Tag: pubmed

Ann Saudi Med. 2025 Nov-Dec;45(6):381-387. doi: 10.5144/0256-4947.2025.381. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Errors in clinical laboratory tests can have a detrimental effect on healthcare delivery. The pre-analytical phase accounts for most laboratory errors, known as pre-analytical errors (PAEs).

OBJECTIVE: This study investigated the causes and frequencies of PAEs occurring within a laboratory of a tertiary care hospital.

DESIGN: A single-center, retrospective, observational study.

SETTING: King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia.

MATERIALS AND METHODS: All laboratory test orders and repeated or rejected specimens in the Laboratory Information System (LIS) during 2021. The data consisted of the types of PAEs, their distribution across laboratory sections, the patient source among hospital departments, and the working shift during which PAEs were recorded.

MAIN OUTCOME MEASURES: The causes and frequencies of PAEs across laboratory sections, hospital departments, and work shifts were analyzed.

SAMPLE SIZE: 2104 PAEs from a total of 3 346 199 test orders.

RESULTS: Of the 3 346 199 test orders, 3137 were recorded as either repeated or rejected. Of these, 2104 (67.1%) were attributed to PAEs, representing a rate of 0.063% (95% CI: 0.060-0.066%) of the total test orders. ‘Clotted specimens’ (32%) and ‘insufficient quantity’ (31%) were the most frequent PAEs. Significant differences were identified in the error rate and type of PAEs across laboratory sections, hospital departments, and working shifts (P<.001 for each). The highest error rate was in the blood bank (0.4%). The hematology section accounted for the largest proportion of errors (48.4%). Most PAEs were test orders from the inpatient department (47.3%), with a majority occurring in the morning shift (58.2%).

CONCLUSION: Our study revealed a low overall PAE rate of 0.063%. ‘Clotted specimens’ and ‘insufficient quantity’ were the most frequent errors. Importantly, we identified significant differences in the types of PAEs across laboratory sections, hospital departments, and working shifts, indicating their multifaceted and context-dependent nature.

LIMITATIONS: A retrospective, single-center study.

PMID:41275351 | DOI:10.5144/0256-4947.2025.381

Ann Saudi Med. 2025 Nov-Dec;45(6):388-394. doi: 10.5144/0256-4947.2025.388. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted cancer care, resulting in significant diagnostic delays.

OBJECTIVES: While prior studies have examined shifts in clinical stage, limited data exist on the pandemic’s effect on histopathological features and long-term survival in gastric cancer (GC). We aimed to address this gap through a comprehensive comparative analysis.

DESIGN: Retrospective cohort study.

SETTING: Tertiary-care center.

PATIENTS AND METHODS: This single-center study included 317 participants newly diagnosed with GC, divided into pre-pandemic (March 2018-March 2020) and pandemic (March 2020-March 2022) groups. Demographic, clinical, and detailed histopathological characteristics and 1- and 3-year overall survival (OS) rates were compared between groups.

MAIN OUTCOME MEASURES: Comparison of clinical stage, treatment modality, histopathological features, and 1- and 3-year overall survival between GC patients diagnosed before and during the COVID-19 pandemic.

SAMPLE SIZE: 317 patients.

RESULTS: The pandemic group exhibited a significantly higher rate of metastasis at diagnosis (38.0% vs. 26.9%; P=.035), lower rate of surgical resection (54.0% vs. 65.3%; P=.041), and higher rate of palliative therapy (44.0% vs. 31.1%; P=.018). Histopathologically, this cohort had a greater proportion of high-grade (G3) tumors (P=.014), lower median number of dissected lymph nodes (P=.002), and poorer response to neoadjuvant therapy (P=.025). Both 1- and 3-year OS were significantly lower in the pandemic group (P=.009 and .045, respectively).

CONCLUSIONS: The COVID-19 pandemic was associated with more advanced disease at diagnosis and significantly worse long-term survival for patients with GC. These outcomes appear to result from diagnostic and treatment delays rather than substantial changes in tumor biology. These findings underscore the need to establish resilient cancer care systems to reduce vulnerability during health crises.

LIMITATIONS: Single-center retrospective design and selection bias due to histopathological analyses being limited to surgically treated patients.

PMID:41275347 | DOI:10.5144/0256-4947.2025.388

Ann Saudi Med. 2025 Nov-Dec;45(6):421-434. doi: 10.5144/0256-4947.2025.421. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage.

OBJECTIVES AND DESIGN: This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy.

METHODS: A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied.

MAIN OUTCOME MEASURES: The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events.

SAMPLE SIZE: Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group).

RESULTS: ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events.

QUALITY OF EVIDENCE: Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger’s regression test indicated a low risk of publication bias for LVEF.

HETEROGENEITY: High (I²=97%) for LVEF at 6 months.

CONCLUSION: ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits.

LIMITATIONS: The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects.

REGISTRATION: PROSPERO CRD42024555546.

PMID:41275346 | DOI:10.5144/0256-4947.2025.421

Ann Saudi Med. 2025 Nov-Dec;45(6):395-405. doi: 10.5144/0256-4947.2025.395. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Obstetric anal sphincter injuries (OASIS) are severe complications of vaginal deliveries with long-term physical and psychological sequelae. Data on the prevalence and risk factors of OASIS are limited in Saudi Arabia. This study aimed to assess the incidence of OASIS annually from 2017 to 2020, identify associated maternal and delivery factors, and investigate patients’ characteristics related to OASIS Grades.

OBJECTIVE: To evaluate the annual incidence of OASIS from 2017 to 2020, identify maternal and delivery-related risk factors, and assess characteristics associated with different OASIS grades.

DESIGN: Single-center, retrospective observational study.

SETTING: King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS: Medical records of all vaginal deliveries from 2017 to 2020 were reviewed. The study included 112 patients with singleton vaginal deliveries complicated by OASIS, out of a total of 12 081 deliveries. Exclusion criteria included preterm births and incomplete records. Data on maternal demographics, obstetric history, labor type, mode of delivery, episiotomy use, and neonatal outcomes were collected. The Royal College of Obstetricians and Gynaecologists (RCOG) classification was used to grade OASIS severity. Chi-square and t-tests were used for analysis.

MAIN OUTCOME MEASURES: Annual incidence of OASIS, distribution of OASIS grades, and associations between clinical variables and injury severity.

SAMPLE SIZE: 112 cases of OASIS among 12081 vaginal deliveries.

RESULTS: The incidence of OASIS was 0.93%, showing a decreasing trend from 2017 to 2020. Most patients were Saudis (78.6%), primigravidae (58%), and nulliparous (67%). Spontaneous vaginal delivery occurred in 73.2% of cases, with episiotomies performed in 62%. Grade III tears were observed in 79.5% of cases, whereas 8.0% were classified as Grade IV. No significant differences were observed between Grades III and IV in terms of maternal and delivery characteristics, except for higher estimated blood loss in Grade IV cases. Incomplete documentation was noted in repair techniques and episiotomy details.

CONCLUSION: Incidence of OASIS shows a decreasing trend in both the number of cases and the incidence rate over the four years between 2017 and 2020. Further research is necessary to address documentation gaps and refine regional prevention and management practices.

LIMITATION: Retrospective design and missing values limited the ability to analyze some variables thoroughly.

PMID:41275344 | DOI:10.5144/0256-4947.2025.395

Med Sci Monit. 2025 Nov 23;31:e950460. doi: 10.12659/MSM.950460.

ABSTRACT

BACKGROUND Intrauterine devices (IUDs) are widely used for contraception and are generally well tolerated. A rare complication is spontaneous fracture of the IUD while in situ. This study aimed to evaluate the prevalence of spontaneous IUD fractures and compare occurrence between 2 IUD types. MATERIAL AND METHODS This retrospective study included 463 women who underwent IUD insertion and follow-up between January 1, 2011, and December 31, 2021. Two IUDs were evaluated: Type 1, a copper IUD with a gold core (375 mm²), and Type 2, a copper IUD (300 mm²) without a gold core. Spontaneous fractures were identified based on symptoms or routine annual ultrasonography. Statistical analyses included descriptive statistics, normality testing, and comparisons using chi-square, t-tests, or Mann-Whitney U tests. A p value <0.05 was considered significant. RESULTS Among 463 patients, 183 used a Type 1 IUD and 280 used Type 2. Spontaneous fractures were observed in 12 of 183 Type 1 users (6.56%, 95% CI: 2.97-10.15%), while no fractures occurred among Type 2 users. Overall fracture prevalence was 2.59% (95% CI: 1.49-4.48%). Fractured arms were often located in the uterine cornua (n=9) and cervical canal (n=3). Fragments in the canal were removed using Novak extraction, while those in the cornua required hysteroscopy. CONCLUSIONS Spontaneous IUD fractures can occur without symptoms and must be considered during follow-up. Prompt recognition is essential to avoid complications. Hysteroscopy and Novak extraction are effective for fragment removal. Clinicians should consider routine ultrasonographic evaluation to detect asymptomatic IUD fractures, especially in users of Type 1 devices.

PMID:41275328 | DOI:10.12659/MSM.950460

J Psychosom Obstet Gynaecol. 2025 Dec 31;46(1):2584909. doi: 10.1080/0167482X.2025.2584909. Epub 2025 Nov 22.

ABSTRACT

OBJECTIVE: This study aims to systematically analyze the disease burden and epidemiological characteristics of depression among women of childbearing age (WCBA) globally and across regions from 1990 to 2021, as well as explore the current research status and hotspots.

METHODS: Data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2021) were used to examine age-standardized incidence rates (ASIR) and disability-adjusted life years (DALYs) of depression among WCBA by region, age, and socio-demographic index (SDI) level. Relevant literature was retrieved from the Web of Science Core Collection, with bibliometric analyses (temporal-spatial distribution, themes, keywords) performed via VOSviewer and CiteSpace.

RESULTS: In 2021, there were ~133 million new global cases of depression among WCBA, with an ASIR of 6,808.01 per 100,000 population. Incidence rose significantly since 1990, accelerating from 2019 to 2021. High SDI regions had higher ASIR, age-standardized DALY rates (ASDR), and average annual percentage change (AAPC). Globally, incidence peaked at 45-49 years with age growth, but younger WCBA (15-29 years) in high SDI regions had higher ASIR. Bibliometric analysis showed rapid research expansion in recent years, covering pregnancy, risk factors, and obesity, with “polycystic ovary syndrome” and “oxidative stress” as emerging hotspots.

CONCLUSION: The study highlights the rising global burden of depression among WCBA and disparities across regions, socioeconomic backgrounds, and age groups, providing scientific evidence for targeted public health interventions.

PMID:41275327 | DOI:10.1080/0167482X.2025.2584909

BMC Pregnancy Childbirth. 2025 Nov 22. doi: 10.1186/s12884-025-08523-x. Online ahead of print.

ABSTRACT

BACKGROUND: The postpartum period is a critical phase that can impact maternal mental health and functional adaptation. This study evaluated the effect of midwife-led psychosocial counseling with family support on postpartum depression and maternal functioning among primiparous women.

METHOD: This randomized controlled trial enrolled 56 primiparous women aged 15-45 years who were recruited from healthcare centers in Tehran, Iran. Participants were selected through convenience sampling and randomly assigned to intervention and control groups using a four- block randomization protocol. The intervention group received three individualized 120-minute sessions of midwife-led psychosocial counseling, with a family member support person present; these sessions were administered at 3-5, 15-30, and 42 days postpartum. The control group received routine postpartum care. The Edinburgh Postnatal Depression Scale and the Barkin Index of Maternal Functioning were administered before, immediately after, and one month post-intervention.

RESULTS: Repeated measures analysis revealed that depression scores declined over time in both groups; however, between-group differences were not statistically significant (P = 0.07, CI [-1.45-2.94]. Furthermore, repeated measures analysis indicated that maternal functioning improved significantly in the intervention group compared to the control group (p = 0.02, CI [0.58-7.03], η² = 0.075).

DISCUSSION: Midwife-led psychosocial counseling with family participation significantly enhances maternal functioning in the early postpartum period. However, no statistically significant between-group effect was observed for postpartum depression, indicating that improvements in depressive symptoms may require longer follow-up or more intensive approaches.

TRIAL REGISTRATION: The study was registered in the Iranian Clinical Trials Registry with NO (IRCT20231209060304N1) on 2024/2/20.

PMID:41275322 | DOI:10.1186/s12884-025-08523-x

BMC Oral Health. 2025 Nov 22. doi: 10.1186/s12903-025-07299-y. Online ahead of print.

ABSTRACT

BACKGROUND: Dental caries ranks among the most frequent childhood diseases worldwide, significantly impacting oral health and overall well-being. The objective of this systematic review and meta-analysis was to evaluate the efficacy of school-based supervised toothbrushing (STB) intervention in the prevention of dental caries by enhancing oral hygiene.

METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, Scopus, Web of Science, and other databases up to February 2025. Eligible studies were those that contrasted school-based STB intervention with no-intervention controls, documenting results in DMFT/dmft or DMFS/dmfs indices. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Risk of Bias 2 (RoB2) tool. A random-effects model was used to pool the results, and standardized mean differences (SMDs) were calculated to account for differences in dentition types. Heterogeneity was assessed using the I² statistic and Cochran’s Q test.

RESULTS: Five of the eight RCTs that satisfied the inclusion requirements were included in the meta-analysis. A statistically significant reduction was shown in DMFS/dmfs that resulted from STB intervention (SMD = -0.22; 95% CI: -0.42 to -0.01; p = 0.037; I² = 64.6%), indicating a modest preventive effect with moderate heterogeneity. However, there was no significant effect on DMFT/dmft (SMD = 0.05; 95% CI: -0.27 to 0.37; p = 0.754; I² = 86.8%), reflecting high between-study variability.

CONCLUSION: School-based supervised toothbrushing intervention appear to effectively reduce dental caries at tooth surface level, as reflected in the significant reduction in DMFS/dmfs scores. However, their effect on whole-tooth caries, as measured by DMFT/dmft, remains less evident in the short term. These findings support using STB as a practical community-level intervention to promote oral health in children.

TRIAL REGISTRATION: We have registered the protocol on the Open Science Framework (OSF) (Registration DOI: https://doi.org/10.17605/OSF.IO/2JWR9).

PMID:41275321 | DOI:10.1186/s12903-025-07299-y

BMC Nurs. 2025 Nov 22. doi: 10.1186/s12912-025-04090-w. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer and its treatments accelerate frailty in older adults with cancer (OACA). Exercise is safe and beneficial during and after treatment, yet many, including older adults, do not meet current exercise guidelines. The primary objective of this study was to understand oncology clinic nurses’ knowledge and current practices regarding exercise discussion and promotion in patients with cancer, including in older patients. The secondary objectives were to: (1) explore barriers to initiating exercise discussion and promotion; and (2) explore the relationship between oncology nurses’ exercise behavior, and their knowledge about existing guidelines and exercise promotion practices.

METHODS: A cross-sectional online survey was conducted via REDCap between February and May 2023 involving nurses who practice in outpatient oncology clinics. The survey was developed based on the expert consensus of the study team and was distributed through professional networks. Descriptive statistics and chi-square were used to analyze the collected data.

RESULTS: Ninety-seven nurses participated. The majority were aged 41-50 years (38.1%) and 31-40 years (27.8%). Mean years of practice was 13.5 (0.5-45). Many nurses lacked formal training on exercise discussion with patients (57.8%), yet expressed interest in learning (91%). Most nurses (90%) agreed exercise benefits patients during treatment. The majority (75%) reported discussing or recommending exercise to patients with cancer, especially advising patients to stay active during and after treatment. Barriers to promoting exercise included limited clinic time (77.7%) and concerns about safety especially for OACA (72.2%). 37.6% of nurses reported engaging in moderate-intensity aerobic activity. 26.6% endorsed both being quite/very knowledgeable in discussing exercise guidelines with patients with cancer in general and 74.7% reported typically discussing exercise with patients with cancer in general. A statistically significant association was found between nurses’ exercise promotion behaviour and perceived knowledge about exercise promotion (p = .01).

CONCLUSION: Many nurses agree that exercise promotion is important and consider it part of their scope of practice to discuss exercise with patients with cancer. Although perceived knowledge regarding specific recommendations is generally low, nurses express interest in enhancing their knowledge and participating in diverse educational opportunities. Institutions should prioritize nurse education to support efforts in exercise promotion.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41275319 | DOI:10.1186/s12912-025-04090-w

Antimicrob Resist Infect Control. 2025 Nov 22. doi: 10.1186/s13756-025-01653-z. Online ahead of print.

ABSTRACT

BACKGROUND: The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.

METHODS: A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.

RESULTS: During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58-79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.

CONCLUSIONS: In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.

PMID:41275300 | DOI:10.1186/s13756-025-01653-z