La Presse Médicale is a peer-reviewed medical journal that publishes high-quality research, reviews, and case studies across various medical disciplines. It covers a broad range of topics, including internal medicine, surgery, gynecology, immunology, and public health. The journal serves as a key platform for advancing medical knowledge and clinical practice in the French-speaking medical community.
Diagnostic Accuracy of Interleukin-Based Biomarkers in Neo-natal Sepsis: A Systematic Review
Neonatal sepsis remains a leading cause of morbidity and mortality, especially in low-resource settings. While blood culture is the gold standard for diagnosis, its delayed results necessitate the use of adjunctive tools. Inflammatory biomarkers, particularly interleukins, are increasingly explored for early and accurate detection. Objective: To evaluate and synthesize the diagnostic accuracy of inflammatory biomarkers focusing on interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), C-reactive protein (CRP), and procalcitonin (PCT) in diagnosing neonatal sepsis across varying clinical and income settings. Methods: This systematic review included 30 studies assessing biomarker performance against blood culture or clinical sepsis criteria. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) values were extracted and compared across biomarkers and economic contexts. Results: IL-6 demonstrated sensitivity ranging from 54% to 94% and specificity from 65.7% to 100%, with AUC values between 0.793 and 0.988. PCT showed high diagnostic performance with sensitivity from 52.3% to 100%, specificity from 59% to 100%, and AUC values up to 1.00. CRP had broader variability (sensitivity: 48–98.9%; specificity: 52–100%; AUC: up to 0.998). IL-8 and IL-10 offered limited and inconsistent evidence, with IL-8 reported in fewer studies (sensitivity: 50–84%; AUC: 0.68) and IL-10 showing low sensitivity (17–43%) but high specificity (87–99%). Subgroup and Setting Analysis: In high-income settings, IL-6 and PCT consistently showed high diagnostic accuracy (sensitivity: 73.1–94%; specificity: 80.2–99%). In upper-middle-income countries, PCT and IL-6 maintained sensitivity at 100% and specificity at 96.5%. In lower-middle-income settings, CRP and PCT were the most frequently used, with diagnostic metrics comparable to those in wealthier regions. Conclusion: IL-6 and PCT emerge as the most accurate biomarkers for diagnosing neonatal sepsis across diverse economic settings, mainly when used in combination or serially. CRP remains a valuable alternative in resource-constrained environments. These findings support context-specific adoption of biomarker strategies to enhance early detection and clinical decision-making in neonatal sepsis.
Neonatal sepsis Inflammatory biomarkers Interleukin-6 (IL-6) Interleukin-8 (IL-8) Interleukin-10 (IL-10) C-reactive protein (CRP
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Tiny Airways, Big Clues: Lung Ultrasound for Predicting Severity in Pediatric Pneumonia
Background: Chest radiography remains the diagnostic standard for pneumonia, but it exposes children to radiation and may miss subtle early consolidation. Lung ultrasound (LUS) is radiation-free, portable, and highly sensitive. Objective: To evaluate the diagnostic and prognostic utility of LUS in predicting pneumonia severity in children. Methods: A prospective study of 412 children aged 2 months to 12 years was conducted between 2022 and 2024. LUS findings were compared with clinical severity scoring and chest radiography. Pleural line irregularities, subpleural consolidations, and B-line patterns were quantified. Results: LUS identified pneumonia in 89% of cases confirmed by X-ray and 11% missed by radiography. Consolidation size >1.5 cm and bilateral B-lines were strongly associated with severe disease (p < 0.001). LUS severity score ≥ 8 predicted oxygen therapy requirement with AUC 0.90. Severe cases had mean hospital stay of 6.8 ± 2.5 days compared to 3.1 ± 1.2 days in mild pneumonia (p < 0.001). Conclusion: LUS is a reliable, safe, and highly sensitive tool for diagnosing and grading pediatric pneumonia. It can reduce reliance on radiography and guide early treatment.
Lung ultrasound, Pneumonia, Pediatrics, Severity prediction, Imaging
Beyond the Scalpel: Predicting Anastomotic Leakage After Colorectal Surgery Through Inflammatory Biomarkers
Background: Anastomotic leakage remains one of the most serious complications after colorectal surgery. Early identification of high-risk patients may reduce morbidity and mortality. Objective: To evaluate perioperative inflammatory biomarkers as predictors of anastomotic leakage. Methods: A prospective cohort of 538 patients undergoing elective colorectal resection was followed between 2021 and 2024. Serum C-reactive protein (CRP), procalcitonin (PCT), and neutrophil–lymphocyte ratio (NLR) were measured postoperatively. Anastomotic leakage was confirmed radiologically or surgically. Results: Leakage occurred in 47 patients (8.7%). Mean CRP on postoperative day 3 was 186 ± 42 mg/L in leakage patients versus 95 ± 33 mg/L in non-leakage patients (p < 0.001). PCT > 0.9 ng/mL predicted leakage with sensitivity 82% and specificity 79% (AUC 0.88). Combined CRP+PCT model achieved AUC 0.91. Prolonged operative time (>210 minutes) and BMI ≥ 30 increased risk (OR 2.1 and 1.8). Conclusion: CRP and PCT on postoperative day 3 are strong early indicators of anastomotic leakage. Routine monitoring may guide preemptive imaging and early intervention.
Keywords: Colorectal surgery, Anastomotic leakage, CRP, Procalcitonin, Surgical outcomes
Silent Vessels: Early Detection of Subclinical Atherosclerosis Using Carotid Ultrasound Elastography in Diabetic Adults
Background: Subclinical atherosclerosis often develops silently in diabetic patients before clinical manifestations of cardiovascular disease. Conventional carotid intima–media thickness (CIMT) may not capture early vessel stiffness changes. Elastography-based vascular imaging could detect biomechanical alterations earlier than structural changes. Objective: To assess the diagnostic value of carotid shear-wave elastography for early detection of subclinical atherosclerosis in adults with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted on 412 diabetic adults (mean age 55 ± 9 years) and 128 non-diabetic controls between 2022 and 2024. Ultrasound elastography measured mean carotid wall stiffness (kPa), while CIMT and serum biomarkers (HbA1c, LDL-C, hs-CRP) were recorded. Logistic regression and ROC analysis assessed the predictive value of stiffness for subclinical atherosclerosis (CIMT ≥ 0.9 mm). Results: Mean stiffness was higher in diabetics (28.3 ± 5.4 kPa) than controls (21.9 ± 4.2 kPa, p < 0.001). Among diabetics, 38.6% had subclinical atherosclerosis. Carotid stiffness ≥ 26 kPa predicted CIMT ≥ 0.9 mm with sensitivity 83% and specificity 78% (AUC 0.88, 95% CI 0.84–0.91). HbA1c ≥ 8% and stiffness ≥ 26 kPa combined yielded an AUC of 0.92. Stiffness correlated with LDL-C (r = 0.46, p < 0.001) and hs-CRP (r = 0.42, p = 0.002). Conclusion: Carotid elastography detects vascular stiffness preceding structural changes in diabetic adults. Integration into routine screening could improve early identification of atherosclerotic risk before irreversible vessel damage occurs.
Atherosclerosis, Diabetes Mellitus, Carotid Elastography, Subclinical Disease, Vascular Imaging
Prevalence and Risk Factors of PTSD in Displaced Children and Adolescents
Doi : https://doi.org/10.5281/zenodo.17807839 Background : Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern among children and adolescents from displaced areas, often stemming from exposure to war, conflict, and forced migration. These experiences disrupt normal development and increase vulnerability to psychological distress. Studies have shown that displaced youth frequently exhibit symptoms such as re-experiencing trauma, emotional numbness, and hyperarousal, underscoring the need to address PTSD in this population to foster resilience and improve long-term mental health outcomes. Objective: To determine the prevalence of PTSD and its associated factors among Sudanese children and adolescents living in displacement shelters in Kassala, Eastern Sudan. Methods: A descriptive cross-sectional community-based study was conducted in Kassala displacement shelters targeting Sudanese children and adolescents aged 8–18 years. A sample of 384 participants was selected by simple random sampling. Data were collected through structured, closed-ended interviews using a PTSD checklist (PCL-M). PTSD was assessed with a cutoff score of 44. Data were analyzed with SPSS 28.0, using descriptive statistics and chi-square tests for associations. Results: Of the 384 participants (mean age ~13 years), 52.6% were female and 92.0% were of low socioeconomic status. Most originated from Khartoum State (70.0%). The mean PTSD checklist score was 52.3 (SD = 8.7). PTSD prevalence was 50.8%, using the cutoff score of 44. Younger age and lower education level were significantly associated with higher PTSD prevalence (p < 0.05). No significant association was found between PTSD and socioeconomic status (p = 0.78). Conclusion:There is a high prevalence of PTSD among displaced Sudanese children and adolescents in Kassala shelters, reflecting the heavy psychological toll of conflict on youth. Younger children and those with less education were more likely to have PTSD, indicating the need for targeted mental health interventions for these groups. Although socioeconomic status was not significantly linked to PTSD in this study, the overall findings highlight the importance of addressing mental health challenges among displaced youth to promote resilience and well-being.
Post-Traumatic Stress Disorder (PTSD); Displacement; Children and Adolescents; Sudan; Conflict; Mental Health; Prevalence; Risk Factors; Kassala; PCL-M Checklist.
Invisible Anemia: Iron Deficiency Without Anemia and Cognitive Fatigue in SchoolchildrenSystematic Review and Meta-Analysis
Doi : https://doi.org/10.5281/zenodo.17833375 Background: Iron deficiency without anemia (IDWA) is an under-recognized condition in children that may impair neurocognitive development even in the absence of overt anemia . School-aged children with IDWA often exhibit “invisible” cognitive fatigue and performance issues in class despite normal hemoglobin levels. We conducted a systematic review and meta-analysis to examine the prevalence of IDWA in schoolchildren, its impact on cognitive and behavioral outcomes, the diagnostic criteria applied, and the efficacy of iron interventions in this population. Methods: We followed PRISMA guidelines to search PubMed, Scopus, Web of Science, and Google Scholar (through November 2025) for studies of children aged 5–18 with iron deficiency (low ferritin or transferrin saturation) but normal hemoglobin. Eligible designs included cross-sectional, case–control, cohort studies, and randomized controlled trials (RCTs), excluding those involving anemic children or preschool/adult populations. Data on IDWA definitions, cognitive/academic outcomes, and intervention results were extracted. Risk of bias was assessed with the Cochrane ROB-2 tool for RCTs and appropriate tools for observational studies. Meta-analyses were performed for cognitive outcomes of iron supplementation in non-anemic versus anemic subgroups. Results: The search identified 50 potential articles; 7 high-quality studies met inclusion criteria after screening. These included large cross-sectional studies, a targeted case-control study, two systematic reviews with meta-analyses, and one RCT. IDWA was prevalent in schoolchildren (ranging from 14% to >36% across regions) often exceeding the prevalence of iron deficiency anemia . Included studies consistently linked IDWA to impaired cognitive performance: e.g., non-anemic iron-deficient children scored significantly lower in math achievement (mean scores 6 points below iron-replete peers) and had over twice the risk of below-average academic performance . IDWA was associated with deficits in attention, working memory, and learning, as well as increased behavioral problems and subjective fatigue . Despite these associations, meta-analysis of RCT data showed no significant short-term cognitive benefit from iron supplementation in IDWA children (e.g., Standardized Mean Difference for IQ 0.01, p = 0.89) . By contrast, anemic children (IDA) in the same trials exhibited large, significant cognitive improvements with iron (e.g., IQ SMD 0.79, p = 0.001) . Risk of bias was low in the RCT and moderate in observational studies, with the main limitations being difficulty isolating IDWA effects and variability in iron status assessment. Conclusions: IDWA is a common “invisible” condition in schoolchildren that is associated with measurable cognitive and behavioral deficits. However, short-term iron supplementation in mid-childhood yields little cognitive improvement in non-anemic children, in stark contrast to its benefits in anemic children. This suggests that subclinical iron deficiency may cause subtler or more long-standing neurodevelopmental impacts that are not rapidly reversible. Routine ferritin screening in at-risk children could help detect IDWA early, and interventions may need to occur earlier in life or for longer durations to mitigate cognitive fatigue and learning difficulties.
Iron Deficiency Without Anemia (IDWA); Cognitive Fatigue; Schoolchildren; Neurocognitive Development; Iron Status; Ferritin; Academic Performance
Clinical Outcomes of Acute Ischemic Stroke in Sudanese ICUs & HDUs: A Multicenter Study
Doi : https://doi.org/10.5281/zenodo.17790830 Acute ischemic stroke (AIS) requiring critical care carries high mortality, yet outcome data from low-resource settings remain scarce. We quantified short-term outcomes and determinants among AIS patients admitted to intensive care units (ICUs) and high-dependency units (HDUs) across major hospitals in Khartoum, Sudan. Methods: Prospective, multicenter observational study across five hospitals (January–June 2023). Adults (≥18 years) with CT-confirmed AIS admitted to ICU/HDU were consecutively enrolled. Exposures included demographics, comorbidities, prior cerebrovascular disease, early enteral nutrition (EEN ≤48 h), complications, and CT territory. Primary outcome was in-hospital mortality; secondary outcomes were hospital length of stay (LOS) and complication profile. Associations were assessed using χ²/Fisher’s exact tests and t-tests (α=0.05). Results: Seventy-two patients were included (61.1% female; mean age ~65 years). Comorbidities were frequent: hypertension 62.5%, diabetes 44.4%, cardiac disease 30.6%, and renal disease 31.9%; 26.4% had prior stroke. EEN was provided to 84.7%. Median LOS was 7 days (IQR not computed); mean 9.74±12.04 days; 87.5% were discharged or died within ≤14 days. In-hospital mortality was 63.9% (46/72). Complications were common: stroke-associated pneumonia 41.7%, mechanical ventilation 38.9%, coma 23.6%, UTI 18.1%, pressure ulcers 15.3%, malaria 13.9%. On univariate analysis, renal disease was the only factor significantly associated with mortality (death in 82.6% with renal disease vs 55.1% without; χ²=5.133, p=0.023). Sex, age group, diabetes, hypertension, cardiac disease, smoking, prior stroke/TIA, and EEN showed no significant association with mortality. Prior stroke predicted longer hospitalization (mean 15.37 vs 7.72 days; p=0.016); no other covariates, including EEN, significantly affected LOS. CT most often showed MCA-territory involvement; infarct territory was not associated with mortality. No patient received thrombolysis or thrombectomy. Conclusions: AIS requiring ICU/HDU care in this Sudanese cohort had very high mortality (64%) and a heavy complication burden. Renal disease identified a particularly high-risk subgroup for death, while prior stroke prolonged LOS among survivors. Widespread EEN use showed no detectable association with survival or LOS. Findings underscore urgent system-level needs earlier presentation, availability of reperfusion therapy, dedicated stroke units and meticulous critical-care practices (infection prevention, renal optimization, nutrition protocols) to improve outcomes in resource-limited settings.
acute ischemic stroke; intensive care; high dependency unit; mortality; renal impairment; enteral nutrition; Sudan
When the Pressure Builds: A Systematic Review of Intraocular Pressure Fluctuations and Glaucoma Progression
https://doi.org/10.5281/zenodo.16944256 Background: Glaucoma is a leading cause of irreversible blindness, with intraocular pressure (IOP) fluctuations increasingly recog- nized as critical drivers of disease progression beyond mean IOP levels. Conventional clinic-based tonometry often fails to capture diurnal or nocturnal IOP variability, underscoring the need for evidence synthesis on its role in disease outcomes. Objective: This systematic review evaluates the association between IOP fluctuations and glaucoma progression, compares monitoring methods, and highlights implications for clinical practice. Methods: A comprehensive search of studies published between 2000 and 2025 identified 25 eligible investigations, including retro- spective and prospective cohorts and randomized controlled trials. Data were extracted on study design, IOP measurement methods, progression criteria, and clinical outcomes. Quantitative associations between IOP variability, peak IOP, and glaucoma progression were analyzed. Results: Of the 25 included studies, 20 (80%) demonstrated a significant association between higher IOP variability and structural or functional progression. Hazard ratios for progression ranged from 1.15 to 5.69 depending on fluctuation metrics, with diurnal and nocturnal spikes posing the greatest risks. Fluctuations predicted faster retinal nerve fiber layer thinning and visual field deterioration in primary open-angle and angle-closure glaucoma, whereas associations were weaker in normal-tension glaucoma. Monitoring strat- egies varied: Goldmann applanation tonometry (8 studies) remained the most common, but home-based rebound tonometry and con- tinuous contact lens sensors captured greater variability and nocturnal peaks, offering superior risk stratification. Conclusion: IOP fluctuations, independent of mean IOP, are strong predictors of glaucoma progression. Incorporating fluctuation met- rics into risk models, employing home or continuous monitoring, and selecting treatments that stabilize 24-hour IOP profiles may enhance patient outcomes. Future research should standardize definitions of IOP variability and validate innovative monitoring ap- proaches in diverse populations. Keywords: glaucoma, intraocular pressure, fluctuations, progression, monitoring, visual field, optic nerveKeywords: Diabetic Macular Edema; Anti-VEGF Therapy; Aflibercept; Ranibizumab; Bevacizumab; Visual Acuity
glaucoma, intraocular pressure, fluctuations, progression, monitoring, visual field, optic nerveKeywords: Diabetic Macular Edema; Anti-VEGF Therapy; Aflibercept; Ranibizumab; Bevacizumab; Visual Acuity
Impact of Surgical Workforce Shortages on Postoperative Outcomes in Sub-Saharan Africa: A Systematic Review and Meta-Analysis
Access to safe and timely surgical care remains profoundly inequitable, with nearly 5 billion people worldwide lacking essential surgical services. Sub-Saharan Africa bears a disproportionate burden, where over 95% of the population lacks access to basic surgical care, compared to near-universal coverage in high-income countries. This systematic review and meta-analysis synthesized evidence from 30 studies (2009–2025), of which 13 were eligible for quantitative pooling. A total of 2,983 surgeries across diverse cohorts were analyzed. The pooled postoperative complication rate was 20% (95% CI: 16–24%), with individual study rates ranging from 16.4% to 27.2%. Complication clustering was evident, with 6 of 9 studies reporting rates between 18% and 22%. Postoperative mortality pooled at 5.1% (95% CI: 4.1–6.2%), but heterogeneity was high (I² ≈ 78%) due to one pediatric-focused study that reported a mortality rate of 25.6% (32/125 patients). In contrast, most adult-focused studies reported mortality between 1.2% and 4.8%. Workforce density data underscored critical disparities, with East Africa reporting only 0.25 surgeons per 100,000 population, compared to 5.69 per 100,000 in high-income regions. Risk-of-bias assessment using the Newcastle–Ottawa Scale showed 50% low risk, 37.5% moderate risk, and 25% high risk. These findings highlight a preventable gap, as an estimated 143 million additional surgical procedures are required annually to meet global needs. Strengthening the surgical workforce, investing in infrastructure, and expanding task-sharing programs are urgent priorities to reduce avoidable morbidity and mortality in Sub-Saharan Africa.
Surgical workforce shortage, Sub-Saharan Africa, Postoperative outcomes, Systematic review, Meta-analysis, Complication rate, Mortality rate, Task-sharing
Subclinical Biomarkers for Early Neurodegenerative Disease Detection: A Systematic Review
Doi : 10.5281/zenodo.17218654 Neurodegenerative diseases (NDs) such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and amyotrophic lateral sclerosis (ALS), impose a growing global burden, yet diagnoses often occur late when therapeutic options are limited. Subclinical biomarkers detectable in cognitively unimpaired individuals may enable earlier detection and intervention. Objectives: This systematic review assessed the predictive performance of cerebrospinal fluid (CSF), plasma, imaging, and omics-based biomarkers in preclinical neurodegeneration. Methods: Following PRISMA 2020 guidelines, 25 longitudinal and nested case–control studies published between 2000 and 2025 were included, encompassing more than 100,000 participants. Cohorts were drawn primarily from the United States (56%) and Sweden (24%), with follow-up durations ranging from 2 to 30 years. Results: Biomarker abnormalities consistently preceded clinical onset by more than a decade. CSF markers including NfL, Aβ42, and P-tau181 predicted dementia with hazard ratios (HRs) of 1.6–4.77 and prediction windows of up to 20 years. Plasma biomarkers showed strong prognostic performance: P-tau181 (HR=1.15; 95% CI: 1.06–1.25), NfL (HR=1.92; 95% CI: 1.72–2.14), and GFAP (HR=2.35; 95% CI: 1.22–4.53) predicted dementia over 6–24 years, while plasma P-tau217 emerged as the most specific AD marker (HR=3.54; p<0.0001). Imaging biomarkers confirmed pathology, with amyloid PET predicting impairment at HR=10.36 and MRI volumetric analyses achieving AUCs up to 0.95. Temporal trajectories showed Aβ and tau divergence 10–18 years pre-diagnosis, followed by NfL at ~11 years and neuroinflammatory markers later. Combining plasma Aβ42/40, P-tau, and NfL improved predictive accuracy (AUC 70.9–82.6%) and reduced trial sample sizes by up to 30%. Beyond AD, serum NfL predicted PD (OR=2.54) and plasma NfL was elevated up to 5 years before ALS (RR=2.68). Conclusions: Subclinical biomarker abnormalities are robust predictors of neurodegeneration detectable long before symptoms, with plasma P-tau217, CSF NfL, and multimodal biomarker panels showing greatest clinical promise.
Subclinical biomarkers, neurodegeneration, plasma p-tau217, neurofilament light chain (NfL), Alzheimer’s disease, early detection, predictive performance
Audit of Compliance with Pediatric Emergency Care Standards (September 2025)
Doi : 10.5281/zenodo.17214573 Background: The baseline audit in July 2025 identified major compliance gaps in pediatric emergency care standards, including documentation (66.2%), policy adherence (52.1%), and safety practices such as consent documentation (24.4%) and visitor access control (15.6%). These deficiencies posed risks to patient safety, regulatory compliance, and accreditation readiness. Objective: To evaluate the impact of a structured training intervention on compliance with pediatric emergency care standards through a re-audit in September 2025. Methods: A re-audit was conducted using the same structured checklists and methodology as the baseline audit. Forty-five patient records and forty-five staff observations/interviews were reviewed across three domains: documentation, policy adherence, and infection control/safety practices. A targeted training program was implemented in August 2025, covering documentation, infection control, patient rights, incident reporting, and emergency preparedness. Compliance rates were compared between July and September 2025, with improvements expressed as absolute percentage-point changes. Results: Documentation compliance improved from 66.2% to 85.0%, with substantial gains in patient demographics (+37.8%) and medication administration records (+24.4%). Policy compliance increased from 52.1% to ~80.0%, with dramatic improvements in consent and patient rights (+57.8%), emergency preparedness (+46.7%), and visitor access control (+48.8%). Observational practices rose from 67.3% to ~90.0%, with notable increases in patient identification (+28.9%) and bedside documentation (+28.9%). Conclusion: The re-audit demonstrated significant improvements in pediatric emergency care compliance within two months of targeted training. While overall compliance approached 85–95% across most domains, residual gaps persisted in adverse event reporting (57.8%) and visitor access control (64.4%). Sustained monitoring, leadership support, and reinforcement of safety culture are recommended to consolidate and extend these gains.
Pediatric emergency care, Clinical audit, Compliance, Patient safety, Infection control
Are Normal Vitals Misleading? A Systematic Review of Physiological Stability in Patients with Undetected Clinical Deterioration
Doi :10.5281/zenodo.17211502 Background: Normal vital signs are often considered reassuring, yet a significant proportion of hospitalized patients experience clinical deterioration despite apparently stable physiology. This phenomenon, termed occult deterioration or occult hypoperfusion, can delay recognition and treatment, leading to preventable morbidity and mortality. Objective: To systematically review the prevalence, characteristics, and outcomes of adult patients who deteriorate despite presenting with normal vital signs, and to evaluate adjunctive tools such as biomarkers, continuous monitoring, and predictive analytics. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar from January 2000 to March 2025. Eligible studies included observational cohorts, retrospective analyses, and case series (≥10 patients) involving adults (≥18 years) with initial normal vital signs who subsequently deteriorated (ICU transfer, cardiac arrest, or death). Risk of bias was assessed with the Newcastle–Ottawa Scale. Data were narratively synthesized due to heterogeneity. Results: Twenty-seven studies (sample sizes 44–20,000+) were included, covering trauma, sepsis, surgical, and ICU populations. Across settings, 30–40% of patients who deteriorated had normal vital signs at presentation. Trauma cohorts revealed occult hypoperfusion detectable only by lactate or base deficit, strongly predicting mortality. In sepsis, normotensive patients with elevated lactate had significantly higher mortality compared with normolactatemic peers. Post-operative and ICU studies showed poor outcomes despite stable hemodynamics when hyperlactatemia persisted. Continuous monitoring and predictive analytics demonstrated earlier recognition than intermittent checks, though alarm fatigue remained a limitation. Conclusion: Normal vital signs do not guarantee physiological stability. A substantial minority of patients at risk for adverse outcomes present with “normal” values, particularly in trauma and sepsis. Adjunctive biochemical markers, trend-based monitoring, and predictive models enhance early detection and should complement conventional vital sign assessment to improve patient outcomes.
Normal vital signs; Occult hypoperfusion; Clinical deterioration; Lactate; Continuous monitoring; Early warning scores; Systematic review
The Fever Gap: Disparities in Febrile Seizure Management in Urban vs. Rural Pediatric Emergency Units
Abstract: Background: Febrile seizures (FS) are common, yet their management varies by facility resources. This study compares clinical protocols, diagnostic testing, and outcomes between rural and urban pediatric ERs. Methods: Retrospective review of 682 children (6 months–5 years) presenting with FS across urban and rural hospitals in India (2021–2023). Investigations, treatments, hospitalization rates, and follow-up adherence were assessed. Results: CT scans were more frequently performed in rural ERs (42.8% vs. 11.5%, p < 0.001) with no difference in intracranial findings. Hospitalization was higher in rural sites (29.2% vs. 17.8%, p = 0.02). Urban ERs had better adherence to follow-up (81% vs. 49%, p < 0.001). Conclusion: Management of febrile seizures is influenced by setting and resource availability. Standardized guidelines and telemedicine access could reduce disparities and improve care.
febrile seizures, rural health, emergency pediatrics, disparities, overuse
The Diagnostic Mirage: Incidental Thyroid Nodules and Over-Investigation in Low-Risk Patients
Abstract: Background: The widespread use of imaging has led to incidental thyroid nodule detection, prompting excessive workup. This study investigates patterns of over-investigation and cost implications in low-risk individuals. Methods: A review of 412 incidental thyroid nodules (ITNs) found on CT/MRI in asymptomatic adults in France. Ultrasound features, FNA rates, cost analysis, and malignancy outcomes were assessed. Results: 76.2% of ITNs were <1.5 cm with benign features, yet 61.4% underwent FNA. Only 3.4% were malignant. The average cost per malignancy detected was €8,920. Use of ACR TI-RADS reduced unnecessary FNA by 42%. Conclusion: Over-investigation of ITNs remains widespread despite guidelines. Adherence to risk-based protocols can reduce patient burden and resource waste.
thyroid nodules, overdiagnosis, incidental findings, TI-RADS, low-value care
The Pain Paradox: Opioid-Sparing Techniques and Long-Term Recovery in Open Abdominal Surgery
Abstract: Background: Opioid-sparing approaches are increasingly used in surgery, but their long-term effects on recovery and pain perception remain unclear. This study evaluates patient outcomes 3 months postoperatively following opioid-sparing vs. standard analgesia. Methods: A randomized trial of 276 patients undergoing open abdominal surgery in the USA (2022–2024). Group A received regional blocks and NSAID-based regimens; Group B received opioid-based analgesia. Pain scores, return to activity, and opioid dependence at 3 months were analyzed. Results: Group A reported lower chronic pain scores at 3 months (VAS 2.1 vs. 4.0; p < 0.001) and faster return to activity (median 29 vs. 42 days; p = 0.004). Opioid dependence occurred in 2.9% of Group A vs. 9.6% of Group B (p = 0.03). Conclusion: Opioid-sparing strategies improve long-term pain and recovery without increasing short-term discomfort. They represent a sustainable, safer postoperative pain paradigm.
opioid-sparing, postoperative pain, abdominal surgery, regional blocks, recovery
The Digital Diet: Screen Time and Gut Microbiome Disruption in Preschool Children
Abstract: Background: Excessive screen time in early childhood has been linked to obesity and behavior changes, but its effect on gut microbiota is unclear. This study assesses microbiome diversity in relation to daily screen exposure in preschoolers. Methods: Stool samples from 248 healthy children aged 3–5 in Singapore were analyzed via 16S rRNA sequencing. Screen time was logged using parental diaries. Shannon diversity, Firmicutes/Bacteroidetes ratio, and behavioral assessments were compared across screen time quartiles. Results: Children with >4 hours/day of screen time had reduced microbial diversity (Shannon index 2.3 vs. 3.1; p < 0.001) and higher Firmicutes/Bacteroidetes ratio (3.2 vs. 1.8; p = 0.004). Aggressive behavior scores were higher in the highest screen group (p = 0.03). Conclusion: Excessive screen time is associated with altered gut microbiota composition and behavior markers in preschoolers. Early digital exposure may disrupt gut–brain signaling and warrants integration into pediatric health guidelines.
gut microbiome, screen time, early childhood, behavior, dysbiosis
The Inflammatory Clock: Chronobiology of CRP and Cardiometabolic Risk in Pre-Diabetic Adults
Abstract: Background: Circadian fluctuations in inflammatory biomarkers may influence cardiometabolic risk, yet remain uninvestigated in prediabetes. This study evaluates daily C-reactive protein (CRP) variation and its association with insulin resistance and lipid profiles. Methods: A cohort of 312 adults with impaired fasting glucose (IFG) from Germany was studied. CRP was measured at 8AM, 2PM, and 8PM on two consecutive days. HOMA-IR and lipid panels were assessed. Chronotype was identified using the Munich ChronoType Questionnaire. Results: Mean CRP levels peaked at 8PM (2.9 ± 1.4 mg/L) vs. 8AM (1.8 ± 0.9 mg/L; p < 0.001). Evening chronotypes had higher CRP variability and elevated HOMA-IR (3.9 vs. 2.6; p = 0.02). Multivariate regression showed evening CRP elevation independently predicted HOMA-IR >2.5 (OR = 2.81, 95% CI: 1.66–4.71). Conclusion: CRP demonstrates circadian fluctuation in prediabetic adults, with evening elevation associated with worse insulin sensitivity. Chronobiological monitoring of inflammation could improve cardiometabolic risk stratification.
prediabetes, CRP, inflammation, circadian rhythm, insulin resistance
The Effects of Nutritional Interventions on the Cognitive Development of Preschool-Age Children: A Systematic Review
DOI: 10.5281/zenodo.17209643 Background: Undernutrition during early childhood adversely affects growth and neurodevelopment. While the first 1,000 days of life are recognized as a critical period, evidence also suggests that nutritional interventions in the preschool years (2–6 years) can influence cognitive outcomes. Objective: To systematically review randomized and quasi-randomized trials assessing the effect of nutritional interventions on cognitive development among preschool-aged children. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Library up to September 2025, following PRISMA 2020 guidelines. Eligible studies included randomized controlled trials (RCTs) or quasi-randomized trials of children aged 2–6 years, evaluating nutrition-specific interventions (e.g. micronutrient supplementation, fortified foods, food-based interventions) with cognitive or developmental outcomes. Data on study characteristics, interventions, cognitive measures, and findings were extracted. Risk of bias was assessed with Cochrane criteria. Due to heterogeneity, results were narratively synthesized. Results: From >5,000 records, 20 trials involving ~8,000 children met inclusion criteria. Interventions included single-nutrient supplementation (iron, iodine, DHA, B-vitamins), multiple micronutrient powders, fortified foods, fatty fish diets, and combined nutrition plus psychosocial programs. Overall, 15 trials reported at least one positive cognitive effect, while five showed null findings. The most consistent benefits were observed in undernourished or anaemic populations, particularly improvements in attention, working memory, processing speed, and language. For example, iron supplementation improved attention in anaemic children [38], and multiple micronutrient powders enhanced language outcomes in low-resource preschool settings [45]. Food-based interventions (e.g. salmon, herring) produced modest gains in reasoning and processing speed in well-nourished children [36,37]. One Indonesian trial combining nutrition with psychosocial stimulation yielded the largest effect, with an average +5.7 IQ point gain [43]. No serious adverse events were reported. Conclusion: Nutritional interventions in preschool years can significantly enhance cognitive outcomes, particularly when targeting nutrient deficiencies in at-risk populations. Iron, multi-micronutrient, and protein/PUFA-rich food interventions were most effective. Benefits were domain-specific (attention, memory, language) and greatest when paired with stimulation or education. Nutrition during the “second 1,000 days” remains a key opportunity to promote child cognitive development, with implications for school readiness and long-term human capital. Keywords: Preschool nutrition; Cognitive development; Micronutrients; Iron; Omega-3; Randomized controlled trials; Systematic review
Preschool nutrition; Cognitive development; Micronutrients; Iron; Omega-3; Randomized controlled trials; Systematic review
Digital Pathology and Artificial Intelligence in the Diagnosis and Prognosis of Aggressive B-Cell Lymphomas
DOI: https://zenodo.org/records/17208243 Aggressive B-cell lymphomas including diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL), and Burkitt lymphoma (BL) remain difficult to classify and prognosticate because of overlapping morphology and genetic heterogeneity. Digital pathology integrated with artificial intelligence (AI) offers opportunities to improve diagnostic accuracy, biomarker detection, and outcome prediction. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, and Google Scholar were searched (2014–2024) for peer-reviewed original studies applying AI/deep learning to whole-slide images (H&E or IHC) of DLBCL, HGBL, or BL. Eligible studies reported diagnostic or prognostic outcomes. Data on sample size, AI method, performance metrics, and validation strategies were extracted. Risk of bias was assessed using PROBAST criteria. Results: Twenty studies were included. Diagnostic applications showed consistently high accuracy: an ensemble CNN distinguished DLBCL from other lymphoid entities with ~99–100% accuracy across external cohorts; EfficientNet achieved ~95% accuracy in a three-class task (DLBCL, indolent lymphoma, benign lymphadenopathy). A DenseNet-based system differentiated BL from DLBCL with 94% case-level accuracy (AUC 0.92). Biomarker detection was also robust: a CNN predicted MYC rearrangements with 93% sensitivity, potentially reducing FISH testing by one-third; another model identified double-hit HGBL with AUC 0.95, 100% sensitivity, and 87% specificity. An attention-based multiple instance learning approach quantified c-MYC/BCL2 expression with strong correlation to pathologists (r=0.84–0.92) and prognostic significance, while AI-assisted PD-L1 scoring improved inter-observer agreement, particularly in small biopsies. Prognostic studies revealed added value: a multi-modal model integrating pathology and clinical data predicted R-CHOP response with AUC 0.856 and stratified relapse-free survival. However, most studies were retrospective, single-center, and at high risk of bias, with limited external validation and interpretability. BL and HGBL remained under-represented. Conclusion: AI-enabled digital pathology demonstrates strong potential to refine classification, automate biomarker assessment, and enhance prognostic stratification in aggressive B-cell lymphomas. Broader multi-center datasets, prospective validation, and explainable models are essential to realize clinical integration.
Digital pathology; Artificial intelligence; Aggressive B-cell lymphomas; Diffuse large B-cell lymphoma; Prognosis.
Steel and Silicon: A Systematic Review ofRobotic Surgery versus Traditional Techniquesin Major operations
DOI 10.5281/zenodo.17182130 Robotic-assisted surgery (RAS) has become a transformative innovation in operative care, offering superior dexterity, three-dimensional visualization, and improved ergonomics. Despite its increasing adoption, concerns remain regarding its comparative value against established laparoscopic and open techniques. Objective This systematic review synthesizes evidence on perioperative outcomes, oncological performance, and economic implications of RAS across major surgical disciplines. Methods Following PRISMA guidelines, a comprehensive search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase for studies published from 2005 to 2025. Eligible studies included randomized controlled trials, prospective cohorts, and comparative analyses evaluating RAS versus conventional approaches in urological, gynecological, colorectal, cardiothoracic, and general surgery. Primary endpoints were conversion to open surgery, perioperative complications, and margin status. Secondary measures included operative time, hospital stay, recovery, and cost-effectiveness. Results From 135 included studies (15 RCTs), findings indicate that RAS is non-inferior to standard approaches regarding major complications and oncological adequacy. Advantages include consistently lower conversion rates, particularly in anatomically complex procedures such as rectal cancer resection and pulmonary lobectomy. However, these benefits are offset by significantly longer operative times and cost premiums estimated at 20–40% higher per case than laparoscopy. Long-term survival and functional outcomes were broadly comparable. Conclusions: RAS enhances technical precision in complex surgeries but does not confer superior overall patient outcomes. Its high costs limit widespread adoption, underscoring the need for selective use where technical advantages are most relevant. Future priorities include cost-reduction strategies, robust long-term data, and standardized reporting frameworks.
Robotic Surgical Procedures; Laparoscopy; Comparative Effectiveness Research; Operative Time; Cost-Benefit Analysis; Treatment Outcomes.
Beyond Borders: A Rare Case of Visceral Leishmaniasis Presenting with Fulminant Hepatitis in a Non-Endemic Region
DOI 10.5281/zenodo.17181622 Introduction:Visceral leishmaniasis (VL), also known as kala-azar, is rare in Oman, a non-endemic country, making diagnosis challenging due to low clinical suspi- cion. Case Presentation: We describe a 25-year-old Ethiopian male who presented with a 4-day history of nausea, vomiting, epigastric pain, fever, and epis- taxis. Physical examination revealed jaundice and mas- sive hepatosplenomegaly (liver palpable 16 cm below the costal margin, spleen 18 cm). Initial laboratory tests showed elevated C-reactive protein, mild hepatic transaminase elevation, and pancytopenia. He was ini- tially treated for malaria without improvement. Twenty days later, persistent fever, fatigue, and recurrent epis- taxis prompted reevaluation. Bone marrow aspiration revealed Leishmania donovani amastigotes, and an rK39 rapid test was positive. Shortly after admission, the patient developed acute liver failure. Liver biopsy demonstrated acute hepatitis with confluent necrosis and numerous intracytoplasmic amastigotes; PCR con- firmed L. donovani. He was treated with liposomal amphotericin B (3 mg/kg daily for 5 days, with addi- tional doses on days 14 and 21). Outcome: The patient demonstrated gradual clinical and biochemical improvement and achieved complete recovery within one month. Conclusion: This rare case of VL with fulminant hep- atitis in a non-endemic setting highlights the impor- tance of considering VL in patients with relevant travel or migration history. Early diagnosis and timely therapy are essential for favorable outcomes and emphasize the need for heightened awareness and improved diagnostic access in both endemic and non-endemic regions
Visceral leishmaniasis; kala-azar; fulminant hepatitis; Leishmania donovani; non-endemic regions
The Gazira Diabetes Puzzle: Logistic Regression Reveals Key Predictors of Type 1 Diabetes in Adolescents
BACKGROUND: Type 1 diabetes (T1D) in adolescents poses a growing public health concern worldwide, particularly in low-resource settings such as Sudan, where fragile healthcare infrastructure, limited laboratory access, and ongoing conflict exacerbate management challenges. Understanding determinants of glycaemic control is critical for designing targeted interventions. This study aimed to identify predictors of glycaemic control among adolescents with Type 1 Diabetes (T1D) in Gazira State and to evaluate the performance of a logistic regression model in predicting outcomes. Methods: A cross-sectional study was conducted among 400 adolescents with type 1 diabetes mellitus (T1D) between 2020 and 2021. Data were obtained through structured Visual Abstract JAREM Vol. 69 No. 25 (2025): New Findings in the East Mediterranean Region Questionnaires and clinical records. Glycaemic control was assessed by HbA1c, categorised as controlled (< 7.5%) or uncontrolled (≥ 7.5%). Associations between sociodemographic, clinical, and knowledge-related factors and control status were examined using Chi-square tests. A binary logistic regression model was applied to identify independent predictors, with model fit evaluated using Hosmer–Lemeshow statistics and predictive accuracy assessed. Results: Of the participants, 250 (62.5%) had uncontrolled HbA1c, and 150 (37.5%) had controlled values. Disease duration was significantly associated with poor control (χ 2 = 20.606, p = 0.015). Knowledge-related factors showed strong effects: adolescents who knew their last HbA1c (χ 2 = 83.115, p < 0.001), understood HbA1c as an average glucose indicator (χ 2 = 15.706, p < 0.001), recognised vomiting as a ketoacidosis symptom (χ 2 = 2.246, p = 0.019), and tested more frequently when sick (χ 2 = 4.245, p = 0.035) were more likely to have controlled HbA1c. Logistic regression confirmed a good fit (Model χ 2 = 98.924, p < 0.001; Hosmer– Lemeshow χ 2 = 0.839, p = 0.999) with 95% overall accuracy, high specificity (98.7%) for uncontrolled cases, but low sensitivity (37.5%) for controlled cases. Independent predictors included frequency of HbA1c testing (OR = 2.29, p = 0.034), knowledge of own HbA1c result (OR = 2.65, p < 0.001), and knowledge to test more when ill (OR = 4.17, p = 0.108). Conclusion: Most adolescents in Gazira had uncontrolled diabetes, with practical knowledge and disease duration as key determinants. Specific skills—such as HbA1c literacy and sick-day monitoring—were stronger predictors than general awareness. Improving adolescent-focused education, ensuring reliable HbA1c testing, and addressing systemic barriers are crucial to reducing the T1D burden in Sudan and similar contexts
Clinical Audit Report: Enhancing Compliance with Pediatric Emergency Care Standards for Safer, Smart-er Practice
This hospital-wide audit was conducted to assess the hospital's adherence to key clinical, administrative, and ethical standards. It used global benchmarks from the Ministry of Health (MOH), Joint Commission International (JCI), World Health Organization (WHO), and the Occupational Safety and Health Administration (OSHA). A mixed-methods approach was used across five main areas: medical documentation, policy compliance, staff feedback, real-time clinical observation, and comparison with international standards. Data were collected from 45 patient records and 45 healthcare workers, encompassing over 200 compliance indicators. The findings revealed a notable discrepancy between the hospital's performance in emergency care and its management of everyday operations. There were high compliance rates in areas such as medication safety (86.7%), emergency preparedness (77.8%), and the use of PPE (75.6%), indicating that the hospital is well-prepared for high-risk situations. However, basic practices were lacking: only 48.9% of records contained correct patient demographic information, only 55.6% had proper documentation for the medication given, and just 24.4% followed the rules for reporting adverse events and obtaining patient consent. Additionally, 71.1% of staff reported being afraid to report safety problems, and only 44.4% received regular training. Statistical analysis supported this, showing widespread issues with documentation (χ² = 16.05, p = 0.066) and significant differences in how policies are enforced (χ² = 85.89, p < 0.000001), with better compliance in areas that are more closely monitored. The audit reveals that the hospital tends to prioritize what is visible to outside reviewers but falls short in everyday safety and ethical practices. To address this, the report recommends five key improvements: enhanced documentation, stricter enforcement of policies that are often overlooked, establishing a safe environment for staff to report issues, more comprehensive training, and developing a system for mitigating risks before problems arise. If these changes are not made, the hospital could face accreditation problems, legal risks, and harm to patient safety. This audit makes it clear that the hospital must move from a reactive approach to one that focuses on ongoing, organization-wide quality improvement.
Clinical audit, patient safety, documentation compliance, healthcare quality, emergency prepar-edness
Seconds to Save: Effectiveness of Rapid Sepsis Screening Tools in Emergency Departments
Background: Sepsis requires rapid recognition and treatment, yet delays in emergency departments (EDs) remain common. Objective: To evaluate the effectiveness of qSOFA, NEWS2, and a combined model in predicting sepsis-related mortality. Methods: A retrospective cohort study of 3,216 ED patients with suspected infection was conducted across 5 hospitals in China (2021–2023). Mortality within 28 days was the primary outcome. Results: qSOFA had AUC 0.72, NEWS2 had AUC 0.81, and the combined model improved to AUC 0.88. The combined model showed sensitivity 86.3% and specificity 82.5%. Conclusion: A combined sepsis screening model outperforms qSOFA and NEWS2 alone. Adoption of integrated screening could improve early recognition and survival in EDs.
Sepsis, Emergency Medicine, Screening Tools, qSOFA, NEWS2
Time Lost is Brain Lost: Delays in Acute Stroke Management and Their Impact on Functional Recovery
Background: Stroke outcomes depend critically on timely intervention, yet pre-hospital and in-hospital delays remain major barriers. Objective: To evaluate pre-hospital and in-hospital delays in acute ischemic stroke care and their association with functional recovery. Methods: A prospective cohort of 784 patients with acute ischemic stroke was enrolled in French tertiary hospitals (2022–2023). Key time intervals were recorded: symptom onset-to-door, door-to-needle, and door-to-groin. Outcomes were measured by modified Rankin Scale (mRS) at 90 days. Results: Median onset-to-door time was 146 minutes; door-to-needle was 58 minutes. Only 41% achieved mRS 0–2 at 90 days. Each 30-minute delay reduced odds of good recovery by 8% (OR 0.92, 95% CI 0.88–0.95, p < 0.001). Conclusion: Delays remain substantial in stroke care, directly reducing recovery rates. Streamlined pre-hospital triage and in-hospital workflows could markedly improve outcomes. Keywords: Stroke, Ischemic Stroke, Time-to-Treatment, Outcomes, Neurology
Stroke, Ischemic Stroke, Time-to-Treatment, Outcomes, Neurology
Silent Burden: Undiagnosed Hypertension Among Adults Attending Outpatient Clinics in Urban Centers
Background: Hypertension remains a leading risk factor for cardiovascular morbidity, yet up to one-third of patients remain undiagnosed, particularly in busy outpatient settings. Objective: To determine the prevalence of undiagnosed hypertension among adults attending outpatient clinics and identify predictors of missed diagnosis. Methods: A cross-sectional study of 2,436 adults was conducted across 6 tertiary outpatient clinics in Italy (Jan–Dec 2023). Blood pressure was measured using standardized protocols. Data on demographics, comorbidities, and health-seeking behaviors were collected. Logistic regression identified predictors of undiagnosed hypertension. Results: The prevalence of undiagnosed hypertension was 17.8%. Independent predictors included obesity (OR 2.6, 95% CI 1.9–3.5, p < 0.001), male sex (OR 1.9, 95% CI 1.4–2.7, p < 0.001), and low health literacy (OR 2.3, 95% CI 1.6–3.2, p < 0.01). Conclusion: Nearly one in five adults attending outpatient clinics had undiagnosed hypertension. Opportunistic screening programs in outpatient settings could significantly reduce the hidden burden of hypertension.
Hypertension, Undiagnosed, Outpatient, Prevalence, Public Health
AI Application in Age-Related Macular Degeneration Diagnosis and Progression Detection: Systematic Review and Meta-Analysis
Doi: 10.5281/zenodo.16939143 Background: Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the elderly, and artificial intelligence (AI) has emerged as a promising tool for its early detection and progression monitoring. This review synthesizes evidence on the diagnostic accuracy, model architectures, and clinical applicability of AI in AMD. Methods: We systematically analyzed 22 studies published between 2013 and 2024, encompassing fundus photography, optical coherence tomography (OCT), and multimodal imaging. Studies were assessed for design, dataset size, AI architecture, diagnostic metrics, and real-world validation. Results: Of the 22 included studies, 13 used fundus photography, 9 used OCT, and 3 applied multimodal approaches. CNN-based models dominated (n=20), with Inception, ResNet, VGG, and EfficientNet being most common, while 5 studies used ensemble methods and 4 applied alternative machine learning approaches. Dataset sizes ranged widely, from 61 OCT scans to over 306,000 fundus images. Diagnostic performance was consistently high. Sixteen studies reported area under the curve (AUC) values between 0.75 and 0.9976, with 11 exceeding 0.90. Sensitivity was reported in 9 studies, ranging from 55.3% to 100%, while specificity in 8 studies ranged from 82.5% to ≥99%. Accuracy, reported in 4 studies, varied between 63.3% and 100%. Stage-specific performance showed higher accuracy for advanced AMD (AUCs up to 0.9944) compared with early disease or progression prediction (as low as 67%). Fundus-based models achieved AUCs of 0.81–0.99, while OCT-based systems frequently exceeded 0.94. Multimodal fusion further improved detection of subtle features such as reticular pseudodrusen. Real-world evaluations were limited: only 10 studies reported external validation and fewer assessed workflow integration. Nevertheless, performance in clinical-like settings remained strong, with accuracies up to 99.2% and κ of 92%. Conclusion: AI systems demonstrate excellent diagnostic capability for AMD, with pooled performance estimates approximating AUC 0.94–0.97, sensitivity 92%, and specificity 91%. Despite these promising results, external validation and clinical workflow integration remain limited, underscoring the need for large-scale, prospective trials before routine implementation.
Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review and Meta-Analysis
Doi: 10.5281/zenodo.16938855 Corresponding Author : *Amna Elbasheer Background: Diabetic macular edema (DME) remains a leading cause of visual impairment worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents—including ranibizumab, aflibercept, and bevacizumab—have emerged as standard treatments. However, uncertainties persist regarding their comparative efficacy, optimal dosing schedules, safety profiles, and cost-effectiveness. Methods: This systematic review and meta-analysis included 25 studies published between 2005 and 2025, comprising 20 randomized controlled trials and 5 observational studies. The primary outcomes assessed were best-corrected visual acuity (BCVA), central retinal thickness (CRT), safety events, and economic impact. Data were pooled using a random-effects model, accounting for heterogeneity with an I² threshold above 50%. Results: Anti-VEGF therapy consistently produced meaningful improvements in visual function and anatomical outcomes. Aflibercept showed the highest efficacy, with BCVA gains ranging from +13.1 to +17.1 ETDRS letters, particularly benefiting patients with baseline visual acuity of ≤20/50 or <69 letters. Ranibizumab achieved improvements between +5.9 and +14.0 letters, while bevacizumab yielded gains from +4.9 to +12.1 letters, with better outcomes observed in patients with less severe vision loss. Central retinal thickness reductions followed a similar hierarchy: aflibercept led to a mean reduction of approximately −171 µm, ranibizumab between −119 and −194 µm, and bevacizumab from −42 to −126 µm. Regarding treatment protocols, monthly and pro re nata (PRN) regimens were both effective. However, treat-and-extend protocols notably reduced injection frequency after the first year while maintaining efficacy. All three agents demonstrated a favorable safety profile. Serious adverse events were rare and included endophthalmitis (0.05–0.1%), arterial thromboembolic events (≤1%), transient elevations in intraocular pressure, and conjunctival hemorrhage. Bevacizumab emerged as the most cost-effective option, particularly for patients with milder disease severity, while aflibercept remained the agent of choice in cases requiring maximal therapeutic effect despite its higher cost. Conclusion: Anti-VEGF therapy offers robust improvements in both visual acuity and retinal anatomy for patients with DME. Aflibercept provides the greatest benefit in more severe cases, whereas bevacizumab offers a practical and cost-effective alternative. Treat-and-extend regimens represent a promising approach to reduce treatment burden without compromising efficacy. Future studies should focus on long-term safety outcomes, personalized treatment strategies, and innovative drug delivery systems to improve adherence and outcomes.
Diabetic Macular Edema; Anti-VEGF Therapy; Aflibercept; Ranibizumab; Bevacizumab; Visual Acuity
Reading the Heart's Code: A Systematic Review of Artificial Intelligence in Electrocardiography, from Diagnostic Models to Ethical Challenges
Corresponding Author : Ahmed-Lamin Gehani Background: Artificial intelligence (AI) is transforming electrocardiogram (ECG) interpretation through high-speed, high-accuracy automation, particularly in diagnosing arrhythmias and myocardial infarction. With cardiovascular disease remaining the leading cause of mortality worldwide (responsible for ~17.9 million deaths annually), rapid and precise ECG analysis is critical. Objective: This systematic review evaluates current applications of AI in ECG analysis, focusing on model types, diagnostic performance, dataset quality, clinical integration, and ethical considerations. Methods: Following PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, Web of Science, and IEEE Xplore was conducted. A total of 679 records were identified; after screening and eligibility assessment, 20 studies were included. These encompassed 3 experimental studies, 3 simulation-based studies, 3 systematic reviews, and 11 narrative reviews. Deep learning models – especially convolutional and recurrent neural networks – accounted for over 70% of the algorithms applied across studies. Results: AI-enhanced ECG systems achieved impressive diagnostic accuracies between 87% and 98%, with sensitivity rates up to 95% and area-under-curve (AUC) values frequently above 0.90. Ensemble machine learning methods (e.g., XGBoost) yielded F1-scores >0.92 for classifying cardiac conditions. Real-time AI-embedded wearable devices demonstrated a >40% reduction in diagnostic latency for arrhythmia detection in clinical settings. However, 60% of studies utilized non-diverse training datasets, limiting model generalizability, and only about 25% of the studies addressed model explainability through tools like SHAP or LIME. Conclusion: AI markedly advances ECG-based diagnostics, improving accuracy and efficiency. Yet, challenges remain regarding model transparency, ethical deployment, and demographic representativeness of training data. Future efforts must emphasize more inclusive datasets, interpretable and clinically validated models, and rigorous ethical frameworks to support safe integration of AI-ECG systems in diverse real-world healthcare settings.
Artificial intelligence, Electrocardiogram, Deep learning, Arrhythmia detection, Diagnostic accuracy
Artificial Intelligence in Pediatric Diagnostics: A Systematic Review of Accuracy, Safety, and Clinical Impact
DOI : 10.5281/zenodo.16934731 Corrsponding Author : Afag Badr Background Artificial intelligence (AI) is increasingly being adopted in paediatric diagnostics, offering potential benefits in diagnostic speed and accuracy. However, its clinical safety, validation, and applicability to diverse paediatric populations remain underexplored. Objective: This systematic review aimed to evaluate the diagnostic accuracy, clinical safety, and implementation challenges of AI tools used in paediatric diagnostics Methods: A comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, and Web of Science for studies published between 2005 and 2025. Eligible studies evaluated AI-based diagnostic tools in paediatric populations (0–18 years) and reported performance metrics such as sensitivity, specificity, and area under the curve (AUC). Quality was assessed using the QUADAS-2 tool, and a narrative synthesis was performed due to methodological heterogeneity. Results: Forty-two studies were included, covering a wide range of AI algorithms and paediatric conditions including respiratory disorders, neurological conditions, ophthalmological diseases, dermatology, oncology, and cardiology. Most AI models demonstrated high diagnostic performance, with AUC values commonly exceeding 0.90. However, the majority of studies lacked external validation, were single-centre, and did not report clinical outcomes or adverse events. Ethical concerns, including data bias and lack of explainability, were noted but infrequently addressed empirically. Conclusion: AI-based diagnostic tools show strong promise in enhancing paediatric diagnostics, particularly for image-based conditions. However, significant gaps remain in safety reporting, real-world validation, and ethical oversight. Rigorous prospective trials and clinician-AI integration strategies are essential for their responsible deployment in paediatric care.
Artificial intelligence, Paediatrics, Diagnostic accuracy, Machine learning, Clinical safety, Systematic review