أهداف البحث تقييم ومقارنة دقة التشخيص باستخدام التصوير المقطعي المحوسب والموجات فوق الصوتية في الكشف عن نقائل العقد اللمفاوية العنقية لدى مرضى سرطان الغدة الدرقية، وذلك باستخدام معايير الإبلاغ عن دراسات دقة التشخيص لعام ٢٠١٥. طرق البحث شملت هذه الدراسة الاسترجاعية لدقة التشخيص ١٣٤ مريضًا بسرطان الغدة الدرقية خضعوا لفحص التصوير المقطعي المحوسب أو الموجات فوق الصوتية قبل الجراحة للكشف عن نقائل العقد اللمفاوية في مستشفى مدينة الملك عبد الله الطبية، مكة المكرمة، المملكة العربية السعودية، بين عامي ٢٠٠٩ و٢٠٢٠. وكان الفحص النسيجي المرضي هو المعيار المرجعي. وتم تقييم الحساسية والنوعية والقيمة التنبؤية الإيجابية والقيمة التنبؤية السلبية والدقة الإجمالية للتصوير المقطعي المحوسب والموجات فوق الصوتية. النتائج بلغ متوسط عمر المشاركين ٤٦ عامًا، وشكلت الإناث أكثر من ثلثي العينة. وكان سرطان الغدة الدرقية الحليمي هو التشخيص الأكثر شيوعًا، يليه سرطان الغدة الدرقية الجريبي ثم سرطان الغدة الدرقية النخاعي. لوحظ غزو الأوعية اللمفاوية في 32% من الحالات. بلغت حساسية التصوير المقطعي المحوسب مع الموجات فوق الصوتية، ونوعيته، وقيمته التنبؤية الإيجابية، وقيمته التنبؤية السلبية، ودقته، ومساحة المنطقة تحت المنحنى 71.05%، و91.67%، و77.14%، و88.89%، و85.82%، و0.814 على التوالي؛ بينما بلغت 28.95%، و98.96%، و91.67%، و77.87%، و79.10%، و0.64 في العقد اللمفاوية العنقية المركزية (المنطقة السادسة)، و73.68%، و90.63%، و75.68%، و89.69%، و85.82%، و0.822 في العقد اللمفاوية العنقية الطرفية، على التوالي. الاستنتاجات يُحسّن التصوير المقطعي المحوسب مع الموجات فوق الصوتية دقة تشخيص انتشار سرطان الغدة الدرقية إلى العقد اللمفاوية العنقية. ويُظهر التصوير المقطعي المحوسب وحده حساسية أقل في تشخيص العقد اللمفاوية العنقية المركزية، مما يُبرز الحاجة إلى الجمع بين طرائق التشخيص لتحسين الأداء التشخيصي.
أهداف البحث هدفت هذه الدراسة إلى تحضير مادة لاصقة سنية قائمة على ثنائي ميثاكريلات ثلاثي إيثيلين الغليكول (TEGDMA)، ومدعّمة بجسيمات الكيتوسان النانوية (CNPs) المغلّفة بالببتيد IG-13-1، وتقييم خصائص البلمرة، والأداء الفيزيائي والميكانيكي وقوة الارتباط، والنشاط المضاد للبكتيريا، والتوافق الخلوي للمادة المحضّرة. طرق البحث جرى تحضير خمس مجموعات من العينات (5 عينات لكل مجموعة)، شملت: مادة لاصقة سنية شاملة تجارية (Ruby Bond)، ومادة تجريبية ضابطة غير محشوة قائمة على TEGDMA، وثلاث مواد لاصقة تجريبية تحتوي على جسيمات الكيتوسان النانوية المغلّفة بالببتيد IG-13-1 بنسب وزنية قدرها 1.5% و3% و6%. عولجت العينات ضوئيًا باستخدام الصمام الثنائي الباعث للضوء (LED) بشدة 1300 ملي واط/سم2 لمدة 20 ثانية لكل جانب. وقُيّمت درجة التحول باستخدام مطيافية الأشعة تحت الحمراء بتحويل فورييه وتقنية الانعكاس الكلي المخفف، وعمق التصلبوفقًا للمواصفة القياسية ISO 4049، وامتصاص الماء على مدى 21 يومًا، ومقاومة الانحناء وفقًا للمواصفة ISO 4049، ومقاومة ارتباط القص بمينا الأسنان وفقًا للمواصفة ISO 29022. كما جرى تقييم النشاط المضاد لبكتيريا العقدية الطافرة (Streptococcus mutans) باستخدام اختبار التلامس المباشر، وذلك بقياس الكثافة الضوئية عند طول موجي 600 نانومتر (OD600)، إضافة إلى اختبار انتشار الأقراص. وتم تقييم التوافق الخلوي باستخدام اختبار ألامار بلو. النتائج أظهرت جميع المواد اللاصقة التجريبية درجة تحول مرتفعة تجاوزت 90%، إلا أنها انخفضت بصورة ذات دلالة إحصائية مع زيادة نسبة جسيمات الكيتوسان النانوية (p < 0.001). كما أظهرت مقاومة ارتباط القص فروقًا ذات دلالة إحصائية (p < 0.001)، وانخفضت مع زيادة نسبة الجسيمات النانوية؛ إذ بلغت 4.549 ± 0.698 ميغاباسكال في المادة اللاصقة التجارية، مقارنةً بـ 2.080 ± 0.302 ميغاباسكال عند نسبة تحميل بلغت 6%. وأظهر تقييم النشاط المضاد لبكتيريا العقدية الطافرة باستخدام اختبار التلامس المباشر أن جسيمات الكيتوسان النانوية المغلّفة بالببتيد خفّضت قيمة الكثافة الضوئية عند 600 نانومتر من 1.6846 إلى 0.53275، أي بنسبة انخفاض بلغت 68.38%، في حين خفّضت جسيمات الكيتوسان النانوية غير المغلّفة القيمة من 1.5267 إلى 1.196، أي بنسبة 21.66%. وظلت حيوية الخلايا أعلى من 85% في جميع المعالجات. الاستنتاجات أدى دمج جسيمات الكيتوسان النانوية المغلّفة بالببتيد IG-13-1 في المادة اللاصقة السنية إلى تحقيق نشاط قوي مضاد للبكتيريا، مع الحفاظ على درجة تحول مرتفعة وتوافق خلوي مقبول. ومع ذلك، أدت زيادة نسبة الجسيمات النانوية إلى انخفاض عمق التصلب وقوة الارتباط بمينا الأسنان، مما يشير إلى ضرورة تحسين تركيز الجسيمات النانوية وتوزيعها داخل المادة اللاصقة.
Objectives:Cancer involves abnormal cell proliferation and migration throughout the body. Genetic changes occurring in hereditary breast cancer led to the activation of oncogenes, resulting in gain-of-function effects. This study was designed to conduct a phylogenetic analysis of breast cancer-related oncogenes and tumor suppressor genes families in humans relevant to different species and their potential against breast cancer. Methods:The protein sequence data were retrieved from Ensembl Genome Browser and NCBI databases. BLAST searches were performed to obtain FASTA sequences of selected vertebrates. Multiple sequence alignment was conducted using ClustalW in MEGA X, followed by the construction of neighbor-joining phylogenetic trees in circular format. Tree robustness was assessed through bootstrap analysis with 500 pseudoreplicates. Results:Among the eleven oncogenes, the CBLC and JUN gene has two paralogues, BCL3, DDX6, FEV, MYB, KARAS, LCK, NUP214 and MPL had 5, while TFG have no paralogues. These gene families determine functional networks including transcriptional regulation, signaling cascades, receptors activity, and RNA processing, all influence breast cancer pathogenesis. In the 10 tumor suppressor genes, the CDH1, JAK2, PML, PTEN, GPC3, SOCS1, gene had 5 paralogues, EXT1 and WRN gene has 4, NPM1 has 2, VHL has 1 paralogue. These paralogues show corresponding molecular functions vital for tumor suppression and cellular homeostasis. The phylogenetic analysis exposed all studied genes share common evolutionary source in vertebrate lineage. Conclusions:In conclusion, variability in paralogue numbers among oncogenes and tumor suppressor genes, with some genes having multiple paralogues and others, like TFG and VHL, having few or none was found. Phylogenetic trees highlighted evolutionary relationships among vertebrates.
Background:Post-polypectomy surveillance is essential for colorectal cancer prevention, but adherence to guidelines varies and data from KSA are limited. This study evaluated surveillance documentation and guideline concordance at King Saud University Medical City. Methods:A retrospective audit included patients aged 18-75 years who underwent screening colonoscopy with polypectomy. Documented surveillance intervals were compared with USMSTF 2020 guidelines, and absence of a documented plan was considered a primary quality metric. Results:Among 207 patients, 74.9% had no documented surveillance plan. Among the 52 patients (25.1%) with a plan, only 29 (14.0% overall) were guideline-concordant, whereas 20 (9.7%) were over-surveyed and 3 (1.4%) under-surveyed. The majority of plans (45/52) were documented by gastroenterologists and the remaining seven by primary care physicians. Conclusion:Surveillance documentation is markedly limited, with suboptimal adherence, highlighting the need for structured interventions to improve guideline-based practice.
Background Despite high public support, organ donation after death remains suboptimally practiced in Saudi Arabia. This disparity highlights a critical willingness-to-commitment gap in the population. This study aimed to identify a historical baseline of awareness and acceptance of organ donation after death, and explore its principal determinants and barriers. Methods Retrospective analysis was conducted using a data set derived from an anonymous cross-sectional survey among adult residents of Saudi Arabia in 2017. The questionnaire assessed awareness of donation campaigns, attitudes toward organ donation after death, and the possession of donor card. Associations between demographic variables and key outcomes were analyzed using chi-squared tests and odds ratios (ORs). Results Among 2609 participants (mean age 30.9 ± 11.1 years; 56% female; 94.5% Saudi), 82.1% supported organ donation after death but only 5.6% possessed donor cards. Males expressed lower support (OR = 0.76, p < 0.05). Higher educational qualification was associated with increased awareness of donation events (OR = 1.38, p < 0.01), knowledge of donor cards (OR = 1.41, p < 0.01), and card possession (OR = 2, p < 0.01). Being employed significantly impacted awareness and card possession ( p < 0.01). Religious uncertainty (26%), emotional fears (20%), and concerns about body manipulation (17%) were the most cited barriers. Males more often cited religious reasons (33%), whereas women more frequently reported personal concerns (23%). Conclusion Public support for organ donation is strong in Saudi Arabia but formal registration remains low. To bridge this intention-to-action gap, public health efforts could benefit from targeted outreach directed at key demographic groups characterized by high acceptance, as well as incorporating strategies to reach underserved populations with lower awareness to ensure a more comprehensive public health approach.
Background:Nursing education involves various teaching and learning techniques, as well as sharing information, wisdom, and sound judgment, aiming to close the knowledge-practice gap and reaching the ultimate goal of improving quality of care and benefiting the population served. Objectives:This study aimed to assess the theory-practice gap in teaching nursing students and associated factors at teaching institutions in west and southwest Shewa zones, Oromia, Ethiopia during 2024. Methods:An institutional-based explanatory sequential cross-sectional study was conducted using both quantitative and qualitative approaches from June to August 2024. In total, 422 undergraduate nursing students participated in the quantitative component using a structured self-administered questionnaire, and 16 nursing instructors were purposively selected for in-depth interviews. Quantitative data were analyzed using descriptive statistics and binary logistic regression, whereas qualitative data were analyzed by thematic analysis, with triangulation applied to integrate the findings. Results:Almost all participants (99.1%) reported the presence of a theory-practice gap, with an overall mean score of 3.6. Students who practiced in non-teaching hospitals were significantly more likely to experience the theory-practice gap than those in teaching hospitals (adjusted odds ratio = 2.83; 95% confidence interval: 1.43-5.60). The qualitative findings identified several contributing factors, including excessive emphasis on theoretical teaching, limited clinical integration, inadequate communication between theoretical and clinical instructors, insufficient learning resources, and weak institutional collaboration between universities and healthcare facilities.
Introduction:Inconsistent wound assessment and inappropriate dressing selection remain major barriers in chronic diabetic wound management. Digital decision-support systems offer a practical approach for standardizing clinical processes and supporting evidence-based care. Objective:The aims of this study were to develop and evaluate a mobile application that integrates wound severity detection with modern dressing selection to support standardized chronic diabetic wound management. Methods:A research and development design was used with the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. The application integrated the Perdana Kusuma II wound severity scoring system with a moisture-based dressing recommendation algorithm. Content validity was evaluated by 10 multidisciplinary experts using a four-point Likert scale. Usability was assessed by 12 wound care nurses with the System Usability Scale (SUS). A descriptive pre-test and post-test evaluation examined the performance in wound color identification, inflammation assessment, exudate evaluation, and dressing selection among new graduate and independent wound care nurses. Results:All expert validation items achieved the maximum score (4.00), with item-content validity and scale-content validity indexes of 1.00. The application exhibited good usability based on the SUS interpretation. Among the new graduate nurses, the mean pre-test scores increased from 0.92 to 1.42 to 1.92-2.00 across all domains. Independent wound care nurses had consistently high baseline scores (1.58-2.00) and near-maximum post-test values. Automated wound severity outputs were comparable to the manual assessments, and dressing recommendations were aligned with modern wound care standards. Conclusion:The mobile application developed in this study is a feasible digital clinical decision-support tool with the potential to support standardized wound assessment and evidence-informed dressing selection, particularly for early-career nurses, while maintaining expert-level clinical accuracy.
Sodium oxybate (SO) is an effective therapy for narcolepsy type 1 (NT1) but has been infrequently linked to complex sleep-related behaviors. We describe a case of NT1 who developed sleep-related eating disorder (SRED) after progressive gradual titration of SO. A 15-year-old female was diagnosed with NT1. Symptoms remained disabling despite high doses of modafinil and venlafaxine, and thus SO was initiated and titrated over months. After increasing to a dose of 4 g twice per night, the family reported episodes of partial arousal with altered consciousness beginning 1-2 h after the first dose, where the patient left the bed, ate large quantities of calorie-dense foods, and appeared unresponsive, before returning to bed again with complete amnesia. These episodes contributed to significant distress for the patient and her family, and notable weight gain. Gradual dose reduction to 7 g/night combined with structured behavioral interventions (dietary modification, bedside snacks, and environmental safety measures) successfully resolved SRED while maintaining excellent cataplexy control, demonstrating that combined management strategies can avoid medication discontinuation.
Objective:This study focused on measuring oxidative DNA damage and oxidative stress biomarkers in subclinical hypothyroidism (SCH) patients to gain insight on the condition's contribution to metabolic consequences. Additionally, it assesses the impact of levothyroxine replacement therapy on oxidative stress and DNA damage in patients with SCH over a specified duration of treatment. Methods:A case-control study was done at the Diabetes and Endocrine Center, Azadi Teaching Hospital, Duhok, Kurdistan Region, Iraq, from June 2024 to February 2025. The participants were divided into four groups: euthyroid controls (G1, n = 80), previously treated SCH (G2, n = 44), newly diagnosed SCH (G3, n = 105), and newly diagnosed SCH patients on follow-up levothyroxine therapy (LT4) (G4, n = 20). Oxidative stress and oxidative DNA damage biomarkers were assessed and compared in all study groups. Results:The research comprised 249 participants: 169 with SCH and 80 euthyroid controls. Compared to G1, oxidized low-density lipoprotein (ox-LDL) and total oxidant status (TOS) were higher in groups G2, G3, and G4 (p < 0.0001). The marker of oxidative DNA damage 8-hydroxy-2'-deoxyguanosine (8-OHdG) was significantly higher in G3 and G4. The oxidative stress index (OSI) was higher in the SCH groups compared to controls. Total antioxidant status (TAS) was significantly decreased compared to controls (p < 0.0001). There were no significant differences regarding the levels of malondialdehyde (MDA) between the groups. Conclusion:SCH patients, especially newly diagnosed, show elevated oxidative stress, DNA damage, and reduced antioxidant capacity versus euthyroid controls, elucidating metabolic complications and validating oxidative biomarkers for early risk stratification.
Background:The implementation of competency-based medical education (CBME) demands robust, validated workplace-based assessment (WBA) tools. In this study, we aimed to develop and conduct an initial validation of the clinical competency logbook (CCL) as a structured instrument designed to assess the observed clinical competencies of undergraduate medical students in authentic practice settings. Methods:A prospective validation study was conducted during the 2024-2025 academic year with 129 fourth-year medical students. The CCL was systematically constructed through literature review and expert consensus using a two-round Delphi process to establish content validity. Students were assessed using the CCL during two consecutive 4-week clinical rotations. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC) with a two-way random-effects model. Exploratory fairness analysis was conducted based on subgroup comparisons between male and female students. Results:The CCL exhibited strong content validity throughout its expert-driven development process. Overall test-retest reliability was moderate to good (ICC = 0.711, 95% confidence interval [0.591, 0.796]). However, the reliability varied significantly by gender subgroups: ICC = 0.507 for males and ICC = 0.346 for females, which was attributed to ceiling effects and restricted score variance in the female subgroup. The mean scores differed significantly between genders, highlighting the need for further investigations of potential rater bias or other unmeasured variables, although these findings remain strictly exploratory. Conclusion:The CCL exhibited acceptable psychometric properties for formative assessment in undergraduate medical education. The strong content validity and moderate overall reliability (though highly dependent on score distribution and varying by subgroup) support its use for tracking student progress and providing structured feedback. These findings highlight the importance of contextual interpretation of reliability coefficients and suggest that caution is required for high-stakes summative decisions. In this study, we produced an evidence-informed instrument and methodological framework for developing WBA instruments in CBME programs.
Routine urine toxicology screening may be misleading when adolescents present with acute psychotic symptoms and systemic toxicity after exposure to drugs not included in the screening panel. We report a 17-year-old girl with no known psychiatric or neurologic illness who developed agitation, persecutory delusions, fever, diaphoresis, tachycardia, limb rigidity, and a brief generalized tonic-like episode after suspected repeated nonprescribed pregabalin misuse and misuse of an amantadine-containing over-the-counter cold preparation. Collateral history and medication packaging retrospectively suggested 1200 mg pregabalin per episode with six tablets of the cold preparation per episode, corresponding to estimates of 600 mg amantadine and 1500 mg acetaminophen. Serum or urine concentrations of pregabalin and amantadine were not measured, and the serum acetaminophen concentration or international normalized ratio was not obtained. A limited qualitative urine toxicology screen was negative, but the panel did not include pregabalin, amantadine, acetaminophen, caffeine, or chlorpheniramine. Creatine kinase increased from 9590 to 13,840 U/L. Serum myoglobin exceeded the assay upper limit (>2700 ng/mL) and urinalysis supported myoglobinuria. Renal function remained normal. Troponin I remained normal despite creatine kinase-MB elevation, and cardiac assessment did not support primary myocardial necrosis. Neuroimaging and electroencephalography detected no explanatory abnormality. The working diagnosis was probable mixed-medication intoxication with acute delirium, psychotic symptoms, multifactorial rhabdomyolysis, and spontaneous pneumomediastinum with a small pneumothorax. Treatment consisted of drug withdrawal, hydration, cooling, benzodiazepine-based sedation, short-term antipsychotic treatment for dangerous agitation, and conservative pulmonary observation. Creatine kinase decreased to 495 U/L by day 15. This case highlights the need for collateral medication histories and expanded toxicological testing when routine screening is negative.
Objectives:Temporomandibular disorders (TMDs) are a common cause of chronic orofacial pain, and patients are increasingly using the Internet to locate health information. However, the quality of web-based information, especially in Arabic, has not been previously evaluated. Methodology:In this study, we analyzed 408 Arabic language websites, including those for medical centers, dental centers, non-profit organizations, and universities. The DISCERN instrument, Journal of the American Medical Association standards, and Health On the Net (HONcode) certification were used to assess quality and reliability. Adapted Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simplified Measure of Gobbledygook (SMOG) indices were used as measures of readability. Results:Quality and transparency varied significantly across website affiliations (p < 0.001). Only 11% of sites had a HONcode certification, 31.4% included source attributions, and 59.6% disclosed authorship. The overall mean DISCERN quality scores ranged between 3.33 and 3.87 (scale 1-5). The quality varied significantly between affiliated websites (p < 0.001). Video content was present on 6.9% of the websites and audio content on 0.03% of websites. No validated Arabic-language instruments exist for readability assessment, so the FRE, FKGL, and SMOG indices (all developed for English) produced unrealistic values (mean FRE = 174.41), and given the scale of 0-100, it was impossible to reach any conclusions. Conclusion:Significant shortcomings were found in terms of transparency, evidence attribution, and balance in the presentation of TMD information online in Arabic. We recommend the creation of evidence-based, methodological, and patient-centered Arabic digital health content on TMDs.
Objectives:To evaluate serum leptin, adiponectin, and selected trace elements in newly diagnosed patients with papillary thyroid carcinoma (PTC) before and after treatment and to assess their diagnostic potential as biomarkers. Methods:This prospective case-control study included 50 newly diagnosed patients with PTC and 50 healthy controls. Serum leptin, adiponectin, and trace element levels were measured pre- and post-treatment in patients and compared to controls. Results:Before treatment, patients with PTC had significantly higher leptin and lower adiponectin levels than post-treatment patients and healthy controls (both p < 0.0001). Zinc, selenium, and magnesium levels were significantly decreased, whereas manganese, copper, and iodine levels were significantly increased (all p < 0.001). Leptin was negatively correlated with Zn, Se, Mg, and Ca (p < 0.0001), whereas adiponectin showed positive correlations. The leptin/adiponectin ratio demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.951. Conclusion:Patients with PTC exhibit significant alterations in serum adipokines and trace elements that improve following treatment. Leptin, adiponectin, and particularly the leptin/adiponectin ratio may serve as promising non-invasive biomarkers for the diagnosis and postoperative monitoring of PTC.
Objectives:Bone remodeling usually depends on complex molecular signaling, where receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG) are key modulators that regulate osteoclastogenesis and the overall bone metabolism process. The aims of this systematic review were to evaluate the effects of different graft materials on RANKL and OPG expression following alveolar ridge preservation. Methods:Electronic literature searches were performed in Embase via Ovid, Medline via Ovid, CINAHL, Scopus, and Web of Science databases, in addition to manual searches regarding all related articles. The PRISMA guidelines and PICO framework were followed in this systematic review. The inclusion criteria were limited to studies published in English that focused on RANKL and/or OPG biomarker outcomes in post-extraction dental sockets preserved with various types of bone grafts. The extracted data were synthesized in a standardized MS Excel form, including general study characteristics, graft interventional details, and RANKL/OPG expression, in addition to other outcomes regarding bone healing. Risk of bias was assessed using ROBINS-I and RYRCLE tools, as well as certainty of evidence for the studies included. Results:The initial search yielded 307 articles. After thorough screening and reviewing stages, 12 studies were finally selected for inclusion and comprehensive analysis. The findings showed that socket preservation with different grafts led to significant differences in promoting RANKL downregulation and OPG upregulation compared with controls, where composite grafts obtained superior outcomes than other types. The lowest RANKL/OPG ratio (0.11) was reported for a biologically enhanced autograft, whereas using a synthetic graft alone had the highest value (1.88). Conclusion:Bone substitutes that combine bioactive agents with scaffolds may provide potential benefits for socket preservation, possibly through modulating the RANKL/OPG axis. However, their superior performance compared with other grafts and the reliability of using the RANKL/OPG ratio as a predictive biomarker remain uncertain, warranting further clinical investigation.
Background:Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide important glycemic, cardiovascular, and renal benefits in patients with type 2 diabetes mellitus (T2DM). However, their long-term effects on mineral and electrolyte homeostasis in routine clinical practice remain uncertain. Objectives:To assess the effects of dapagliflozin on serum calcium, magnesium, phosphorus, creatinine, and parathyroid hormone (PTH) levels in patients with T2DM over two years. Methods:This retrospective cohort study included adults with T2DM treated with dapagliflozin at King Saud University Medical City, Riyadh, Saudi Arabia, between January 2023 and August 2025. Laboratory values were collected at baseline and after one and two years of treatment. Longitudinal changes were evaluated using descriptive statistics, one-way analysis of variance with post-hoc comparisons, and multivariable linear regression. Results:The study included 549 patients with a mean age of 62.9 ± 12.8 years, and 49.4% were male. Serum calcium increased significantly after one year of dapagliflozin therapy compared with baseline (p = 0.009), with no further significant increase during the second year. Serum magnesium decreased significantly by the second year (p < 0.001). Serum creatinine increased significantly at both follow-up points compared with baseline (p < 0.001). No significant longitudinal changes were observed in serum phosphorus or PTH. In multivariable analysis, the year of measurement independently predicted changes in serum magnesium and phosphorus levels. Conclusions:Long-term dapagliflozin therapy was associated with statistically significant but clinically modest changes in serum calcium, magnesium, and creatinine, while phosphorus and PTH remained stable over two years. These findings support the overall metabolic safety of dapagliflozin in routine practice. Nevertheless, periodic monitoring of renal function and electrolyte levels, particularly magnesium, may be advisable in patients receiving prolonged therapy or those at increased risk of renal or electrolyte disturbances. Further prospective studies are needed to clarify relevance of these biochemical changes in vulnerable populations.
Objectives:This study aimed to evaluate the prescribing patterns and determinants of long-term proton pump inhibitor (PPI) therapy across four public hospitals in Malaysia. Methods:Adult inpatients aged ≥18 years old and who received PPIs during medical ward admission in 2023 were recruited as respondents, whereas adult inpatients who were pregnant, prescribed PPIs for Zollinger-Ellison syndrome, Barrett's esophagus, or Helicobacter pylori eradication, or with incomplete data were excluded. Results:In total, 392 adult inpatients with PPI prescriptions in 2023 were included. The mean age was 66.7 years, with most patients aged ≥60 years (76.5%) and predominantly male (75%). Pantoprazole was the most frequently prescribed (83.7%), and only 29.6% had documented indications. Long-term PPI therapy over 12 weeks was observed in 87.5% of patients and 71.4% received continuous therapy. Laboratory analyses also found significant reductions in serum magnesium and hemoglobin post-PPI therapy (p < 0.001), whereas changes in pre- and post-corrected calcium levels (p = 0.115) were not significant. In addition, multivariate logistic regression analysis identified the number of received medications as the only independent predictor of long-term PPI use over 12 weeks (odds ratio = 1.913, 95% confidence interval: 1.525-2.398, p < 0.001). Conclusions:Long-term PPI therapy beyond 12 weeks was highly prevalent in Malaysian public hospitals, and predominantly driven by the number of medications received by patients. These findings highlight the need to rationalize PPI prescribing and implement strategies to optimize patient safety.
Background:Research involving terminally ill patients presents unique ethical challenges due to vulnerability, fluctuating consent capacity, and risk of undue influence. In Nigeria, cultural norms, religious beliefs, and family dynamics further shape ethical engagement, but empirical evidence regarding physicians' perspectives remains limited. Objectives:Exploring physicians' ethical perspectives regarding the involvement of terminally ill patients in research by focusing on consent practices, safeguards, and culturally sensitive approaches to participation. Methods:A qualitative descriptive study was conducted at two tertiary hospitals in Enugu State, Nigeria. Twenty-four purposively selected physicians involved in oncology and palliative care participated in in-depth and key informant interviews. Data were analyzed thematically using Braun and Clarke's framework. Results:Four themes emerged: facilitators of consent, consent practices, preferred decision-makers, and ethical concerns. Physicians emphasized clear communication, empathy, and culturally sensitive support. Direct patient consent was prioritized, with surrogate consent and pediatric assent used when appropriate. Family involvement was central, although surrogate reliability required careful assessment. Ethical concerns focused on minimizing harm, ensuring equity, and integrating cultural and spiritual guidance. Conclusion:In general, physicians in this study supported the ethical inclusion of terminally ill patients in research provided rigorous safeguards are applied. They operationalize autonomy, beneficence, and justice within a relational framework that integrates family and spiritual guidance. These findings highlight culturally sensitive consent practices and provide practical guidance for ethics committees, researchers, and educators when promoting the ethical participation of vulnerable patients.
Objective Traumatic oral ulcers are common lesions that may interfere with oral function and quality of life. Golden sea cucumber (Stichopus herrmanni) contains various bioactive compounds with potential wound healing properties. This study aimed to evaluate the effects of different concentrations of golden sea cucumber extract gel on traumatic oral ulcer healing in Wistar rats. Methods Twenty male Wistar rats were randomly divided into four groups: control, 20%, 40%, and 80% golden sea cucumber extract gel groups. Traumatic ulcers were induced on the lower labial mucosa using a heated burnisher. The treatment groups received topical application of the extract gel once daily. Histopathological evaluations were performed on days 4 and 7 post-ulcer induction. The observed parameters included macrophage count, mast cell count, angiogenesis, collagen density, and re-epithelialization. Statistical analysis was performed using one-way ANOVA followed by Tukey's post hoc test, with p < 0.05 considered statistically significant. Results The 40% concentration group demonstrated higher angiogenesis compared with the other groups during the early healing phase. Meanwhile, the 80% concentration group showed greater macrophages, epithelial thickness, and collagen density during the proliferative phase. Significant differences were observed among treatment groups in several histological parameters (p < 0.05), indicating enhanced wound healing activity following golden sea cucumber extract administration. Conclusion Stichopus herrmanni extract gel accelerated traumatic oral ulcer healing by modulating inflammation, promoting angiogenesis, enhancing re-epithelialization, and increasing collagen deposition. Different concentrations exhibited distinct therapeutic effects at different stages of oral wound healing, suggesting its potential as a natural adjunctive therapy for traumatic oral ulcers.
For most of recorded history, the heart was considered far more than a pump. The Qur'an and Sunnah (ahadith) describe it as the seat of reasoning, faith, emotion, and moral accountability, employing a vocabulary of at least four distinct cardiac terms (qalb, fu'ad, lubb, and sadr) that appear over 200 times in contexts extending well beyond circulation. Arab-Islamic physicians and philosophers, including al-Balkhi, al-Razi, Ibn Sina, and al-Ghazali, built this into a systematic framework linking cardiac physiology to emotion, cognition, and spiritual life, centuries before the Cartesian biomedical model first treated the organ primarily as a hemodynamic pump. This integrative narrative review asks whether contemporary science has moved back toward the earlier view. Evidence is drawn from neurocardiology, cardiac endocrinology, cardioception research, psychophysiology, and studies of interpersonal synchrony. The heart has an intrinsic nervous system with ∼14,000-94,000 neurons, which are capable of autonomous information processing and local reflex processing that operates within central autonomic regulation. It synthesizes oxytocin and releases atrial natriuretic peptide, and these molecules are implicated in social bonding and anxiolysis. Approximately 80% of vagal cardiac fibers carry signals from the heart to the brain, contributing to emotional and perceptual processing alongside descending central regulation. Heartbeat-evoked potentials gate access to emotional stimuli across the cardiac cycle, and heart rate variability indexes the brain's capacity for emotional regulation and sound judgment. In a recent group study, cardiac synchrony between individuals in group settings was associated with collective decision-making performance. It is not claimed that science proves scripture, but instead it is shown that independent scientific disciplines, working without reference to religious texts, have arrived at a portrait of the heart that stands in analogical consonance with descriptions in Islamic tradition over fourteen centuries ago. Limitations are noted where evidence is weak, particularly regarding transplant personality-change reports and cardiac electromagnetic field claims. Future directions include characterizing intrinsic cardiac neuron subtypes in humans, examining the cardiac effects of practices such as dhikr, and designing prospective transplant protocols.
