Gland Surgery (GS) is an esteemed international, peer-reviewed journal dedicated to the field of gland surgery. It publishes cutting-edge research, clinical studies, and innovations related to various aspects of gland surgery, including thyroid, parathyroid, adrenal, and salivary glands.
PRE-EMPTIVE ORAL PREGABALIN VERSUS ORAL CLONIDINE FOR POSTOPERATIVE ANALGESIA FOLLOWING LOWER LIMB ORTHOPAEDIC SURGERY UNDER SPINAL ANAESTHESIA: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL
Background: Effective postoperative pain control is essential after lower limb orthopaedic surgery to facilitate early mobilization, improve patient comfort, and reduce analgesic-related complications. Pregabalin and clonidine have been used as pre-emptive analgesic agents; however, evidence directly comparing their efficacy in patients undergoing spinal anaesthesia remains limited. This study compared the postoperative analgesic efficacy of oral pregabalin and oral clonidine in lower limb orthopaedic surgery performed under spinal anaesthesia. Methods: This prospective, randomized, double-blind, placebo-controlled study included 90 ASA physical status I–II patients aged 18–65 years undergoing elective lower limb orthopaedic surgery. Patients were randomly allocated into three equal groups (n=30 each): Group A received oral clonidine 150 μg, Group B received oral pregabalin 150 mg, and Group C received placebo one hour before surgery. All patients underwent spinal anaesthesia with 3 mL of 0.5% hyperbaric bupivacaine. Postoperative pain was assessed using the Visual Analogue Scale (VAS). Duration of analgesia, time to first rescue analgesia, total diclofenac consumption, sedation scores, and adverse effects were recorded during the first 24 postoperative hours. Results: Baseline demographic characteristics and spinal block parameters were comparable among the three groups (p>0.05). Patients receiving pregabalin demonstrated significantly lower postoperative VAS scores throughout the study period compared with clonidine and placebo (p<0.05). The duration of analgesia was longest in the pregabalin group (689±136 min), followed by the clonidine (517±107 min) and placebo groups (381±100 min) (p<0.001). Time to first rescue analgesia was significantly prolonged with pregabalin (572±136 min) compared with clonidine (400±106 min) and placebo (264±102 min) (p<0.001). Total postoperative diclofenac consumption was lowest with pregabalin (80.0±19.0 mg), compared with clonidine (110.0±38.1 mg) and placebo (182.5±37.8 mg) (p<0.001). Adverse effects were mild and comparable across all groups. Conclusion: Preoperative oral pregabalin (150 mg) provided superior postoperative analgesia compared with oral clonidine (150 μg) and placebo by reducing pain intensity, prolonging analgesia, delaying rescue analgesic requirement, and decreasing postoperative analgesic consumption without increasing clinically significant adverse effects. Oral pregabalin may therefore be considered an effective component of multimodal analgesia for lower limb orthopaedic surgery performed under spinal anaesthesia.
Navdeep Kumar, Anita Kumari, Pooja Abbi, Prabhjot Kaur Gill
SUGAMMADEX VERSUS NEOSTIGMINE FOR REVERSAL OF NEUROMUSCULAR BLOCKADE AND PREVENTION OF RESPIRATORY ADVERSE EVENTS FOLLOWING FUNCTIONAL ENDOSCOPIC SINUS SURGERY: A RANDOMIZED DOUBLE-BLIND STUDY
Objective To compare perioperative respiratory adverse events (PRAEs) and neuromuscular recovery following reversal of vecuronium-induced neuromuscular blockade with sugammadex versus neostigmine in patients undergoing functional endoscopic sinus surgery (FESS). Methods In this prospective randomized double-blind study, 70 ASA I–II patients undergoing FESS were allocated to receive either sugammadex 4 mg/kg (Group A) or neostigmine 0.05 mg/kg with glycopyrrolate 0.4 mg (Group B). Neuromuscular function was monitored using train-of-four (TOF). The primary outcome was incidence of PRAEs. Secondary outcomes included time to TOF recovery, haemodynamics, and recovery profile. Results PRAEs were significantly lower in Group A (17.1%) compared with Group B (74.3%) (p < 0.001). Bucking and straining were significantly higher in Group B (p < 0.001). Time to TOF recovery was significantly shorter with sugammadex (122.14 ± 56.82 s vs 465.71 ± 113.05 s; p < 0.001). Haemodynamic variables were comparable between groups. Conclusion Sugammadex provides faster neuromuscular recovery and significantly reduces early PRAEs compared with neostigmine in Functional endoscopic sinus surgery patients.
Gaganjot Kaur, Mandeep Saini, Sunil Chawla, Ruchi Gupta, Arvinderpal Singh, Prabhjot Kaur Gill
EFFECT OF ULTRASOUND-GUIDED INDIVIDUALIZED FLUID OPTIMIZATION ON NAUSEA AND VOMITING FOLLOWING SPINAL ANAESTHESIA: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Background: Nausea and vomiting are common complications of spinal anaesthesia and are largely attributed to sympathetic blockade-induced reduced organ perfusion. Conventional fixed-volume fluid preloading does not account for individual differences in intravascular volume status, which may limit its effectiveness. Ultrasound-guided assessment of the inferior vena cava (IVC) provides a simple, non-invasive method for individualized fluid optimization before spinal anaesthesia. Objective: To evaluate the effect of ultrasound-guided individualized fluid optimization on the incidence of nausea and vomiting following spinal anaesthesia. Methods: This prospective randomized controlled trial included 98 adult patients aged 18–60 years with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective infraumbilical surgery under spinal anaesthesia. Patients were randomized to receive either ultrasound-guided individualized fluid optimization (Group U; n=49) based on IVC assessment or conventional crystalloid preloading (Group C; n=49). The primary outcome was the incidence of intraoperative nausea and vomiting. Continuous and categorical variables were analyzed using the independent t-test, Chi-square test, or Fisher's exact test, with P<0.05 considered statistically significant. Results: Baseline demographic and perioperative characteristics were comparable between the groups. Nausea occurred in 4 (8.2%) patients in Group U compared with 13 (26.5%) in Group C (P=0.031). Vomiting was observed in 2 (4.1%) and 10 (20.4%) patients, respectively (P=0.028). Ultrasound-guided fluid optimization reduced the relative risk of nausea by 69.2% (RR=0.31; NNT=6) and vomiting by 80.0% (RR=0.20; NNT=7). Conclusion: Ultrasound-guided individualized fluid optimization significantly reduced nausea and vomiting following spinal anaesthesia. This patient-specific, bedside approach offers an effective strategy for improving perioperative comfort and supports the incorporation of point-of-care ultrasound into routine perioperative fluid management.
Sohail Singh Sodhi, Ruchi Gupta, Arvinder Pal Singh, Rajesh Arora
MAMMAGLOBIN EXPRESSION AND ITS ASSOCIATION WITH HORMONE RECEPTOR STATUS AND CLINICOPATHOLOGICAL CHARACTERISTICS IN INVASIVE BREAST CARCINOMA: IMMUNOHISTOCHEMICAL STUDY
Background Breast cancer is a biologically heterogeneous malignancy, and reliable tissue biomarkers are needed to improve prognostic assessment. Mammaglobin, a breast-specific glycoprotein, has emerged as a promising immunohistochemical marker; however, evidence regarding its clinicopathological significance in Indian patients remains limited. The present study evaluated mammaglobin expression and its association with hormone receptor status and established clinicopathological parameters in invasive breast carcinoma. Methods This hospital-based cross-sectional study included 52 consecutive patients with histopathologically confirmed invasive ductal carcinoma (no special type) who underwent modified radical mastectomy between July 2024 and December 2025. Mammaglobin, estrogen receptor (ER), progesterone receptor (PR), and HER2 expression were assessed by immunohistochemistry. Associations between mammaglobin expression and clinicopathological variables were analyzed using the Chi-square test or Fisher's exact test, with p<0.05 considered statistically significant. Results Mammaglobin expression was observed in 31 of 52 tumors (59.6%). Positive expression showed a significant inverse association with histological grade, being more frequent in Grade II than Grade III tumors (80.0% vs. 46.9%; p=0.022). Mammaglobin positivity was also significantly associated with ER positivity (81.8% vs. 43.3%; p=0.009) and PR positivity (82.4% vs. 48.6%; p=0.034). No significant associations were identified with age, tumor size, lymphovascular invasion, lymph node status, or HER2 expression (all p>0.05). Conclusion Mammaglobin expression is significantly associated with lower histological grade and hormone receptor positivity in invasive breast carcinoma, supporting its role as a complementary immunohistochemical biomarker of favorable tumor biology. Although it was not associated with HER2 status or other clinicopathological variables, mammaglobin may provide additional prognostic information when interpreted alongside established pathological markers. Larger multicenter studies are warranted to validate its clinical utility.
Anupreet Kaur, Karamjit Singh Gill, Sanjay Piplani, Arshdeep Kaur, Prabhjot Kaur Gill
EXPRESSION OF KI-67 AND ITS CORRELATION WITH ESTROGEN RECEPTOR, PROGESTERONE RECEPTOR, AND HER2/NEU STATUS IN BREAST CARCINOMA: A CROSS-SECTIONAL IMMUNOHISTOCHEMICAL STUDY
Background Ki-67 is a well-established marker of cellular proliferation and has emerged as an important prognostic biomarker in breast carcinoma. Its relationship with hormone receptor status and HER2/neu expression remains variable across populations. Objective To evaluate Ki-67 expression in breast carcinoma and determine its association with estrogen receptor (ER), progesterone receptor (PR), HER2/neu status, and clinicopathological parameters. Materials and Methods This hospital-based cross-sectional study included 52 histopathologically confirmed breast carcinoma cases. Immunohistochemistry was performed for Ki-67, ER, PR, and HER2/neu. Associations between Ki-67 expression and clinicopathological variables were analyzed using Chi-square and logistic regression analyses. Results Ki-67 positivity was observed in 29 of 52 cases (55.8%). Among Ki-67-positive tumors, high proliferative activity (>20%) was identified in 48.3% of cases. Ki-67 expression demonstrated a significant positive association with higher tumor grade (p=0.023) and significant inverse associations with ER expression (p=0.024) and PR expression (p=0.038). No significant correlations were observed with age, tumor size, lymphovascular invasion, lymph node status, combined ER/PR status, or HER2/neu expression. Univariate logistic regression revealed that Grade III tumors (OR=4.09, 95% CI: 1.25–13.36) and ER-negative tumors (OR=4.08, 95% CI: 1.27–13.13) were significantly associated with Ki-67 positivity. Conclusion Ki-67 expression is significantly associated with higher histological grade and hormone receptor negativity in breast carcinoma. Routine assessment of Ki-67 alongside ER, PR, and HER2/neu may enhance prognostic stratification and facilitate individualized therapeutic decision-making.
Dhara Gupta, Manisha Sharma, Manas Madan, Karamjit Singh Gill
EXPRESSION OF GATA3 IN INVASIVE DUCTAL CARCINOMA OF THE BREAST: AN IMMUNOHISTOCHEMICAL CLINICOPATHOLOGICAL STUDY
Background GATA-binding protein 3 (GATA3) is a lineage-specific transcription factor that plays a critical role in mammary epithelial differentiation and has emerged as a valuable immunohistochemical marker in breast carcinoma. However, its association with clinicopathological characteristics and molecular subtypes remains variable across different populations. The present study evaluated GATA3 expression and its relationship with histopathological parameters, hormone receptor status, HER2 expression, and immunohistochemically defined molecular subtypes in invasive ductal carcinoma of the breast. Methods This cross-sectional study included 52 histopathologically confirmed cases of invasive ductal carcinoma, no special type (IDC-NST), treated at a tertiary care teaching hospital. Formalin-fixed, paraffin-embedded tissue sections were subjected to immunohistochemistry for GATA3, ER, PR, and HER2. GATA3 expression was assessed using a semi-quantitative immunoreactivity scoring system and categorized as negative, weak, moderate, or strong. Associations between GATA3 expression and clinicopathological variables were analyzed using the Chi-square test or Fisher's exact test, with p < 0.05 considered statistically significant. Results GATA3 expression was positive in 27 of 52 cases (51.9%). A significant association was observed between GATA3 expression and histological grade (p = 0.008), with higher positivity in Grade II than Grade III tumors. GATA3 expression was also significantly associated with ER positivity (p = 0.032) and PR positivity (p = 0.019). No significant associations were found with patient age (p = 0.721), tumor size (p = 0.300), lymphovascular invasion (p = 0.176), axillary lymph node status (p = 0.673), or HER2 expression (p = 0.278). Analysis according to molecular subtype demonstrated a significant association between GATA3 expression and immunohistochemically defined molecular classification (χ²=8.393, df=3, p=0.038). GATA3 positivity was highest among hormone receptor-positive tumors, whereas triple-negative breast cancers exhibited the lowest expression. Conclusion GATA3 expression is significantly associated with lower histological grade, hormone receptor positivity, and hormone receptor-positive molecular subtypes in invasive ductal carcinoma of the breast. These findings support the role of GATA3 as a reliable marker of luminal differentiation and emphasize its diagnostic value in the immunohistochemical evaluation and molecular characterization of breast carcinoma.
Sargun Singh, Karamjit Singh Gill, Menka Khanna, Dilbar Sama, Prabhjot Kaur Gill
EARLY PREDICTION OF SEVERE ACUTE PANCREATITIS: COMPARATIVE VALIDATION OF BISAP AND RANSON SCORING SYSTEMS IN A PROSPECTIVE COHORT
Background: Acute pancreatitis is a common gastrointestinal emergency with a highly variable clinical course ranging from mild, self-limiting inflammation to severe disease complicated by persistent organ failure and mortality. Early identification of patients at risk of severe acute pancreatitis is crucial for timely intervention, appropriate triage, and optimal utilization of healthcare resources. Among the available prognostic tools, the Bedside Index for Severity in Acute Pancreatitis (BISAP) and Ranson’s Criteria are widely used; however, their comparative performance remains a matter of clinical interest. Methods: This prospective observational study included 50 consecutive adult patients diagnosed with acute pancreatitis at a tertiary care centre. BISAP scores were calculated within the first 24 hours of admission, whereas Ranson’s Criteria were assessed at admission and after 48 hours. Disease severity was compared between the two scoring systems and correlated with etiological factors and biochemical parameters using appropriate statistical analysis, with a p-value <0.05 considered statistically significant. Results: The study population comprised predominantly males (70%), with alcohol (60%) and gallstone disease (36%) representing the leading etiologies. At 48 hours, hypoxemia and a hematocrit decline >10% were observed in 80% of patients, reflecting substantial systemic involvement. Ranson’s Criteria classified a significantly greater proportion of patients as having severe disease than BISAP (76% vs. 42%; p=0.001). Among patients with gallstone-induced pancreatitis, severe disease was identified in 83.3% by Ranson’s Criteria compared with 44.4% by BISAP. Although disease etiology was not independently associated with severity, Ranson’s Criteria demonstrated greater sensitivity in detecting progressive systemic involvement, particularly in patients with elevated pancreatic enzyme levels. Conclusions: Both scoring systems are clinically valuable for early risk stratification in acute pancreatitis. BISAP offers a rapid and practical bedside assessment suitable for early triage, whereas Ranson’s Criteria provide a more comprehensive evaluation of evolving disease severity over the initial 48 hours. Their complementary use may facilitate timely clinical decision-making, particularly in resource-constrained healthcare settings.
Anumaan Singh Padda, Darpan Bansal, Mohit Sharma, Prabhjot Kaur Gill
COMPARATIVE ANALYSIS OF POINT-OF-CARE ULTRASOUND AND CONVENTIONAL CLINICAL ASSESSMENT FOR VOLUME STATUS EVALUATION IN NEWLY ADMITTED HOSPITAL PATIENTS
Background: Accurate volume status assessment is essential for managing newly admitted hospital patients. However conventional clinical methods have known limitations. Point-of-care ultrasound (POCUS) offers a rapid bedside alternative. This study compares the diagnostic performance of POCUS using inferior vena cava (IVC) assessment against standard clinical evaluation. Methods: We conducted a prospective comparative study at the National Heart Institute with 150 newly admitted adults. Each patient underwent both a POCUS IVC exam and a conventional clinical assessment performed by separate blinded doctors. The reference standard was hemodynamic response to passive leg raise or fluid bolus. Results: POCUS achieved a sensitivity of 81.2% and specificity of 84.6% for predicting fluid responsiveness using an IVC collapsibility index cutoff of 44%. Conventional clinical assessment gave a sensitivity of only 52.4% and specificity of 58.7%. Inter-observer agreement was excellent for POCUS (ICC 0.91) but poor for clinical exam (kappa 0.42). POCUS also took less time (4.2 vs 8.5 minutes) and changed management decisions in 35% of cases. Conclusions: POCUS guided IVC assessment is significantly more accurate reliable and efficient than conventional clinical evaluation for volume status in newly admitted hospital patients. Routine integration of POCUS into admission protocols is recommended. [1]
Osama Hosni Abdelhady Dakka, Isam Mohamed Osman Gaafar, Ahmed Samir Goda Ahmed, Mohamed Osama Mohamed Helaly, Mohamed Amin Mohamed Ali, Abrar Hadi Hadi Najar, Amany Faheem Abdelsalam, Aljawhra Mohammed Abuaali, Tarek Abdelhay Mostafa
THE EFFECT OF TACTILE-KINESTHETIC STIMULATION ON WEIGHT AND LENGTH OF HOSPITAL STAYS IN PRETERM NEONATES: A RANDOMIZED CLINICAL TRIAL
Background: Preterm birth is a major cause of neonatal mortality and long-term neurodevelopmental impairment, while the stressful NICU environment negatively affects preterm neonates' growth, weight gain, and length of hospital stay (LOS). Although Tactile-Kinesthetic Stimulation (TKS) is an evidence-based, non-pharmacological intervention that may reduce these adverse effects, further high-quality evidence is needed to establish its effectiveness in improving growth and clinical outcomes among preterm neonates. Purpose: This study evaluated the clinical efficacy of the TKS protocol on weight trajectories and the LOS among preterm neonates. Design and Method: A parallel-group, randomized clinical trial design was utilized at the NICU of King Abdullah University Hospital in northern Jordan. A total of 69 stable preterm neonates (gestational age 34–37 weeks, birth weight 1500–2500 grams) were randomized to either the TKS group (n = 34) or the control group (n = 35). The study group received routine NICU care combined with a standardized 15-minute, skin-to-skin TKS protocol administered twice daily for 5 consecutive days, consisting of prone tactile stroking and supine passive range-of-motion exercises. The control group received only routine nursing care. Primary outcomes included daily weight, discharge weight, and LOS. Data analyzed using the Statistical Package for the Social Sciences (SPSS) version 23.0. Result: Independent samples t-tests revealed no statistically significant differences in raw mean absolute weights between the TKS and control groups at baseline (1986 ± 220 grams vs1972 ± 257 grams), post-intervention day five (2061 ± 224 grams vs 1983 ± 258 grams), or medical discharge (2117 ± 217 grams vs 2120 ± 223 grams). Daily weight velocity also lacked significant variations (9.46 ± 5.17 grams/day for the TKS group vs10.88 ± 24.9 grams/day for the control group, p = 0.219). Interestingly, the percentage of weight gain from day 5 to discharge was significantly higher in the control group than in the TKS group (5.5% ± 4.1% vs 2.31% ± 0.71%, p = 0.031). Preterm neonates in the TKS group experienced an average hospitalization duration of 14 ± 3 days compared to 12 ± 3 days in the control group, which was not statistically significant (p = 0.143). Linear regression modelling confirmed that TKS exposure did not serve as a statistically meaningful independent predictor of absolute discharge weight or length of hospital stay. Conclusion: Although the TKS protocol did not achieve a statistically significant independent reduction in absolute discharge weights or hospital length of stay within this specific sample, it established positive directional trends in neonatal weight trajectories. Practical Implication: TKS is a safe, non-invasive, and cost-effective intervention that can be integrated into routine neonatal nursing care to support early physiological stability in preterm neonates. Future large-scale, multicenter RCTs with long-term follow-up are needed to confirm its effectiveness and determine the optimal intervention dosage.
Sumaia Mahmoud Abu-Hatab, Ibtisam Abdelrazzaq Alarabyat, Banan Talal Qurdahji, Heyam Ahmad Al-Aaraj, Husam Al Khatib, Saddam Younes Al-Marahfeh, Rawan M. Alassaf, Majd Waleed Al Hammouri, Etap Mohammad Saleh Alswaiti, Lama Shukri Arabyat
NON-PHARMACOLOGICAL INTERVENTIONS FOR FEEDING AND GROWTH IN PRETERM NEONATES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIAL
Feeding intolerance (FI) delays nutritional advancement, growth, and discharge readiness in preterm neonates (<37 weeks' gestation). Non-pharmacological interventions (NPIs) - including oral stimulation, non-nutritive sucking (NNS), premature infant oral motor intervention (PIOMI), abdominal massage, KMC, and multisensory stimulation - are increasingly applied as safe, low-risk strategies to support feeding and growth in neonatal intensive care units. This systematic review and meta-analysis evaluated randomized controlled trial evidence for NPIs on feeding tolerance, oral feeding progression, growth, and hospitalization outcomes in preterm neonates. Eligible studies published between 2020 and 2026 were identified through database and manual reference searching. Continuous outcomes were summarized as mean differences (95% Confidence Interval); dichotomous outcomes as risk ratios. Missing variance data were not imputed. Twenty-one eligible RCTs were included, encompassing oral stimulation, PIOMI, NNS, abdominal massage, I Love You massage, Chinese pediatric Tuina, prone positioning, Kangaroo mother care (KMC), and multistimulation. Pooled analysis demonstrated that NPIs reduced GRV by 3.07 mL (95% CI −3.33 to −2.81; I² = 0%). KMC significantly reduced FI events (RR = 0.22, 95% CI 0.08–0.63), and abdominal massage reduced post-feeding abdominal circumference. Oral-motor interventions favored earlier feeding readiness, faster transition to full oral feeding, and shorter hospitalization, though several outcomes were not poolable. NPIs are effective supportive strategies for improving feeding outcomes in preterm neonates. Evidence is strongest for gastric residual volume (GRV) and FI events; standardized outcome reporting across future trials remains necessary.
Sumaia Mahmoud Abu-Hatab, Ibtisam Abdelrazzaq Alarabyat, Alaa Abdelkhaleq Abuattallah, Haifa Mahmoud Mousa Eid, Lama Shukri Arabyat
SURVIVAL OUTCOMES FOLLOWING VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION FOR ACUTE HEART FAILURE WITH REFRACTORY CARDIOGENIC SHOCK: A CONTEMPORARY SYSTEMATIC REVIEW AND META ANALYSIS
Background: Refractory cardiogenic shock (RCS) complicating acute heart failure (AHF) represents a life-threatening condition with historical mortality exceeding 80%. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a salvage intervention providing temporary mechanical circulatory support, yet its survival benefit remains controversial. Objectives: To synthesize contemporary evidence quantifying survival outcomes following VA-ECMO deployment in AHF-RCS and identify prognostic determinants influencing clinical outcomes. Methods: We conducted a systematic review following PRISMA guidelines, searching PubMed, Embase, and Cochrane databases from January 2018 through April 2024. Eligible studies reported short-term (ECMO weaning) and intermediate-term (hospital discharge or 30-day) survival in adults with AHF-RCS managed with VA-ECMO. Random-effects meta-analysis generated pooled proportions with 95% confidence intervals (CI). Heterogeneity was quantified using I² statistics. Subgroup analyses stratified outcomes by shock etiology. Results: Forty-three studies (one randomized controlled trial, 42 observational studies; n=9,842 patients) met inclusion criteria. Pooled successful weaning from VA-ECMO occurred in 65.2% (95% CI: 60.1-70.0%; I²=78%). However, survival to hospital discharge or 30 days was achieved in only 38.5% (95% CI: 34.2-43.0%; I²=82%). Etiology-specific survival varied substantially: myocarditis 58.1% (95% CI: 49.5-66.3%), acute myocardial infarction 35.8% (95% CI: 30.1-41.9%), post-cardiotomy shock 33.5% (95% CI: 27.0-40.6%), and out-of-hospital cardiac arrest 27.3% (95% CI: 21.0-34.5%). The EOLE randomized trial demonstrated non-significant survival improvement with VA-ECMO versus medical therapy (31% vs. 22%; p=0.21). Major complications included bleeding requiring intervention (41.2%), limb ischemia (12.4%), and stroke (9.1%). Conclusions: VA-ECMO effectively stabilizes the majority of patients with AHF-RCS, enabling successful weaning in approximately two-thirds. However, survival to discharge remains modest at 38.5%, with a substantial 27-percentage-point gap between weaning and survival. Outcomes are highly etiology-dependent, with myocarditis demonstrating the most favorable prognosis. The considerable complication burden and marginal survival benefit in unselected populations underscore the critical importance of rigorous patient selection, etiology-based risk stratification, and integration within comprehensive mechanical support algorithms. Future research must prioritize randomized trials in specific patient subgroups and strategies to mitigate life-threatening complications.
Extracorporeal membrane oxygenation; Cardiogenic shock; Acute heart failure; Mechanical circulatory support; Meta-analysis; Survival; Mortality; ECMO complications
Osama Hosni Abdelhady Dakka, Mohamed Abdelataif Almandoh Aboghabena, Ahmed Samir Goda Ahmed, Mohamed Osama Mohamed Helaly, Fatma Sameer Mohammed Hamayed, Bader Hameed Shreethen Aljuhani, Fahad Khalid Farhan Alanazi, Naif Ahmed A. Alabbad
REPROGRAMMING IMMUNITY: A META-ANALYSIS OF LIFESTYLE, NUTRITION, AND MICROBIOME INTERVENTIONS
Chronic low-grade inflammation is implicated in the pathogenesis of metabolic, cardiovascular, renal, and age-related diseases. Non-pharmacologic interventions-spanning lifestyle modification, nutritional strategies, and microbiome-directed therapies-have been proposed as upstream modulators of inflammatory physiology, yet cross-domain quantitative syntheses remain scarce. This systematic review and meta-analysis evaluated whether lifestyle, nutrition, microbiome-directed, and hybrid interventions reduce circulating inflammatory biomarkers relative to control conditions in adult populations. A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL (January 2011–April 2026) identified randomized or controlled intervention studies reporting C-reactive protein (CRP/hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), or lipopolysaccharide (LPS) endpoints. Fifteen studies met strict eligibility criteria. Random-effects meta-analyses were conducted using Hedges’ g with inverse-variance weighting. All four biomarker families showed pooled effects favoring intervention. CRP/hs-CRP yielded the most robust estimate (k = 11; Hedges’ g = −0.51, 95% CI [−0.81, −0.20]; I² = 73.4%). IL-6 (k = 6; g = −1.76, 95% CI [−3.18, −0.33]; I² = 96.3%), TNF-α (k = 4; g = −1.50, 95% CI [−2.61, −0.38]; I² = 91.2%), and LPS (k = 2; g = −0.75, 95% CI [−1.45, −0.04]; I² = 68.0%) showed large effects with considerable heterogeneity. Microbiome-directed interventions constituted the dominant evidence base. Non-pharmacologic interventions are associated with reduced inflammatory biomarker burden in adults, with the most stable evidence for CRP-family outcomes. These findings support a biomarker-centered interpretation of immune recalibration and highlight the need for domain-balanced trials with standardized inflammatory outcome reporting.
meta-analysis, inflammation, C-reactive protein, microbiome, probiotics, lifestyle interventions, nutrition, immunomodulation, systematic review
Alaa Abdelfattah, Fawaz Al-Alloosh, Ahmed Osman Hassan Ali, Mohd Ayman Mustafa Hammad, Mohammad Hisham Abdelaziz Aljarbouah, Shaimaa Farouk
THE PREVALENCE OF HIGH LDL-C AMONG DIABETIC PATIENTS TYPE 2, SECURITY FORCES HOSPITAL, RIYADH, SAUDI ARABIA
Introduction: Dyslipidemia is associated with a high risk of developing heart diseases and macrovascular diseases, such as stroke, particularly among diabetic patients. In Saudi Arabia, there is a need to evaluate the magnitude of dyslipidemia and aggravating factors that are associated with dyslipidemia among diabetic patients. The aim of this study is to assess prevalence of dyslipidemias, mainly high LDL, among T2DM diabetic patients. Methods: This is a descriptive, hospital-based, and cross-sectional study recruited 100 patients with T2DM who have 2 readings of LDL, at least 6 months apart. Patients with diagnosed hypothyroidism or alcohol drinking were excluded from the study. A gender balanced sample of 50 males and 50 females at the age range of 18-75 years old were recruited from primary care department at Security Forces Hospital (SFH). The data was extracted form medical electronic records from 1st of January 2018 to 31st of December 2020. Multiple linear regression were used to determine the significant predictors of LDL level. Results: A total of 100 patients with T2DM included with mean age of 57.3±7.7. About a third of the patients had high LDL level in both readings, compared to 21% had low level of HDL. The mean level of LDL was higher in females than in males but the differences were not statistically significant. An improvement in glycemic control among the included patients when comparing baseline and follow-up level of HbAc1. Concerning gender difference in dyslipidemia, the present study showed that levels of all dyslipidemia parameters were higher in females than in males but significant difference only detected in T. cholesterol and HDL. Change-rate in T. cholesterol level, change-rate in triglyceride level, and change-rate in HDL level were significant predictors for change-rate in LDL level. The change-rate in LDL level increased by 0.89 mg/dl for one unit rise in T. cholesterol change-rate. Differently, the change-rate in LDL level decreased by 0.36 or 0.54 mg/dl for one unit rise in triglycerides or HDL change-rate, respectively. Conclusions: Based on robust estimations, a considerable proportion of diabetic patients had abnormal levels of dyslipidemia parameters, particularly LDL level. The change rate in lipid profile could be considered as a rough indicator for the effect of self-control or therapy in this study. An improvement in glycemic control was found when comparing baseline and follow-up level of HbAc1. Change-rate in T. cholesterol level, change-rate in triglyceride level, and change-rate in HDL level were significant predictors for change-rate in LDL level.
Dyslipidemia, high cholesterol, atherosclerosis, glycemic control, hyperglycemia
Dr. Abdullah Saeed AlQahtani, Dr. Bader Saad Alzahrani, Dr. Anwar Shawel, Fahad Alshahrani
HYPERTENSION, TYPE 2 DIABETES, AND CARDIOVASCULAR RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS
Hypertension and type 2 diabetes mellitus (T2DM) are major cardiometabolic risk factors worldwide, yet observational evidence has not always distinguished their independent associations with specific cardiovascular outcome families. To systematically review recent observational studies examining the independent association of hypertension, and separately T2DM, with cardiovascular risk, and to conduct quantitative synthesis only in prespecified subgroups with sufficient methodological comparability. PubMed/MEDLINE, Scopus, and Web of Science were searched in January 2025 for English-language cohort studies published from January 2011 onward. Sixteen cohort studies met PECO eligibility criteria (nine hypertension, seven T2DM). Methodological quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted only for prespecified subgroups with at least three sufficiently comparable hazard-based estimates; smaller or non-comparable strata were synthesized narratively. Reporting followed PRISMA 2020 and MOOSE guidance. Stage 1 hypertension was associated with higher broad composite CVD risk (HR = 1.42; 95% CI: 1.24–1.62; I² = 81.1%; n = 6). T2DM was associated with higher heart failure risk (HR = 1.57; 95% CI: 1.38–1.78; I² = 79.7%; n = 4). Narrative evidence for hypertension-related stroke, cardiovascular mortality, T2DM-related broad CVD, coronary events, and cardiovascular mortality was directionally positive but limited by small study counts and lack of direct quantitative comparability. Recent observational evidence supports an association of stage 1 hypertension with broad composite CVD and of T2DM with heart failure, while evidence for other outcome families remains suggestive rather than definitive. Findings support cautious, exposure-specific cardiometabolic risk assessment and should not be interpreted as providing equally certain estimates across all cardiovascular domains.
hypertension; type 2 diabetes mellitus; cardiovascular disease; meta-analysis; systematic review; cardiometabolic risk
Tayseer Hussein Ibrahim Hussein, Fawaz Al-Alloosh, Dr. Farrukh Ameer, Ahmed Osman Hassan Ali, Ahmad Mohammed Ishaque Aal Ibrahim, Mostafa Ahmed Mohamed, Mohamed A. Bassiony
PROGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO IN CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Cardiovascular diseases (CVDs) remain the leading cause of death globally. The neutrophil-to-lymphocyte ratio (NLR), an inexpensive inflammatory biomarker derived from routine blood counts, has shown promise for risk stratification, yet pooled prognostic evidence across heterogeneous CVD populations remains limited. This study systematically synthesised the prognostic value of baseline NLR for mortality across the full spectrum of CVD. Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched (January 2011–March 2026). Studies reporting multivariable-adjusted hazard ratios (HRs) for mortality in CVD patients with NLR as a prognostic exposure were included. Random-effects meta-analysis (DerSimonian–Laird), subgroup analyses (ACS vs. non-ACS; heart failure vs. CAD/interventional), leave-one-out sensitivity analysis, and publication bias tests (Egger’s, Begg’s) were performed. Twenty studies met the inclusion criteria; 16 contributed to the primary mortality HR pool. The pooled adjusted HR was 1.30 (95% CI: 1.20–1.40; p < 0.001; I² = 89.4%). The ACS/STEMI subgroup showed a higher pooled HR of 2.18 (95% CI: 1.15–4.13) compared with non-ACS conditions (HR = 1.30; 95% CI: 1.20–1.42). The association remained robust in all leave-one-out iterations. Egger’s test indicated potential publication bias (p = 0.031). Elevated NLR independently predicts mortality across diverse CVD populations. As a universally available, zero-cost biomarker, NLR holds considerable promise as an adjunctive risk-stratification tool. Future research should establish standardised cutoffs and test NLR-guided management strategies.
Neutrophil-to-lymphocyte ratio; cardiovascular disease; mortality; meta-analysis; systematic review; inflammatory biomarker
Basel Mohammad Hamad Khawaldeh, Dr. Farrukh Ameer, Basmalah Saeed Al-Hawadi, Saif Saeed Alhawadi, Ahmed Osman Hassan Ali, Khaled Mohamed Aly Eltamawy, Eman Mohamed Mahmoud Habib
THE GROWING ROLE OF FAMILY MEDICINE IN DIABETES MANAGEMENT AND CONTROL: A SYSTEMATIC REVIEW AND META-ANALYSIS
Diabetes affects approximately 830 million adults globally, yet endocrinology specialist capacity lags behind demand. Family medicine is positioned to expand its endocrine care role, but no prior synthesis has quantified the collective impact of primary care–anchored endocrine strategies. To estimate the pooled effect of family medicine–anchored interventions defined as interventions implemented within general practice/family medicine/primary care services, including team-based delivery on glycated hemoglobin (HbA1c) and to develop a practical expansion framework. PRISMA 2020–guided systematic review and random-effects meta-analysis of PubMed/MEDLINE (2011–2025). Eligible studies evaluated primary care–led endocrine interventions in adults with diabetes. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool. Subgroup analyses examined intervention categories. Fifteen studies met inclusion criteria; 13 contributed to the pooled analysis (N = 13,554). The pooled HbA1c mean difference was −0.22 percentage points (95% CI: −0.35 to −0.08; I²= 75%). The largest effect was from an intensive primary care–led weight management program (−0.85%; 95% CI: −1.10 to −0.59), achieving 46% diabetes remission. Technology-enabled and behavioral interventions showed variable but favorable effects. Family medicine interventions produce a modest but significant HbA1c reduction, with larger effects from intensive metabolic and technology-enabled strategies. A four-pillar framework team-based care, behavior change integration, technology-enabled workflows, and specialist partnership can guide systematic expansion.
family medicine, primary care, endocrinology, diabetes, telehealth, eConsult, HbA1c, integrated care, meta-analysis
Reem Sameer Abu Qbitah, Mansoor Mohamed Mansoor Alamri, Tamara Samer Nabeel Skafi, Deyala Haitham Faris Jbarah, Aon Moh'd Ali Almauhawesh, Fawaz Al-Alloosh, Ahmed Osman Hassan Ali
PADINA PAVONICA ETHANOL EXTRACT TRIGGERS APOPTOSIS AND CELL CYCLE DISRUPTION THROUGH REDOX STRESS AND PI3K/AKT MODULATION IN LUNG AND BREAST CARCINOMA CELLS
Background: Marine brown algae contain bioactive compounds with anti-cancer properties. Padina pavonica (PP), a common brown alga, remains understudied for cancer cell effects. This study evaluated the cytotoxic and molecular effects of ethanol extract versus cisplatin (CP) on human lung carcinoma (A549) and breast carcinoma (MCF‑7) cells. Methods: The SRB test was used to determine cell toxicity by determining the IC50 values. After treatment with Padina pavonica (PP) extract and cisplatin (CP), cell shape changes were observed microscopically. A FLUOstar Omega microplate reader was used to measure cellular glutathione (GSH) and total antioxidant capacity. Flow cytometry with Annexin V/PI staining and PI DNA analysis was used to assess cell death and cell cycle progression. RT-qPCR measured Bax, Bcl-2, PI3K, and AKT1 gene expression, while western blotting confirmed the protein levels. One-way ANOVA with Tukey's test was used to check for statistical significance. Results: Padina pavonica extract reduced cell viability in a dose-dependent manner, with IC50 values of 60.73 µg/mL in A549 and 173.11 µg/mL in MCF‑7, versus 1.32 µg/mL and 1.72 µg/mL for cisplatin (CP), respectively. Morphological analysis showed cytotoxic features, including shrinkage, rounding, and detachment. PP treatment depleted intracellular glutathione (GSH) and reduced antioxidant capacity, indicating disrupted redox homeostasis; depletion was partial in A549 cells but profound in MCF‑7 cells. Flow cytometry revealed that PP induced late apoptosis in A549 cells and late apoptosis/necrosis in MCF‑7 cells, whereas CP triggered both early and late apoptosis. Cell cycle analysis showed that PP caused G1 arrest in A549 cells and sub‑G1 accumulation in MCF‑7 cells, whereas CP increased the sub‑G1 population. RT‑qPCR showed upregulation of Bax and downregulation of Bcl‑2, PI3K, and AKT1 in A549 cells, while MCF‑7 cells showed reduced Bcl‑2 and AKT1 but increased PI3K. Western blotting validated these changes at the protein level, confirming PP as a modulator of apoptotic pathways. Conclusion: Padina pavonica extract exhibits anticancer activity by reducing cell viability, altering morphology, depleting glutathione, lowering antioxidant capacity, and disrupting redox homeostasis. These effects induce apoptosis and cell cycle arrest and modulate PI3K/AKT signaling, with stronger responses in A549 versus MCF-7 cells. Although less potent than cisplatin, PP extract impaired survival pathways through layered mechanisms. These findings highlight the potential of marine brown algae as anticancer agents.
A549, MCF-7, Padina pavonica, Apoptosis, PI3K/AKT signaling pathway, Oxidative stress.
PATIENT SAFETY AND ERROR PREVENTION: THE INDISPENSABLE ROLE OF MULTIDISCIPLINARY TEAMS
Medical​‍​‌‍​‍‌​‍​‌‍​‍‌ errors remain among the leading causes of ill health and death globally, and therefore, represent a major challenge for health-care systems. This paper elaborates on the main role of multidisciplinary teams (MDTs) as a core strategy to improve patient safety and prevent errors. It traces patient-safety history, describes the organization and role of well-functioning MDTs, and explains how they reduce risk through better communication, shared mental models, and collective decision-making. The article cites the scientific research as evidence of the positive impact of MDTs on patient safety, error reduction, and safety culture. It also discusses problems associated with the implementation of such teams, e.g., hierarchical structures, lack of resources, and logistical difficulties and proposes research-supported solutions. The discussion about the current models leads to the following steps with the inclusion of technology and continuous improvement methods. The final section argues that robust, adequately resourced MDTs are not merely another feature but a precondition for the emergence of resilient, high-reliability healthcare organizations that are committed to error prevention and providing excellent patient care.
Patient Safety, Medical Error, Multidisciplinary Team, Interprofessional Collaboration, Healthcare Quality, Error Prevention, Communication, Human Factors.
Norah Mohammed Alqahtani, Ahmed Jawad Almarhoon, Abdulaziz Rashed Al Warthan, Laila Ali Almouibid, Nassren Masoud Alyami, Samar Naif Almutairi, Fatimah Mohammed Asiri, Wilayah Ali Alawadh, Ahad Abdullah Alanzi , Marwa Habeeb Almubarak Rawan Anwar Al-Sultan, Abdullah Ahmed Alghamdi
THE ROLE OF INTERPROFESSIONAL TEAMWORK (NURSING, PHARMACY, AND LABORATORY) IN MANAGING ANTIMICROBIAL RESISTANCE: A COLLABORATIVE APPROACH TO STEWARDSHIP
Antimicrobial resistance is considered one of the critical global health challenges and is grave in the Gulf Cooperation Council countries. The following review discusses the role that interprofessional collaboration between nursing, pharmacy, and laboratory professionals can play in fighting AMR through promoting effective ASPs. Based on literature from 2020 to date, the article will discuss how each profession contributes synergistically, identify issues with implementation unique to Middle Eastern healthcare contexts, and present evidence-based practices to optimize interprofessional work. Some of the major challenges facing the Saudi Arabian health system are the high rates of use of antibiotics, diversity in the expatriate workforce in health care, and other varying levels of infrastructure. As indicated by the critical analysis of available literature and regional data, structured interprofessional teamwork yields significant improvement in antimicrobial prescribing practice, reduces the rates of resistance, and improves patient outcomes. However, their successful implementation has barriers relating to hierarchical cultures in health care, to resources, and to culturally adapted educational interventions. The findings raise an alarm for policy reforms and investment in interprofessional training programs tailored to the GCC region.
antimicrobial resistance, interprofessional collaboration, antimicrobial stewardship, nursing, pharmacy, clinical laboratory, Saudi Arabia, Gulf region
Asmaa Hamed Aldaghrir1, Reem Khalid Alotaibi2, Reham Ahmed Mahnashi3, Naimah Abdullah Alsaqer4, Aqeela Ahmed Suwilh5, Abeer Ali Dhamri 6, Jumanah Mohammed Albaqami7, Hind Ibrahem Alghamdi8, Sharifa Ali Alshamrani9, Rahmah Ali Al-Yami10, Hissah Ahmed Alsaeed11, Fatin Ibrahim Alghamdi12
NURSING CHALLENGES IN MANAGING INVASIVE AND NON-INVASIVE PROCEDURES
This study investigated perceived difficulty and emotional stress of nurses for invasive and non-invasive medical procedures in different hospital departments. Using a quantitative design, 300 nurses' data were collected, and variables of perceived difficulty, emotional stress, years of experience, and type of procedure were examined. The study found that invasive procedures were far harder (means = 3.7) and emotionally stressful (means = 6.5) compared with their non-invasive equivalents (means = 2.6 and 3.6, respectively) with high statistical power (p < 0.001). Importantly, type of hospital department did not have a significant effect on perceived difficulty (ANOVA p = 0.37), and therefore routine protocols and repeated training may serve to reduce variability. A significant negative correlation between years of experience and perceived difficulty (r = -0.33, p < 0.001) was also observed, suggesting that experienced nurses perceive procedures as easier. Risk of infection and bleeding, and patient cooperation and communication were most frequent perceived difficulties with invasive and non-invasive procedures, respectively. Implications for nurse education, staffing plans, and design of support systems for improving procedural readiness and patient safety are provided by the findings. The limitation of the study is the use of subjective outcome measures and limited sample size. Future research is necessary to examine the impact of targeted intervention and further predictors of procedural difficulty.
Nursing challenges; Invasive procedures; Emotional stress; Procedure complexity; Experience level; Departmental protocols; Nurse training; Patient safety; Quantitative analysis; Healthcare staffing.
Hameeda Aljanabi, Huda Al-Hussain, Fatimah Alobaidan, Mona Alkhalaf, Hamad Alanazi, Zainab Alhammad, Leen Al-Wehaiby, Mohammed Alzahrani, Danyh Abdulaziz, Maram Jalis, Rahaf Alqurashi, Maryam Alanazi, Fatima Alsaaed, Ibtihal Al-Ruwaili
NURSES’ PERCEPTIONS TOWARD MEDICATION ERRORS IN SAUDI ARABIA
In healthcare contexts, medication administration errors (MAEs) pose a substantial patient safety challenge, particularly for nurses who are responsible for medication delivery. The objective of this investigation was to investigate the perceptions of MAEs among nurses in Saudi Arabia, as well as to identify the factors that contribute to these perceptions and to devise strategies to improve patient safety. Five germane studies published between 2021 and 2024 were identified through a systematic literature evaluation. The analysis identified four predominant themes: the influence of MAEs on patient safety, nurses' perceptions of error prevalence, the factors that contribute to medication errors, and proposed strategies for error reduction. The results showed that a significant number of nurses reported experiencing MAEs; however, many nurses were hesitant to disclose them due to the perception of culpability and the lack of adequate support systems. High responsibilities, inadequate training, and systemic deficiencies were among the contributing factors. The recommended strategies to reduce these errors included the enhancement of medication awareness, the cultivation of a culture of safety, and the enhancement of training programs for nurses. The study emphasizes the importance of addressing the knowledge and reporting practices disparities among nurses in order to enhance the quality of care and overall patient safety in Saudi Arabian healthcare systems. These insights are essential for the purpose of fostering a secure healthcare environment and guiding targeted interventions.
Jawza Radhi Alshammari1, Fawziah Radhi ALShammari2, Fudh Amash ALshammary3, Wafa Ghazi Alshammari4, Nourah Hamad Alshammari5, Alia Bashir AlAnazi6, Ghaziah Meshref Alshammry7
ENHANCING PATIENT SAFETY THROUGH EFFECTIVE COMMUNICATION BETWEEN NURSES AND LABORATORY TECHNICIANS
Background: Effective communication between nurses and laboratory technicians is essential for ensuring accurate diagnostics, timely interventions, and patient safety. Despite its critical role, interprofessional communication in this domain remains underexplored within the Saudi Arabian healthcare context. Objective: This study examined the relationship between communication quality and patient safety outcomes, and explored contextual factors influencing nurse–laboratory technician interactions. Methods: A mixed-methods design was employed across three tertiary hospitals and two urban clinics in Saudi Arabia. Quantitative data were collected from 206 participants using the validated Nurse–Laboratory Technician Communication Scale (NLTCS) and patient safety indicators, including diagnostic error rates, turnaround times, and satisfaction scores. Pearson’s correlation and multiple regression analyses assessed associations and predictive strength. Qualitative data from semi-structured interviews with 24 participants underwent thematic analysis. Results: Quantitative findings showed a strong negative correlation between communication quality and diagnostic errors (r = –0.68, p < 0.001) and a strong positive correlation with patient satisfaction (r = 0.71, p < 0.001). Regression analysis identified communication quality as a significant independent predictor of safety outcomes (p < 0.001). Qualitative themes highlighted workflow synchronization gaps, mutual trust, and technology use as key factors shaping communication effectiveness. Conclusion: High-quality communication between nurses and laboratory technicians significantly enhances patient safety outcomes. Integrating structured communication training, standardized reporting protocols, and optimized LIS–EHR systems can address identified barriers and sustain improvements. These strategies align with national patient safety priorities and can support Saudi Arabia’s vision for high-quality, efficient healthcare delivery
Patient safety, nurse–laboratory communication, diagnostic accuracy, LIS–EHR integration, Saudi Arabia.
Abdulaziz Ali Mohammed Yaseen1, Yasser Saeed Jumaan Alzahrani2, Aminah Fahad Ali Althuwaini3, Ali Mohammed Ali Asiri4, Ibrahim Ali Abdullah Alshehri5, Turki Marzog Serag Alotape6, Bashayr Khalil Ibrahim Aldhafallah7, Ghala Ayil Ahmed Khubrani8, Hind Gobran Hassan Mahzari9, Saud Sulaiman Hathal Alotaibi10
MULTIDISCIPLINARY COLLABORATION BETWEEN INTERNISTS, PHARMACISTS, OPTOMETRISTS, BIOCHEMISTRY AND LABORATORY SPECIALISTS IN IMPROVING CLINICAL DECISION-MAKING
Background: Effective clinical decision-making requires integration of diverse expertise, yet many healthcare systems continue to operate within professional silos. Fragmented decision processes increase the risk of diagnostic errors, medication mishaps, and poor patient outcomes. Objective: This study evaluated the impact of structured collaboration among internists, pharmacists, optometrists, biochemists, and laboratory specialists on the accuracy, safety, and efficiency of clinical decision-making in Saudi hospitals. Methods: A prospective, multicenter, mixed-methods design was implemented across six healthcare institutions. Quantitative data were collected from 250 professionals using validated instruments assessing decision accuracy, collaboration behaviors, and medication error rates, supplemented by chart audits of patient cases. Qualitative insights were obtained through focus groups and semi-structured interviews with a purposive sample of 30 participants. Data were analyzed using descriptive and inferential statistics, structural equation modeling, and thematic analysis. Results: Decision-making accuracy scores improved significantly across all professions after structured collaboration (mean increase +0.76, p < 0.001). Chart reviews showed diagnostic errors decreased by 50% and prescribing errors by 63%. Patient outcomes improved, with average hospital stay reduced by 1.7 days and 30-day readmissions nearly halved. Qualitative themes highlighted shared knowledge, conflict resolution, workflow integration, and patient-centered care as drivers of improvement. Conclusion: Multidisciplinary collaboration between internists, pharmacists, optometrists, biochemists, and laboratory specialists enhances diagnostic precision, medication safety, and overall patient care. Formalizing such teamwork within hospital policy, training, and electronic health record systems offers a practical strategy to improve healthcare quality in complex clinical environments.
Multidisciplinary collaboration, clinical decision-making, interprofessional practice, patient safety, Saudi Arabia.
Atif Barakah Jubran Alfarsi1, Ebtehal Faisal Nahari2, Ali Saad Alghamdi3, Abdul Majeed Mohammed Alsofyani4, Shaymaa Mohammed Felemban5, Abdullah Mohammed Almalki6, Mohammed Yahya Mohammed Alabbas7, Nahla Saad Al-Thagafi8, Rafaa Abdulraouf Garoot9, Dina Mohammed Salman10, Shoroug Talal Al-Shareef11
CASE REPORT: OPTIMIZING POSITIVE END-EXPIRATORY PRESSURE USING ESOPHAGEAL BALLOON CATHETER MONITORING IN ARDS
Background: Mechanical ventilation in patients with Acute Respiratory Distress Syndrome (ARDS) presents significant challenges, particularly in those with altered respiratory mechanics due to conditions like obesity. This case report explores the use of an esophageal balloon catheter for optimizing Positive End-Expiratory Pressure (PEEP) in a critically ill patient with ARDS. Case Presentation: A 46-year-old male with morbid obesity (BMI of 62 kg/m²), hypertension, and chronic Helicobacter pylori infection presented with symptoms of abdominal distention, constipation, shortness of breath, and oliguria. The patient was diagnosed with acute and chronic respiratory acidosis, leading to respiratory failure. Despite initial management with BiPAP therapy and mechanical ventilation, the patient's oxygenation remained inadequate.
Optimizing, Positive, End-Expiratory, Pressure Esophageal Balloon Catheter Monitoring ARDS.
Ahmad Alessa1, Badr Allehyani2, Ammar Baalkhir3, Ali Alanazi4, Faris Altuwairqi5, Ahmed Samir Ahmed6, Ibrahim R. Elkeshta7, Osama Dakka8 , Mohamed Helaly9
NURSING PRACTICES AND THEIR IMPACT ON WOUND INFECTION RATES: A CROSS-SECTIONAL ANALYSIS
Wound infections still represent a key clinical challenge, increasing the rate of morbidity amongst patients and driving up healthcare costs. The present study determines the effect of nursing practices on wound infection rates in a cross-section of 175 patients, with focus on hand hygiene compliance, nurse experience, and frequency of dressing changes. Through the parametric descriptive statistics, t-test, ANOVA, and logistic regression analyses performed using SPSS, the results revealed significant improvement in hand hygiene (p = 0.004), nurse experience (p = 0.007), and dressing change frequency (p = 0.0015), each associated with a reduction in wound infection rates. Within the logistic regression model, all three factors, both independently and when combined, were predictive of infection status, giving clinical relevance to these findings. The study thus highlights the crucial role that quality nursing care plays in infection prevention, providing empirical evidence that nursing training and hospital policies should consider for intervention. This study fills a bare patch in the literature by quantitatively binding nursing behavior to infection outcomes, providing healthcare practitioners with insight into actions to reduce wound infections through enhancing nursing.
Wound infection, Nursing practices, Hand hygiene compliance, Nurse experience, Dressing change frequency, Infection control, Logistic regression, Cross-sectional study, Patient outcomes
Sarah K. Alqurashi1, Hameeda Aljanabi2, Ruba M. Alrishi3, Raniya A. Alhusayni4, Nawal H. Alshammari5, Zahra O. Zekri6, Majed M. Althagafi7, Khalid S. Alluqmani8, Abdulaziz A. Alhumam9, Waheeb Alshammria10, Ruyaa Busayyis11, Ebtesam Alruwaily12, Rahaf Alghamdi13
A SYSTEMATIC REVIEW EXAMINING THE CORRELATION BETWEEN NURSE STAFFING RATIOS AND QUALITY OF CARE OR PATIENT SAFETY OUTCOMES
In healthcare settings in the Kingdom of Saudi Arabia (KSA), this systematic review examines the relationship between nurse labor ratios and patient safety or quality of care outcomes. Despite the critical role that adequate nurse staffing plays in assuring patient safety and care quality, there is a substantial disparity in the comprehension of this relationship in the context of KSA. Five studies that satisfied the established criteria were included after a thorough survey of peer-reviewed literature from 2021 to 2024 was conducted across multiple databases. The results indicate a robust correlation between improved nurse staffing levels and improved patient outcomes, emphasizing that low nurse-to-patient ratios are associated with increased rates of adverse events, including patient accidents and pressure injuries. Furthermore, the review suggests that patient safety is substantially influenced by factors such as professional competence and the nursing work environment. The imperative necessity for evidence-based policy interventions to enhance the quality of healthcare in KSA and optimize nurse staffing ratios is emphasized by the evidence presented. In order to improve comprehension and inform policy initiatives, future research should concentrate on further investigating these relationships in a variety of healthcare contexts.
Examining Correlation, Nurse Staffing, Ratios and Quality Care, Patient Safety Outcomes.
Tahani Owaid Alanazi1, Najla Hathal Alotaibi2, Ketbah Edham Alonazi3, Ahani Owaid Alanazi4, Fatimah Ahmed Alabdrabalrasol5, Maha Salman Alfify6, Mathayel Ibrahim Alyami7
BURNOUT AND JOB SATISFACTION AMONG HEALTH CARE PROVIDERS AT SAUDI ARABIA: SYSTEMATIC REVIEW
The purpose of this systematic review is to investigate the prevalence, risk factors, and impact of burnout on job satisfaction among Saudi healthcare providers, with a focus on the implications for patient care and the overall healthcare environment. According to the literature, unstable working conditions, high productivity demands, and inadequate workplace assistance all lead to mental health issues for healthcare personnel, reducing job satisfaction and service quality. Job satisfaction is critical for patient safety, whereas burnout, which is defined by emotional weariness, depersonalization, and a lack of personal accomplishment, has a negative impact on job performance and patient outcomes. This review summarized findings from five empirical research published between 2020 and 2024, focusing not just on physicians but also on other healthcare professionals. The findings show a significant prevalence of burnout and low levels of job satisfaction across diverse Saudi healthcare settings. Burnout was significantly influenced by a high workload, stress, and gender dynamics. The findings highlight the critical need for comprehensive interventions that reduce burnout and increase job satisfaction through better management practices and support systems. This information is critical for healthcare policymakers and stakeholders looking to establish healthier work environments, which will contribute to better patient outcomes and healthcare services in Saudi Arabia.
Burnout Job, Satisfaction, Among Health Care, Providers.
Jhayer Neqa Alshammari1, Fahad Naqaa Alshammari2, Sabah Huthlul Alshammary3, Ghofran Abdulmusleh Alserhani4, Eman Abdullah Albalawi5, Rawan Abdulmusleh Alsarhani6
THE EFFECTIVENESS OF NURSE-LED PROGRAMS FOR ENHANCING PATIENT ENGAGEMENT AND SELF-MANAGEMENT IN CHRONIC DISEASE CARE AT SAUDI ARABIA: SCOPING REVIEW
Introduction: Chronic diseases are a huge global health burden that require effective management techniques. Nurse-led programs have emerged as a viable way to improve patient involvement and self-management in chronic disease treatment. Aim: This scoping review sought to map and synthesize available data on the efficacy of nurse-led interventions in improving these outcomes in Saudi Arabia. Methods: To find relevant papers published between 2022 and 2024, a comprehensive search approach was used across electronic databases (PubMed, Scopus, CINAHL, Web of Science, and Saudi Digital Library). The inclusion criteria included studies that focused on nurse-led interventions for patients with chronic conditions in Saudi Arabia, with results linked to patient engagement, self-management, or clinical improvements. Exclusion criteria included studies conducted outside of the required timeframe, population, or without nurse-led treatments. A standardized form was used for data extraction and synthesis, as well as theme analysis. Results: Five studies of which met the inclusion criteria. The data repeatedly show the effectiveness of nurse-led programs for a variety of chronic illnesses, including cardiovascular disease and diabetes. Nurse-led interventions were found to reduce cardiovascular-related hospital readmissions and emergency department visits, as well as improve blood pressure control and lipid profiles. In diabetes care, nurse-led patient education initiatives led to significantly increased medication adherence and better glycemic control. Several studies highlight nurses' vital role in providing individualized treatment, patient education, and emotional support, which leads to increased patient satisfaction, fewer hospital admissions, and a higher quality of life. Conclusion: Nurse-led initiatives have significant potential to improve patient involvement, self-management, and health outcomes in chronic illness treatment in Saudi Arabia. These interventions present a practical and successful strategy for enhancing patient care. This analysis argues that nurse-led initiatives require targeted policy reforms, budget allocation, and health-care system improvements to support their implementation and extension.
nurse-led interventions, patient participation, self-management, chronic conditions
Abdulrahman Munwer Al Shamry1, Arwa Sayel Al Shammari2, Bandr Dhidan Al Shammary3, Samia Mohammed Al Ameen Taleb4, Sawsan Nabeel Khateeb5, Seham Mohammed Alqawfi6, Shahad Omar Almeshabi7
TELEHEALTH READINESS AND ITS RELATED FACTORS AMONG HEALTH CARE PROVIDERS AT SAUDI ARABIA: SYSTEMATIC REVIEW
Introduction: Telemedicine and telehealth have revolutionized the healthcare industry by offering remote treatment services using telecommunications technology. While many nations have integrated these technologies to improve healthcare quality, many deployments encounter considerable challenges. Despite advances in telemedicine acceptability, significant gaps exist in understanding healthcare professionals' preparedness to utilize new technologies, notably in Saudi Arabia. Objective: The purpose of this systematic review was to analyze and map the current literature on telehealth readiness among Saudi healthcare practitioners, focusing on the factors that influence their willingness to use telehealth services. Methodology: A comprehensive search was carried out across numerous academic databases, including PubMed, Scopus, and Google Scholar, using preset keywords relevant to telehealth readiness. The inclusion criteria centered on peer-reviewed empirical research published between 2022 and 2024 that particularly evaluated telehealth preparation among Saudi healthcare practitioners. Results: Five relevant studies were discovered and evaluated. The findings revealed a general excitement for telehealth services among healthcare professionals; nevertheless, there were considerable knowledge gaps and impediments to effective implementation. Issues such as a lack of knowledge, insufficient training resources, and systemic issues hampered comprehensive telehealth integration. Notably, while pharmacists exhibited a high desire to participate in telepharmacy practices, other healthcare workers showed significant diversity in their comprehension and preparedness to utilize telehealth technology. Conclusion: The analysis reveals the potential for telehealth services among Saudi healthcare practitioners, as well as significant knowledge and infrastructure shortages. To ensure effective adoption, specific educational programs, supporting policies, and training resources are required to connect healthcare practitioners' skills with their favorable attitudes regarding telehealth. Addressing these problems is critical to attaining the healthcare goals established in Saudi Vision 2030, which will eventually improve patient care and accessibility across the region.
Telehealth Readiness, Related Factors Among, Health Care, Providers.
Bushara Kedar Hadad1, Fatmah Mohamed Alhamadi2, Manal Awad Aljohani3, Mehad Anwar Aljohani4, Noha Abdalrhman Abu Alola5, Sultan Aladham Alshammari6, Tahani Abdullah Bagasheer7
EVALUATING THE EFFICACY OF PROBIOTICS IN PREVENTING GESTATIONAL DIABETES MELLITUS IN SAUDI WOMEN: A RANDOMIZED CONTROLLED TRIAL
Background: Gestational Diabetes Mellitus (GDM) poses significant risks for maternal and neonatal health. Objective: To evaluate the efficacy of probiotics in preventing GDM among pregnant Saudi women. Methods: A randomized controlled trial was conducted involving 176 pregnant women from different Saudi hospitals. Participants were assigned to either a Probiotics or Placebo group. GDM incidence and glucose levels (FBG, OGTT 1hr, 2hr) were measured and analyzed. Results: The Probiotics group showed a significantly lower GDM incidence (22%) compared to the Placebo group (47%, p < 0.01). Fasting and post-glucose intake values were also significantly improved in the Probiotics group (p < 0.001). Conclusion: Probiotics significantly reduce GDM incidence and improve glycemic control, suggesting their potential as a non-pharmacological preventive strategy for GDM in Saudi women.
Gestational Diabetes Mellitus (GDM), Probiotics, Pregnancy, Saudi Arabia, Fasting Blood Glucose, OGTT, Randomized Controlled Trial, Maternal Health
Razan M. Abutalib, Dalal Bamohammed, Rahaf Algrafi, Refan Almowalad, Sheren Saleh, Shahad Alharbi, Aisha Albeladi, Aseel Al Moutiri, Muna Abu Alkhair, Sultana Khan, Raghad N. Alruwaili, Nibras Mustafa Ibrahim Abdelqader, Ibtihaj Alruwaili, Rozan Radwan