The Journal of Advanced Research in the East Mediterranean (JAREM) is a peer-reviewed, multidisciplinary academic journal dedicated to advancing research across various fields relevant to the East Mediterranean region. The journal serves as a platform for scholars, researchers, and professionals to publish high-quality studies that contribute to scientific, medical, social, and technological advancements. JAREM is committed to promoting open-access knowledge exchange and fostering collaborations within the academic community.
Cutting the Risk: Surgical Site Infection Predictors in Major Abdominal Surgery
Section: Articles Keywords: Surgical Site Infection, Abdominal Surgery, Risk Factors, Perioperative Care, Infection Control Surgical site infections (SSI) remain among the most costly and preventable postoperative complications. This prospective cohort study evaluated predictors of SSI following major elective abdominal surgery. Between 2022 and 2024, 782 patients undergoing colorectal, hepatobiliary, or complex gastrointestinal surgery were followed for 30 days. SSI was defined using standardized criteria and categorized as superficial, deep, or organ-space. Overall SSI incidence was 11.6% (n=91), with organ-space infections accounting for 34.1% of SSIs. Independent predictors included operative time >180 minutes (aOR 2.4; 95% CI 1.5–3.9; p<0.001), perioperative hypothermia (<36°C) (aOR 1.8; p=0.01), and diabetes mellitus (aOR 1.9; p=0.006). Appropriate prophylactic antibiotics within 60 minutes before incision reduced SSI risk by 29.3% (p=0.02), while postoperative glycemic control (mean glucose <180 mg/dL in first 48h) was associated with lower SSI rates (8.7% vs 14.9%; p=0.01). A risk stratification model using five variables (operative time, wound class, diabetes, hypothermia, transfusion) showed AUC 0.82, sensitivity 76.4%, specificity 74.1%. These results support targeted perioperative bundles focusing on timing of prophylaxis, temperature maintenance, and strict glucose control to reduce SSI rates in high-risk abdominal surgery populations.
Surgical Site Infection, Abdominal Surgery, Risk Factors, Perioperative Care, Infection Control
Copyright (c) 2026 Journal of Advanced Research -EMR
The Silent Liver: Metabolic Syndrome and the Hidden Burden of Non-Alcoholic Fatty Liver Disease
Section: Articles Keywords: NAFLD, Metabolic Syndrome, Obesity, Liver Disease, Diabetes Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver disease worldwide. This study investigated the relationship between metabolic syndrome components and the prevalence of NAFLD among adults attending primary healthcare clinics. A cross-sectional study involving 1,540 participants aged 30–65 years was conducted between 2022 and 2024. Liver ultrasound and metabolic assessments were performed. NAFLD was detected in 34.7% of participants. Individuals with obesity had a 2.9-fold increased risk, while patients with diabetes had a 3.4-fold increased risk of NAFLD. Elevated triglyceride levels and hypertension were also significantly associated with disease development. The study highlights NAFLD as a growing metabolic health challenge requiring early detection and lifestyle intervention.
NAFLD, Metabolic Syndrome, Obesity, Liver Disease, Diabetes
The Sugar That Speaks: Early Metabolic Signals Predicting Cardiovascular Events in Young Adults with Type 2 Diabetes
Section: Articles Keywords: Type 2 Diabetes, Cardiovascular Risk, Metabolic Syndrome, HbA1c, Young Adults Cardiovascular disease remains the leading cause of mortality among patients with type 2 diabetes. However, early metabolic predictors of cardiovascular events among young adults with diabetes remain poorly characterized. This prospective cohort study evaluated metabolic biomarkers associated with early cardiovascular risk among adults aged 25–45 years with type 2 diabetes. A total of 1,086 patients were enrolled from three tertiary hospitals between 2021 and 2024. Participants were followed for 36 months. Clinical parameters including HbA1c, triglycerides, LDL cholesterol, inflammatory markers, and insulin resistance indices were analyzed. During follow-up, 14.3% of participants developed cardiovascular events, including myocardial infarction, unstable angina, or ischemic stroke. Patients with HbA1c ≥8.5% had a 2.8-fold increased risk of cardiovascular events (95% CI: 1.9–4.2). Elevated triglyceride levels above 200 mg/dL were associated with 2.1-fold increased risk. Multivariate analysis identified insulin resistance index, systemic inflammation (CRP), and triglyceride levels as the strongest predictors of early cardiovascular complications. Patients with combined metabolic risk factors had a threefold higher probability of cardiovascular events. These findings highlight the importance of aggressive metabolic control in young adults with diabetes and support early cardiovascular risk stratification strategies in clinical practice.
Type 2 Diabetes, Cardiovascular Risk, Metabolic Syndrome, HbA1c, Young Adults
A Pressure Without Pain: Early Detection of Silent Glaucoma Using Optical Coherence Tomography
Section: Articles Keywords: Glaucoma, OCT, Optic Nerve, Early Detection, Retinal Nerve Fiber Layer Glaucoma remains one of the leading causes of irreversible blindness worldwide. Early detection is essential because significant retinal nerve fiber layer damage may occur before visual symptoms appear. This diagnostic accuracy study assessed the ability of optical coherence tomography (OCT) to detect early glaucoma in asymptomatic individuals. A total of 842 adults undergoing routine eye examinations were included. OCT measurements of retinal nerve fiber layer thickness and ganglion cell complex were analyzed. Early glaucoma was confirmed in 214 participants (25.4%). The OCT-based detection model achieved sensitivity of 86.3% and specificity of 88.1%, with an area under the ROC curve of 0.91. Patients with RNFL thickness <82 µm had a 4.7-fold increased risk of early glaucoma. The study demonstrates that OCT screening can detect structural optic nerve damage before clinical symptoms develop, emphasizing the importance of incorporating imaging-based screening programs into routine ophthalmic practice.
Glaucoma, OCT, Optic Nerve, Early Detection, Retinal Nerve Fiber Layer
Digital Eye Strain and the Hidden Epidemic of Dry Eye Among University Students
Section: Articles Keywords: Digital Eye Strain, Dry Eye Disease, Screen Exposure, Ocular Surface, Students Digital eye strain (DES) has emerged as a major public health concern in the era of intensive screen exposure. This study investigated the association between prolonged digital device use and the prevalence of dry eye disease among university students. A cross-sectional multicenter survey involving 1,312 students aged 18–28 years was conducted across three universities. Participants completed validated symptom questionnaires including the Ocular Surface Disease Index (OSDI), while clinical assessments included tear breakup time (TBUT), Schirmer test, and corneal staining evaluation. Daily screen exposure was categorized into <4 hours, 4–6 hours, and ≥6 hours. The prevalence of symptomatic digital eye strain was 46.8%, while clinically diagnosed dry eye disease was present in 32.5% of participants. Students with ≥6 hours of daily screen exposure showed significantly lower TBUT values (5.9 ±2.3 seconds) compared with those using screens <4 hours (8.1 ±2.7 seconds, p<0.001). Meibomian gland dysfunction was detected in 41.2% of high-exposure participants. Logistic regression analysis demonstrated that prolonged screen use increased the odds of dry eye disease by 2.31 times (95% CI: 1.84–2.89). Female gender, reduced blinking frequency, and air-conditioned environments were also independent predictors of disease. The findings highlight digital eye strain as a growing environmental and behavioral risk factor for ocular surface disorders. Preventive strategies such as screen-time regulation, blink training, and artificial tear supplementation may significantly reduce the burden of digital eye disease in young populations.
Digital Eye Strain, Dry Eye Disease, Screen Exposure, Ocular Surface, Students
The Drop That Slows the Fall: Real-World Atropine Strategy for High Myopia Progression in Adolescents
Section: Articles Keywords: Atropine, High Myopia, Axial Length, Myopia Control, Pediatric Ophthalmology High myopia is one of the fastest growing causes of visual impairment globally, particularly among adolescents. This study evaluated the long-term effectiveness and safety of low-dose atropine therapy in slowing myopia progression in adolescents with high myopia. A prospective multicenter observational study was conducted between 2022 and 2025 across three ophthalmology clinics. A total of 524 adolescents aged 10–16 years with baseline spherical equivalent ≤ −6.00 diopters were enrolled. Participants received nightly 0.01% atropine eye drops, and were followed for 24 months. Primary outcomes included changes in spherical equivalent (SE) and axial length (AL). Secondary outcomes included adverse effects, treatment adherence, and visual performance. Results demonstrated that annual myopia progression decreased significantly from −0.92 ±0.41 D/year before treatment to −0.37 ±0.29 D/year during therapy, representing a 59.8% reduction in progression (p <0.001). Axial length elongation decreased from 0.36 mm/year to 0.18 mm/year (50% reduction). Treatment adherence exceeded 86%, while mild photophobia was reported in 17.4% of patients and near-vision blur in 9.2%. Only 4.6% discontinued treatment due to side effects. Subgroup analysis showed stronger treatment response among patients aged 10–13 years, with a 63% reduction in myopia progression compared with 49% in older adolescents. No serious ocular or systemic adverse effects were recorded. The findings support low-dose atropine as an effective and safe strategy for controlling high myopia progression in adolescents. Early initiation of treatment appears to provide the greatest benefit. Integrating atropine therapy into pediatric ophthalmology protocols may significantly reduce future risks of retinal detachment, myopic maculopathy, and glaucoma.
Atropine, High Myopia, Axial Length, Myopia Control, Pediatric Ophthalmology
Silent Disruptions: Predicting Post-Thyroidectomy Hypocalcemia Through Early Postoperative Electrolyte Patterns
Section: Articles Keywords: Thyroidectomy, Hypocalcemia, Calcium dynamics, PTH, Surgery outcomes Background: Hypocalcemia remains the most common complication after total thyroidectomy, with incidence ranging from 15% to 35%. Timely prediction may reduce morbidity and hospital stay. Objective: To determine whether early postoperative calcium-phosphate dynamics can reliably predict hypocalcemia within 48 hours of surgery. Methods: A prospective cohort of 482 thyroidectomy patients was evaluated between 2021 and 2024. Serum calcium, phosphate, magnesium, and parathyroid hormone (PTH) levels were measured preoperatively and at 6, 12, and 24 hours postoperatively. Symptomatic hypocalcemia was defined by standard clinical criteria. Results: Postoperative hypocalcemia occurred in 28.4% of patients. A 24-hour calcium drop ≥ 0.9 mg/dL predicted hypocalcemia with sensitivity 84% and specificity 78% (AUC 0.89). PTH <15 pg/mL at 6 hours had sensitivity 81% and specificity 73%. Combining calcium and PTH improved AUC to 0.93. Serum phosphate elevation (>4.8 mg/dL) at 12 hours was independently associated with hypocalcemia (OR 2.4, 95% CI 1.6–3.9). Early replacement therapy reduced symptom duration by 38%. Conclusion: Early postoperative calcium-phosphate fluctuations provide a reliable, rapid method for predicting hypocalcemia after thyroidectomy. Combining calcium drop and PTH enhances predictive accuracy and supports individualized supplementation strategies.
Thyroidectomy, Hypocalcemia, Calcium dynamics, PTH, Surgery outcomes
Copyright (c) 2025 Journal of Advanced Research -EMR
Unmasking the Hidden Burden: Early Renal Microvascular Injury in Prediabetes Using Urinary Biomarkers
Section: Articles Categories: Close Acess Keywords: Prediabetes, Biomarkers, Kidney injury, Microalbuminuria, Internal medicine Background: Prediabetes is traditionally viewed as a reversible metabolic stage, yet emerging evidence suggests microvascular damage may begin before overt diabetes. Early renal injury remains poorly characterized. Objective: To assess the prevalence of early renal microvascular dysfunction in prediabetic adults using novel urinary biomarkers. Methods: A cross-sectional analysis of 624 adults aged 25–55 was conducted between 2022 and 2024. Participants were classified as prediabetic (n = 372) or normoglycemic controls (n = 252). Urinary neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 (KIM-1), and microalbuminuria were quantified. Renal resistive index (RRI) was measured through Doppler ultrasound. Results: Elevated uNGAL (>20 ng/mL) was found in 46.2% of prediabetic subjects versus 11.5% of controls (p < 0.001). KIM-1 levels were 1.9-fold higher in prediabetics (1.14 ± 0.32 vs 0.60 ± 0.21 ng/mL, p < 0.001). Microalbuminuria prevalence was 18.8% in prediabetics compared with 4.2% in controls (p < 0.001). RRI exceeded 0.70 in 29.3% of prediabetic participants, correlating significantly with HbA1c (r = 0.42). Combining biomarkers (uNGAL + KIM-1) achieved an AUC of 0.87 for early renal injury detection. Conclusion: Nearly half of prediabetic adults exhibit biomarker evidence of renal microvascular injury, suggesting kidney damage begins earlier than expected. Screening with urinary biomarkers may facilitate earlier intervention.
Prediabetes, Biomarkers, Kidney injury, Microalbuminuria, Internal medicine
Association Between Digital Eye Strain and Academic Performance Among Clinical-Year Medical Students at the University of Bahri, Khartoum State, Sudan, 2025.
Section: Articles Keywords: : Digital eye strain, clinical-year medical students, visual hygiene, screen time, academic performance https://doi.org/10.5281/zenodo.17857798 Digital eye strain (DES) is a growing occupational and academic issue among clinical-year medical students, driven by prolonged screen exposure during both theoretical learning and clinical training. Symptoms such as eyestrain, ocular dryness, headaches, and musculoskeletal discomfort may impair concentration, reduce productivity, and negatively influence academic outcomes. Methodology: A cross-sectional study was conducted among 272 clinical-year medical students at the University of Bahri. Data were obtained using a validated electronic questionnaire assessing DES symptoms, visual-hygiene practices (screen duration, frequency of breaks, posture, and lighting conditions), and self-reported academic performance measured by GPA. Students from all three clinical years were included to ensure representativeness. Results: The most frequently reported symptoms were eyestrain (64.3%), eye dryness (51.1%), headaches (49.3%), and neck/shoulder/back pain (41.5%). Prolonged screen use, suboptimal posture, and limited adherence to visual-hygiene behaviors such as the 20-20-20 rule were significantly associated with higher DES severity. Increased symptom severity was correlated with lower GPA, demonstrating a measurable impact on academic performance. These findings align with the study objectives by identifying the prevalence of symptoms, contributing factors, and their academic implications. Conclusion: DES is highly prevalent among clinical-year medical students and is strongly influenced by modifiable behavioral and ergonomic factors. The observed association between symptom burden and academic performance highlights the importance of structured preventive measures. Implementing visual-hygiene education, ergonomic training, and integrating DES awareness into the medical curriculum may help reduce symptom severity and improve learning outcomes. Future research should explore long-term DES impacts and evaluate the effectiveness of targeted preventive interventions.
: Digital eye strain, clinical-year medical students, visual hygiene, screen time, academic performance
The Effect of Night Study Patterns on Academic Performance among Medical Students at Bahri University, Khartoum State, Sudan, 2025.
Section: Articles Keywords: Night study; Medical students; Academic performance; Sleep; Daytime sleepiness; Sudan Doi : https://doi.org/10.5281/zenodo.17849719 Background : Medical students often adopt night-time study habits to cope with heavy academic loads and long curricula. While many believe that studying at night improves focus and productivity, the real impact of these patterns on academic performance and well-being is still unclear, especially in Sudanese medical schools. Objectives: To assess the prevalence of night study habits among final-year medical students at Bahri University and to examine their association with academic performance, sleep, mood, stress, and sociodemographic characteristics. Methods: A descriptive cross-sectional study was conducted among 71 final-year medical students at Bahri University, Khartoum State, Sudan, in 2025. Data were collected using a structured questionnaire covering sociodemographic characteristics, study and sleep patterns, academic performance (GPA, failed courses, satisfaction), and indicators of well-being (daytime sleepiness, mood changes, stress). Associations between night study habit (yes/no) and outcome variables were analyzed using Chi-square tests and comparison of means, with a significance level of p < 0.05. Results: More than half of the students (54.9%) reported primarily studying at night. The overall mean age was 24.3 ± 3.4 years, and most participants were female (54.9%), single (64.8%), and in their fifth year of study (60.6%). Night studiers had a significantly higher mean GPA than non-night studiers (3.3 ± 0.5 vs. 2.9 ± 0.6, p = 0.002) and were more likely to have no failed courses (94.9% vs. 71.9%, p = 0.024). Although academic satisfaction did not differ significantly (p = 0.115), a larger proportion of night studiers were satisfied or very satisfied with their performance (61.5% vs. 40.6%). Night studiers slept an average of 4.9 ± 1.8 hours per night and studied past midnight on 4.2 ± 1.9 nights per week. They reported lower rates of daytime sleepiness (17.9% vs. 84.4%, p < 0.001) and fewer mood changes (59.0% vs. 87.5%, p = 0.008). Stress levels were high overall (50.7% “stressful/very stressful”), with no significant difference between groups (p = 0.064). No significant associations were found between night study and gender, year of study, residence, or marital status (all p > 0.05). Conclusion: In this sample of final-year medical students, night study was common and was associated with higher GPA and fewer failed courses, despite markedly reduced sleep duration. Night studiers also reported less daytime sleepiness and fewer mood changes, suggesting possible adaptation to nocturnal study patterns. However, given the cross-sectional, self-reported data and small sample size, these findings should be interpreted cautiously. Educational programs should promote balanced study routines that support both academic success and adequate sleep, and future studies with larger samples and objective sleep measures are recommended. Keywords: Night study; Medical students; Academic performance; Sleep; Daytime sleepiness; Sudan
Night study; Medical students; Academic performance; Sleep; Daytime sleepiness; Sudan
Prevalence and Determinants of Placental Malaria in Gezira State, Sudan: The Role of Demographic, Clinical, and Socioeconomic Factors
Section: Articles Keywords: placental malaria; Plasmodium falciparum; pregnancy; Sudan; Gezira State; risk factors; histology; antenatal care; insecticide-treated nets. Background: PLacental malaria (PM) due to Plasmodium falciparum remains a significant cause of maternal anaemia, low birth weight (LBW), preterm birth, and perinatal mortality in malaria-endemic regions, particularly in sub-Saharan Africa.[1–4] The burden of malaria in pregnancy (MiP) varies with transmission intensity, parity, age, and socioeconomic conditions.[1,5–7] In Sudan, several hospital-based studies have documented high PM prevalence and important regional variation,[8–11] but data from Gezira State remain limited. This study estimated the prevalence of PM in Gezira and explored demographic, clinical, and socioeconomic determinants. Methods: A cross-sectional hospital-based study was conducted from January to December 2021 in three central localities of Gezira State (Wad Medani, Hasahesa, and Almanagil). Consecutive women with singleton pregnancies delivering at selected public facilities were enrolled (n = 275). A structured questionnaire and record review captured information on age, parity, education, residence, antenatal care (ANC) utilisation, insecticide-treated net (ITN) use, body mass index (BMI), and obstetric history. Peripheral maternal blood and cord blood were examined by microscopy, and placental biopsies were examined histologically and classified as no infection, active, active-chronic, or past-chronic infection. Placental malaria for analysis was defined as any histological evidence of infection. Associations were explored using chi-square tests and multivariate logistic regression. Results: The mean maternal age was 28.06 years (median 28; range 21 years). Age group, parity, education level, and place of residence were all significantly associated with malaria status in bivariate analyses (p < 0.001 for age, parity, and education; p = 0.008 for residence). Overall, 40.0% of women had peripheral parasitaemia and 40.0% had cord blood parasitaemia. Placental histology revealed that 20.0% had active infection, 20.0% had active-chronic infection, and 20.0% had past-chronic infection, yielding a cumulative histological PM prevalence of 60.0%. ITN use (reported by 60.0% of women) was not associated with malaria status (p = 1.0). In multivariate logistic regression, age remained a strong independent predictor of PM (β = 0.4236, p < 0.001), while parity was not significant (β = −0.0747, p = 0.515). The highest infection burdens were observed in women aged 26–35 years with parity 2–3. None of the women classified as overweight had malaria, whereas 50.0% of women with normal BMI were infected. Conclusion: Placental malaria is highly prevalent among women delivering in Gezira State, with histology revealing a 60% cumulative infection burden despite relatively high ANC attendance and self-reported ITN use. Age was the dominant independent predictor, and the expected protective effect of increasing parity was not seen after adjustment. The findings highlight the influence of socio-environmental conditions and gaps in the quality of preventive services, and suggest that MiP control strategies in Gezira should extend beyond primigravidae to include older multigravid women
placental malaria; Plasmodium falciparum; pregnancy; Sudan; Gezira State; risk factors; histology; antenatal care; insecticide-treated nets.
Nosiba Nosiba Abd Alraheem Aljack Awad Alkareem
The Impact of Fear of Missing Out (FOMO) and Social Comparisons on Clinical Medical Students at University of Bahri 2025
Section: Articles Keywords: Fear of Missing Out; Social Comparison; Coping Strategies; Medical Students; Mental Health; Sudan Doi : https://doi.org/10.5281/zenodo.17844213 Background: Fear of Missing Out (FOMO) is a modern psychological phenomenon characterized by anxiety over being excluded from rewarding experiences, particularly through social media exposure. Among medical students, the combination of academic pressure and continuous online engagement can intensify FOMO, affect mental well-being, and shape social comparison behaviors. Objectives: This study assessed the prevalence of FOMO among clinical medical students at the University of Bahri, examined its relationship with social comparison and coping strategies, and explored gender differences in these patterns. Methods: A descriptive cross-sectional study was conducted from August to September 2025 among 251 fourth-, fifth-, and sixth-year medical students. Data were collected via a structured online questionnaire measuring FOMO, social comparison, and cognitive, emotional, behavioral, and maladaptive coping. Sampling was stratified by academic year, and data were analyzed using SPSS v26. Descriptive statistics, Cronbach’s α reliability, and Mann–Whitney U tests were applied with a significance level of 0.05. Results: The mean FOMO score was 18.9 ± 6.8, indicating moderate levels, while social comparison averaged 16.8 ± 4.1. Many students reported anxiety when peers enjoyed events without them and frequently monitored others online. Males scored higher in social comparison (p = 0.040), whereas females scored higher in cognitive (p < 0.001), emotional (p = 0.001), and maladaptive coping (p = 0.008) scores, though overall FOMO did not differ by gender (p = 0.761). Cognitive coping predominated (63.7% focused on personal goals), while emotional and behavioral coping were less utilized. Conclusion: Moderate FOMO and active social comparison were prevalent among students, reflecting the psychological strain of digitally connected academic life. Targeted digital wellness programs that foster resilience, media literacy, and adaptive coping are essential to safeguard students' mental health and academic performance.
Fear of Missing Out; Social Comparison; Coping Strategies; Medical Students; Mental Health; Sudan
Quality of Life in Sudanese Systemic Lupus Erythematosus Patients: A Cross-Sectional Study
Section: Articles Keywords: : Systemic lupus erythematosus; Quality of life; SF-36; SLEDAI; Disease activity; Sudan. Doi : 10.5281/zenodo.17843636 Background Systemic lupus Erythematosus (SLE) is a multisystem autoimmune disease predominantly affecting women of childbearing age. Its broad range of clinical manifestations and relapsing-remitting course can severely impact patients’ health-related quality of life (HRQoL). There is limited data on HRQoL in SLE patients in Sudan. Objectives: To evaluate the quality of life of Sudanese SLE patients attending a rheumatology clinic and assess the influence of disease activity and socio-demographic factors on HRQoL. Methods: We conducted a descriptive observational cross-sectional study among 81 SLE outpatients at Haj Alsafi Teaching Hospital (Khartoum, Sudan) from 2022–2023. All patients met the American College of Rheumatology classification criteria for SLE. HRQoL was measured using the Short Form-36 (SF-36) questionnaire, yielding Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Disease activity was assessed by the SLE Disease Activity Index (SLEDAI) and a patient-reported Quick SLE Activity Questionnaire (Q-SLAQ). Sociodemographic data were collected via interviews. Data were analyzed using SPSS v26. Descriptive statistics, univariate linear regression, Mann–Whitney U, and Kruskal–Wallis tests were used to examine associations between patient factors and SF-36 domain scores. A p-value < 0.05 was considered statistically significant. Results: The cohort was 98.8% female (80/81) with a mean age of 34.8 ± 11.2 years. Overall SF-36 scores were modestly reduced: mean PCS was 49.8 ± 5.3 and MCS 47.6 ± 4.1 (on a 0–100 scale), indicating mild impairment. Most patients (98.8%) fell in the “less disability” range (SF-36 score 81–100). Common symptoms included fatigue (81% of patients) and musculoskeletal pain, and 55.6% of patients had high disease activity by Q-SLAQ. Older age was associated with worse physical functioning and vitality (fatigue) scores (p = 0.005 and p = 0.032, respectively). Higher disease activity was significantly correlated with lower scores in nearly all SF-36 domains (p < 0.05). Patients residing in rural areas reported significantly poorer overall QoL than those in urban areas (p < 0.001). Unemployed patients had more physical role limitations and lower energy/emotional well-being compared to employed patients (p = 0.040 and p = 0.026). Educational level and disease duration showed no significant correlation with HRQoL, although patients with longer disease tended toward lower scores. Notably, patients adherent to treatment had better physical health scores than non-adherent patients. Conclusions: Sudanese SLE patients experience impaired HRQoL, particularly in physical health domains. Increased age and active disease are associated with poorer QoL, whereas better outcomes are seen with effective disease control and treatment compliance. Socioeconomic factors such as unemployment, lower education, and rural residence may further compromise quality of life. Interventions aimed at stringent disease control and improved support for SLE patients : including access to medications, education, and psychosocial support : are recommended to enhance HRQoL in this population.
: Systemic lupus erythematosus; Quality of life; SF-36; SLEDAI; Disease activity; Sudan.
Advancing Forensic Medicine Through Legislative Reform and Institutional Modernization: Toward Global Standards of Practice
Section: Articles Keywords: : forensic medicine, Sudan, legal framework, forensic reforms . He forensic medicine system continues to face deep structural challenges arising from the absence of a comprehensive legal and regulatory framework. Deficiencies in policies governing evidence collection, preservation, chain-of-custody procedures, and accountability mechanisms have undermined adherence to international forensic standards. Political interference and administrative fragmentation further compromise the reliability, transparency, and independence of forensic investigations. This study adopts a qualitative exploratory approach, integrating the professional and field-based insights of a forensic consultant with a thematic review of policy documents, academic literature, and non-governmental reports. The analysis focuses on identifying systemic gaps, ethical violations, and operational inefficiencies, while comparing national practices with international forensic standards to propose feasible reforms. Findings reveal a backlog of approximately 4,000 unidentified bodies accumulated in major morgues between 2019 and 2023, with fewer than 50 autopsies conducted during that period. The causes include inadequate legal authority for forensic operations, limited infrastructure, outdated training curricula, and a severe shortage of skilled personnel. Modernizing curricula, introducing certification systems, and implementing standardized evidence-handling protocols could reduce this backlog by nearly 75%. The study concludes that comprehensive legislative reform and the establishment of independent oversight mechanisms are critical to strengthening forensic governance, improving operational efficiency, and restoring public confidence. Aligning forensic practice with global standards is vital not only for justice delivery but also for supporting transitional justice and human rights accountability
: forensic medicine, Sudan, legal framework, forensic reforms .
Optimizing Radiology Through AI: A New Frontier in Workload Reduction
Section: Articles Categories: Close Acess BACKGROUND: Rapidly increasing imaging volumes and workforce shortages have placed radiology under mounting strain. Artificial intelligence (AI) solutions ranging from triage algorithms to automated reporting have been proposed to optimize workflow, reduce reading burden, and maintain diagnostic quality. Objectives: This systematic review aimed to evaluate the quantitative impact of AI on radiologist workload and efficiency, identify the most effective AI applications, and outline implementation challenges. Methods: A systematic search of PubMed and Google Scholar (2012–2025) identified original studies assessing AI interventions in clinical radiology with measurable workload outcomes. Eligible studies included randomized, cohort, and simulation designs. Twelve studies met inclusion criteria, spanning mammography, tomosynthesis, prostate MRI, ultrafast MRI, and chest radiography. Data were narratively synthesized. Results:AI integration consistently decreased radiologist workload across modalities. In screening mammography, triage protocols reduced human reads by 40–70% while maintaining non-inferior sensitivity (≈70–90%) and lowering false-positive recalls by up to 25%. Meta-analytic data showed mean 27.2% faster reading times and 44–61% fewer cases requiring radiologist review. AI rule-out models for prostate MRI safely excluded up to 20% of normal scans, and ultrafast breast MRI achieved 15.7% workload and scanner time reduction with 98% sensitivity. Chest X-ray AI assistance improved detection and reduced reading time modestly. Across studies, diagnostic accuracy was preserved or slightly improved (+12% pooled sensitivity). Conclusion: Artificial intelligence markedly enhances radiology efficiency, particularly in screening workflows, achieving up to 50% workload reduction without loss of diagnostic integrity. Successful deployment depends on threshold calibration, local validation, and workflow integration to ensure safety, trust, and sustainable productivity gains.
Crimson Echoes: Hemodynamic Changes and Predictors of Postpartum Hemorrhage Using Doppler Flow Studies
Section: Articles Categories: Close Acess Keywords: Postpartum Hemorrhage, Doppler Ultrasound, Obstetrics, Predictive Model, Maternal Health Abstract Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, contributing to roughly 25–30 % of maternal deaths in low-resource settings. Traditional risk factors (e.g., uterine atony, hypertensive disorders) are well-known, but predictive hemodynamic changes before bleeding onset have not been fully characterized. Uterine artery Doppler indices may provide early insight into uteroplacental vascular conditions that predispose to hemorrhage. Objective: To evaluate the utility of uterine artery Doppler flow measurements at 36 weeks gestation as predictors of PPH and develop a predictive model combining Doppler metrics with clinical factors. Methods: In a prospective cohort of 986 pregnant women enrolled from three tertiary obstetric centers between 2022 and 2024, uterine artery Doppler ultrasound was performed at 36 weeks to record pulsatility index (PI) and resistance index (RI). Clinical variables included parity, hemoglobin, labor duration, and prior obstetric history. Outcomes of postpartum hemorrhage (≥ 1000 mL blood loss within 24h) were recorded. Logistic regression and ROC analysis were used to build predictive models. Results: The incidence of PPH in the cohort was 7.2 % (n = 71). Women who developed PPH had significantly lower mean uterine artery PI (0.57 ± 0.08) compared to non-PPH (0.65 ± 0.10), p < 0.001, and RI (0.78 ± 0.05 vs 0.84 ± 0.07, p < 0.001). A combined model incorporating PI, RI, parity ≥ 3, and labor duration > 12 hours achieved an AUC of 0.89 (95 % CI: 0.85–0.93), with sensitivity 82 %, specificity 80 %. In multivariable analysis, PI < 0.60 (OR = 3.5, 95 % CI 2.2–5.4), multiparity (OR = 2.1), and prolonged labor (OR = 1.8) remained independent predictors. Women in the top risk decile (predicted probability > 0.20) had a PPH incidence of 23 %, versus 3.4 % in the low-risk decile. Conclusion: Uterine Doppler flow indices measured in late pregnancy significantly predict risk of postpartum hemorrhage. When combined with clinical parameters, the model reliably stratifies patients at high risk. Incorporation of Doppler screening into routine antenatal assessment could enable preemptive measures (uterotonics, blood planning, monitoring) to reduce maternal morbidity and mortality.
Postpartum Hemorrhage, Doppler Ultrasound, Obstetrics, Predictive Model, Maternal Health
Scars of Precision: Predicting Postoperative Complications Using Artificial-Intelligence-Assisted Intraoperative Data
Section: Articles Categories: Close Acess Keywords: Artificial Intelligence, Surgery, Intraoperative Monitoring, Postoperative Complications, Predictive Modeling Background: Despite major advances in perioperative care, postoperative complications remain a major determinant of surgical morbidity and cost. Global data suggest that nearly 15 % of patients undergoing major surgery experience preventable adverse outcomes. Real-time analytics through artificial intelligence (AI) can transform intraoperative monitoring from passive observation into predictive decision-making. Objective: To develop and validate an AI-based predictive model for postoperative complications using continuous intraoperative physiological data and surgical variables. Methods: This multicenter prospective study analyzed 2,520 general surgical procedures performed across four academic hospitals between 2019 and 2023. Data streams from anesthesia monitors captured hemodynamic parameters every 10 seconds, including blood pressure, heart rate, temperature, and oxygen saturation. Additional variables included operative time, estimated blood loss, and intraoperative fluid balance. Gradient-boosting and long short-term memory (LSTM) neural-network models were trained on 70 % of the dataset and validated on 30 %. Performance metrics included area under the curve (AUC), sensitivity, and specificity. Results: Overall complication rate was 11.6 %. The LSTM model achieved superior accuracy with an AUC of 0.91 (95 % CI 0.89–0.93), sensitivity 87 %, and specificity 83 %, outperforming traditional logistic regression (AUC 0.78). The top predictors were prolonged intraoperative hypotension > 10 min (OR 3.1, p < 0.001), blood loss > 500 mL (OR 2.8, p < 0.001), and core temperature < 35 °C (OR 1.9, p = 0.02). Model deployment in the validation phase allowed real-time risk alerts, reducing unanticipated complications by 29 % and median hospital stay by 1.8 days (p = 0.01). Conclusion: AI-driven intraoperative analysis provides reliable early prediction of postoperative complications, enabling proactive interventions before surgical closure. Integration of predictive dashboards into operating-room systems may markedly improve safety, reduce costs, and redefine precision surgery.
Artificial Intelligence, Surgery, Intraoperative Monitoring, Postoperative Complications, Predictive Modeling
Shadows of the Mind: Quantitative MRI Markers of White Matter Integrity and Depression Severity
Section: Articles Categories: Close Acess Keywords: MRI, Diffusion Tensor Imaging, Depression, White Matter, Neuroimaging Biomarkers, Radiology Background: Major depressive disorder (MDD) is a highly prevalent psychiatric illness with complex neurobiological underpinnings. Increasing evidence suggests that MDD is linked to microstructural alterations in white-matter tracts, yet the quantitative neuroimaging correlates of depression severity remain insufficiently explored. Diffusion tensor imaging (DTI) provides a sensitive tool for assessing white-matter integrity through parameters such as fractional anisotropy (FA) and mean diffusivity (MD), which may serve as objective biomarkers of disease burden. Objective: This study aimed to evaluate DTI-derived FA and MD metrics as potential indicators of depression severity in patients with MDD compared with healthy controls. Methods: A total of 262 adults diagnosed with MDD and 120 age- and sex-matched healthy controls underwent 3-Tesla MRI scanning. FA and MD values were computed for major prefrontal and limbic white-matter tracts, including the cingulum, corpus callosum, and uncinate fasciculus. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D). Correlations between imaging parameters and clinical scores were analyzed using Pearson’s coefficients and receiver-operating-characteristic (ROC) analysis. Results: MDD participants exhibited a 12% reduction in mean FA values compared with controls (0.37 ± 0.04 vs 0.42 ± 0.03; p < 0.001), particularly within fronto-limbic circuits. FA values were inversely correlated with HAM-D scores (r = –0.58; p < 0.001), while MD was elevated by 9% in patients with severe depression. ROC analysis demonstrated high discriminative accuracy (AUC = 0.88; 95% CI 0.84–0.91), identifying FA < 0.38 as a threshold for moderate-to-severe MDD. Conclusion: Quantitative MRI using DTI detects subtle but clinically significant disruptions in white-matter integrity associated with depression severity. These findings support the potential use of DTI-based biomarkers for objective monitoring of disease progression and treatment response in MDD.
MRI, Diffusion Tensor Imaging, Depression, White Matter, Neuroimaging Biomarkers, Radiology
Beneath the Pulse: Hidden Patterns of Resistant Hypertension and Renal Microvascular Damage in Treated Patients
Section: Articles Categories: Close Acess Keywords: Resistant Hypertension, Renal Microvascular Damage, Doppler Ultrasound, Internal Medicine, Kidney Function Background: Resistant hypertension (RH) persists in 10–15% of treated hypertensive adults and is linked to subclinical kidney injury. Microvascular changes often precede overt dysfunction. Objective: To determine the prevalence of renal microvascular damage among RH patients and evaluate associated predictors. Methods: In this multicenter cross-sectional study (n = 842, mean age = 56 ± 9 years), hypertensive adults on ≥3 medications were enrolled. Renal Doppler resistive index (RRI) and microalbuminuria were measured. Logistic regression identified predictors of abnormal RRI (>0.7). Results: RH prevalence = 13.8%. Microvascular damage was detected in 41.6% (95% CI 37.9–45.2). Independent predictors were poor medication adherence (OR 2.9, p < 0.001), diabetes (OR 2.1, p = 0.01), and BMI > 30 kg/m² (OR 1.7, p = 0.04). Mean RRI correlated with systolic BP (r = 0.46, p < 0.001) and microalbuminuria (r = 0.51). Conclusion: Subclinical renal damage affects 4 in 10 patients with resistant hypertension. Routine Doppler evaluation should complement blood-pressure control strategies to prevent end-organ failure.
Resistant Hypertension, Renal Microvascular Damage, Doppler Ultrasound, Internal Medicine, Kidney Function
Asthma Prevalence and Management in Low-Resource Pediatric Settings: Identifying Gaps in Diagnosis and Treatment
Section: Articles Keywords: Asthma, Pediatrics, Low-resource settings, Diagnosis, Inhaled corticosteroids, Caregiver knowledge, Systematic review Asthma is one of the most common chronic diseases in childhood and a major cause of morbidity worldwide. In low- and middle-income countries (LMICs), its diagnosis and management remain particularly challenging due to limited diagnostic tools, poor access to essential medicines, and caregiver knowledge gaps. Objectives: To systematically review the prevalence, diagnostic barriers, management practices, and interventions for pediatric asthma in LMICs and underserved populations. Methods: This review followed PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies published between 2005 and 2025. Eligible studies included children aged 0–18 years and reported on prevalence, diagnosis, treatment, caregiver perceptions, or interventions. Two reviewers independently screened and extracted data. Study quality was appraised using JBI, AMSTAR-2, CASP, or RoB-2 tools as appropriate. Findings were synthesized narratively due to heterogeneity. Results: Twenty-five studies met inclusion criteria. Reported prevalence varied from 2% to 20%, with pooled estimates in India at 7.9% and underdiagnosis rates as high as 68% in Georgia. Diagnostic barriers included poor access to spirometry (available in <20% of facilities) and frequent misdiagnosis as pneumonia. Management gaps were characterized by low inhaled corticosteroid (ICS) use (<30%), reliance on oral medications, and poor adherence. Caregiver misconceptions, stigma, and limited health literacy further compromised outcomes. Interventions such as caregiver education, school-based programs, and spirometry training improved asthma control but were small in scale and lacked long-term evaluation. Conclusion: Pediatric asthma in LMICs remains under-recognized and suboptimally managed. Strengthening health systems, improving access to affordable ICS, and scaling culturally adapted educational interventions are essential. Future priorities include implementation science and large-scale pragmatic trials to close persistent care gaps.
Asthma, Pediatrics, Low-resource settings, Diagnosis, Inhaled corticosteroids, Caregiver knowledge, Systematic review
Breaking the Cycle: Predicting 30-Day Readmission in Chronic Obstructive Pulmonary Disease Using Electronic Health Record Models
Section: Articles Categories: Close Acess Keywords: COPD, Readmission, Predictive Model, Internal Medicine, EHR Background: COPD is a leading cause of hospital readmissions worldwide, with 30-day rates often exceeding 20%. Accurate predictive models could reduce preventable readmissions. Objective: To develop an EHR-based predictive model for 30-day readmission in COPD patients. Methods: A retrospective cohort of 3,214 COPD patients hospitalized in France (2018–2022) was analyzed. Variables included age, comorbidities, prior admissions, medications, and spirometry. Logistic regression and random forest models were trained and validated. Model accuracy was measured with AUC, sensitivity, and specificity. Results: Thirty-day readmission occurred in 21.6% of cases. The random forest model outperformed logistic regression with AUC 0.87 (95% CI: 0.84–0.90), sensitivity 82%, and specificity 78%. Independent predictors included ≥2 admissions in prior year (OR: 2.4), comorbid heart failure (OR: 1.9), and low FEV1 (<50% predicted, OR: 2.7). Conclusion: EHR-based models can predict COPD readmission with high accuracy. Incorporating such tools into discharge planning could guide targeted interventions, reduce costs, and improve patient outcomes.
COPD, Readmission, Predictive Model, Internal Medicine, EHR
Whispers Before the Stroke: Evaluating Cognitive Decline as a Predictor of Silent Cerebral Infarcts in Elderly Populations
Section: Articles Categories: Close Acess Keywords: Silent Cerebral Infarct, Cognitive Decline, Elderly, Neurology, Stroke Risk Background: Silent cerebral infarcts (SCIs) are common among older adults and significantly increase the risk of dementia and stroke. Subtle cognitive decline may precede radiological detection, yet it is underutilized in clinical practice. Objective: To investigate whether early cognitive decline is a predictor of SCIs in elderly patients. Methods: A prospective cohort of 842 adults aged ≥65 years was followed at two neurology clinics in Germany between 2020–2024. Baseline cognitive testing (MMSE and MoCA) and MRI scans were performed. Participants were re-evaluated every 18 months for four years. Logistic regression models identified predictors of SCIs. Results: SCIs were detected in 29.4% of participants. Those with ≥2-point MMSE decline at baseline had 2.5 times higher odds of SCIs (OR: 2.5, 95% CI: 1.7–3.7, p < 0.001). MoCA decline of ≥3 points predicted SCIs with sensitivity 81% and specificity 74%. Hypertension (OR: 1.8, 95% CI: 1.3–2.6) and diabetes (OR: 1.5, 95% CI: 1.1–2.2) further increased risk. Conclusion: Subtle early cognitive decline is a strong predictor of SCIs in elderly patients. Combining cognitive screening with routine MRI may allow earlier detection and intervention to prevent dementia and overt stroke.
Silent Cerebral Infarct, Cognitive Decline, Elderly, Neurology, Stroke Risk
Scalpel vs. Scope: Comparing Outcomes of Open and Laparoscopic Appendectomy in Resource-Limited Hospitals
Section: Articles Categories: Close Acess Keywords: Appendectomy, Laparoscopy, Open Surgery, Surgical Outcomes, Resource-Limited Hospitals Background: Appendectomy remains one of the most frequently performed emergency surgeries worldwide. In high-resource settings, laparoscopic appendectomy is considered the gold standard due to reduced postoperative pain, shorter hospital stay, and lower infection rates. However, its adoption in resource-limited hospitals is hindered by concerns about cost, availability of equipment, and surgical expertise. Understanding the comparative outcomes of open versus laparoscopic appendectomy in such environments is essential for guiding policy and training. Objective: To compare postoperative outcomes between open and laparoscopic appendectomy in resource-limited hospital settings. Methods: A prospective multicenter study was conducted in three regional hospitals in Sudan between March 2022 and February 2024. A total of 640 patients diagnosed with acute appendicitis were included, of whom 358 underwent open appendectomy and 282 laparoscopic appendectomy. Data collected included operative time, length of hospital stay, wound infection rates, and readmissions within 30 days. Statistical analysis was performed using chi-square and logistic regression. Results: The laparoscopic group demonstrated significantly lower wound infection rates (6.1% vs. 14.9%, p < 0.01), reduced mean length of hospital stay (2.4 ± 0.7 vs. 4.1 ± 1.2 days, p < 0.001), and lower postoperative pain scores at 24 hours (mean 3.1 vs. 5.7, p < 0.001). Operative time was slightly longer in the laparoscopic group (68 vs. 59 minutes, p = 0.04). Readmission rates were lower among laparoscopic patients (3.2% vs. 7.5%, p < 0.05). Conclusion: Laparoscopic appendectomy provides superior postoperative outcomes compared to open surgery, even in resource-limited hospitals, though with modestly increased operative time. Scaling up laparoscopic capacity through equipment investment and surgeon training could significantly improve surgical outcomes in low-resource settings.
Appendectomy, Laparoscopy, Open Surgery, Surgical Outcomes, Resource-Limited Hospitals
Metabolic Shadows: Early Detection of Non-Alcoholic Fatty Liver Disease Using Combined Biomarkers and Ultrasound in Primary Care
Section: Articles Categories: Close Acess Keywords: NAFLD, Primary Care, Biomarkers, Ultrasound, Internal Medicine Background: Non-alcoholic fatty liver disease (NAFLD) is now recognized as the most common chronic liver disease globally, affecting nearly one in four adults. Despite its prevalence, NAFLD is often underdiagnosed in primary care, where opportunities for early intervention are frequently missed. Reliable, accessible tools for early detection are urgently needed to prevent progression to cirrhosis and hepatocellular carcinoma. Objective: To evaluate the diagnostic accuracy of a combined approach using serum biomarkers and liver ultrasound for early detection of NAFLD in primary care settings. Methods: A cross-sectional study was conducted between January and December 2023 in six primary care centers across northern Italy. A total of 1,120 adults aged 25–65 years without known liver disease underwent screening. Liver ultrasound was performed by trained radiologists, and serum biomarkers (ALT, AST, FIB-4 index, triglycerides) were measured. Logistic regression models and ROC curve analysis were used to assess predictive value. Results: The overall prevalence of NAFLD was 32.4%. Biomarkers alone achieved a diagnostic accuracy with AUC of 0.84 (95% CI: 0.81–0.87), while ultrasound alone yielded AUC 0.88 (95% CI: 0.85–0.90). The combined model (biomarkers + ultrasound) demonstrated superior performance, with AUC 0.91 (95% CI: 0.89–0.93), sensitivity 86.2%, and specificity 82.7%. Independent predictors of NAFLD included BMI ≥30 (OR: 2.9, p < 0.001), elevated triglycerides (OR: 2.2, p < 0.01), and ALT >40 U/L (OR: 2.6, p < 0.001). Conclusion: Integrating simple biomarker screening with liver ultrasound significantly improves early detection of NAFLD in primary care. This combined approach is feasible, cost-effective, and could be incorporated into routine health checks to prevent advanced liver disease.
NAFLD, Primary Care, Biomarkers, Ultrasound, Internal Medicine
Evaluating knowledge and skills in Transfusion medicine among faculty of medicine university of Khartoum graduates
Section: Articles Keywords: Transfusion medicine; medical education; knowledge and skills; curriculum reform; University of Khartoum; Sudan Doi : https://doi.org/10.5281/zenodo.17043474 BACKGROUND: The educational exposure to transfusion medicine within medical schools in Sudan is insufficient and lacks a standardized national curriculum. This deficiency has led to increase, often unnecessary, clinical use of blood transfusions and associated complications, underscoring the need for a comprehensive reform in medical training programs. The aim of this study is to assess the knowledge and skills of graduates from the Faculty of Medicine at the University of Khartoum regarding transfusion medicine. Methods: This cross-sectional analytical study was carried out at the Faculty of Medicine, University of Khartoum, between September and November 2022. A total of 108 graduates participated, and data were obtained through a pre-coded structured questionnaire. Quantitative analysis was performed using SPSS, applying descriptive statistics and chi-square tests, while qualitative responses were examined using thematic analysis. Results: The findings demonstrated variable levels of knowledge and skills among graduates, with notable deficiencies in emergency transfusion protocols and blood storage practices. Many participants emphasized the need for additional time dedicated to transfusion medicine training, particularly in the form of field-based exposure and hands-on practical sessions. Conclusions: The study identified critical gaps in knowledge of emergency transfusion protocols and blood storage, underscoring the urgent need for curriculum reform in transfusion medicine education. It recommends strengthening practical training, extending course coverage, and adopting more effective teaching strategies to ensure better preparedness of future healthcare providers.
Transfusion medicine; medical education; knowledge and skills; curriculum reform; University of Khartoum; Sudan
Puzzle Pieces of Progress: Jigsaw Peer Learning and Its Effects on Perception and Performance in a Primary Health Care Course
Section: Articles Keywords: : Jigsaw learning; cooperative learning; medical education; peer teaching; Saudi Arabia; ac-tive learning Doi : 10.5281/zenodo.17015801 CONTEMPORARY medical education increasingly embraces student-centered, collabo- rative pedagogies. The Jigsaw peer learning strategy, which fosters active participation and cooperative knowledge construction, has been adopted globally but remains under- evaluated within Saudi Arabian contexts. Aim: This study aimed to assess the impact of the Jigsaw learning technique on student comprehension, engagement, teamwork, and academic performance in a Primary Health Care course at Najran University. Methods: A mixed-methods cross-sectional study was conducted among 52 fourth-year male medical students. The Jigsaw method was integrated into a session on immunization. Quantitative data were collected via structured surveys and analyzed using descriptive statistics and chi-square tests. Open-ended responses provided qualitative insight into student experiences. Results: Approximately 63.5% of students reported improved understanding of immunization, and prior exposure to Jigsaw significantly enhanced perceived benefit (p = 0.02). Collaboration (65.4%), teamwork (59.6%), and knowledge acquisition (59.6%) were frequently cited gains, with academic performance improvements significantly linked to these perceptions (p = 0.000). While 42.3% reported better exam performance, 86.5% found Jigsaw equally or more effective than traditional lectures. A majority (63.5%) recommended its integration into other courses. Conclusion: The Jigsaw peer learning approach demonstrated clear educational value in enhancing cognitive and interpersonal outcomes among medical students. Although implementation challenges such as role imbal- ance and instructional clarity—were noted, these can be addressed through structured facilitation. Broader adoption and further research using diverse cohorts and objective performance metrics are recommended.
: Jigsaw learning; cooperative learning; medical education; peer teaching; Saudi Arabia; ac-tive learning
Severe respiratory failure is a leading cause of pediatric ICU admissions for pneumonia. Early identification of children at risk could improve survival and optimize resource allocation
Section: Articles Categories: Close Acess Keywords: Pediatric Pneumonia, Respiratory Failure, Early Warning Score, Predictive Model, Critical Care Background: Severe respiratory failure is a leading cause of pediatric ICU admissions for pneumonia. Early identification of children at risk could improve survival and optimize resource allocation. Objective: To evaluate the accuracy of an early warning algorithm combining clinical signs and laboratory markers for predicting severe respiratory failure in hospitalized children with pneumonia. Methods: A prospective multicenter cohort study was conducted in five tertiary pediatric hospitals in China from January 2022 to December 2023. A total of 1,024 children aged 1 month to 12 years with radiologically confirmed pneumonia were enrolled. Data on respiratory rate, oxygen saturation, work of breathing, CRP, and lactate were collected at admission. Severe respiratory failure was defined as the need for invasive mechanical ventilation within 48 hours of admission. Model performance was evaluated using ROC curves. Results: Severe respiratory failure occurred in 142 children (13.9%). The algorithm demonstrated an AUC of 0.92 (95% CI: 0.90–0.94), with sensitivity of 88.0% and specificity of 85.2%. Independent predictors included SpO₂ < 90% (OR = 4.6, p < 0.001), respiratory rate above age-specific thresholds (OR = 3.8, p < 0.001), and lactate > 2.0 mmol/L (OR = 2.9, p < 0.01). Early identification reduced median time to escalation of care by 3.5 hours (p < 0.001). Conclusion: An integrated early warning algorithm combining clinical and laboratory parameters can accurately predict severe respiratory failure in pediatric pneumonia. Incorporation into hospital triage systems could reduce ICU delays and improve outcomes.
Pediatric Pneumonia, Respiratory Failure, Early Warning Score, Predictive Model, Critical Care
Shadows Before Birth: Early Detection of Placental Insufficiency Using First-Trimester Doppler Indices
Section: Articles Categories: Close Acess Keywords: Placental Insufficiency, Doppler Ultrasound, Fetal Growth Restriction, First Trimester, Obstetrics Background: Placental insufficiency is a major cause of fetal growth restriction (FGR) and adverse perinatal outcomes. Early detection could enable timely interventions to improve fetal survival. Objective: To evaluate the predictive accuracy of uterine artery Doppler pulsatility index (PI) in the first trimester for detecting placental insufficiency and subsequent FGR. Methods: A prospective cohort study was conducted across three tertiary maternity centers in Italy from January 2022 to December 2023. A total of 612 pregnant women (11–14 weeks gestation) underwent uterine artery Doppler ultrasound. Outcomes measured included FGR (<10th percentile) and abnormal placental histology. PI thresholds were analyzed for predictive performance. Results: Placental insufficiency was diagnosed in 12.7% of pregnancies. A uterine artery PI >1.6 showed an AUC of 0.87 (95% CI: 0.83–0.90), sensitivity of 82.4%, and specificity of 81.1% for predicting FGR. Combination with maternal serum PAPP-A improved AUC to 0.91. Women with abnormal Doppler and low PAPP-A had a 5.3-fold increased risk of adverse perinatal outcomes. Conclusion: First-trimester uterine artery Doppler, especially when combined with biochemical markers, is a strong predictor of placental insufficiency and FGR. Incorporating this into routine screening could allow earlier risk stratification.
Placental Insufficiency, Doppler Ultrasound, Fetal Growth Restriction, First Trimester, Obstetrics
Timing is Tissue: Early vs. Delayed Fasciotomy in Acute Compartment Syndrome and Its Impact on Limb Salvage Rates
Section: Articles Categories: Close Acess Keywords: Acute Compartment Syndrome, Fasciotomy, Limb Salvage, Orthopedic Trauma, Surgical Timing Background: Acute compartment syndrome (ACS) is a surgical emergency where delayed decompression can lead to irreversible tissue damage, limb loss, and even death. The optimal timing for fasciotomy remains debated in resource-variable settings. Objective: To compare limb salvage rates, functional outcomes, and complication profiles between early (<6 hours) and delayed (>6 hours) fasciotomy in patients with ACS. Methods: A multicenter retrospective cohort study was conducted in four tertiary trauma centers in India from January 2020 to December 2023. A total of 312 patients (mean age 34.8 years; 72% male) with ACS confirmed by clinical and intracompartmental pressure measurement were included. Patients were grouped into early (n=186) and delayed (n=126) fasciotomy cohorts. Primary outcome was limb salvage rate at 3 months. Secondary outcomes included infection rates, reoperation rates, and functional recovery (Lower Extremity Functional Scale, LEFS). Results: Limb salvage rate was significantly higher in the early fasciotomy group (96.2%) compared to the delayed group (78.6%) (p < 0.001). Mean LEFS score at 3 months was higher in the early group (71.4 ± 6.3 vs. 58.9 ± 7.1, p < 0.001). Delayed fasciotomy was associated with a higher incidence of wound infection (22.2% vs. 10.8%, p = 0.01) and increased need for secondary reconstructive procedures. Conclusion: Early fasciotomy within 6 hours of ACS diagnosis significantly improves limb salvage and functional outcomes while reducing postoperative complications. Delays beyond this window markedly increase the risk of amputation and long-term disability.
Acute Compartment Syndrome, Fasciotomy, Limb Salvage, Orthopedic Trauma, Surgical Timing
Margins That Matter: Intraoperative Frozen Section Analysis to Reduce Positive Resection Margins in Breast-Conserving Surgery
Section: Articles Categories: Close Acess Keywords: Breast-Conserving Surgery, Frozen Section, Surgical Margins, Reoperation, Breast Cancer Background: Positive surgical margins in breast-conserving surgery (BCS) are associated with increased risk of local recurrence and the need for reoperation. Intraoperative frozen section analysis (IFSA) offers a real-time method to guide margin clearance, but its routine adoption remains inconsistent. Objective: To evaluate the impact of implementing routine IFSA on the rate of positive margins and reoperations in patients undergoing BCS for early-stage breast cancer. Methods: A prospective interventional study was conducted in two tertiary surgical centers in Germany between January 2022 and December 2023. A total of 482 patients undergoing BCS were included—241 before IFSA implementation (control) and 241 after (intervention). Positive margins were defined as tumor cells at the inked resection margin. Secondary outcomes included reoperation rates and operative time. Results: The positive margin rate decreased from 18.7% in the control group to 6.6% in the intervention group (p < 0.001). Reoperation rates dropped from 14.5% to 4.5% (p < 0.001). Mean operative time increased by 19 minutes (p = 0.02) in the IFSA group. The accuracy of IFSA was high, with sensitivity of 91.4% and specificity of 98.2%. Conclusion: Routine use of IFSA in BCS significantly reduces the rate of positive margins and reoperations, with only a modest increase in operative time. Surgical units should consider integrating IFSA into standard protocols for early-stage breast cancer.
Breast-Conserving Surgery, Frozen Section, Surgical Margins, Reoperation, Breast Cancer