Secondary Causes of Obesity in Children: A Systematic Review and Meta-Analysis
Background: Secondary causes account for a clinically insignificant minority of childhood obesity; however, prevalence estimates, diagnostic yields, and management outcomes across specific etiological subtypes have not been quantitatively synthesized from primary study data. Objectives: To conduct a systematic review and meta-analysis of primary studies examining the prevalence, clinical features, diagnostic approaches, and management outcomes of secondary causes of obesity in children and adolescents aged 0–18 years. Methods: PubMed/MEDLINE, Web of Science, Scopus, and Embase were searched from January 2000 to December 2025. Only primary studies (cohort studies, randomized controlled trials, cross-sectional studies, clinical trials, and case series with ≥5 patients) were included. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using ROBINS-I for observational studies and Cochrane RoB 2 for the RCT. Random-effects meta-analyses were performed for outcomes reported in ≥2 studies, and heterogeneity was quantified using I² and Cochran’s Q. Publication bias was assessed using Egger’s test with k≥3. Results: Twelve primary studies (N > 3,000 children) met the inclusion criteria. The meta-analysis demonstrated a pooled MC4R deficiency prevalence of 3.6% (95% CI 2.1–5.4%; I²=41%) among children with severe early-onset obesity. Next-generation sequencing yielded a genetic diagnosis in 9.5% (95% CI 7.2–12.1%; I²=28%). Growth hormone therapy in Prader-Willi syndrome significantly reduced body mass index SDS (pooled MD −0.82; 95% CI −1.14 to −0.50; I²=19%). Hypothalamic obesity developed in 42.5% (95% CI 27.1–58.7%; I²=67%) of children following craniopharyngioma treatment. Leptin/leptin-receptor replacement therapy produced marked weight reduction (pooled MD −8.4 kg; 95% CI −12.1 to −4.7; I²=0%). The risk of bias was low in four studies and moderate in eight. Conclusions: This meta-analysis provides precise pooled estimates for the prevalence and treatment effects of major secondary obesity subtypes in children. Growth hormone therapy in PWS achieves consistent, clinically meaningful BMI SDS reduction. Genetic testing in children with severe early-onset obesity yields a diagnosis in approximately 1 in 10 children. Future adequately powered RCTs are urgently needed to evaluate hypothalamic obesity and novel targeted pharmacotherapies.
childhood obesity; secondary obesity; monogenic obesity; Prader-Willi syndrome; hypothalamic obesity; meta-analysis; systematic review; growth hormone; ROBINS-I; MC4R.
Majed M. AlSaleh, Abdullah Saeed, Bander A. Alasmari, Mohammed Y. Asiri(0000-0001-9013-7964), Mohammed Althabbahi, Ayed A. Shati, Mozoun D. Alahmari, Ahmed Albishri, Meteb A. Albraik
Thoracoscopic sympathectomy for treatment of primary palmar hyperhidrosis: Single versus multiple levels division
Background: Palmar hyperhidrosis is a disorder of excessive eccrine gland activity affecting the palms with an estimated prevalence of approximately 2.8%. Endoscopic thoracic sympathectomy (ETS) remains the definitive therapeutic intervention for refractory palmar hyperhidrosis, performed either through multi-level interruption of the sympathetic chain (T2–T5) or targeted single-level division at T3 or T4, the latter demonstrating a reduced incidence of postoperative complications. Methods: This multicentric study employed a descriptive design with both prospective and retrospective components and was conducted between (June 2021) to (June 2023). A total of 45 patients with primary palmar hyperhidrosis underwent endoscopic thoracoscopic sympathectomy (ETS). Patients were followed for a mean duration of 6 months and were assessed for improvement in palmar sweating, postoperative pain, the occurrence of postoperative complications, and overall quality of life. Results: All patients showed an improvement for their 1ry palmar hyperhidrosis, with a significant difference in favor of the single-level cut. Compensatory hyperhidrosis was recorded in all cases of group A (100%) and in 6 cases of group B (40%) and 1 case of group C (6.7%). 2 (13.3%) cases of group B and 6 (40%) cases in group C showed recurrence of 1ry palmar hyperhidrosis, but less severe than the original condition. Patients’ satisfaction with improvement in quality of life was recorded starting from the first postoperative evaluation, but without a difference between the 3 groups. Conclusion: Both techniques were effective for handling palmar hyperhidrosis with a high grade of patients’ satisfaction. Single-level division carries more advantages in the form of less incidence of post-operative pain, short operative time, with fewer incidences of post-operative complications.
Palmar hyperhidrosis, Compensatory hyperhidrosis, Endoscopic thoracic sympathectomy (ETS), Sympathectomy.
Esayed Elmokadem, M.D; Hazem Ali Essa Ali Sheashia, M.D; Mazin Essam Eldin Ali, M.D; Mohamed F. Younis, MD; Ahmed Beheiry, M.D; Mohammed Siam, M.D; Mohamed F. Elfaresy, M.D
Emerging Applications of Wearable Devices and Remote Monitoring Technologies In Cardiovascular Disease Prevention and Management: A Systematic Review
Background: CVDs are the leading cause of mortality worldwide and they have been a burden to healthcare systems in terms of late diagnosis and lack of long-term monitoring interventions. New technologies in wearable technologies such as smartwatches, ECG patches, cuffless blood pressure monitoring, and heart-failure remote-sensing platforms have also brought new possibilities of continuous and real-time cardiovascular monitoring. Improved with the help of artificial intelligence (AI) and machine-learning-based algorithms, the devices will provide a more accurate interpretation of physiological patterns and can enhance the field of early detection, risk stratification, and clinical management. This system review is an inquiry into the emerging evidence of wearable and remote monitoring in the prevention and management of major cardiovascular conditions. Objectives: This review aims to assess the quality of: diagnosis, clinical utility, and methodology of modern wearable devices and remote monitoring technologies to determine their use in atrial fibrillation, hypertension, heart failure, and other cardiovascular diseases. Methods: The systematized search was performed according to the principles of PRISMA 2020 in relation to eight large databases between January 2010 and February 2025. The studies had to meet the following criteria: they had to evaluate wearable or remote monitoring technologies and provide cardiovascular-related diagnostic or clinical outcomes. Data that were extracted comprised sample features, the type of device, performance indicators, AI implementation, and validation methods. The risk of bias was evaluated with the help of ROBINS-I and QUADAS-2. Narrative and quantitative syntheses were conducted and pooled accuracy estimates, forest plots, as well as, correlation analyses to interpret device performance and methodological patterns were used. Results: There were 58,740 participants that were included in 42 studies. The analysis has indicated that wearable devices possess great diagnostic potential, especially the devices that detect atrial fibrillation by the use of PPG- and ECG-based technologies, which had high sensitivity and specificity. Cuffless blood pressure devices demonstrated average accuracy, whereas heart-failure remote devices were always able to decrease hospitalization or give an early warning of decompensation. Signal processing with AI added value helped in enhancing the quality of diagnostic accuracy in several types of devices. There were also methodological weaknesses, though, since a smaller portion of the studies were external validation, and the problem of calibration of the devices was rather common. Correlation tests showed that the greater the sample size and the number of multi-sensor devices a higher the diagnostic accuracy and external validity. Conclusion: The use of wearable devices and remote monitoring technologies has a lot of potential to revolutionize the process of cardiovascular disease detection and continuous management. Smartwatches, ECG patches and heart-failure monitoring systems have already shown clinically meaningful consequences, and the use of AI is still continuing to expand the level of accuracy or predictive ability of the devices. However, discrepancies in validation procedures, calibration difficulties of blood pressure in equipments, and study-to-study heterogeneity means that more standardization and stringent clinical testing is required, before a wide clinical integration is attained. To achieve the full potential of wearable cardiovascular technologies in preventative and personalized medicine, it will be crucial to persist in research in multi-sensor systems, transparent AI models, and limited clinical trials on a large scale.
Wearable; remote monitoring; heart diseases; atrial fibrillation; hypertension; heart failure; artificial intelligence; photoplethysmography; ECG patches; digital health.
Abdullah Al Kium, Shakila Azad, Md Mahamudul Hasan, Aktaruzzaman Azad, Md Mahamudul Islam, Momtaz Akter Mitu, Mohammed Tanjim Uddin Chowdhury, Mehedi Hasan Pritom
Extraction, Standardization, and Phytochemical Characterization of Bioactive Compounds from Emblica officinalis, Ocimum sanctum, and Tinospora cordifolia
Background: Emblica officinalis (fruit), Ocimum sanctum (leaves), and Tinospora cordifolia (leaves) are well-known medicinal plants used in traditional systems of medicine. Scientific standardization and characterization of their bioactive constituents are essential to validate their therapeutic potential and to ensure the quality, safety, and consistency of plant-based formulations. Methods: Authentic plant materials were collected and subjected to quality control and standardization tests, including determination of moisture content, foreign matter, total ash, acid-insoluble ash, and extractive values. Phytochemical screening was conducted to identify major classes of secondary metabolites. Chromatographic analyses using thin-layer chromatography (TLC) and high-performance thin-layer chromatography (HPTLC) were performed to profile phytoconstituents. Bioactive compounds were isolated through column chromatography and characterized using spectroscopic techniques such as UV–visible spectroscopy, infrared spectroscopy, nuclear magnetic resonance, and mass spectrometry. Main Findings: Phytochemical analysis revealed the presence of flavonoids, alkaloids, terpenoids, steroids, tannins, and phenolic compounds in the plant extracts. TLC and HPTLC analyses showed multiple Rf values, indicating chemical diversity within the extracts. Column chromatography led to the isolation of rutin from Emblica officinalis, stigmasterol from Ocimum sanctum, and a flavonoid compound from Tinospora cordifolia. Spectroscopic data confirmed the structural identity of these bioactive constituents. Conclusion: The study successfully standardized and characterized Emblica officinalis, Ocimum sanctum, and Tinospora cordifolia, confirming the presence of important bioactive phytoconstituents. The isolation and spectroscopic identification of key compounds support the medicinal relevance of these plants and provide a scientific basis for their use in herbal formulations and further pharmacological research.
Emblica officinalis (Amla), Ocimum sanctum (Tulsi), Tinospora cardifolia, spectral characterization.
The Unmeasured Ischemic Burden of Non-Cardiac Surgery: A Systematic Review of Postoperative Myocardial Injury
Background: Myocardial injury after non-cardiac surgery (MINS) is increasingly recognized as a major contributor to postoperative morbidity and mortality. Despite its impact, MINS remains grossly under-diagnosed because the majority of affected patients are asymptomatic, and routine postoperative troponin surveillance is rarely performed outside specialized centers. Over the past decade, evidence has accumulated regarding its definition, mechanisms, clinical outcomes, and potential treatment approaches, yet clinical implementation remains limited. Objective: To systematically review contemporary evidence (2010–2023) on the definition, detection, prognosis, surveillance strategies, and therapeutic approaches for MINS, with emphasis on the persistent lack of awareness and poor implementation of guideline-recommended monitoring. Methods: Following PRISMA-2020 guidelines, a systematic search was performed in PubMed/Medline and major cardiology and perioperative guideline sources. Eligible evidence included randomized trials, prospective cohorts, and expert guidelines discussing postoperative myocardial injury. Due to significant heterogeneity across assays, endpoints, and patient populations, a narrative synthesis was conducted. Results: Across large prospective cohorts, MINS is common and associated with a substantially increased risk of 30-day and 1-year mortality. Most cases have no ischemic symptoms, and diagnosis relies solely on troponin measurement. Clinical guidelines from AHA (2021) and ESC (2022) recommend postoperative troponin testing for 48–72 hours in high-risk surgical patients; however, adoption remains limited. The MANAGE randomized trial provides the strongest therapeutic evidence to date, suggesting that dabigatran may reduce major vascular events in carefully selected MINS patients. Observational data reinforce the prognostic significance of even small troponin elevations.
Faisal Makki, Syed Fouzaan Albeez, Hasan Ali Ahmed, Altaf Khan, Amjad Khan, Layaan Zainab Mohammed, Faaleha Heba Fakruddin, Ahmed Mirza Zafar Baig, Yahiya Khan, Bilal Abdul Qayyum, Ammara Naseem
Study of Incidence, Risk Factors, With Special Reference To Role Of Anemia In The Development Of Retinopathy Of Prematurity
Background: ROP, or Retinopathy of Prematurity, is a major cause of avoidable childhood blindness, especially in infants born prematurely or with low birth weights. For prompt diagnosis and treatment, early risk factor identification is crucial. Methods: To ascertain the incidence and risk variables linked to ROP, a prospective hospital-based study was carried out at SCB Medical College and SVPPGIP, Cuttack, between September 2015 and September 2017. A total of 374 newborns who met the screening requirements were assessed. A total of 124 newborns were included in the final analysis after completing follow-up exams. Risk factors for mothers, newborns, and clinicians were evaluated. Results: ROP was present in 27.4% of cases overall. ROP development was substantially correlated with lower birth weight and gestational age. Infants with birth weights under 1000 g and gestational ages under 28 weeks had a greater incidence. Prolonged oxygen therapy, apnea, respiratory distress syndrome, and blood transfusion were significant newborn risk factors. Term infants with known risk factors also showed signs of ROP. ROP newborns had decreased mean hemoglobin levels, however anemia by itself was not determined to be a risk factor. While some patients showed spontaneous regression, the majority of cases were Stage I or II ROP, and severe cases needed surgery or laser therapy. Conclusion: ROP is still a serious health risk for low birth weight and preterm babies. It can also happen to term babies who have risk factors. Significant factors include blood transfusions, oxygen therapy, birth weight, gestational age, and respiratory issues. Early screening, increased provider awareness, and organized follow-up programs are necessary to guarantee prompt treatment and lessen the incidence of avoidable pediatric blindness.
Pediatric Blindness, Retinopathy of Prematurity, Infant, Respiratory Issues, Gestational Age.
Parasite contamination impact on nutritional and phytochemical composition of Gongronema latifolium, Ocimum gratissimum and Piper guineense leaves
Background: Consumption of raw vegetables has been implicated in the transmission of parasites. And as such the cultivation as well as harvesting should be done properly in order to avoid contamination. Objective: The impact of parasite contamination on the phytochemical and nutritional composition of commonly consumed Nigeria vegetables (Gongronema latifolium. Ocimum gratissimum and Piper guineense) were determined to ascertain the extent contamination can influence beneficial potential of these vegetables which are sometimes consumed raw. Methods: Both qualitative and quantitative techniques were used to assess the phytochemical and nutritional composition of these vegetables both when contaminted or not. The parasites present in the contaminated samples were also determined through floatation method and examining under the microscope. Results: Results showed that parasite contamination had a noticeable impact on the phytochemical contents of the studied vegetables. Alkaloids, flavonoids, saponin, tannin and phenol were slightly present in the contaminated leaves of G. latifolium and O . gratissimum but were in reasonable amount in non- contaminated. Dry matter was high in both contaminated and non-contaminated (88.72%) and (89.32%) in G. latifolium , (89.52%) and (89.72%) in O . gratissimum and (89.40%) and (88.40%) in P . guineense. Fat was low in both contaminated and non-contaminated (1.70%) and (1.50%) in G. latifolium , (1.90%) and (1.70%) in O . gratissimum , (1.82%) and (1.67%) in P . guineense leaf. Parasites such as Entamoeba histolytica, Giardia lamblia, Cryptosporidium spp, Strongyloides spp, Toxocara spp. were identified in all the contaminated vegetables. Conclusion: Parasites such as nematodes and protozoa have the capability to consume or degrade proteins in the vegetables which could be the reason for noticeable reduction of proteins in the contaminated samples.. Hence, parasite contamination is capable of affecting the nutritional and phytochemical content of vegetables negatively and undermines the beneficial use of vegetables in amelioration and prevention of diseases.
*Stella Ngozi Nmezi, Magnus Chinwendu Nwoko, Venatius Chiamaka Ubah,, John Luka, Ogechukwu Eucharia Okwueze, Jane Chinaza. Okoro.
Postpartum Depression in a Tertiary Maternity Service in Dhaka, Bangladesh: Prevalence, Risk Factors, Comorbid Anxiety, and Care Cascade — A Hospital-Based Observational Study (2024–2025)
Background: Postpartum depression (PPD) affects approximately 17% of women globally but reaches substantially higher rates in Bangladesh, where estimates range from 22% to 60% depending on the setting and screening threshold. Despite recommendations for routine screening, the care cascade from positive screening to sustained treatment in Bangladeshi tertiary hospitals remains poorly characterised. Methods: This hospital-based observational study was conducted at a tertiary maternity service affiliated with Bangladesh Medical University, Dhaka, during 2024–2025. A total of 1,200 postpartum women were screened using the validated Bangla Edinburgh Postnatal Depression Scale (EPDS; primary), the Patient Health Questionnaire-9 (PHQ-9), and the Generalised Anxiety Disorder scale (GAD-7) at 4–12 weeks postpartum. The study comprised (A) a cross-sectional prevalence and risk-factor component at first postpartum contact and (B) a prospective follow-up cohort for symptom trajectories and care cascade evaluation. Binary PPD was defined as EPDS ≥10 (primary) and ≥13 (sensitivity analysis). Multivariable logistic regression identified independent risk factors. The care cascade was quantified as proportions progressing through sequential steps from positive screen to treatment engagement. Reporting followed STROBE guidelines. Results: Among 1,200 women (mean age 26.1 ± 4.6 years), the prevalence of PPD was 38.9% (95% CI: 36.2–41.7) at EPDS ≥10 and 16.8% (95% CI: 14.8–19.1) at EPDS ≥13. PHQ-9 ≥10 prevalence was 22.8% (95% CI: 20.5–25.3); postpartum anxiety (GAD-7 ≥10) was 9.2% (95% CI: 7.7–10.9). In multivariable analysis, the strongest independent predictors of PPD were prior depression/anxiety (aOR 11.61, 95% CI: 6.92–19.47), comorbid anxiety (aOR 9.50, 95% CI: 4.89–18.47), intimate partner violence (aOR 3.64, 95% CI: 2.69–4.93), emergency caesarean section (aOR 3.33, 95% CI: 2.26–4.90), unplanned pregnancy (aOR 3.19, 95% CI: 2.37–4.29), sleep problems (aOR 2.48, 95% CI: 1.85–3.33), and NICU admission (aOR 2.02, 95% CI: 1.36–3.02). Among screen-positive women, 69.6% received counselling, 50.3% were offered referral, but only 20.1% attended at least one mental health appointment. Cohen's kappa for EPDS ≥10 versus PHQ-9 ≥10 agreement was 0.498 (moderate). Conclusions: PPD is highly prevalent in this urban tertiary-hospital population with substantial care-cascade attrition. Integration of routine EPDS screening into postnatal and immunisation clinic contacts, combined with on-site counselling and structured referral pathways, is urgently needed.
Postpartum Depression; Edinburgh Postnatal Depression Scale; Bangladesh; prevalence; risk factors; care cascade; screening; mental health services; anxiety; intimate partner violence.
Dr. Sabrin Khan Mou, Dr. Asma Ul Hosna, Zahid Hossain Faisal, Dr. Khandaker Morshedul Alam Azad, Santu Das, Dr. Md. Nazrul Islam, Dr. Shaila Ahmed Munia, Siam Ashraf
Association between Online Food Delivery App Use and Dietary Quality among Working Adults in Urban India-An Analytical Cross Sectional Study
Background: Online food delivery applications (OFDAs) have been a major feature of the urban food ecology in India, especially among working adults who tend to have hectic schedules. Even though these platforms are convenient, there are fears about the effect they have on the quality of diets. The subject of this study was to examine the patterns of using of the OFDA, its perceived availability of healthy food choices and their correlation with the quality of the dietary choices among the working adults in Indian cities. Methods: A cross-sectional web-based study was undertaken and was carried out between January and March 2025 among the working adults living in Tier-1 Ahmedabad. Students over the age of 25 years who had used OFDAs at least once a month were enlisted. There were convenient and snowball methods of sampling. A validated and structured questionnaire that measured sociodemographics, patterns of using OFDA, quality of diet with a modified Healthy Eating Index and perceptions of healthy food availability and safety were used to collect data. Descriptive statistics, Chi-square tests, MannWhitney U tests and Kruskal-Wallis H tests were used. A p-value below 0.05 was found to be statistically significant. Findings: 472 people took part in the survey, and 52.3% were frequent users of OFDA. More often than not, frequent users were older, lived alone and had higher incomes (P < 0.05). The most ordered was fast food (84.7%). Whereas 66.8 percent of them stated that they had tried to find healthier choices, most of the people struggled to find them (54.3%). An increased use of OFDA was linked with the poorer quality of the diet and higher snacking behaviour. Food choice was heavily influenced by price (74.1%), and food appearance (63.4%). Categorization of hygiene, packaging and temperature of meal played a big role in determining who would make an order. Conclusion: The frequent use of OFDA by working adults might be the contributor of poor quality in food and unhealthy eating habits. Healthier food options and better health outcomes would be facilitated through increasing the visibility, affordability, and attractiveness of healthy foods on OFDAs.
Online food delivery, dietary quality, working adults, digital food environment, India.
Dr. Darshna Kishorkumar Sarvaiya, Dr. Veneel Arvindkumar Parikh, Dr. Karuna Amarsinh Vasava
Adjunctive Use of CytoSorb Hemoadsorption with Sustained Low-Efficiency Dialysis (SLED) in Septic and Cardiogenic Shock with Multi-Organ Failure: A Case Report
Background The combination of septic shock and cardiogenic shock (CS) causes extremely high mortality associated with systemic inflammation, as well as progressive multi-organ failure (MOF). Adjunct therapies for refractory shock, such as hemadsorption with CytoSorb are noninvasive extracorporeal blood purification procedures that are being developed; these are mostly investigated in combination with Continuous Renal Replacement Therapy (CRRT) or ECMO. We report on the case of a CytoSorb/BMT impregnated SLED treatment in low-income resources area. Case A 35-year-old Bangladeshi male was admitted with complaints of sudden onset sharp chest pain, shortness of breath and diarrhea which rapidly developed into Anterior septal ST-Elevation Myocardial Infarction (STEMI) complicated by severe Cardiogenic Shock, Acute Kidney Injury (AKI), and refractory Sepsis (high procalcitonin and CRP). He was intubated, needed high dose vasopressors (inotropic x 2) and a TMP for brady-arrhythmia. Because of sustained hemodynamic instability and AKI, SLED was initiated. Intervention and Results Given refractory, severe shock and systemic inflammation, CytoSorb hemadsorption was incorporated as an adjunct to the SLED circuit. After 3 days of concomitant CytoSorb and SLED therapy, the patient had an impressive clinical stabilization with decreased need for vasopressors, elimination of lactate and improvement in laboratory values. The patient was treated until recovered from MOF, weaned off mechanical ventilation and renal replacement therapy and discharged after 32 days with stable hemodynamics. Conclusion In cases of combined septic and cardiogenic shock and MOF, particularly for patients with limited access to CRRT, the adjunct application of CytoSorb in combination with SLED is technically feasible and an effective therapeutic option. This is a unique combination in the context of multi-organ extraction for cardiac disease.
Cardiogenic Shock; Septic Shock, Multi-organ Failures; CytoSorb Application; Hemoadsorption and Sustained Low Efficiency Dialysis (SLED).
Shihan Mahmud Redwanul Huq, Raziuddin Ahmed, Raihan Rabbani, Mohammad Mufizul Islam Polash, Shahzadi Sayeeda Tun Nessa, Mehjabeen Jahangir
When Jugular Foramen Schwannoma Imitates Other Skull Base Tumors Insights from Advanced Imaging
Jugular schwannoma is a rare benign neoplasm arising from the sheath of the lower cranial nerves within the jugular foramen. Its deep anatomical position and overlapping imaging characteristics with other skull base lesions often complicate diagnosis. We report the case of a 30-year-old male presenting with tinnitus, vertigo, and gait disturbance, in whom imaging findings were crucial for diagnosis. Contrast-enhanced computed tomography (CT) demonstrated a heterogeneously enhancing, partially solid lesion occupying the jugular foramen with evidence of adjacent bone erosion. Magnetic resonance imaging (MRI) revealed a mass that appeared hypointense on T1-weighted images, hyperintense on T2-weighted sequences, and showed moderate to marked post-contrast enhancement. Histopathological evaluation confirmed the diagnosis of jugular schwannoma. This case emphasizes the pivotal role of multimodal imaging—particularly high-resolution MRI, CT with bone detail, and MR angiography—in distinguishing jugular schwannoma from other skull base tumors such as paraganglioma, meningioma, or metastasis by assessing bone remodeling, vascularity, and the nerve of origin. Early and accurate radiologic identification of jugular schwannoma is essential for appropriate surgical planning and improved patient outcomes.
Jugular Schwannoma; Cranial Nerve Tumor; Jugular Foramen; Skull Base Lesion; Magnetic Resonance Imaging; Computed Tomography; Differential Diagnosis; Surgical Planning.
Harry Galuh Nugraha, Raisa Mahmudah, Luthfi Hilman Taufik, Birgitta Maria Dewayani
The Forgotten Vasculature: How Microvascular Rarefaction in Chronic Kidney Disease Shapes Kidney Transplant Outcomes
Introduction: Systemic microvascular rarefaction and dysfunction are important hallmarks of chronic kidney disease (CKD), and are associated with clinical outcomes post kidney transplantation. This systematic review synthesizes the evidence linking microvascular health in CKD to post-transplant graft adaptation, function, and survival. Methods: We conducted a comprehensive systematic review of 80 studies, including systematic reviews, meta-analyses, randomized controlled trials, and observational studies. Screening was based on predefined criteria focusing on CKD patients or kidney transplant recipients, microvascular assessment methods, and transplant-related outcomes. Data were extracted on assessment methodologies, microvascular abnormalities in CKD, recipient microvascular status, graft outcomes, post-transplant hypertension, and interventions affecting the microvasculature. Results: Microvascular abnormalities, such as capillary rarefaction, endothelial dysfunction, and reduced reactivity, are well-known outcomes of CKD and worsen with disease progression. These changes can be seen by various methods such as retinal imaging, near-infrared spectroscopy, and Doppler ultrasound. Pre-transplant microvascular status, particularly elevated renal resistive index (RI >0.85), is a strong predictor of adverse outcomes, including graft failure and mortality (Kolonko et al., 2012). Post-transplant, microvascular health is affected by immunosuppressive regimens, with calcineurin inhibitors exacerbating dysfunction. Post-transplant hypertension (>90% prevalence) is closely linked to microvascular dysfunction and sympathetic overactivity. Interventions such as calcium channel blockers, renin-angiotensin system inhibitors, aerobic exercise, and targeted therapies (e.g., eculizumab) show promise in improving microvascular parameters and graft outcomes. Discussion: The evidence consistently demonstrates that microvascular dysfunction is a systemic marker of cardiovascular and renal risk in CKD that persists after transplantation, affecting graft adaptation. The heterogeneity in assessment methods and study designs presents challenges, but the prognostic value of microvascular evaluation is clear. Calcineurin inhibitor-free regimens and non-pharmacological interventions like exercise training improve microvascular function and may enhance long-term prognosis. Conclusion: Microvascular rarefaction and dysfunction are fundamental to CKD pathophysiology and have profound implications for kidney transplantation outcomes. Integrating microvascular assessment into pre- and post-transplant care could improve risk stratification and guide personalized therapeutic strategies. Future research should focus on standardizing assessment methods and conducting randomized trials of microvascular-targeted interventions.
Chronic Kidney Disease, Kidney Transplantation, Microvascular Rarefaction, Endothelial Dysfunction, Graft Survival, Hypertension, Renal Resistive Index, Immunosuppression.
Muhammad Rizki Fadil, Fabian Gamal Sutrisno, Ricky Lie, Muhammad Yolga Faridillah Fatza, Mega Putri Rukmana, Faris Renata
Evaluation of CT Imaging in Complex Polytrauma Patients through Hospital-Based Case Study Review
Computed Tomography (CT) imaging is the key to the fast diagnosis and treatment of patients with complex polytrauma with several organ systems simultaneously involved. Timely and precise imaging in the emergency department of a hospital is vital in surgical intervention to guide intervention, prioritize, and save lives. It is an assessment study assessing CT protocols and results based on a case review of a tertiary care hospital polytrauma patient admission. The study aims at the diagnostic yield of whole-body CT (WBCT), optimization of contrast-enhanced imaging and incorporation of advanced reconstruction methods including multiplanar reformats and 3D volume rendering. The results point out that WBCT is a significantly better mode of detection of occult injuries, especially in thoracoabdominal trauma, and it reduces diagnostic delays over selective imaging. Other challenges that are identified in the study encompass the management of radiations dose, nephropathy as a result of contrast, and the bottlenecks in emergency radiology workflow. Outcome analysis shows that standardized CT protocols improve theHow often injuries are detected, multidisciplinary decision-making, and are associated with a better survival outcome among high Injury Severity Score (ISS) patients. This study emphasizes the significance of protocol-based CT imaging in challenging poly-trauma care by integrating technical assessment with clinical outcome assessment, which is evidence-based and provides the recommendation on how to maximize the diagnostic accuracy, safety of the patients, and the use of resources in the hospital trauma systems.
CT Imaging, Polytrauma Patients, Whole-Body CT, Contrast Enhancement, Injury Detection, Emergency Radiology, Radiation Dose, Multiplanar Reformats, Clinical Outcomes, Trauma Protocols.
Reva Gupta, Siddharth Pande, Shubham Mehta
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.