What is Journal of Carcinogenesis? Despite the advances in the treatment of cancer and the increasing knowledge of the processes responsible for the disease, there is a gap in the understanding of molecular events leading to cancer and the mechanisms of action by anticancer agents. The field of carcinogenesis is far from being completely explored. Many novel ideas and concepts still need to be introduced into the field, and the results of several provocative experiments are yet to be disseminated and shared. There is a need for multidisciplinary research in the field and a forum for accelerated publication of results. These are the considerations that led to the birth of the online journal, Journal of Carcinogenesis. Journal of Carcinogenesis is a peer-reviewed, online journal designed to bring together many aspects of research to develop the understanding of carcinogenesis. Edited by Gopala Kovvali, Journal of Carcinogenesis is supported by an international Editorial Board. 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Multicriteria evaluation of cancer prevention pathways integrating MICMAC structural analysis and Régnier Abacus.
Introduction: Cancer prevention requires comprehensive approaches that consider the complexity of the social, institutional, and behavioral factors involved. This study aimed to evaluate cancer prevention pathways using a multicriteria approach, integrating the MICMAC structural analysis method and Régnier Abacus, in order to identify the most relevant and feasible strategies for strengthening public health policy. Methods: A mixed, descriptive, prospective, and participatory study was developed, structured in four phases: (1) a literature review for the identification of variables; (2) validation and prioritization of variables with 12 experts in public health and prospective studies; (3) application of the MICMAC method for the analysis of influence and dependence between variables, complemented with the Régnier Abacus for the evaluation of desirability and feasibility of the strategies; and (4) validation of the model and reliability analysis. Results: The structural model identified five driving variables: health education, community participation, sustainable public financing, intersectoral coordination, and institutional governance, as determining factors of the preventive system. Régnier Abacus ranked five main strategies: Strategies R1 (Community Health Education and Communication) and R4 (Strengthening Primary Health Care) obtained the highest scores for desirability and feasibility, establishing themselves as priority actions for immediate implementation. Expert consensus exceeded 80%, confirming the coherence between the structural analysis and the multi-criteria prioritization. Conclusion: The MICMAC–Régnier approach enabled the development of a comprehensive, participatory, and validated model that guides strategic planning for cancer prevention. The findings highlight the importance of strengthening health education, primary care, and governance as cornerstones of sustainable intervention, and demonstrate the usefulness of multicriteria analysis for public health decision-making. The model is replicable in other contexts and at different levels of health policy
Multicriteria evaluation; consensus; public health policies; health governance; health education.
Edwin Martelo Gómez, Raúl José Martelo Gómez, David Antonio Franco Borré
Evaluation of Radiation Exposure in Pediatric Patients for Minimizing Radiation-Induced Risks in a Tertiary Care Hospital
Objectives: This study aims to evaluate the radiation dose received by pediatric patients (PPs) during lumbar-sacral spine (LS spine) imaging, review current imaging practices, identify potential risks, and promote radiation safety by adhering to pediatric-specific dose optimization protocols. Methods: The entrance surface dose (ESD) was calculated using five different mathematical formulas, and direct measurements were obtained with a dose-area product (DAP) meter during LS spine imaging of PPs. Results: The lowest mean ESD during lumbar spine imaging was observed in pediatric patients aged 1–5 years, measured at 0.25 mGy or 0.48 mGy·cm². Conversely, the highest mean ESD was recorded in the 10–15-year age group for the same projection, reaching 1.05 mGy or 0.89 mGy·cm². These values were derived from mathematical formulas and DAP meter measurements. Conclusion: Radiation dose assessment should be performed for every medical imaging procedure using appropriate dosimetry equipment or validated methods. This is essential to optimize radiation exposure in pediatric patients while maintaining diagnostic image quality.
Entrance surface dose, Pediatric patients, Dose reference levels, DAP meter, Radiation dose optimization
Ajay Prajapati, Arun Chougule, Anu Bhandari, Mahesh Kumar Saini, Desh Deepak Singh
Radiologic Detection of Pulmonary Metastatic and Non-Metastatic Disease in Gynecologic Malignancies: Diagnostic Accuracy and Clinical Impact: A Systematic Literature Review
Background: Pulmonary involvement is a recognized manifestation of advanced gynecologic malignancies and represents a critical determinant of disease staging, prognosis, and therapeutic planning. Radiologic imaging remains the cornerstone for detecting pulmonary metastatic and non-metastatic disease; however, diagnostic performance varies significantly across imaging modalities and tumor subtypes. Objective: To systematically review the diagnostic accuracy and clinical impact of radiologic imaging techniques in detecting pulmonary metastatic and non-metastatic disease in gynecologic malignancies. Methods: A systematic search of PubMed/MEDLINE, Embase, Scopus, and Web of Science was conducted for studies published up to December 2024. Eligible studies evaluated radiologic imaging modalities—chest radiography, computed tomography (CT), positron emission tomography–computed tomography (PET-CT), and magnetic resonance imaging (MRI)—in adult women with gynecologic cancers. Diagnostic accuracy measures and impact on clinical management were synthesized qualitatively. Results: Twenty-seven studies comprising over 8,500 patients were included. CT demonstrated high sensitivity for pulmonary metastases, while PET-CT offered superior specificity and staging accuracy. Non-metastatic pulmonary findings frequently mimicked metastatic disease, particularly on CT, underscoring the importance of multimodality imaging and clinical correlation. Conclusion: Radiologic imaging plays a pivotal role in pulmonary assessment of gynecologic malignancies. CT remains the diagnostic backbone, whereas PET-CT provides added clinical value in staging and management. Standardized imaging pathways are required to optimize diagnostic accuracy and avoid overtreatment.
Gynecologic malignancies, pulmonary metastases, diagnostic imaging, CT, PET-CT, systematic review
Dr. Anjabeen Ahmad, Dr. Samreen Qamar, Dr. Afshan Nisar, Dr. Amber Shams, Dr. Maham Maryam
Detection of Vancomycin Resistance (van Genes) in Clinical Isolates of Enterococcus A review study
Vancomycin-resistant enterococci (VRE), primarily Enterococcus faecium and E. faecalis, are high-priority healthcare related pathogens that cooperation empiric therapy, prolong hospitalization, and increase mortality. Resistance is most often facilitated by acquired van gene clusters—especially vanA and vanB—which remodel the peptidoglycan target from D-Ala–D-Ala to D-Ala–D-Lac (or D-Ala–D-Ser), reducing vancomycin binding. Mobile elements (e.g., Tn1546) and plasmids facilitate horizontal spread within and between lineages and species. Phenotypic detection uses consistent MIC methods (broth microdilution; careful use of automated systems) guided by CLSI, while molecular detection targets van operons by PCR or WGS. In India, surveillance advises data shows rising VRE proportions in tertiary centers with E. faecium predominance, reflecting global trends reported by CDC. Therapeutic options include linezolid and high-dose daptomycin (often with synergy), while infection-prevention and antimicrobial-stewardship remain basic controls.
Enterococcus faecium, Enterococcus faecalis, VRE, vanA, vanB, Tn1546, CLSI, EUCAST, linezolid, daptomycin, infection control
Shaista Mobin, Prof. (Dr.) Abhineet Mehrotra, Dr. Umar Rashid Khan, Dr. Uneza Husain, Saifi Aajam
Extraocular Sebaceous Carcinoma of the Toe in a Young Adult: A Case Report.
Background: Sebaceous carcinoma is a rare and potentially aggressive malignant adnexal tumor, most commonly occurring in the periocular region. Extraocular presentations, particularly involving the extremities, are uncommon and may pose diagnostic and management challenges due to their non-specific clinical appearance. Case Presentation: We report the case of a 22-year-old female who presented with a chronic non-healing lesion over the medial aspect of the right big toe. The lesion had been present for two years with progressive enlargement. Initial excision and skin grafting were performed at an outside hospital; however, histopathology revealed positive surgical margins, and the wound failed to heal. Further evaluation confirmed sebaceous carcinoma with deep margin involvement. The patient was referred to a tertiary care center, where a definitive wide local re-excision achieved clear margins. The surgical defect entirely healed by secondary intention without the need for further reconstruction. Conclusion: This case highlights an unusual presentation of extraocular sebaceous carcinoma in a young patient and underscores the importance of early suspicion, accurate histopathological diagnosis, and complete surgical excision with clear margins. Adequate oncologic management can result in favorable outcomes even in rare and atypical presentations.
Sebaceous carcinoma, Extraocular sebaceous carcinoma, Toe neoplasm, Wide local excision, Case report
Dr. Ezdehar Bakr Fallatah, Dr. Shahad F. Felemban, Dr.Sultanah K. Alamoudi, Abdulaziz Fahad Samandar, Thekra Abdulhafith Alwafi
Labial bone thickness and root volume changes after alignment with two different types of Ni Ti wire.
Objectives: To Compare between two types of nickel titanium arch wires during initial orthodontic alignment as regards bone thickness change and root volume change. Methods: This randomized clinical trial included patients aged 13 and 23 years, selected from the orthodontic outpatient clinics at Al-Azhar University, Assiut. Patients with Class I malocclusion, Little’s irregularity index 4-6 mm and non-extraction treatment of the maxillary arch were randomly assigned to receive two types of alignment arch after randomly grouping to conventional NiTi group and Cu-NiTi group. Four sizes of wire (14,16,18,16*22) were used in present study, every wire change after 28 days and place the next archwire. before initial (T0) and final (T1) archwire cone beam CT was taken to evaluate the change regarding bone thickness and root volume. Results: Comparison between the two groups revealed no significant statistical differences in bone thickness across all root levels, nor in root volume alterations after alignment. Conclusion: These two types of Ni Ti archwires produced comparable effects on bone thickness at various root levels as well as on root volume changes.
Orthodontics wires, Nickel titanium, copper Nickel titanium, alignment, bone thickness and root volume
Mostafa Magdi Abdelmonem AbdelAllah, Mostafa Mohamed Mahmoud Dawaba, Hussein Shokry Hassan Ahmed, Esmail Kamal Hewy Raslan, Ahmed Mahmoud Ahmed Ali, Ahmed Mohamed Kilany, Mahmoud Mohamed Salah Eldin
Clinical Profile and Prognosis of Critically Ill Patients: Emphasis on Glycemic Status
Background: Admission hyperglycemia, irrespective of prior diabetic status, is associated with increased mortality and adverse outcomes in critically ill patients. Several studies have demonstrated that stress hyperglycemia in non-diabetics confers a worse prognosis than chronic hyperglycemia in known diabetics.¹–⁴ Objectives: To evaluate the clinical profile and prognosis of critically ill patients with emphasis on glycemic status and its association with mortality and length of hospital stay. Methods: A prospective observational study was conducted on 441 adult patients admitted to the MICU and ICCU of a tertiary care hospital. Patients were stratified into diabetics, non-diabetics with stress hyperglycemia, and non-diabetics without hyperglycemia. Clinical outcomes were compared across groups. Results: Non-diabetics with stress hyperglycemia had the highest mortality (68.66%) and longest hospital stay. Admission blood glucose >150 mg/dl was significantly associated with increased mortality (p < 0.05). Conclusion: Stress hyperglycemia is a strong independent predictor of mortality and prolonged hospitalization in critically ill patients, particularly among non-diabetics.
Stress hyperglycemia, critical illness, mortality, ICU outcomes, diabetes
Dr. Nitin Kumar Pandey, Dr. Avanish Shukla, Dr. Rishi Kumar Garg, Dr. Anshuman Sharma
Transfer Learning for Automated Diagnosis of Skin Conditions using Existing Convolutional Neural Network (CNN) Architectures
Biomedical image analysis has been exploited considerably by recent technology involvements, carrying about a pattern shift towards‘automation’ and ‘error free diagnosis’ classification methods with markedly improved accuratediagnosisproductivityandcosteffectiveness.Thispaperproposesan automated deep learning model to diagnose skin disease at an early stage by usingDermoscopyimages.Theproposedmodelhasfourconvolutionallayers, twomaxpoollayers,onefullyconnectedlayerandthreedenselayers.Allthe convolutional layers are using the kernel size of 3 ∗3 whereas the maxpool layer is using the kernel size of 2 ∗ 2. The dermoscopy images are taken fromtheHAM10000dataset.Theproposedmodeliscomparedwiththethree different models of ResNet that are ResNet18, ResNet50 and ResNet101. The models are simulated with 32 batch size and Adadelta optimizer. The proposed model has obtained the best accuracy value of 0.96 whereas the ResNet101 model has obtained 0.90, the ResNet50 has obtained 0.89 andtheResNet18modelhasobtainedvalueas0.86.Therefore,featuresobtained from the proposed model are more capable for improving the classification performance of multiple skin disease classes. This model can be used for early diagnosis of skin disease and can also act as a second opinion tool for dermatologists.
Dermoscopyimages;CNN;deeplearning;classification; optimizer; ResNet; diagnosis; skin disease
Mrs. Neetu Tyagi, Mr. Kishan Kaushal, Ms. Priyanka Shukla
Comprehensive Management of Chronic Conditions in Primary Care: A Focus on Diabetes, Hypertension, and Cardiovascular Health
The paper carefully examines and integrates effective, evidence-based strategies. It is integrated management of this important three-condition triad in the primary care setting. It stimulates meaningful changes in clinical control and quality of life for Chronic Non-Communicable Diseases (NCDs), namely Diabetes Mellitus, Hypertension, and the ensuing spectrum of Cardiovascular Disease (CVD). The greatest global health challenge, with the vast majority of the global morbidity and mortality. The comprehensive, coordinated, and continued management should be done in the primary care setting. The effective pharmacological and non-pharmacological interventions, outcomes are often not optimized because of factors like patient nonresponse, clinical inertia, and care fragmentation. The concept of the Chronic Care Model (CCM), based on the principles of active structuring of health systems and patient activation, lies at the basis of effective management. The main interventions consist of changes in the direction of team-based care and the application of the full scope of practice of nurses, pharmacists, dietitians, and community health workers to complement physician-based management. The intensive culturally sensitive patient education and behavioral counseling aimed at lifestyle changes diet, physical activity, smoking cessation. The methodical implementation of clinical information systems, including population management patient registries, automatic recall systems, and clinical decision support that are integrated with electronic health records. The effectiveness of successful programs is based on standardized implementation of evidence-based clinical guidelines to achieve. The multi-faceted organizational and clinical interventions that help primary care alter the trajectory of chronic disease, resulting in a positive patient outcome and future reductions in the use of healthcare resources.
Chronic Disease Management , Primary Care, Diabetes Mellitus, Hypertension, Cardiovascular Disease , Chronic Care Model , Self-Management Support, Clinical Information Systems
Haseeb Nasarullah, Nudrat Fariha, Dr Javaid Akhtar Hashmi
The Role of Nursing in the Early Prediction of Clinical Deterioration in Hospitalized Patients Using Artificial Intelligence–Based Smart Alert Systems: A Systematic Review
Background:Artificial intelligence (AI)–based early warning systems (EWSs) have revolutionized patient monitoring by detecting subtle physiological and behavioral signs of deterioration before clinical collapse. Nurses, as the primary bedside observers, play an integral role in translating these predictive insights into actionable care decisions. Objective: To synthesize empirical evidence on nursing’s role in implementing and responding to AI-driven EWSs for early detection of patient deterioration in hospital settings. Methods: A systematic review was conducted according to PRISMA 2020 guidelines across PubMed, Scopus, Web of Science, Embase, and CINAHL up to December 2025. Ten eligible studies (n = 10) were included, encompassing randomized controlled trials, pragmatic cluster designs, and multicenter validations. Results: AI-enhanced EWSs, such as CONCERN, eCARTv5, MEWS++, and Deterioration Index models, significantly improved mortality, length of stay, and sepsis outcomes. Systems integrating nursing documentation and soft signs achieved the highest predictive accuracy (AUROC 0.80–0.94). Nurse-led alert interventions reduced mortality by 16–36% and improved escalation timeliness. However, studies noted alert fatigue and workflow strain, emphasizing the need for balanced automation. Conclusions:Integrating AI-based EWSs into nursing practice enhances patient safety through predictive surveillance and early intervention. Future designs should optimize human–AI collaboration to sustain clinical trust and minimize cognitive workload
Artificial intelligence, Early warning system, Clinical deterioration, Nursing surveillance, Machine learning, Hospital mortality, Predictive analytics, Smart alerts, Patient safety, Healthcare technology
Moamen Abdelfadil Ismail, Nazeeha Hamzah Ibrahim Barnawi , Ali Abbas etwadi , Nawaf Mohammed Marzouq Towairqi, Khadijah Mohammed Bohaligah , Salman safar Aedh Alnefaie , Haneen Fawaz Abdullah Almanjumi , Riyadh Saad Abdullah Alharthi, Rayan Abdullah Saleh Alhabsi, Rahaf Awad Altalhi , Fahd Abdullah Ahmed Alshehri, Abdulaziz Saleh Alamoudi
Clinico-pathological and molecular profile of myeloproliferative neoplasms- An Observational Study.
Background and Objectives: Myeloproliferative neoplasms (MPNs) are a group of clonal hematopoietic stem cell disorders with variable clinical, morphological, and molecular characteristics. The study aimed to evaluate the clinico-pathological features, hematologic parameters, peripheral smear findings, bone marrow morphology, and molecular/cytogenetic profiles of MPN patients at a tertiary care center. Methods: This was a cross-sectional observational study conducted over 2 years in a tertiary care teaching hospital. Fifty patients diagnosed with MPNs—including Chronic Myeloid Leukemia (CML), Primary Myelofibrosis (PMF), Polycythemia Vera (PV), and Essential Thrombocythemia (ET)—were enrolled. Detailed clinical history, examination findings, complete hemogram, peripheral smear, bone marrow studies, and molecular assays (BCR::ABL1, JAK2 V617F mutation) were recorded and analyzed. Descriptive statistics and subgroup comparisons were performed. Results: CML was the most frequent MPN subtype (56%), followed by PMF (24%), PV (16%), and ET (4%). The median age of presentation was lowest in PV (47 years) and highest in ET (66 years), with a male predominance in all subtypes except PV. Fatigue and abdominal fullness were the most common presenting symptoms. Comorbidities such as hypertension and diabetes were common in CML and PMF. Palpable splenomegaly was seen in 68% of patients, with ultrasound confirming splenomegaly in 92%. Hematologic parameters revealed leukocytosis in CML, anemia in PMF, and thrombocytosis in PV/ET. Bone marrow showed classical morphological patterns for each MPN subtype. BCR::ABL1 was detected in all CML patients, while JAK2 V617F mutation was positive in 87.5% of PV, 50% of ET, and 41.7% of PMF patients. Interpretation and Conclusion: MPNs present with diverse clinical and laboratory profiles, necessitating an integrated approach using clinical examination, hematological analysis, bone marrow morphology, and molecular testing. CML remains the predominant MPN subtype, and younger age at presentation in Indian patients compared to Western cohorts warrants further population-based studies.
Myeloproliferative neoplasms, Chronic Myeloid Leukemia, JAK2, BCR::ABL1, bone marrow
Dr. Linu Lukose, Dr. Anasuya S Desai, MD, Dr. Sanjukta S Rao, Dr. Manjula R, MD, PhD, Dr L K Rajeev
Effectiveness of Influenza Vaccination in Reducing Hospitalization and Mortality Among Adults
Introduction: Influenza remains a major public health concern, leading to substantial morbidity, mortality, and economic burden, particularly among adults with comorbidities and the elderly. Annual vaccination is the most effective preventive measure, yet its effectiveness varies by viral strain match, age, and immune status. This meta-analysis evaluated influenza vaccination effectiveness in reducing hospitalization, ICU admission, and mortality in adults. Methods: This systematic search of PubMed, Scopus, Web of Science, and Google Scholar has been performed up to 2024, following PRISMA guidelines. Inclusion criteria were adult populations (≥18 years) receiving seasonal influenza vaccination with outcomes of hospitalization, ICU admission, or mortality. Five studies (case-control and cohort designs) were included. Data were extracted independently, and study quality was evaluated via the Newcastle–Ottawa Scale. Odds ratios with ninety-five percent confidence intervals have been estimated utilizing fixed- or random-effects models based on heterogeneity (I²). Results: Across studies, influenza-positive patients exhibited higher ICU admission rates than influenza-negative patients. Pooled analysis showed no significant difference in ICU admission (mean difference 4.45, 95% CI: 2.27–8.73, P=0.00001). Mortality analysis revealed significantly lower death rates among vaccinated or influenza-positive adults (mean difference 5.20, 95% CI: 2.26–11.97, P=0.0001). Heterogeneity has been observed for both outcomes (I² = 86–87%). Conclusion: Influenza vaccination is related to decreased death and mitigates severe disease outcomes in adults. These results reinforce the importance of annual vaccination programs to decrease hospitalizations and prevent death among adult populations.
Influenza, Vaccination, Hospitalization, ICU Admission, Mortality
Ashwaq Saad Alghamdi, Hassan J. Alzahrani, Saad Ahmed Alghamdi, Shahad saad alkhaldi, Abeer Hazza Alotaibi
Hepatitis A Virus Seropositivity as a Predictor of Thrombocytopenia and Disease Progression in Chronic Liver Disease
Background: Thrombocytopenia represents a frequent complication in chronic liver disease, yet reliable non-invasive predictive biomarkers remain inadequately characterized. The tissue inhibitor of metalloproteinase-1 (TIMP-1) and matrix metalloproteinase-2 (MMP-2) participate in hepatic fibrogenesis and may serve as indicators of disease progression. Aim: To evaluate hepatitis A virus seropositivity, serum TIMP-1, MMP-2, and their ratio as predictive biomarkers for thrombocytopenia in chronic liver disease patients. Methods: This cross-sectional study enrolled 148 chronic liver disease patients. Participants underwent assessment of anti-HAV IgG status, serum TIMP-1, MMP-2 levels, and complete hematological profiles. Thrombocytopenia was defined as platelet count below 150 × 10⁹/L. Receiver operating characteristic analysis determined optimal cut-off values. Results: HAV IgG-positive patients demonstrated significantly higher thrombocytopenia prevalence (65.0% vs. 42.6%, p=0.025). Serum TIMP-1 was markedly elevated in HAV-positive thrombocytopenic patients (180.46 ± 68.41 ng/mL) compared to HAV-negative patients without thrombocytopenia (80.90 ± 44.05 ng/mL, p<0.001). The TIMP-1/MMP-2 ratio showed excellent discriminative capacity for thrombocytopenia in HAV-positive patients (AUC=0.805, sensitivity 84.6%, specificity 71.4% at cut-off ≥1.15). Multivariate analysis confirmed HAV IgG positivity (OR=2.28, p=0.031), elevated TIMP-1 (OR=1.021 per ng/mL, p<0.001), and reduced MMP-2 (OR=0.988 per ng/mL, p<0.001) as independent thrombocytopenia predictors. Conclusion: HAV seropositivity, serum TIMP-1, MMP-2, and particularly the TIMP-1/MMP-2 ratio represent valuable non-invasive biomarkers for predicting thrombocytopenia in chronic liver disease, potentially reducing dependence on invasive diagnostic procedures.
Chronic liver disease; Thrombocytopenia; TIMP-1; MMP-2; Hepatitis A virus; Biomarkers; Liver fibrosis
Mahmoud Mohamed Gamal Eldeen Saleh, Sahar Mohamed Hassany, Awny Ali Abdelrahman, Noha Salah Fatim Abdallah, Mohammed Abu-Elmaaty Mohammed
Systematic Review: The Effectiveness of Pediatric Early Warning Scores (PEWS) for the Early Detection of Critical Illness in Pediatric Emergency Departments.
Background: Pediatric Early Warning Scores (PEWS) are clinical tools designed to aid in the early identification of critical illness in children. Widely implemented in inpatient wards, the utility of PEWS in pediatric emergency departments (EDs) for early triage and detection of deterioration remains under investigation. Objective: This systematic review evaluates the effectiveness of PEWS for the early detection of clinical deterioration and critical illness in pediatric emergency settings, focusing on its sensitivity, specificity, predictive accuracy, and implementation feasibility across varied clinical environments. Methods: Twenty-five studies published between 2011 and 2025 were systematically reviewed using a comprehensive multi-database search strategy. Included studies examined the diagnostic utility, predictive value, and clinical outcomes associated with PEWS in pediatric EDs. Studies were appraised using standardized criteria and risk of bias tools. Results: The review found that PEWS demonstrated moderate to high sensitivity (75%–90%) and acceptable specificity (65%–85%) in predicting deterioration and ICU admissions. The tool improved clinical communication and decision-making, especially when integrated with response systems. Implementation in low-resource settings was feasible but presented adaptation challenges. Conclusion: PEWS is an effective triage and monitoring tool in pediatric emergency settings. However, standardization, local adaptation, and electronic integration are essential for optimal utility. Further RCTs are needed to confirm causality and refine threshold values.
Pediatric Early Warning Score, PEWS, Pediatric Emergency Department, Critical Illness, ICU Admission, Clinical Deterioration, Pediatric Triage
Badriah Gharamah Al Asmari, Haya Abdulrahman Alnafisah, Khadijah Mohammed Bohaligah, Nouf Meslet Al-Otaibi, Ahmed Eissa Al-Eissa, Waleed Ali Alshehri, Sarah Nasser Alshehri, Atheer Abdulrahman Ghous, Norah Mohammed Alamri, Ahmad Khalid Abdulqader, Omar Saud Albluwi, Rakan Abdullah Alarifi
Outcome of Tubularized Incised Plate (TIP) Urethroplasty in Distal Penile Hypospadias in Pediatric Patients.
Background: Tubularized incised plate (TIP) urethroplasty is widely regarded as a preferred technique for the correction of distal penile hypospadias due to its technical simplicity, reliability, and favourable cosmetic outcomes. However, surgical results may vary depending on tissue characteristics and operative factors. This study aimed to evaluate the functional and cosmetic outcomes, as well as the complication profile, of TIP urethroplasty in paediatric patients with distal penile hypospadias. Methods: A prospective observational study was conducted involving 71 paediatric patients with primary distal penile hypospadias who underwent TIP urethroplasty between January 2019 and August 2025. Preoperative characteristics, intraoperative details, and postoperative outcomes were recorded. Cosmetic outcomes were assessed using the Hypospadias Objective Scoring Evaluation (HOSE) system, while parental satisfaction was evaluated through structured feedback. Statistical analysis was performed using SPSS, with a significance level set at p < 0.05. Results: The mean age at surgery was 2.9 ± 1.4 years. Coronal hypospadias was the most common subtype (45.1%), and chordee was present in 25.4% of patients. Urethrocutaneous fistula occurred in 8.5% of cases, while meatal stenosis (5.6%) and glans dehiscence (2.8%) were less frequent. Poor urethral plate quality was significantly associated with fistula formation (p = 0.013). Good cosmetic outcomes (HOSE score ≥14) were achieved in 88.7% of patients, and 85.9% of parents reported satisfaction with the surgical results. Reoperation was required in 9.9% of cases. Conclusion: TIP urethroplasty is a safe and effective option for the management of distal penile hypospadias in children. Careful assessment of urethral plate quality and meticulous surgical technique are essential to minimize complications and optimize outcomes.
Tubularized Incised Plate, Hypospadias, Pediatric Urology, TIP Repair, Urethroplasty, Surgical Outcomes, HOSE Score
Abid Hussain, Syed Muhammad Hassan Akhtar, Dr Muhammad usman akram, Dr Abdul Rehman, Hassan Iqbal, Dr Sarfraz Ahmad
Car-T and Bispecific Antibodies for Refractory Non-Hodgkin Lymphoma: Long-Term Safety and Autoimmune Sequelae.
Background: Refractory non-Hodgkin lymphoma (r/r-NHL) is a clinical problem that has remained challenging even with the significant progress in immunotherapy. The introduction of chimeric antigen receptor T-cell (CAR-T) and bispecific antibody (BsAb) treatment has significantly increased the remission rates, but their safety and autoimmune sequelae are not well-defined in the long run. Professional awareness and attitudes to these new toxicities should be understood to construct safe and sustainable immunotherapeutic systems. Methods: The cross-sectional quantitative study was carried out in the group of oncologists, hematologists, immunologists, pharmacists, and researchers (n = 263). The questionnaire consisted of 20 items in the Likert scale and was used to collect the data on the efficacy perception, awareness of the toxicity, and long-term immune surveillance. Shapiro-Wilk normal test, Cronbach alpha reliability, KMO and Bartlett validity tests, t-test, ANOVA, Kruskal-Wallis, and Chi-square tests were used as analyses of group differences. Pearson correlation and multiple regression models were used to determine relationships between variables and predictive variables. Results: There was no significant deviation of items (p > 0.05), high reliability (α =.931), and sufficient adequacy of the sample of validity (KMO =.824; p =.001). High gender, age, professional, or clinical experience differences were identified (p < 0.05). The correlation analysis indicated that there is an overall strong positive inter-item correlation (r = 0.620.78, p < 0.01). The regression analysis has verified that the strongest predictor is Managed-Patient experience (B = 0.21, p = 0.001) with R 2 = 0.177. In general, the respondents agreed on the curative liability as well as the danger of delayed immune dysregulation as a result of CAR-T and BsAb treatment. Conclusion: The research paper establishes that healthcare experts are reliable, valid, and perceive the issue of immunotherapy of advanced lymphoma in a well-informed manner. The understanding through experience improves awareness of chronic cytopenia, autoimmune reactions, and infection risks of the results from durable CAR-T or BsAb reactions. The latter findings support the importance of ongoing immunovigilance, multi-disciplinary work, and longitudinal follow-up to achieve sustainable clinical outcomes.
Only sources about the topic are included in the list of keywords
Hamad Mohammad Ali Duleh, Atunde Folajimi, Krisli Serani, Dorina Ruci
"The Rise of Mini Dental Implants: A Comprehensive Review".
Background and objective : Mini dental implants (MDIs), a subset of reduced diameter implants (RDIs), have evolved significantly since their introduction in 1994 by Barber and Seckinger as “miniplants.” Initially intended as temporary supports for interim prostheses, these implants demonstrated unexpected osseointegration, leading to their use as permanent solutions. Subsequent innovations, such as Sendax’s 1.8 mm ultra-small implants, expanded the understanding of RDI functionality and clinical applications.This review aims to evaluate the development, clinical indications, benefits, and surface treatments associated with MDIs, along with highlighting current evidence supporting their use. Characterized by diameters less than 3 mm, MDIs offer advantages such as minimally invasive placement, immediate loading, reduced surgical trauma, and suitability for narrow ridges and edentulous mandibles.Literature supports high survival rates for MDIs, with studies reporting outcomes comparable to conventional implants, especially when used in the mandibular arch. MDIs are also favored for stabilizing removable prostheses, particularly in patients with compromised bone conditions. Surface modifications, including sandblasting, acid etching, and bioactive coatings, further enhance osseointegration and clinical longevity.Despite promising outcomes, terminology surrounding RDIs—such as "mini," "small diameter," and "narrow diameter" implants—remains inconsistent, complicating clinical communication and literature interpretation. Conclusion :In conclusion, MDIs represent a reliable, cost-effective alternative for specific patient populations, especially those unsuitable for conventional implants due to anatomical or economic constraints. Ongoing standardization in terminology and further high-quality clinical studies are essential to refine their indications and optimize treatment outcomes.
Mini Implants, small diameter implants, conventional implants
Dr Abhinandan K. Bokriya, Dr Pramod F.Waghmare, Dr Vidya Dodwad, Dr Nishita Bhosale, Dr Pranav Kulkarni, Dr Unnati Shirbhate
A Critical Review Of Interprofessional Communication In Patient Care: Strengthening Teamwork Among Nurses, Nursing Assistants, And Medical Secretaries In Saudi Arabian Hospitals
In Saudi hospitals, interprofessional communication is relevant in providing safe and effective care to patients. As a critical review, the analyzed literature was published within the span of 2020 to 2025 and was aimed at analyzing the dynamics of communication, communication barriers, and communication intervention between nurses, nursing assistants, and medical secretaries. The review is based on 32 empirical studies and demonstrates that interprofessional communication is always effective and linked to better clinical and patient-related outcomes. The literature indicates that when teamwork and information sharing are high, medication errors are reduced by between 25 and 40 percent and patient satisfaction by between 46 and 78 percent. These advantages notwithstanding, cooperation is skewed. In 65 to 85 percent of studies, hierarchies were determined as a significant impediment, in addition to time constraints, work pressures, and cultural obstacles to shared decision-making. There are only moderate perceptions of teamwork reflected in quantitative measures whose reported scores are 3.5 to 6.2 out of 10. Interprofessional education (IPE) became one of the central facilitators, and structured interprofessional programs led to a 15-30 percent attitude change towards working in a team. Other key gaps identified during the review include: an overrepresentation of urban hospital setting and insufficient data in rural areas. All in all, the results indicate that IPE, digital communication tools, and supportive policy changes are necessitated. The enhancement of interprofessional collaboration goes hand in hand with the Saudi Vision 2030 and its focus on high-quality, patient-centered care..
Interprofessional communication, patient care teamwork, Saudi hospitals, nurses nursing assistants’ medical secretaries, Vision 2030, communication barriers, interprofessional education, error reduction, patient satisfaction, cultural resistance, hierarchy in healthcare, quality improvement
Abdulhadi Hassan Hamad Alsallum, Khazari Inad Alanazi ,Bashayer Sayah Aldogmany, Fahad Mohammed Abdu Khobrani, Aeshah Falah Abdan Alazmi, Norah Farhan Atallah Alanazi, Mohammed Hassan Hamad Lasloom
Comparative Evaluation of the Accuracy, Precision, and Clinical Efficiency of Intraoral Digital Scanners Versus Conventional Elastomeric Impression Techniques
Background: Accurate dental impressions are essential for the fabrication of restorations and orthodontic appliances. Conventional elastomeric impression materials, such as polyvinyl siloxane (PVS), have been widely used but are often associated with patient discomfort, material distortion, and time-consuming procedures. Intraoral digital scanners have emerged as an alternative, offering potential advantages in accuracy, efficiency, and patient comfort. However, comparative clinical evidence is still limited. Aim: To compare the accuracy, precision, clinical efficiency, and patient comfort of intraoral digital scanning versus conventional elastomeric impression techniques. Materials and Methods: A comparative clinical study was conducted on 30 patients requiring diagnostic impressions. Conventional impressions were made using PVS material and poured in Type IV dental stone. Digital impressions were obtained using an intraoral scanner, and STL files were analyzed using three-dimensional evaluation software. Accuracy was assessed in terms of trueness and precision using linear measurements and superimposition analysis. Clinical efficiency was measured by recording chairside time for each technique. Patient comfort and preference were assessed using a Visual Analog Scale (VAS) questionnaire. Data were analyzed using SPSS software. Paired and independent t-tests were used for continuous variables, and the Chi-square test was used for categorical variables. The level of significance was set at p < 0.05. Results (Expected): Intraoral digital scanners are expected to demonstrate superior accuracy and precision compared to conventional impressions. Chairside time is anticipated to be significantly shorter for digital impressions. Patients are expected to report higher comfort and preference for digital scanning over conventional methods. Conclusion: Within the limitations of the study, intraoral digital scanning is likely to be a reliable, accurate, and patient-friendly alternative to conventional elastomeric impressions, supporting the integration of digital workflows in contemporary dental practice
Digital impressions, Conventional impressions, Intraoral scanner, Accuracy, Patient comfort, Clinical efficiency
Majid Mohammad Alshammari, Nasser Mohammed Aldhafeeri, Mohammed Khaled Almutlaq, Mohammed Khalif Aldhafeeri, Hamad Ghafel Aldhfeeri, Nasser Siran Alharbi, Yazeed aied Alrawili, Bandar Hamdan Alsuwayt, Raid marhjaldhafeeri, Fadi Fahad Alshammari, Abdulrahm
Oral Pharmaceutical Product Packaging – An Enhanced Quality-Based Approach of Performance Evaluation
A critical aspect of drug delivery that ensures the product's safety, efficacy, and compliance with regulations is Pharmaceutical Packaging (PhP). In this process, the packaging material choice mostly relies on factors like the drug's characteristics, required level of protection, and cost. Prior studies regarding the packaging materials, market movement, and quality deficiency studies were limited, though the significance of packaging was well-known. Therefore, analysing the quality-based approach for the packaging of oral pharmaceuticals is the main aim of the present study. The present study adopts a mixed method and collects data from primary and secondary sources. 100 eligible participants (n=20 material converters, n=80 end-consumers) are selected for the study utilizing a purposive sampling method and a standardised questionnaire. In the study outcomes, an enhanced market movement and market preference (50%) of flexible materials in various industries was proven. It also verified that the products’ quality was highly influenced by the packaging defects (44%). Furthermore, the preference for flexible materials and their potential demand in future packaging industries was highlighted in the present findings.
Pharmaceutical Packaging Technology, Oral Pharmaceuticals, Defect Detection, and Quality by Design.
Dr. Sanjeeta Rane, Dr. Shilpa Bhilegaonkar
Anthropomorphic Ai Language and Its Psychological Influence on Consumer Trust And Decision Intention
Advances in conversational artificial intelligence have intensified interest in how users psychologically interpret machine-generated language. Unlike system-styled communication, anthropomorphic language enables AI to convey human warmth, intention and social presence, which may alter how consumers evaluate information and form decisions. This study examines how human-like linguistic cues in AI systems shape consumer trust and subsequently influence decision intention. Drawing on anthropomorphism theory, social presence theory, and trust formation models, the research establishes trust as a psychological mediator in consumer–AI interaction. A between-subjects experimental design was employed, exposing participants to either anthropomorphic or non-anthroporphic AI recommendation messages. Measures of perceived trust and decision intention were analysed using descriptive statistics, correlation analysis and regression-based mediation testing. Findings indicate that anthropomorphic AI evokes emotional connection, reduces uncertainty and increases perceived credibility, significantly enhancing decision intention as compared to objective system language. The study concludes that communication tone functions as a persuasive mechanism within AI interfaces, and strategic anthropomorphism offers a pathway to optimise user acceptance and decision-making outcomes.
Anthropomorphic Ai, Language Style, Consumer Trust, Decision Intention, Social Presence
Comparison of outcome of total extra-peritoneal repair versus open hernia repair in inguinal hernia
Introduction: Most patients with an inguinal hernia are symptomatic and the treatment of choice is surgical repair with mesh using open or laparoscopic approach. Laparoscopic inguinal hernia repair can be done by total extra peritoneal (TEP) approach. The choice of approach to the laparoscopic repair of inguinal hernia is controversial because of scarcity of data comparing the two approaches and some questions remain unanswered about their relative merits and risks. Objectives: To compare the outcome of total extra-peritoneal repair versus open hernia repair in inguinal hernia. Study Design: Randomized Controlled Trial Study Duration: 1st June 2021 to 30th November 2021. Settings: Department of General Surgery, Services Hospital, Lahore. Materials & Methods: A total of 60 patients aged 20-70 years presenting with inguinal hernia undergoing surgery under general anesthesia were included. Patients with ASA III or IV, redo surgery or recurrent hernia (on medical record), liver disease (ALT & AST >40IU, hepatitis B or C), renal dysfunction (creatinine>2mg/dl or on hemodialysis), anemia (HB<10g/dl) and BMI >35 kg/m2, incarcerated or massive scrotal hernias were excluded. In group A, patient were undergone surgery by TEP. In group B, patient were undergone open surgery. All surgeries were done by a single surgical team with assistance of researcher under general anesthesia. Doing surgery, operative time was noted. Postoperatively patients were shifted in post-surgical wards and were discharged and total hospital stay was noted. Results: Mean operative time in Group A (total extra-peritoneal repair) was 64.40 ± 7.66 minutes while in Group B (open hernia) was 87.30 ± 5.86 minutes (p-value = 0.0001). Mean post-operative pain in Group A (total extra-peritoneal repair) was 1.63 ± 1.07 while in Group B (open repair) was 3.23 ± 1.38 (p-value = 0.0001). Wound infection occurred in 3.33% cases in open method while did not occur in any case in TEP group. Also urinary retention occurred in 6.67% cases in open method group while nil in TEP group (p>0.05). Conclusion: This study concluded that total extra-peritoneal repair results in less operative pain and hospital stay as compared to open repair of inguinal hernia.
Inguinal Hernia, Total Extra-Peritoneal Repair, Hospital Stay
Zeeshan Ishaque, Saad Bin Abdul Qudus, Mustansar Iqbal, Muhammad Hassan, Muhammad Ahmad Yusuf, Mohibba Azam
Clinical Scores For Acute Appendicitis – Alvarado Score Vs Appendicitis Inflammatory Response Score
Background: Acute appendicitis is the most frequent cause of acute abdomen in young adults. Alvarado score is the most commonly used clinical scoring system but has variable specificity and sensitivity. Appendicitis Inflammatory Response (AIR) score has been found better than the older Alvarado score. The rationale of this study was to determine the diagnostic accuracy of two scoring systems which are commonly used in acute appendicitis. Materials and Methods: 289 patients fulfilling criteria with suspected acute appendicitis were included. Demographic data was recorded. A score of 8 was cut off threshold for AIR and 7 for Alvarado Score. Sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) for AIR and Alvarado score were calculated. Specimen were sent for histopathology for final diagnosis. Statistical analysis was done using SPSS version 21. Results: Results showed that Alvarado scoring at value > 7 had sensitivity of 53.03%, specificity of 90.45%, PPV of 82.35%, NPV of 69.61% and diagnostic accuracy of 73.36%. Furthermore, AIR scoring > 8 had sensitivity of 51.52%, specificity of 96.82%, PPV of 93.15%, NPV of 70.37% and diagnostic accuracy of 76.12%. Conclusion: The diagnostic accuracy of AIR score was 76.12% and diagnostic accuracy of Alvarado score was 73.36%. AIR score has been found to have a higher discriminating power as compared to Alvarado score.
Alvarado score, Appendicitis Inflammatory Response (AIR) score, Acute Appendicitis, Diagnostic accuracy
Saad Bin Abdul Qudus, Zeeshan Ishaque, Mustansar Iqbal, Muhammad Hassan, Muhammad Ahmad Yusuf, Mohibba Azam
Evaluation of Adrenal Insufficiency in Thalassemia Patients – 50 Cases in BSMMU, Dhaka, Bangladesh
Background: Thalassemia is a hereditary hemoglobinopathy characterized by chronic hemolytic anemia requiring regular blood transfusions. Repeated transfusions and iron overload may affect endocrine organs, including the adrenal glands, leading to adrenal insufficiency (AI). Limited data exist regarding AI prevalence among thalassemia patients in Bangladesh. This study aimed to evaluate adrenal function in thalassemia patients attending Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Methods: This prospective cross-sectional study included 50 patients with transfusion-dependent thalassemia (TDT) aged 5–30 years, attending the Biochemistry and Molecular Biology Department of BSMMU from January 2022 to December 2022. Baseline demographics, clinical history, and transfusion details were collected. Serum cortisol levels were measured at 8:00 AM, and low-dose ACTH stimulation tests (1 μg ACTH) were performed to assess adrenal reserve. Serum ferritin was measured as a marker of iron overload. AI was defined as peak serum cortisol <18 μg/dL after ACTH stimulation. Data were analyzed using SPSS version 26. Continuous variables were expressed as mean ± SD, and categorical variables as percentages. Associations between AI and clinical/biochemical parameters were analyzed using chi-square and t-tests. Results: Among 50 thalassemia patients, 28 (56%) were male and 22 (44%) females, with a mean age of 16.8 ± 6.2 years. The mean serum ferritin was 2870 ± 1025 ng/mL. Adrenal insufficiency was detected in 12 patients (24%). AI prevalence was higher among patients with serum ferritin >3000 ng/mL (P=0.03) and those with disease duration >15 years (P=0.01). There was no significant association with sex or age. Common clinical features of AI included fatigue (80%), hypotension (50%), and poor growth (30%). Conclusion: Adrenal insufficiency is a relatively common endocrine complication among transfusion-dependent thalassemia patients in Bangladesh, particularly in those with severe iron overload and longer disease duration. Routine adrenal function assessment and early intervention may improve morbidity and quality of life in this population.
Thalassemia, Adrenal Insufficiency, ACTH Stimulation Test, Serum Cortisol, Iron Overload, Bangladesh.
Tahmidul Islam, Md. Sunjidul Haque, Md. Saiful Islam, Khan Md. Shahriar Zaman, Rubaiyat-E-Mortaz
Lenvatinib is More Effective & Safer Than Sorafenib in the Treatment of Renal Cell Carcinoma - A Single-Center Retrospective Analysis of 70 Cases
Background: Lenvatinib and sorafenib are multi-tyrosine kinase inhibitors used in advanced renal cell carcinoma (RCC). Comparative real-world data remain limited. We performed a retrospective single-center analysis of 70 patients to compare efficacy and safety of lenvatinib versus sorafenib in routine practice. Methods: Seventy consecutive patients with advanced or metastatic RCC treated between January 2021 to December 2023 were reviewed. Patients received either lenvatinib (n = 35) or sorafenib (n = 35) as systemic therapy (first- or subsequent-line as per treating physician). Primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR; RECIST v1.1), disease control rate (DCR), and grade ≥3 adverse events (CTCAE v5.0). Kaplan–Meier estimates, log-rank tests, Cox proportional hazards models, and chi-square/Fisher exact tests were used. A two-sided p < 0.05 was considered significant. Results: Median follow-up 18.2 months (IQR 11.0–29.4). Median PFS was 10.8 months (95% CI 8.1–13.6) with lenvatinib vs 6.4 months (95% CI 4.7–8.1) with sorafenib (HR 0.58; 95% CI 0.36–0.93; p = 0.023). Median OS was 22.5 months (95% CI 16.4–28.6) vs 16.1 months (95% CI 11.5–20.7) favoring lenvatinib (HR 0.69; 95% CI 0.41–1.16; p = 0.160). ORR was 34.3% vs 11.4% (p = 0.018); DCR 77.1% vs 54.3% (p = 0.028). Grade ≥3 adverse events occurred in 22.9% (lenvatinib) vs 37.1% (sorafenib) (p = 0.18). Lenvatinib had higher rates of hypertension and proteinuria but fewer hand–foot skin reaction and fatigue ≥ grade 3. Dose reductions were required in 28.6% (lenvatinib) vs 40.0% (sorafenib). Conclusions: In this retrospective series of 70 patients, lenvatinib was associated with significantly longer PFS and higher response rate than sorafenib and a numerically lower rate of high-grade toxicities. Prospective randomized data are required to confirm these findings in routine practice.
Renal Cell Carcinoma (RCC), Lenvatinib, Sorafenib, Tyrosine Kinase Inhibitor (TKI), Progression-Free Survival (PFS), Disease Control Rate (DCR), Targeted Therapy, Adverse Events/Safety Profile.
Mohammad Rifat Zia Hossain, Shirin Akter Begum, Mehriban Amatullah, Mumtahena Amir, Shamsun Nahar, Md. Sagor Mia, Rana Jahangir Alam
A Rare Case of Appendicecal Intussusception with Secondary Ileocecal Intussusception
Background: Appendiceal intussusception is an uncommon clinical entity that can mimic acute appendicitis or ileocolic intussusception, particularly in pediatric patients. Preoperative diagnosis is challenging due to nonspecific symptoms and overlapping imaging features. Early recognition and timely surgical intervention are essential to prevent complications. Case Presentation: We report the case of a 12-year-old male who presented with acute right lower abdominal pain, non-bilious vomiting, and decreased appetite for one day. Physical examination revealed localized tenderness and guarding in the right iliac fossa. Ultrasonography showed a mildly thickened inflamed appendix measuring 9 mm with telescoping of the appendix and ileocecal junction into the cecum, suggestive of early appendiculo-ileocecal intussusception. Emergency open appendectomy was performed through a Lanz incision. Intraoperatively, the appendix along with the ileocecal junction was found intussuscepting into the cecum, with the inflamed appendiceal base serving as the lead point. Gentle manual reduction followed by standard appendectomy was carried out. The patient recovered uneventfully and was discharged on postoperative day 5. Histopathological examination confirmed acute appendicitis. At 2-week follow-up, the patient remained asymptomatic.This case highlights the diagnostic difficulty of appendiceal intussusception, which may closely resemble more common causes of pediatric abdominal pain. Imaging may raise suspicion, but definitive diagnosis often occurs intraoperatively. Prompt manual reduction and appendectomy provide excellent outcomes in children when benign pathology is evident. Conclusion:Early surgical exploration should be considered in suspected atypical appendiceal pathology to ensure accurate diagnosis and prevent complications.
Acute appendicitis,Appendiceal intussusception, Case report, Ileocecal intussusception, Pediatric surgery.
Perceived Barriers to Oral Anticoagulants Adherence Among Patients with Atrial Fibrillation after Radiofrequency ablation
Feedback: Atrial fibrillation (AF) stands as the most prevalent sustained cardiac arrhythmia globally. Radiofrequency catheter ablation (RFCA) has emerged as a highly effective and guideline-recommended rhythm control strategy for symptomatic AF. For patients with AF after radiofrequency ablation, maintaining oral anticoagulant (OAC) adherence is a critical yet complex challenge precisely because its advantage of preventing stroke. Purpose: This study aimed to assess perceived barriers affecting adherence oral anticoagulants among patients with atrial fibrillation after radiofrequency ablation. Methods: A descriptive cross-sectional study design was utilized in carrying out this study. The current study was conducted at the outpatient and Cardiac Care Unit (CCU) at Ain-Shams University Hospital in Cairo, Egypt. A sample of 80 patients prescribed treatment regimens was recruited. Results: the majority (88%) of the patients having been diagnosed for over six months with atrial fibrillation (AF) and a significant portion (43%) for more than 20 months, their knowledge is generally inadequate across key domains: understanding of the ablation procedure itself (74% inadequate), healthy lifestyle (65% inadequate), and self-monitoring (62% inadequate). A significant majority (65%) exhibits suboptimal oral anticoagulants adherence, split nearly evenly between medium (26%) and low (39%) levels. Conclusion: One third of the study sample only were adherent with the oral anticoagulant medications. This demonstrates that in this study sample, cognitive recognition is insufficient; adherence is crippled by the tangible burdens and emotional aversions inherent to complex anticoagulant regimens.
Adherence; Atrial Fibrillation; Barriers; Oral Anticoagulants; Radiofrequency ablation
A Comparative Study of Laparoscopic versus Open Inguinal Hernia Repair
Background: Inguinal hernia repair is among the most common procedures performed in general surgery. With the introduction of laparoscopic techniques, outcomes such as postoperative pain, hospital stay, and recovery time have significantly improved. This study compares laparoscopic and open inguinal hernia repair regarding intraoperative and postoperative outcomes. Methods: This randomized prospective comparative study was conducted at Dr. L.N. Pandey Government Medical College & Hospital, Ratlam (M.P.), over 18 months. Patients were divided into two groups—Group A (Laparoscopic hernioplasty using TAPP/TEP) and Group B (Open Lichtenstein repair). Parameters compared included operative time, complications, postoperative pain, hospital stay, and return to normal activity. Results: Laparoscopic repair demonstrated shorter hospital stay, reduced pain scores, and faster return to activity. However, operative time and cost were higher than open repair. Recurrence and complication rates were comparable. Conclusion: Laparoscopic hernia repair offers superior recovery and less pain, while open repair remains a cost-effective alternative suitable for resource-limited settings.
Dr. Vikram Singh Mujalde, Dr. Karishma Jonwal, Dr. Sunil Bhagile, Dr. Anil Dawar, Dr. Neelam R. Charles
Collaborative Clinical Surveillance Across Surgery, Nursing, Radiology, and Pharmacy for Early Identification of Postoperative Adverse Events: A Systematic Review
Background: Postoperative adverse events (AEs) remain a major source of preventable morbidity and mortality. Effective detection and management require multidisciplinary collaboration integrating clinical surveillance across surgery, nursing, radiology, and pharmacy. Objective: This systematic review aimed to synthesize empirical evidence on the effectiveness of collaborative surveillance systems for early AE detection and prevention. Methods: Following PRISMA 2020 guidelines, ten peer-reviewed studies (2013–2025) were analyzed from PubMed, Scopus, Web of Science, BMJ, and other databases. Eligible studies investigated interprofessional teamwork in AE monitoring, including prospective surveillance, trigger tools, and pharmacovigilance approaches. Results: Across settings, adverse event incidence ranged from 2.6 to 38 per 100 patient-days, with 33–60% classified as preventable. Studies demonstrated that nurse-led and pharmacy-supported systems significantly enhanced AE recognition and medication safety, while radiology collaboration expedited diagnostic confirmation. Data-driven approaches and AI-assisted tools showed further potential for precision detection. Despite heterogeneity in study designs, most evidence supported that multidisciplinary surveillance improves AE reporting sensitivity and interdepartmental learning culture. Conclusions: Integrated surveillance models combining human expertise and digital monitoring foster timely AE detection and reduce preventable harm. Strengthening cross-departmental coordination remains pivotal to improving surgical patient safety outcomes.
Collaborative Surveillance, Perioperative Safety, Nursing, Pharmacy, Radiology, Adverse Events, Interprofessional Collaboration, Postoperative Monitoring, Patient Safety, Pharmacovigilance, Artificial Intelligence
Majed Saad Alharthi, Mashail Abdullah Alnemari, Nouf Ali Hamdi Alasmari, Rawabi mousa Salhabi, Najat jaber Alshmrani, Layla Ali Alsultan, Abdulaziz Muidh Alharthi, Shihanah Mohammed Algethami, Bashayr Dhawi Eidhah Aljuaid, Ghadah Mohemmed Hadi Hakami, Faisal Hasan Khadwardi, abdulrahman ali aljohani, Abeer Al Abdullatif, Muhannad Adel Hussien Althobaiti
In-vivo evaluation of Antidiabetic Properties of Plant Extracts in Streptozotocin Induced Diabetes
The primary objective of this study was to evaluate the hypoglycemic effects of alcoholic extracts obtained from Annona squamosa stem bark in rats. Additionally, the research investigated the antidiabetic potential of both alcoholic and aqueous extracts of Annona squamosa stem bark in rats with Streptozotocin-induced diabetes. Preliminary phytochemical analysis revealed the presence of glycosides, fixed oils, tannins, phytosterols, and phenolic compounds in the alcoholic extracts. However, significant hypoglycemic effects were observed only at higher doses. In Streptozotocin-induced diabetic rats, the alcoholic extract of Annona squamosa stem bark demonstrated marked antidiabetic activity at elevated doses, exceeding the efficacy of the standard drug Glibenclamide. Morphological assessments, including water intake, food consumption and body weight measurements, showed comparable effects between the alcoholic extracts and Glibenclamide at higher dosages. Histopathological analysis further revealed substantial restoration of damaged islet cells in the pancreas, surpassing the restorative effects observed with Glibenclamide. These findings suggest that the alcoholic extract of Annona squamosa stem bark exhibits significant antidiabetic properties, validating its traditional use in diabetes management.
Annona squamosa, Hypoglycemic, Antidiabetic, Streptozotocin, Glibenclamide