Renal colic is a common urological emergency marked by acute, severe pain, often requiring opioid analgesia in the emergency department (ED) when NSAIDs are ineffective or contraindicated. Despite widespread use, direct comparisons between morphine and fentanyl remain limited. To compare the efficacy of intravenous morphine and fentanyl in adults with renal colic, with ED length of stay as the primary outcome. Secondary outcomes included recurrence of ED visits, discharge, and admission rates. This retrospective study analyzed 1,620 patients aged 16-65 who presented with flank pain at two tertiary hospitals in Bahrain. Inclusion criteria were confirmed renal colic, VAS >4, opioid administration, and adequate documentation. Patients were grouped based on the initial opioid received. Variables analyzed included demographics, pain scores, rescue analgesia use, ED length of stay, disposition, and recurrence. Statistical analysis was conducted using SPSS with one-way ANOVA and Tukey HSD tests. In the cohort, 40.8% received morphine and 59.1% received fentanyl, with fentanyl initially linked to a significantly shorter emergency department stay (195 vs. 237 minutes; p<0.001), though this difference disappeared after adjusting for factors like pain score, age, gender, and renal stone history. While admission and recurrence rates were comparable, fentanyl was associated with higher discharge rates and morphine with fewer referrals, even after controlling for confounders. Both opioids proved effective for renal colic management. Opioid choice should be guided by clinical context and distinct pharmacokinetic properties. Further prospective studies are warranted to refine opioid selection in this setting.
Breast cancer, particularly Invasive Ductal Carcinoma (IDC), is the most prevalent malignancy among women worldwide. Early detection remains challenging, especially in younger women. Endothelin-Converting Enzyme-1 (ECE-1) and Mannan-Binding Lectin (MBL) have emerged as potential biomarkers due to their roles in tumor angiogenesis, immune modulation, and inflammatory pathways. This study evaluated serum ECE-1 and MBL levels in distinguishing malignant from benign breast disease. A cross-sectional study was conducted on 160 females (20-40 years) divided into three groups: IDC (n=40), benign braeast disease (BBD, n=40), and healthy controls (n=80). Serum ECE-1 and MBL were quantified using sandwich ELISA. Data were analyzed with one-way ANOVA, Tukey post-hoc tests, Pearson correlation, and ROC curve analysis, with p<0.05 considered significant. IDC patients showed significantly elevated serum ECE-1(62.57 +/- 8.34 U/L) and MBL (221.03 +/- 23.31 ng/mL) compared to BBD (28.12 +/- 3.51 U/L; 160.6 t 21.86 ng/mL) and controls (8.54 +/- 1.56 U/L; 81.82 +/- 6.41 ng/mL) (p<0.001). Both biomarkers correlated positively within patient groups (IDC: r=0.373, p=0.018; BBD: r=0.495, p=0.001). ROC analysis revealed higher diagnostic accuracy for ECE-1 (AUC=0.773; sensitivity 72.8%, specificity 93.1%) than MBL (AUC=0.717; sensitivity 67.2%, specificity 89.7%. Elevated serum ECE-1 and MBL are significantly associated with IDC and may serve as useful non-invasive biomarkers. ECE-1 demonstrated superior diagnostic performance, suggesting its potential utility-alone or within a biomarker panel-for early breast cancer detection and differentiation from benign disease.
Major depressive disorder (MDD) is a prevalent and debilitating mental health condition characterized by persistent low mood, anhedonia, and impaired functioning. Although many patients respond to first-line treatments such as antidepressant medications and psychotherapy, a significant subset-referred to as treatment-resistant depression (TRD)-fails to achieve adequate symptom relief despite multiple therapeutic trials. In recent years, non-invasive neuromodulation techniques have been introduced as alternative options for patients with TRD. Among these, repetitive transcranial magnetic stimulation (rTMS) has gained prominence due to its efficacy, safety profile, and favorable tolerability. rTMS involves delivering focused magnetic pulses to targeted regions of the brain, particularly the left dorsolateral prefrontal cortex (DLPFC), which is associated with mood regulation. Compared to electroconvulsive therapy (ECT), which is generally more efficacious, rTMS is often preferred by patients as it does not require general anesthesia, does not induce seizures, and has fewer cognitive side effects. Several studies have demonstrated significant improvement in depressive symptoms following rTMS, yet more data are needed from real-world clinical settings to assess its effectiveness across different populations. This study contributes to this growing body of evidence by evaluating the clinical impact of rTMS on symptomatology in patients with treatment-resistant depression using structured outcome measures at different phases of therapy.
Empathy and compassionate care play an essential role in nursing care so they encourage communication effectively, establishing trust with patients and leads to improved clinical outcomes. Therefore, it is important the nursing student understand these concepts and apply them in their clinical work. Nonetheless, the literature supporting the significance of empathy and compassionate care remains limited, reflecting a gap that needs to be addressed, especially in Jordanian settings. The major aim of this study is investigate the levels of empathy, compassionate care among Jordanian nursing students and identify whether there is a relationship between these variables. A total of 337 nursing Students from three major universities in Jordan were included in the study, the study utilized a descriptive cross-sectional design and data were collected using the Arabic translated version of Toronto Empathy Questionnaire and the Caring Dimensions Inventory. The results showed that overall mean empathy score was 47.17 (SD = 7.03) that indicate for high level of empathy. While the mean score for compassionate care was 1.88 (SD = 0.50) also indicates to high levels of compassionate care. The Person's correlation test indicated to moderate statistically significant positive correlation between both variables (r = 0.56, p <0.001), which showed that the empathy levels increase when compassionate behavior improves. No observed any significant difference in empathy or compassionate care scores based on sociodemographic characteristics including age, gender, academic year or clinical training area. Nursing students showed high levels of empathy and the caring behavior. Accordingly, nursing education strategies that enhance the empathy and caring behavior, should be developed such as structured clinical sessions and classroom activities. Future Qualitative studies may consider the development of empathy and compassionate care as Students transition into professional practice.
Essential (primary) hypertension is a multifactorial disorder shaped by genetic and environmental factors, with prevalence rising worldwide. Interethnic variability strongly influences drug response. Genome-wide association studies (GWAS) have highlighted loci such as AGT, ACE, PLEKHA7, CYP4A11, UMOD, ATP2B1, and CACNA1C in blood pressure regulation. Pharmacogenetic variants-including CYP2D6 with beta-blockers, CYP2C9 with losartan, ACE I/D with ACE inhibitors, and UMOD with loop diuretics-affect efficacy, adverse reactions, and dosing. However, most evidence derives from European, Asian, or African cohorts, leaving a major gap for Middle Eastern populations. Saudi data indicate reduced CYP2D6*4 frequency and higher CYP2C9*2/3 allele prevalence, potentially impacting therapeutic outcomes. This review synthesizes GWAS, meta-analyses, and emerging biomarkers such as non-coding variants, microRNAs, epigenetics, and polygenic scores. Yet, translation into clinical practice is limited by insufficient prospective validation, infrastructure gaps, and ancestry-specific data. Future multi-ethnic studies are critical to enable precision antihypertensive therapy and equitable personalized care.
