors cause these differences in both inpatient and outpatient settings. Methods: The analysis is based on primary household-level data that was gathered from two districts of Eastern Uttar Pradesh. The distribution and concentration of vascular-related OOP spending across socioeconomic strata have been evaluated using a combination of descriptive statistics and sophisticated inequality measures like the Lorenz curve, Gini coefficient, and Theil index. These tools make it possible to comprehend financial inequalities in vascular diagnostics, emergency care, surgery, and long-term disease management in detail. Results: Significant inequalities in OOP spending for vascular healthcare are revealed by empirical findings. Financial stress is significantly increased by the high costs of necessary vascular services, such as diagnostic imaging (Doppler, CT angiography), medications (antiplatelets, anticoagulants), surgical and endovascular procedures, operation theatre fees, blood transfusions, and oxygen support. Low-income and rural households continue to bear a disproportionately heavy burden, which restricts equitable access to timely and appropriate vascular care and may exacerbate disease outcomes. Interpretation & Conclusions: The study highlights an urgent need for targeted policy reforms to reduce financial barriers to vascular healthcare in Eastern Uttar Pradesh. Important steps toward equity include strengthening Universal Health Coverage (UHC), increasing vascular care services at PHCs and CHCs, enhancing referral systems, and lowering reliance on expensive private facilities. Inequalities in financial burden and vascular health outcomes will continue to exist in the absence of systemic improvements. For vascular healthcare to be accessible, affordable, and equitable for all socioeconomic groups, it is imperative that these inequalities be addressed urgently.
Out-of-pocket expenditure, vascular healthcare, inequalities, Lorenz curve, Gini coefficient, Theil index, Eastern Uttar Pradesh.
Dr. Manokamana Ram, Dr. Rakesh Kumar, Dr. Rajkiran Prabhakar, Dr. Sandeep Tiwari, Dr. Ramesh Kumar, Dr. Kripa Shanker Yadav
Theoretical Exploration of Role Integration and Professional Synergy Among Nurse Specialists, Paramedic Technicians, Cardiovascular Technicians, Midwives, and Allied Health Support Professions
The present study offers a comprehensive theoretical exploration of role integration and professional synergy among nurse specialists, paramedic technicians, cardiovascular technicians, midwives, and allied health support professions within the evolving framework of interprofessional healthcare practice. Drawing upon 87 peer-reviewed studies published between 2015 and 2025, this research synthesized conceptual models and theoretical constructs to understand how collaboration, communication, and shared professional identity converge to enhance healthcare outcomes. The results revealed that effective interprofessional collaboration is founded on three interdependent constructs: the Professional Integration Index (PII), representing alignment of professional roles and competencies; the Collaborative Synergy Coefficient (CSC), indicating teamwork effectiveness; and the Interprofessional Identity Density (IID), denoting shared professional identity and trust. The theoretical relationships demonstrated that clarity of communication, interprofessional education, and institutional support serve as key enablers of integration, while contextual factors such as organizational culture and leadership moderate collaborative outcomes. The study concluded that professional synergy arises not merely from co-working but from intentional structural alignment, shared learning, and a collective sense of purpose across healthcare disciplines. The model achieved 93% theoretical consistency when cross-compared with existing frameworks, reflecting strong conceptual validity. The findings emphasize that nurturing interprofessional identity and collaborative culture can strengthen coordination, reduce role ambiguity, and enhance patient-centered care. Ultimately, the study contributes a robust theoretical foundation for future empirical validation, guiding educational and policy efforts aimed at building more integrated, equitable, and efficient healthcare systems.
Role Integration, Professional Synergy, Interprofessional Collaboration, Theoretical Framework, Healthcare Teams, Professional Identity, Communication, Nursing, Allied Health, Collaborative Practice.
Mohammed Ali Saud Almnasif, Ruqaiya Ali S. Almunasif, Awatif Ghanem Ali Alanazi, Saad Ali Saad Al-Shahrani, Mohammed Hassan Malyosi, Abdulaziz Mohammed Alwabli, Ali Mohammed Abdullah Alshehri, Samar Bakr Mohammed, Amal Abdullah Almalki, Fatima Mohammed Aldussari, Tariq Ahmed Saleh Alghamdi, Yakoub Fysal Alnakhly, Reemah Omar Alhousah, Khaled Abdullah Ahmed Alghamdi, Ahmed Adnan Mohammed Mlibary
Clinical Efficacy And Immunomodulatory Effect Of Bal-Rasayana® Syrup In Pediatric Allergic Rhinitis: An Open-Label Prospective Study
Background: Allergic rhinitis (AR) is one of the most common chronic respiratory disorders in children, often associated with asthma and recurrent morbidity. Conventional management with antihistamines is frequently limited by adverse effects, highlighting the need for safe, long-term, immune-modulating therapies. In Ayurveda, AR resembles Vataja Pratishyaya, which arises from Kapha-Vata dosha imbalance and Ama accumulation in the Pranavaha Srotas. Objective: To evaluate the clinical efficacy, safety, and immunomodulatory effects of Bal-Rasayana® syrup, a polyherbal formulation, in children with allergic rhinitis. Methods: An open-label, non-comparative, prospective clinical trial was conducted in the OPD of Balroga, Bharati Vidyapeeth Ayurved Hospital, Pune. Sixty children aged 3–16 years with recurrent AR were enrolled. Participants received Bal-Rasayana® syrup at a dose of Age (years) × 4 ml twice daily for 90 days, with follow-ups on Day 30, 60, 90, and post-treatment review on Day 120. Subjective symptoms (sneezing, rhinorrhea, nasal obstruction, nasal itching, epiphora) were assessed using clinical scoring, while objective parameters included Absolute Eosinophil Count (AEC) and Serum IgE. Statistical analysis was performed using Wilcoxon Signed Rank Test for subjective parameters and paired t-test for objective parameters, with significance set at p < 0.05. Results: Significant improvement was observed in all subjective symptoms: sneezing (81.94%), rhinorrhea (78.74%), nasal obstruction (64.15%), nasal itching (68.66%), and epiphora (85.30%) (p < 0.001). Objective parameters also showed marked improvement: AEC decreased by 64.77% and Serum IgE by 78.65% (p < 0.001). Overall, 44.4% of children achieved moderate improvement (50–75% relief) and 36.5% achieved excellent improvement (75–100% relief). No significant adverse effects were reported. Conclusion: Bal-Rasayana® syrup is a safe, effective, and child-friendly polyherbal intervention for allergic rhinitis, providing significant symptomatic relief and immunomodulatory benefits. The formulation addresses the underlying Ayurvedic pathophysiology by restoring Agni, clearing Ama, pacifying Kapha-Vata dosha, and strengthening the Pranavaha Srotas. These findings support its use as a holistic alternative or adjunct to conventional therapy in pediatric AR.
Allergic rhinitis, Pediatric, Bal-Rasayana® syrup, Ayurvedic therapy, Immunomodulation, Vataja Pratishyaya.
Dr. Ajay Chavan, Dr. Rahul Gujarathi, Dr. Dipti Chavan, Dr. Sumod Khedekar, Dr. Ankita Mukhedkar, Dr. Amitkumar Sukhdeo Mane
Clinical Outcomes of Venous Leg Ulcers Treated with Four-Layer Compression Bandage: A Prospective Study from a Tertiary Care Centre
Background: Venous leg ulcer is the most severe manifestation of chronic venous disease and is associated with delayed healing, high recurrence and significant impairment of quality of life. Multicomponent compression systems are the cornerstone of management, and the four-layer compression bandage is widely used, but Indian prospective data remain limited. Aim: To study the clinical outcome of patients with venous ulcer treated with a four-layer compression bandage in a tertiary care setting. Methods: This observational prospective study was conducted in the Department of General Surgery of a tertiary care medical college and hospital from May 2020 to December 2021 (18 months). Thirty consecutive adult patients (>18 years) with clinically and duplex-confirmed venous disease presenting with venous leg ulcers and fulfilling predefined inclusion and exclusion criteria were enrolled. All patients underwent standard clinical assessment, bedside venous tests (Brodie–Trendelenburg, multiple tourniquet, modified Perthes), and arterial/venous Doppler evaluation. A standard four-layer compression bandage protocol was applied, and patients were followed up clinically. Ulcer characteristics (size, edge, bed, discharge), limb edema and early response at day 4 were recorded, along with subsequent progress until healing or last follow-up. Results: A total of 30 patients with venous leg ulcers received four-layer compression bandaging. On assessment at day 4, 28 (93.3%) ulcers had developed healthy granulation tissue over the ulcer bed, 30 (100%) retained a sloping edge, 22 (73.3%) showed reduced or absent discharge, 23 (76.7%) demonstrated reduction in ulcer size, and 22 (73.3%) had significant reduction in limb swelling. No serious bandage-related complications were recorded during the early follow-up period. [To be updated with mean age, sex distribution, mean ulcer duration and overall time to complete healing based on thesis tables]. Conclusion: Four-layer compression bandage therapy provides favourable early clinical outcomes in patients with venous leg ulcers, with rapid improvement in ulcer bed granulation, reduction in exudate, size and limb edema. These findings support the routine use of multicomponent four-layer compression systems as a simple, effective and well-tolerated modality in the management of venous leg ulcers in resource-constrained tertiary care settings. Larger studies with longer follow-up are needed to confirm healing rates and recurrence outcomes.
Dr. Rajesh G Patil, Dr Jay Gawande, Dr Harish Kumar, Dr. Ashish Jatale
Nurses Led Interventions to Combat Female Adolescents' Anemia: A Systematic Review
Background Anemia, which is mainly because of iron deficiency is a common social problem affecting millions of female adolescents all around the world with severe effects on cognitive development, educational attainment and long-term health. Multi-modal interventions such as supplementation, dietary diversification, and education are advised in accordance with the international targets to curb anemia. School and community nurses are key to the provision of such interventions. This system review will integrate the evidence on the efficacy of nurse-led interventions in preventing and managing anemia among female teenagers. Methods A systematic review has been conducted in accordance with the Cochrane Handbook of Systematic Reviews of Interventions, utilizing PRISMA guidelines. The investigation was performed on PubMed, Scopus, Cochrane Library, Web of Science, CINAHL, and ProQuest from May 2021 to December 2025. Randomized controlled trials, quasi-experimental studies, and mixed-method research were incorporated in the investigations undertaken on female Adolescents aged 10 to 19 years. Quality assessment was conducted with techniques from the Joanna Briggs Institute. Results: 6905 records identified, nine records were included. Structured health education, nutrition counseling, iron-folic acid supplementation, digital educational tools (e.g., mobile apps, games), and school-based programs were the most common interventions and are mostly implemented or overseen by nurses. The findings suggested that there were high levels of improvements in anemia-related knowledge, attitude, dietary habits, and adherence to supplementations. Some of the studies also showed beneficial impacts on hemoglobin levels and decreased prevalence of anemia. Conclusion: Nurse-based interventions can be used to improve hematological outcomes, promote positive health behavior, and knowledge in teenage girls. To provide sustainable anemia prevention and control, it is important to integrate nurses into the school and community health programs. It is advisable that further studies should be conducted using rigor design, follow up, and well-articulated nursing roles to enhance the evidence base and implement policies.
Adolescents, Anemia, Health education, Iron deficiency.
Reem Salem Alghabiwi, Abdullah Awad D Yahya, Wajd Ahmed Abdullah Albeshri, Jameela Jameel Albayedh, Afrah Ayed Alshammari, Faris Saad A. Alkhathami, Jenan Hamed Alghannam, Amr A. Mariee
Effects of Task-Oriented Training According to Stroke Lesion Location: A Pilot Study
Background: Task-oriented training is a widely used rehabilitation approach for individuals with stroke, emphasizing functional task practice and active problem-solving. However, clinical outcomes may vary according to stroke lesion location, and evidence regarding lesion-specific effects of task-oriented training remains limited. This pilot study aimed to examine the effects of a task-oriented training program on activities of daily living and upper extremity motor function according to stroke lesion location. Methods: Four individuals with stroke participated in a six-week task-oriented training program administered five times per week for 30 minutes per session. Participants met inclusion criteria of preserved cognitive function (MMSE-K ≥ 20) and functional independence (modified Rankin Scale ≤ 3). Training tasks were selected from standardized activities and individualized by adjusting task difficulty. Outcome measures included the Korean Modified Barthel Index (K-MBI), Manual Function Test (MFT), and Fugl-Meyer Assessment (FMA). Pre- and post-intervention outcomes were compared descriptively. Results: All participants demonstrated improvements in functional performance following the intervention, although the magnitude and pattern of improvement differed across lesion locations. Improvements in activities of daily living and upper extremity motor function were not uniform, with discrepancies observed between functional independence and motor recovery measures. Conclusion: The results suggest that the therapeutic effects of task-oriented training may differ according to stroke lesion location. Lesion-specific considerations may be essential for optimizing task-oriented rehabilitation strategies. Larger-scale studies are warranted to confirm these findings.
Stroke, Task-oriented training, Lesion location, Upper extremity function, Activities of daily living.
SangMi Jung, BokHee Chong, InKyung Lee, JaeHo Yu
A Comparative Analysis Of The Therapeutic Effectiveness Of Dexamethasone And Infliximab In Psoriasis Patients
Background: Psoriasis is a chronic, immune-mediated inflammatory skin disorder characterized by hyperproliferation of keratinocytes and dysregulation of T-cell–mediated cytokine pathways. The disease significantly impairs patients’ quality of life and often requires long-term pharmacological management. This study compares the therapeutic effectiveness of Dexamethasone (Corticosteroids) and Infliximab (Chimeric monoclonal antibody) in Psoriasis patients. Methods: A comparative study was conducted for six months among 80 adults (aged 18-60yrs) with Psoriasis. Participants were grouped based on therapy with Dexamethasone or Infliximab. Clinical assessment using PASI (Psoriasis Area and Severity Index) and DLQI (Dermatology Life Quality Index) at baseline, week 4, week 12, and week 24. Data were analysed using paired and independent t-tests and Chi-square tests. Results: Infliximab patients displayed a greater baseline mean PASI score (34.51) than Dexamethasone patients (28.51) with a comparable sample size, suggesting the severity, improving the interpretation of symptom improvement statistics. The T-test comparison showed statistically significant differences in PASI scores (p=0.035) and symptom improvement (p=0.021) in favour of Infliximab, while satisfaction scores and treatment duration had no statistically significant difference. Conclusion: The Infliximab showed significantly better symptom improvement and slightly higher patient satisfaction, although the latter was not statistically significant. Both treatment groups had similar durations of therapy, ensuring a fair comparison. The enhanced effectiveness of Infliximab, particularly in improving clinical symptoms, positioning it as a potentially more beneficial option in treating moderate to severe plaque psoriasis.
Psoriasis, Dexamethasone, Infliximab, Therapeutic Effectiveness, Comparative Analysis.
Ranjith Kumar. R1, Sanjay. C, Saron Micahvel.S, Dr. Karthickeyan Krishnan, P. Dr. Palani Shanmugasundaramm
Efficacy of High-Intensity Versus Moderate-Intensity Statins in Primary Prevention of Cardiovascular Disease: A Meta-Analysis
Background: Statins are commonly prescribed for the primary prevention of cardiovascular disease (CVD). However, there is ongoing debate about the most appropriate intensity of statin therapy for individuals without established CVD. Although high-intensity statins produce greater reductions in low-density lipoprotein cholesterol (LDL-C), it remains uncertain whether this biochemical benefit leads to meaningful improvements in cardiovascular outcomes when compared with moderate-intensity therapy. Objective: To evaluate and compare the efficacy and safety of high-intensity versus moderate-intensity statin therapy in adults receiving statins for primary prevention of cardiovascular disease. Methods: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised controlled trials and observational studies published between 2020 and 2025 were identified through structured database searches. Studies that directly or indirectly compared high-intensity and moderate-intensity statin therapy in primary prevention populations were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for major adverse cardiovascular events (MACE), myocardial infarction, stroke, all-cause mortality, and statin-associated adverse effects. Differences in LDL-C reduction were assessed using mean differences, and random-effects models were applied to account for heterogeneity. Results: A total of fifteen studies met the inclusion criteria. High-intensity statin therapy resulted in significantly greater reductions in LDL-C compared with moderate-intensity therapy (mean difference −12.4%, 95% CI −10.1 to −14.7; p < 0.001). Despite this, no statistically significant difference was observed in the incidence of major adverse cardiovascular events between the two treatment strategies (RR 0.97, 95% CI 0.91–1.04; p = 0.42). High-intensity statin use was associated with a higher risk of statin-associated muscle symptoms (RR 1.32, 95% CI 1.18–1.48; p < 0.001) and increased rates of treatment discontinuation. Conclusion: In individuals undergoing primary prevention, high-intensity statins achieve greater LDL-C lowering but do not provide a clear additional benefit in reducing cardiovascular events compared with moderate-intensity therapy. Given the higher frequency of adverse effects and reduced tolerability associated with high-intensity regimens, moderate-intensity statins—particularly when used in combination with ezetimibe—offer an effective and more sustainable option for many patients. Clinical decision-making should therefore focus on individual cardiovascular risk, long-term adherence, and treatment tolerability rather than statin intensity alone.
Primary Prevention, Cardiovascular Disease, Statins, Statin Intensity, Ldl Cholesterol, Meta-Analysis
Ahmad Khaldoun Mohammad Batiha, Khalid Bilal Abid, Mahmoud Tawfik Rashad Moustafa Elmenshawy, Sara Saad Mohamed Mohamed Elkhadragi, Laila Saud Khashan, Ahmed Abdelrahman Abdullah
Case Report of Complete Abdominal Wound Dehiscence After Cesarean Section at Dr. Soetomo General Hospital Surabaya, 2023-2024
Background: Complete abdominal wound dehiscence (CAWD) is a serious post-abdominal surgery complication, including cesarean section, which although rare, is associated with high maternal morbidity and mortality. The increasing rate of cesarean sections makes this complication relevant for recognition, prevention, and optimal management. Case Report: Four cases of complete abdominal wound dehiscence following cesarean section treated at Dr. Soetomo Hospital Surabaya during 2023-2024 are reported. All patients had a history of previous cesarean section and underwent surgery with long duration and significant hemorrhage. Risk factors identified included anemia, hypoalbuminemia, obesity, history of abdominal surgery, and high-risk obstetric conditions such as placenta accreta. Dehiscence manifestations appeared on days 7 to 13 post-operatively. All patients were managed operatively with abdominal wall repair and a multidisciplinary approach, accompanied by culture-specific antibiotic therapy. Conclusion: Complete abdominal wound dehiscence following cesarean section is a multifactorial complication requiring high vigilance in early diagnosis and immediate management. Optimization of preoperative conditions, proper surgical technique, strict postoperative monitoring, and rapid and adequate surgical intervention provide good clinical outcomes.
Complete Abdominal Wound Dehiscence, Cesarean Section, Case Report
Yuli Agustria, Erry Gumilar Dachlan, Muhammad Ilham Aldika Akbar
The Effect of Sleep Hygiene Education on Sleep Deprivation and Sleep Habits among Adolescents in Visakhapatnam.
The objective of the study was to determine the effect of sleep hygiene education on sleep duration, quality, and pleased habit among adolescents in Visakhapatnam. Lack of sleep and bad sleeping habits are common problems within this age group and they have impacted negatively on their health, academic achievement and emotional state. Quasi experimental pretest posttest design was used with the sample consisting of 250 adolescents of between 13-18 years of age across different schools of Visakhapatnam. The participants were given a structured education program on sleep hygiene that emphasized on the best sleep schedules, screen time self-regulation, caffeine avoidance, and the establishment of a favorable sleeping environment. The Pittsburgh sleep Quality Index (PSQI) and the Adolescent Sleep Hygiene Scale (ASHS) were used to gather data at the baseline and four weeks of intervention.The findings showed that there was a considerable increase in the duration of sleep and quality of sleep. The average number of hours of sleep per night went up to 1.5 hours per night as it was at baseline (6.5 hours) and 8.0 hours at the intervention. The scores of PSQI were better (assessed as 5.2 vs. 8.1) which shows that there was better sleep quality. Also, the practice of healthy sleep hygiene, including limiting screen time use before bedtime and maintaining a regular bedtime schedule, also improved significantly. The subgroup analysis revealed that females and those with lesser sleep hygiene at baseline had greater improvements.This paper highlights the success of sleep hygiene education in enhancing sleep behaviors in teenagers. The results demonstrate that schools and even health policymakers should consider teaching sleep hygiene in school curricula and in the community health programs to deal with sleep deprivation and enhance healthy sleeping habits among youths. The intervention revealed that, sleep hygiene is an inexpensive intervention that can improve the aspect of wellness, academic achievement and mental health of adolescents.
Adolescents, Sleep hygiene education, Sleep deprivation, Sleep habits, Visakhapatnam, Intervention study
Health Problems: Menstrual Cycles, Hairfall, tiredness and Muscle Ache of Hypothyroidism After Pregnancy.
Background: The thyroid gland is located in the anterior part of the lower neck, beneath the larynx, or voice box. It is the first glandular tissue to appear during the development of the. embryo in mammals. It develops into a structure with two lobes after starting as two sections of the endodermal pharynx Materials and Methods: Over 470 willing and eligible women were evaluated for this study during and after their pregnancies. One year five months were allotted for the study. The study was conducted in the Obstetrics &amp; Gynecology and Pathology (Biochemistry) departments of Rajeev Gandhi College and General Hospital in Bhopal, Madhya Pradesh Results: The total number of patients studied was 470 from December 2022 to Aug. 2025. Of the 470 individuals who took part in the study, 122 had hypothyroidism, which shows that 25.95% of people have hypothyroidism. Twelve people (9.83%) had subclinical hypothyroidism, and 35 people (28.68%) had overt hypothyroidism out of the 122 participants with hypothyroidism. According to the above table, the maximum number of patients in the study group belongs to the age group of 21-30 years, 39 (31.96%), and in the age group 31- 40 years, 31 cases were seen (25.40%). According to the above table, the maximum number of patients in the study group belongs to the age group of 21-30 years, 39 (31.96%), and in the age group 31-40 years, 31 cases were seen (25.40%), and according to this data is significant. Chi square = 3.28; P = 0.32 (NS). Total of 122 individuals who complained of various bleeding patterns are included in the column above. Menorrhagia was the most prevalent (26.22%). Acyclical (MPH) was found in 20.49% of patients, oligomenorrhea in 23.77%, polymenorrhea in 14.75%, polymenorrhea in 6.55%, hypomenorrhea in 4.1%, and metrorrhagia in 4.1% of cases. Menorrhagia was the most common complaint among patients, followed by oligomenorrhea, and according to this data is significant. Chi square = 8.28; P = 0.032 (S). This table illustrates how the various forms of clinically recognized DUB cases relate to hypothyroidism, subclinical hypothyroidism, and hyperthyroidism. 34.1% of patients with menorrhagia were euthyroid, and 25% and 100% of patients with polymenorrhea had hypothyroidism and hyperthyroidism, respectively. In contrast, 50% of patients with oligomenorrhea had subclinical hypothyroidism, whereas only 16.6% of individuals with menorrhagia had hypothyroidism. 50% of patients with oligomenorrhea had subclinical hypothyroidism, 16.6% had hypothyroidism, and 0% had hyperthyroidism. 40% of patients with polymenorrhea also had subclinical hypothyroidism. Thus, only 50% of patients with subclinical hypothyroidism had oligomenorrhea, while 40% of patients presented with polymenorrhea and 5% with menorrhagia. The majority of hypothyroid and euthyroid individuals had acyclical metropathia (MPH); the respective percentages were 19.31% and 16.6%. Conversely, hyperthyroid individuals were only exhibiting polymenorrhea or oligomenorrhea. The most common bleeding patterns in subclinical hypothyroid patients are polymenorrhea and menorrhagia and according to this data is significant. Chi square = 8.28; P = 0.032 (S). Conclusion: These findings emphasize the need for increased awareness and monitoring of thyroid health in women during and after pregnancy to mitigate potential complications. This study highlights the significant prevalence of thyroid dysfunctions among patients with dysfunctional uterine bleeding (DUB), particularly noting the high incidence of hypothyroidism and hyperthyroidism in specific menstrual irregularities.
Uterine Bleeding, Hyperthyroid, Acyclical Metropathia, Hypothyroidism, Obstetrics & Gynecology.
Shipra Shrivastava, Naveen Singh Chauhan, Devesh Kumar Joshi, Ruchir Jain
Enhanced Recovery Protocol: Is It Safe and Feasible After Open Conventional Liver Surgery?
Background: Open liver resections are essential for managing primary and secondary liver tumors but are often associated with significant morbidity, prolonged recovery, and high healthcare costs. Enhanced Recovery After Surgery (ERAS) protocols have demonstrated improved outcomes in various surgical fields, yet their application in open liver surgery remains under-investigated, particularly in low- and middle-income settings. Objective: To assess the safety, feasibility, and clinical impact of implementing ERAS protocols in open conventional liver resections compared to traditional perioperative care. Methods: A retrospective single-center study was conducted on 100 patients who underwent open liver resections at Tanta University Hospitals (2018–2023). Patients were divided into two groups: Group A (Pre-ERAS, n=50) and Group B (ERAS, n=50). ERAS protocols were implemented according to the ERAS Society Guidelines and involved structured interventions across the preoperative, intraoperative, and postoperative phases. Primary outcomes included operative blood loss, complications, and length of hospital stay. Results: ERAS implementation led to significantly reduced blood loss (376 ± 140 ml vs 428 ± 160 ml, p=0.039), shorter hospital stay (4.68 ± 1.4 vs 6.24 ± 2.1 days, p<0.001), and lower wound infection rates (12% vs 30%, p=0.0041). However, a higher rate of intra-abdominal collections was observed in the ERAS group (30% vs 14%, p=0.07). Conclusions: ERAS protocols are safe and feasible in open liver surgery and significantly improve recovery outcomes. Nevertheless, individualized drain management strategies may be necessary to mitigate the risk of intra-abdominal collections.
Enhanced Recovery After Surgery (ERAS), open liver resection, perioperative outcomes, blood loss, surgical site infection, intra-abdominal collection, postoperative recovery.
Alhassan M. Hassan, Sherif M. Elgarf, Ahmed Swelam, Gamal I. Moussa, Mostafa I. Sharaf, Lobna S. Tafesh, Elghamry E. Elghamry
Cardioprotective Effects of Bromelain on Wistar Rat (Rattus norvegicus) Cardiomyocytes Exposed to Doxorubicin
Introduction: Doxorubicin (Dox) is an effective anthracycline whose clinical use is limited by cardiotoxicity. Bromelain, a proteolytic enzyme from Ananas comosus, has antioxidant and anti-inflammatory properties and may confer cardioprotection. Methods: We conducted an in vivo posttest-only control group study in female Wistar rats (≈8 weeks, 150–200 g; n=5/group) allocated to control (P1), Dox 15 mg/kg intraperitoneally (P2), or Dox 15 mg/kg plus bromelain 40 mg/kg orally 30 min prior (P3). Four hours post-treatment, serum CK-MB was measured by autoanalyzer and NT-proBNP by electrochemiluminescence immunoassay. Normality (Shapiro–Wilk) and homogeneity (Levene) were met; pairwise comparisons used independent t-tests (α=0.05). Results: Mean±SD CK-MB (U/L) were control 0.3530±0.0373, Dox 1.3756±0.0544, Dox+bromelain 1.0218±0.1086; p-values: control vs Dox 0.013, control vs Dox+bromelain 0.026, Dox vs Dox+bromelain 0.037. Mean±SD NT-proBNP (pg/mL) were control 0.3932±0.0304, Dox 1.3924±0.0579, Dox+bromelain 1.0826±0.0647; p-values: control vs Dox 0.028, control vs Dox+bromelain 0.012, Dox vs Dox+bromelain 0.039. Conclusion: Bromelain significantly attenuated Dox-induced increases in CK-MB and NT-proBNP in Wistar rats but did not restore biomarker levels to control values, supporting a cardioprotective effect and warranting larger, longer-term studies to define dose–response, durability, and mechanisms.
Doxorubicin; Bromelain; Cardiotoxicity; CKMB; NT-proBNP; Wistar rats.
Ngurah Arie Kapindra Dharma, Asdi Wihandono, Marjono Dwi Wibowo
Effectiveness of Blood Request and Use During Surgery in Elective Patients of RSUD Dr. Soetomo’s Gedung Bedah Pusat Terpadu
Background: Data from developing countries show that only forty to seventy percent of the total blood cells ordered for patients are transfused. In the Global Database on Blood Safety (GDBS) report published in 148 countries in 2011, the World Health Organization (WHO) estimated that of the total 96.4 million WB donations worldwide, approximately 5 million (5.2%) were wasted. In 2023, the Blood Transfusion Installation (ITD) of Dr. Soetomo Hospital received 34,047 units of blood (various blood types) from the Surgical Unit; 14,249 units of blood were handed over to clinicians to be given to patients. Methods: This retrospective descriptive study recorded preoperative blood filling data, both on-hand supplies and GSH for all elective surgeries performed at the Integrated Central Surgery Building (GBPT) of Dr. Soetomo Hospital. Soetomo from January to December 2023. Results: Of the 5411 study subjects, the C/T ratio was reported to be 0.92 ± 0.31, TI 0.59 ± 0.19, and %T 12.47 ± 7.24. The analysis showed that the C/T ratio and blood demand during surgery had a statistically significant relationship, with a P value of 0.043 and a Pearson correlation of 0.770, indicating a strong positive relationship. The P value of TI and %T against blood demand is 0.903 and 0.193, far above the limit of 0.05 which shows that the two indicators have no correlation with the amount of blood demand. Conclusion: Overall, the C/T ratio is a useful indicator for blood demand planning, while TI and %T showed a less clear relationship.
C/T Ratio, Transfusion Index, Transfusion Percentage
Agustinus Kharisma Haryo Utomo, Prananda Surya Airlangga, Maulydia, Betty Agustina Tambunan, Atika, Kun Arifi Abbas
High-Sensitivity Cardiac Troponin Levels Difference in Before and After Ear and Nose Surgery with Controlled Hypotension Technique
Background: Anesthesia with controlled hypotension or intraoperative hypotension (IOH) is a technique in which arterial blood pressure is lowered in a deliberate and predictable situation, aimed at facilitating surgery and reducing bleeding and transfusion requirements. However, this surgical technique is not without complications. Detection of MI depends on biomarker fluctuations. Cardiac troponin is the biomarker of choice for diagnosing myocardial damage and MI. Research on the relationship between hs-cTn levels and the incidence of postoperative myocardial infarction and controlled hypotension has never been done before, especially in troponin I and in ear and nose surgery. Methods: This study is an observational analytical study with a cross-sectional method to assess the incidence of myocardial infarction in patients undergoing elective tympanoplasty, mastoidectomy, septoplasty, rhinoplasty, and functional endoscopic sinus surgery (FESS). Results: There were 38 study subjects with 57.6% (20 subjects) being male and 47.4% (18 subjects) being female. The mean preoperative hs-cTn level was 33.87 ± 11.78 pg/mL, while the postoperative hs-cTn level was 43.46 ± 12.21. The mean change in hs-cTn levels between preoperative and postoperative was +9.59 ± 6.62 with a median of 7.78 (1.04-28.27) with a significant difference of p<0.001 and a high correlation (r=0.848). Conclusion: From our study, it can be concluded that the difference in hs-cTn levels between before and after ear and nose surgery with controlled hypotension technique is significantly different.
Agustinus Kharisma Haryo Utomo, Prananda Surya Airlangga, Maulydia, Kohar Hari Santoso, Muhtarum Yusuf, Mahmudah
Formulation Development, Characterization, And Optimization Of Teneligliptin-Embedded Transdermal Patches For The Management Of Diabetes Mellitus
Transdermal drug delivery transports active molecules across intact skin into the systemic circulation and can sidestep limitations of oral dosing and hypodermic injections. Teneligliptin hydrobromide hydrate, DPP-4 inhibitors, also known as "gliptins," are a class of oral medications used to treat type 2 diabetes was incorporated into polymeric films to explore a sustained-release patch. Hydroxypropyl methylcellulose (HPMC) and polyvinylpyrrolidone (PVP) were used as film formers; methanol as solvent; dibutyl phthalate as plasticizer; and dimethyl sulfoxide (DMSO) as a permeation enhancer. Among nine trial formulations (F1–F9), the HPMC-rich film F9 (400 mg HPMC; 0 mg PVP) showed uniform thickness (0.410 ± 0.003 mm), acceptable weight (90.2 ± 2.03 mg), and sustained release with 92.58% drug released at 7 h. Diffusion controlled release kinetics was attained as the best-fitting model to describe the release from SNEDDS.transport. Projected shelf-life Stability at Accelerated stability conditions of 40 degrees Celsius, allowing for a 2-degree variance, and 75% relative humidity, with a 5% tolerance. up to 3 months suggested preserved pH, drug content, and release profile with minor physical changes. Overall, F9 appears to be a promising transdermal platform for teneligliptin and may enable reduced dosing frequency and improved adherence in type 2 diabetes care.
Transdermal Patch, Teneligliptin, Dpp-4 Inhibitor, First-Pass Metabolism, Higuchi Kinetics, Bioavailability.
Harleen Kaur, Sonica Rathore, Simerjit Kaur, Maninder Pal Singh, Vikas Srivastava, Abhinav Anand