Journal of Medical and Health Studies (ISSN: 2710-1452) is a peer-reviewed International Journal published by Al-Kindi Center for Research and Development. The journal covers scholarly articles in the fields of Medicine and Public Health. All articles are freely available without charge to the users or their institutions; thus, ensuring high visibility and increasing citations for all research articles published. The journal aims to facilitate scholarly work on recent theoretical and practical aspects of health and medical sciences. Academics, policymakers, and researchers are welcome to submit their manuscripts at any time.
Al-Kindi Center for Research and Development
Femtosecond Laser-Assisted Cataract Surgery: Precision, Safety, and Visual Outcomes — A Comparative Study with Conventional Phacoemulsification at Habboubi Teaching Hospital
Overview: FLACS is thought to have advantages in improving the accuracy of specific procedures such as capsulotomy, nuclear fragmentation and corneal incisions when compared with traditional phacoemulsification. It remains controversial whether the technical improvements lead to better safety and visual outcomes in teaching hospitals. Objectives: The main objectives of the study are to determine the accuracy of capsulotomy, EPT, CDE, corneal endothelial cell damage, visual results, and complication rates in FLACS and CPS in patients who underwent cataract surgery at Habboubi Teaching Hospital. Methods: A prospective, comparative, and intervention study was carried out in the Department of ‎Ophthalmology, Habboubi Teaching Hospital, from January to December 2025. One hundred twenty eyes of 120 cases of age-related cataract were divided equally into two groups; Group A received FLACS with the femtosecond laser system for capsulotomy, lens fragmentation, and corneal incisions before phacoemulsification, whereas Group B received CPS. The accuracy of capsulotomy, EPT, CDE, loss of corneal endothelial cells, CDVA, and any complications were measured at day 1, week 1, and month 1. Results: Capsulotomy deviation from the target diameter was significantly smaller in Group A (0.08 ± 0.04 mm) than Group B (0.31 ± 0.15 mm; p < 0.001). Mean EPT (4.2 ± 1.8 vs 9.6 ± 3.4 seconds) and CDE (3.1 ± 1.4% vs 7.8 ± 2.9%) were significantly lower in Group A (p < 0.001 for both). Endothelial cell loss at 1 month was lower in Group A (6.8 ± 3.2%) than Group B (9.4 ± 3.9%; p = 0.01). At week 1, 85.0% of Group A versus 71.7% of Group B achieved CDVA ≥ 6/9 (p = 0.03); this difference was not significant by month 1 (93.3% vs 90.0%; p = 0.51). Capsule tear in the anterior region occurred more frequently in Group A (3.3% compared to 1.7%), whereas capsular tear in the posterior region was observed more often in Group B (3.3% compared to 1.7%); however, no significant difference was observed. Conclusion: FLACS showed better capsulotomy accuracy, less phacoemulsification energy, and faster visual improvement at the early stage of treatment compared to CPS, with no difference in safety, although there was some trend towards greater anterior capsule problems during learning curve period.
Femtosecond laser-assisted cataract surgery; phacoemulsification; capsulotomy; ‎visual acuity; endothelial cell loss
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by-nc/4.0
Predictors of Mortality in Sepsis Across Medical, Surgical, and Obstetric Populations: A Systematic Review
Sepsis is a heterogeneous syndrome in which mortality reflects the interaction of host vulnerability, infection characteristics, the magnitude and trajectory of organ dysfunction, physiologic reserve, and the timeliness and adequacy of treatment. Contemporary definitions emphasize life-threatening organ dysfunction caused by a dysregulated host response to infection, while clinical practice increasingly requires risk stratification that can identify patients likely to deteriorate before irreversible organ injury develops [1]. To synthesize evidence on clinical, laboratory, physiologic, microbiologic, treatment-related, and population-specific predictors of mortality in adult sepsis, with explicit comparison across medical, surgical, and obstetric populations [2].A structured systematic-review framework was developed using the organization of the previously supplied transfusion-threshold review as a methodological model, including PRISMA-oriented reporting, predefined eligibility domains, outcome definitions, risk-of-bias considerations, subgroup synthesis, and evidence grading. The present manuscript incorporates targeted contemporary evidence from PubMed-indexed systematic reviews, meta-analyses, guidelines, landmark cohorts, and prediction-model studies through August 2026; because a full reproducible multi-database export and dual-reviewer screening log were not supplied, numerical PRISMA counts are deliberately not fabricated [3].The evidence consistently identifies increasing age, higher baseline illness burden, elevated lactate, persistent hyperlactatemia or poor lactate clearance, higher SOFA or other severity scores, vasopressor dependence, mechanical ventilation, acute kidney injury, multiple organ dysfunction, hypoalbuminemia, and selected infection sources as clinically important markers of mortality risk. In prognostic-model literature, age, lactate, albumin, SOFA score, and vasopressor use are among the most frequently incorporated predictors, although methodological quality and external validation remain inconsistent [4]. Mortality in sepsis is best understood as a dynamic phenotype rather than a consequence of a single abnormality. The strongest prognostic signal arises when static vulnerability factors converge with early physiologic deterioration and failure to recover after treatment. Medical, surgical, and obstetric populations share core predictors but differ in baseline physiology, source-control requirements, disease trajectories, and thresholds for escalation, making context-specific risk assessment essential [5].
Sepsis; septic shock; mortality; prognostic factors; SOFA; lactate; organ dysfunction; vasopressors; acute kidney injury; surgical sepsis; maternal sepsis; obstetric sepsis; prediction models; biomarkers; critical care.
Copyright (c) 2026 Journal of Medical and Health Studies
Data Fragmentation in Emerging Market Health Insurance Systems: A Business Intelligence Framework for Claims Integrity and Fraud Reduction
Health insurance fraud in developing economies is fundamentally enabled by data fragmentation — the absence of a unified, auditable data architecture connecting clinical encounters, pharmacy dispensing, and insurance claims into a verifiable record of care. Multi-payer health systems in South Asia operate with disconnected data silos across payers, providers, and government programs, creating systematic opportunities for phantom billing, duplicate claims, and eligibility fraud that drain billions in healthcare financing annually. This paper introduces BI-ClaimGuard, a Business Intelligence framework designed to address the root-cause architectural vulnerability enabling insurance fraud. Drawing on consulting engagements with health insurance operations in Bangladesh, we develop a unified data architecture that consolidates clinical encounter records, pharmacy dispensing logs, and insurance claims submissions into a single auditable source of truth. The framework implements three core components: (1) a cross-system data ingestion layer normalizing heterogeneous claims formats into a standardized schema; (2) a real-time reconciliation engine flagging mismatches between clinical records and submitted claims at the point of data entry; and (3) an audit trail preservation system maintaining immutable records of all data transformations for regulatory review. Evaluated across 2,208,000 insurance claims processed during 2020–2021, BI-ClaimGuard reduces claims reconciliation time by 67% and identifies data integrity violations in 12.3% of submitted claims previously undetected by manual audit processes. These architectural improvements establish a data integration foundation transferable to any multi-payer health insurance environment facing comparable fragmentation challenges.
business intelligence, health insurance, data fragmentation, claims integrity, fraud detection, multi-payer systems, data warehousing, low-and-middle-income countries
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Post-Market Quality Surveillance: Assessing Physicochemical Parameters and Inter-Brand Variations of Cinnarizine Tablets in Thi-Qar_Iraq
As a first-line medication for vertigo management, cinnarizine has been authorized for the treatment of nausea, vomiting, motion sickness, and illnesses affecting the inner ear. Blood viscosity and nystagmus in labyrinth are both reduced by its anti-vasoconstrictor action. The primary objective of the study was to evaluate the worth of both brand-name and generic Cinnarizine available in Iraq. The following tests were performed on 25 mg cinnarizine tablets available in Iraq: in vitro dissolving test, disintegration, friability, drug content, and hardness. The innovator product, Janassen, was coded as CA1. The generic brands, Ibn Hayyan (Syria) and Sama alfayhaa (Iraq), were coded as CA2 and CA3, respectively. A spectrophotometric method was employed for the purpose of drug analysis. Results: Using spectrophotometers, we could detect active drug levels between 95% and 98% in CA1, CA3 having the maximum potency at 99.99%. In terms of mechanical qualities, all the formulations presented similar and excellent resistance to abrasion. The mean friability values were very low, ranging between 0.11% and 0.12%. The tablet hardness and the disintegration behaviors were somewhat different. The innovator product (CA1) had the maximum mechanical strength (9.5 ± 0.21 Kg) and the disintegration time was 4.15 min. The Iraqi generic (CA3) had the lowest hardness (6.5 ± 0.54 Kg) and the disintegration time was almost equal to 4.12 min. The Syrian generic (CA2) was characterized by a quick breakdown (1.47 min) in spite of its intermediate hardness (8.2 ± 0.28).
Cinnarizine, Dissolution, Friability test, disintegration test, hardness.
Verified ACTION PACKET: A Framework for Accountable Decision Support and Communication in Digital Public Health Systems
Public health decisions and their communication increasingly unfold across websites, dashboards, messaging systems, social media, and partner platforms. Across these channels, the evidence, recommendations, and messages supporting a decision must remain synchronized, traceable, accessible, and correctable through repeated revisions. Existing guidance largely evaluates decisions or messages at a single point in time and offers limited support for governing the full pathway from evidence and decision rationale to dissemination, revision, correction, and retirement. When evidence or guidance changes, decision rationales may become difficult to reconstruct, outdated versions persist, corrections fail to propagate, and provenance is lost. This study specifies the Verified ACTION PACKET Framework, a two-layer methodological framework for governing the last mile of public health decision support and communication from provenance through retirement, and presents an evidence-matched validation agenda. Developed through a design-oriented narrative synthesis and retrospective design audit, the framework draws on sources across eleven evidence domains and was positioned against a scoping review of 39 public health frameworks and an overview of 36 systematic reviews informing WHO-INTEGRATE. Recurring challenges in translating evidence into decisions and communications were converted into observable challenge-control pairs and organized as release-quality criteria, procedural governance controls, workflow phases, lifecycle states, and measures. Components were retained when they were consequential, conceptually distinct, assignable, observable, locally feasible, proportionate to risk, and empirically testable. The framework comprises a decision-and-communication governance layer and an implementation layer linked by a persistent, versioned ACTION PACKET. Six ACTION release-quality domains assess whether a communication product and its underlying decision basis are ready for release, while six dependency-ordered PACKET phases govern their development, approval, publication, monitoring, revision, correction, and retirement. Mnemonic labels were applied only after construct boundaries, required outputs, responsible roles, decision points, and evaluation targets had been specified. The result is a bounded, auditable specification for supporting public health decisions and governing their communication from provenance through retirement, while enabling local, multilingual, accessible, and correctable implementation. As a provisional architecture, it now advances to multidisciplinary and community appraisal, usability and inter-rater testing, feasibility implementation, and comparative evaluation of decision quality, communication effectiveness, and scale-up.
Digital public health systems; public health communication; digital health governance; implementation science; organizational health literacy; multilingual communication;
Playing with Colour: A Case Study of Deduako Life Community Special Vocational School and the Garden City Special School
Persons with intellectual disabilities (PWID) often experience limitations in cognitive functioning that distinguish them from the broader population. Although these differences may be real or perceived, they frequently result in significant social consequences, including stigma and exclusion. Deeply rooted cultural attitudes tend to reinforce negative perceptions of intellectual disability, often portraying affected individuals as less capable in various aspects of human endeavour. However, emerging perspectives suggest that PWID may demonstrate strengths in non-verbal and visual forms of communication, particularly through artistic expression. This study explored self-expression through art-making among persons with intellectual disabilities using structured creative art sessions. The research adopted a qualitative approach to examine how participants communicate ideas, emotions, and experiences through visual media. The focus was on understanding art as a medium of expression rather than as a measure of technical skill. The study was conducted with students from two special education institutions in Kumasi, Ghana: Deduako Life Community Special Vocational School and Garden City Special School. Participants were engaged in guided colour-based art activities designed to encourage free expression and creativity within a supportive environment. Findings revealed that persons with intellectual disabilities were able to effectively express themselves through visual art. Their works demonstrated originality, emotional engagement, and the ability to convey meaning through colour, form, and composition. The results challenge deficit-based assumptions about intellectual disability and highlight the communicative and expressive potential of PWID. The study concludes that art-making provides an important avenue for self-expression and communication among persons with intellectual disabilities and supports the need for inclusive creative spaces that foster their artistic development and social participation.
Art, Art Therapy, Intellectual disability
The progress of smart healthcare based on Multimodal Data fusion technology
Smart healthcare is moving towards precision, personalization, and intelligence. Multimodal data fusion technology, as a core means to break medical data silos and improve clinical decision-making efficiency, has received extensive attention. This paper systematically reviews the mainstream methods and their performance in typical medical tasks from four levels: data level, feature level, decision level, and hybrid fusion. Based on this, the current commonly used medical multimodal datasets and evaluation criteria are introduced, and the experimental results of various fusion methods on public datasets are summarized. Further, this paper analyzes the challenges of existing methods in terms of data heterogeneity, modal absence, interpretability, and privacy protection, explores the deficiencies in the dataset construction and evaluation system, and proposes corresponding solutions. Finally, it looks forward to future research directions, emphasizing the synergy of medical-engineering integration, privacy computing and explainable models to provide references for the in-depth research and application of multimodal fusion technologies in smart healthcare.
Smart healthcare; Multimodal data fusion; Data-level fusion; Feature-level fusion; Decision-level fusion; Hybrid fusion
Diagnostic Accuracy of Ultrasound-Estimated Fetal Weight versus Actual Birth Weight: A Prospective Cohort Study on Predictive Performance, Systematic Bias, and Clinical Agreement Near Term
Fetal weight prediction is used to aid decision making, timing of delivery, and counselling for possible macrosomia and fetal growth restriction (FGR). The clinical standard, most commonly the Hadlock formulas, ultrasound estimated fetal weight (EFW) has also been shown to agree with actual birth weight (BW) to a varying degree depending on gestational age, extremes of fetal weight, maternal body habitus, and operator experience. To assess the accuracy, systematic bias, and clinical agreement of ultrasound-derived EFW with BW recorded within 7 days of delivery, as well as to establish factors associated with decreased estimation accuracy. N = 420 (SIMULATED) singleton pregnancies were studied using ultrasound biometry within 7 days prior to delivery. The accuracy was evaluated using mean percentage error (MPE), mean absolute percentage error (MAPE), proportion of estimates within +-10% of birth weight, Bland-Altman limits of agreement, and Lin's concordance correlation coefficient (CCC) for each birth weight category. In this synthetic cohort, EFW showed a mean percentage error of - 0.8% (SD 5.9%), mean absolute percentage error of 4.8% (SD 3.6%), and 90.2% of the estimates were within +-10% of the true birth weight. Bland-Altman analysis showed a mean bias of -25.9 g (95% limits of agreement: -412.5 g to +360.6 g). Pearson r was 0.868 and Lin's CCC was 0.853, suggesting high correlation and agreement. The AUC for EFW to predict macrosomia (birth weight >= 4000 g) and predicted small-for-gestational-age status were 0.976 (71.4% sensitivity and 96.1% specificity) and 0.963 (64.3% sensitivity and 96.0% specificity, respectively). None of the maternal, fetal, or sonographic covariates were statistically significant when explored as a separate predictor of absolute percentage error in adjusted regression. For this simulated dataset, ultrasound EFW was in good overall agreement with actual birth weight with small systematic underestimation and wide individual (personal) limits of agreement, consistent in direction with published datasets this exercise is based on. The findings presented in these tables are intended as hypothetical examples of the analytic process that the study protocol calls for, but cannot be considered evidence of clinical effectiveness since a true cohort of participants with sufficient power would be needed before any of these numbers could support clinical practice.
Estimated fetal weight, birth weight, obstetric ultrasound, Hadlock formula, diagnostic accuracy, Bland-Altman analysis, macrosomia, fetal growth restriction, and neonatal outcomes.
Intracerebral Hemorrhage in the Setting of Lamotrigine-Induced Stevens-Johnson Syndrome: A Case Report
Stevens-Johnson syndrome is a rare but life-threatening severe cutaneous adverse reaction that may involve multiple organ systems and is commonly associated with medication exposure. Although clinicians are familiar with complications such as sepsis, shock, and multiorgan dysfunction, rare neurological complications may be overlooked. We report the case of a 41-year-old Saudi male with epilepsy who developed Stevens-Johnson syndrome following recent initiation and dose escalation of lamotrigine. The patient presented with fever, generalized malaise, and a rapidly progressive diffuse erythematous maculopapular rash associated with painful oral erosions and systemic symptoms. Examination demonstrated widespread skin involvement with mucosal lesions consistent with Stevens-Johnson syndrome. The patient was admitted for close monitoring due to the severity of the reaction and risk of rapid deterioration. During hospitalization, he developed sudden severe headache, repeated vomiting, fluctuating level of consciousness, and objective unilateral weakness. These findings prompted urgent neurological evaluation, and non-contrast computed tomography of the brain revealed an acute intracerebral hemorrhage with intraventricular extension. The patient was subsequently managed in an intensive care setting with multidisciplinary involvement from dermatology, neurology, neurosurgery, and critical care teams. Supportive management of Stevens-Johnson syndrome was continued alongside neurological monitoring and management of the intracranial hemorrhage. The patient's neurological status gradually improved, with concurrent clinical improvement of the cutaneous manifestations following discontinuation of the suspected medication. This case highlights an uncommon but important complication of Stevens-Johnson syndrome and emphasizes that neurological deterioration should not automatically be attributed to sepsis or systemic inflammation. New focal neurological deficits, severe headache, vomiting, or unexplained decline in consciousness should prompt urgent investigation for intracranial pathology. Maintaining diagnostic vigilance and recognizing atypical disease progression may facilitate early diagnosis and improve outcomes in patients with severe drug-induced reactions.
Stevens-Johnson Syndrome, Rash, Oral Mucosa, Fever, Brain Hemorrhage, Sepsis.
Artificial Intelligence, ctDNA, and Biomarker-Driven Precision Oncology: Emerging Molecular Strategies for Cancer Diagnosis and Therapeutic Response Prediction
Precision oncology has emerged as a transformative paradigm in cancer diagnosis and therapeutic decision-making through the integration of molecular diagnostics, genomic profiling, artificial intelligence (AI), and translational medicine. Conventional oncology approaches based primarily on histopathological classification frequently fail to address the extensive intertumoral and intratumoral heterogeneity that contributes to therapeutic resistance, metastatic progression, and variable clinical outcomes. Recent advances in next-generation sequencing (NGS), circulating tumor DNA (ctDNA)-based liquid biopsy technologies, transcriptomics, multi-omics integration, and AI-assisted computational oncology have significantly improved biomarker discovery, molecular surveillance, therapeutic response prediction, and personalized treatment strategies. Machine learning and deep learning algorithms are increasingly utilized for tumor classification, digital pathology, radiomics, survival prediction, biomarker-guided therapeutic optimization, and recurrence monitoring. ctDNA-based liquid biopsy platforms further provide minimally invasive approaches for longitudinal tumor profiling, minimal residual disease (MRD) detection, clonal evolution analysis, and real-time therapeutic response monitoring. Molecular biomarkers including EGFR mutations, HER2 amplification, KRAS mutations, microsatellite instability (MSI), tumor mutational burden (TMB), and angiogenic signaling markers are increasingly incorporated into precision therapeutic frameworks. Additionally, AI-assisted integration of genomics, transcriptomics, proteomics, epigenomics, and metabolomics has accelerated translational precision medicine. Despite substantial advances, major challenges remain, including biomarker standardization, AI interpretability limitations, sequencing costs, data heterogeneity, and clinical implementation barriers. This review discusses recent advances in AI-assisted precision oncology, molecular biomarker systems, ctDNA technologies, therapeutic resistance mechanisms, translational oncology, and emerging multi-omics frameworks. The review also highlights future directions involving AI-assisted molecular surveillance, computational oncology platforms, and personalized cancer therapeutics.
Precision oncology, artificial intelligence, ctDNA, liquid biopsy, molecular biomarkers, translational medicine, computational oncology, therapeutic resistance, personalized medicine
Comparative Efficacy of Intravitreal Aflibercept versus Panretinal Photocoagulation for Proliferative Diabetic Retinopathy: A Randomized Controlled Trial
Proliferative diabetic retinopathy (PDR) remains a leading cause of preventable blindness among working-age adults worldwide. Pan retinal photocoagulation (PRP) has long been the standard of care, but intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have emerged as an alternative that may preserve visual function while inducing regression of neovascularization. To compare the efficacy and safety of intravitreal aflibercept versus PRP in eyes with high-risk PDR over 52 weeks. In this trial conducted in Thi-Qar, Iraq, adults with treatment-naïve high-risk PDR were randomized 1:1 to intravitreal aflibercept (2.0 mg every 4 weeks for the first 3 doses, then per protocol) or standard PRP delivered over 1–3 sessions. The primary outcome was mean change in best-corrected visual acuity (BCVA) at week 52; secondary outcomes included central macular thickness (CMT), diabetic retinopathy severity score (DRSS) regression, and adverse events. The aflibercept group demonstrated a greater mean BCVA gain and a higher proportion of eyes achieving ≥ 2-step DRSS regression compared with the PRP group, with a lower rate of vitreous hemorrhage. Both interventions were generally well tolerated.Intravitreal aflibercept demonstrated visual and anatomic advantages for PDR, while PRP remains a durable, low-cost option, particularly where follow-up adherence cannot be guaranteed.
Proliferative diabetic retinopathy; anti-VEGF; aflibercept; panretinal photocoagulation; randomized controlled trial
Health System Quality of Prevention of Mother-to-Child Transmission Services in Ethiopia: A Structured Narrative Review Using Donabedian and WHO Quality Frameworks
Background: Despite substantial expansion of prevention of mother-to-child transmission (PMTCT) services in Ethiopia through Option B+ and integration within maternal and child health services, vertical HIV transmission remains above the World Health Organization (WHO) elimination target. Evidence on the quality of PMTCT services and their determinants remains fragmented. Objective: To synthesize evidence on PMTCT service quality across WHO quality domains and identify multi-level determinants. Methods: A structured narrative review (SANRA-guided) searched PubMed, Embase, AJOL, HINARI and grey literature (2015–2026). Evidence was synthesized using the Donabedian, WHO Quality of Care, and Socio-ecological frameworks. Results: Quality gaps spanned all domains: suboptimal retention and 9–10% transmission (effectiveness); stock-outs and weak laboratory systems (safety); poor communication and privacy (people-centeredness); delayed ART initiation (timeliness); fragmented care and workforce shortages (efficiency); marked regional and rural–urban inequities; and inconsistent service integration. Determinants included individual stigma and fear of disclosure, provider burnout and inadequate training, facility infrastructure gaps, health system supply chain and digital health weaknesses, and community gender norms with limited male partner involvement. Conclusion: Ethiopia has achieved coverage expansion but implementation quality, equity, and continuity remain major challenges. Progress toward Triple Elimination requires comprehensive health system strengthening, reliable supply chains, workforce development, digital health, continuous quality improvement, and people-centred care to ensure uninterrupted, high-quality services.
PMTCT; HIV; Ethiopia; quality of care; health systems; Option B+; Triple Elimination
Meta-analysis with complementary and supportive medicine methods in migraine headache
This study aimed to conduct a meta-analysis of the effects of complementary and supportive medical methods on migraine headache. In the study, peer-reviewed scientific publications containing complementary and alternative medicine methods related to migraine were examined and analyzed with semiotic analysis. Then, the scanned publications were examined with content analysis. In the light of the findings obtained from the content analysis, the effectiveness of complementary and alternative medicine methods in migraine headache was compared by meta-analysis. The rate of studies including all migraines was 23.3%, the rate of migraine with aura was 33.3% and the rate of migraine without aura was 30.0%. The rate of studies including general migraine as a headache was 13.3%, and tension-type headache and migraine were used closely. The distribution of content indicator themes was 26.7% for ozone, 23.2% for alternative medicine and 20.0% for complementary medicine. The proportion of studies that included both alternative and complementary medicine was found to be 30.0%. The distribution of effect type indicators according to themes was 26.7% physiological-ozone, 30.0% physiological-acupuncture, 23.3% active substance and 20.0% placebo. Although modern medicine cannot provide a permanent and biological solution for migraine type pain, complementary medicine methods and traditional medicine approaches provide much more than just painkillers for symptoms. In treatment methods such as acupuncture that do not use medical agents, the placebo effect has an important function in the symptomatic treatment of migraine type headaches,
Migraine, headache, supportive medicine, complementary medicine
Diagnostic Accuracy of the GeneXpert MTB/RIF Ultra for Tuberculous Meningitis: A Systematic Review and Meta-Analysis
Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis and remains difficult to diagnose because conventional methods are either insensitive or time-consuming. This study aimed to evaluate the diagnostic accuracy of GeneXpert MTB/RIF Ultra for TBM through a systematic review and meta-analysis. A literature search was conducted in PubMed, Scopus, ScienceDirect, and ProQuest, and eligible studies were assessed using the QUADAS-2 tool. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves were generated using Meta-DiSc 2.0. Thirteen studies met the inclusion criteria. Using culture as the reference standard, GeneXpert MTB/RIF Ultra demonstrated high pooled sensitivity (91.01%), specificity (78.66%), and an area under the curve (AUC) of 0.88. When evaluated against the Composite Reference Standard (CRS), pooled sensitivity decreased to 58.88%, whereas specificity remained excellent at 98.52%, with an AUC of 0.90. Publication bias analysis showed no significant evidence of bias for the culture-based studies. Overall, GeneXpert MTB/RIF Ultra demonstrated strong diagnostic performance and represents a rapid, highly specific diagnostic tool for TBM, supporting its clinical use, particularly in high TB-burden and resource-limited settings.
Diagnostic Accuracy of Low-Dose CT versus Standard-Dose CT in the Detection of Urolithiasis
Non-contrast CT is the reference imaging test for urolithiasis, but the associated radiation dose is a concern, especially in young patients who may undergo repeated scans. This study assessed the diagnostic accuracy of low-dose CT (LDCT) against standard-dose CT (SDCT) for the detection of urinary tract stones. In this prospective comparative study at Al-Hussein Teaching Hospital in Al-Nasiriyah (Thi-Qar Province, Iraq), 150 adults with suspected renal colic underwent both LDCT and SDCT in the same session. SDCT served as the reference standard. Two radiologists, blinded to the reference reading, independently interpreted the LDCT images. Per-patient and per-stone sensitivity, specificity, predictive values, and accuracy were calculated with 95% confidence intervals (CI), with subgroup analysis by stone size and body mass index (BMI) and comparison of effective radiation dose. Reporting followed the STARD 2015 guideline. Urolithiasis was present in 102 of 150 patients (68%). LDCT achieved a per-patient sensitivity of 95.1% (95% CI 88.9–98.4), specificity of 97.9% (95% CI 89.1–99.9), and accuracy of 96.0%. Per-stone sensitivity was 94.0% overall but fell sharply for stones smaller than 3 mm (69.2% vs 98.6% for ≥ 3 mm; p < 0.001) and was lower in patients with BMI ≥ 30 (88.9% vs 97.2%). Inter-observer agreement was excellent (κ = 0.88). The mean effective dose was 76% lower with LDCT (1.9 ± 0.5 vs 8.1 ± 1.8 mSv; p < 0.001). LDCT detected urolithiasis with high accuracy at roughly one-quarter of the radiation dose of SDCT and can serve as the first-line protocol for suspected renal colic. Its main limitation is reduced sensitivity for sub-3-mm stones and in obese patients, where a standard-dose protocol should be considered.
Computed tomography; low-dose CT; urolithiasis; renal colic; diagnostic accuracy; radiation dose.
Assessing the Knowledge and Intention on HIV Prevention Among Senior High School Students in Selected Public Schools of San Pablo City
The human immunodeficiency virus (HIV) continues to pose a major public health concern, especially for adolescents and young adults, and there are a growing number of cases being reported worldwide, including in the Philippines. In addition, gaps exist between HIV knowledge and the intention to participate in HIV-preventive behavior despite ongoing prevention initiatives. The purpose of the study was to compare the relationship between HIV knowledge and intention to perform and support HIV preventive actions among selected senior high school students in the public high schools in San Pablo City, Laguna, Philippines. A quantitative, cross-sectional, descriptive correlational design was utilized with 367 respondents who had been randomly selected using a multi-stage sampling process. Using an adapted structured questionnaire, HIV transmission, prevention, and medical management and health services were measured, along with intention to participate in HIV preventive behaviors. Data were analyzed using descriptive statistics and Spearman's rho. A moderate amount of HIV knowledge was reported and a high level of intention to participate in preventive behaviors was also reported. There is a statistically significant but weak positive correlation between the two variables (ρ = 0.124, p = 0.018). There was a major connection between having knowledge about transmission and prevention but there was not a major relationship found between knowledge of medical management or health services. This suggests that there is not much effect of knowledge by itself on an individual's intention to seek the service and therefore shows that a comprehensive behavior-focused education program about health is necessary.
Human Immunodeficiency Virus, HIV knowledge; HIV prevention; intention; adolescents; community health nursing
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Factors Influencing Mortality in Intracerebral Hemorrhage Patients: A Literature Review
Intracerebral hemorrhage (ICH) is a life-threatening neurological condition associated with high mortality rates worldwide. This study aimed to review and synthesize current evidence regarding factors influencing mortality in patients with ICH and to evaluate their relevance to clinical practice at Universitas Airlangga Hospital. A literature review was conducted using 20 peer-reviewed articles published between 2020 and 2025, complemented by three major neurology textbooks. The analysis focused on clinical, radiological, and comorbidity-related predictors of mortality reported in the literature. The findings consistently identified decreased Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhage (IVH), and comorbid conditions such as hypertension and diabetes mellitus as major predictors of mortality. Mortality outcomes were found to be strongly influenced by the interaction between acute hemorrhagic characteristics and underlying systemic diseases. Furthermore, the presence of IVH, infratentorial hemorrhage, hypertension, and diabetes mellitus emerged as key prognostic factors associated with poor clinical outcomes. These findings suggest that early risk stratification based on neuroimaging features, alongside comprehensive management of comorbidities during the acute phase, is essential for guiding clinical decision-making and improving patient outcomes in tertiary healthcare settings, including Universitas Airlangga Hospital.
Intracerebral Hemorrhage, In-hospital Mortality, Prognostic Factors, Intraventricular Hemorrhage, Comorbidities
Management of the “Ring Finger” or Alliance Finger: Three Cases and a Literature Review
Ring finger is a serious accident characterized by a vascular and neurovascular avulsion and skin detachment. This serious accident follows sudden traction exerted on a finger by a ring, well known to hand surgeons.but much less known to other health professionals and even less to the general public. The authors report the observations of three patients, two of whom benefited from McGregor inguinal flap coverage after surgical debridement and amputation for the third with satisfactory functional and aesthetic results, and also address, after reviewing the literature, the different aspects of this pathology.
Alliance finger, Hand trauma, Inguinal flap, Amputation
Barriers to the Implementation of Phase I Cardiac Rehabilitation from the Perspective of Medical Staff Based on Normalisation Process Theory: A Qualitative Study
Background/Objectives: Based on the Normalisation Process Theory (NPT), this study aims to systematically analyze the barriers to knowledge translation of Phase I cardiac rehabilitation (CR) from the perspective of medical staff. Methods: Purposive sampling and snowball sampling were used to recruit 12 members of the cardiac rehabilitation multidisciplinary team for one-on-one in-depth interviews. Colaizzi’s seven-step phenomenological analysis method was employed to organize and summarize the interview data. Results: Four categories of barriers based on the NPT framework were identified: (1) Coherence barriers: low perceived value and benefits of CR among various stakeholders (insufficient explicit efficacy of CR, ambiguous cost-effectiveness); (2) Cognitive participation barriers: insufficient engagement and commitment of medical staff (decision-making inertia, role identity conflicts, risk perception conflicts); (3) Collective action barriers: low organizational resource readiness (leadership conflicts, fragmented referral systems, human resource shortages, lack of continuing education mechanisms for CR); (4) Reflexive monitoring barriers: low contextual compatibility (inadequate policy support, insufficient compatibility in evidence application). Conclusions: The NPT-based analysis reveals barriers in coherence, cognitive participation, collective action, and reflexive monitoring regarding Phase I CR knowledge translation from the perspective of medical staff. Enhancing medical staff’s perceived value of CR, improving organizational resource readiness, and creating highly compatible contexts may systematically promote the normalization of Phase I CR into routine practice.
Cardiac rehabilitation; knowledge translation; barriers; medical staff perspective; normalisation process theory.
Navigating the New Frontier: Enhanced Recovery After Surgery (ERAS) Protocols in Gynecological Nursing Care
Gynecological surgery procedures are responsible for millions of hospital admissions worldwide annually; however, the perioperative recovery protocols have always been based on conservative strategies, which are often paternalistic, based on the convenience of the surgeon and not the patient. Enhanced Recovery After Surgery (ERAS) protocols signify a paradigm shift, a coordinated, multimodal approach to surgery that undermines traditional practices of lengthy fasting, routine use of opioids, and delayed mobilization. Despite strong evidence of surgical impact, the crucial role of nursing in ERAS implementation has not been fully explored in the scholarly literature. This integrative review explores the current understanding of ERAS programs in gynecological surgical practice, focusing specifically on the nursing profession in the preoperative, operative, and postoperative phases. This paper also outlines the institutional challenges to the uptake of ERAS and suggests evidence-based strategies for its sustainable implementation. A systematic search of the PubMed, CINAHL, Cochrane Library, Embase, and MEDLINE databases was performed for literature published from 2017 to 2026. The Boolean search strategies included "ERAS," "enhanced recovery," "gynecological surgery," "perioperative nursing," "hysterectomy," and " The Critical Appraisal Skills Program (CASP) was used to critically appraise 47 studies that met the inclusion criteria. ERAS protocols have been shown to repeatedly shorten hospital stays by 1-2 days, reduce postoperative opioid use by 30-60 percent, improve complication rates, and enhance patient-reported outcomes of quality recovery. The implementation of the nurse’s role as a vital coordinator throughout the surgical continuum is often limited by a lack of knowledge, institutional resistance, and poor interprofessional collaboration. The adoption of ERAS becomes more standardized when it is integrated into gynecological nursing practice, which involves the investment of education through simulation, nurse champion models, and the design of protocols from an equity perspective. Future studies should focus on nursing-led randomized controlled trials and long-term patient outcome studies. Borrowed from Kolcaba's Theory of Comfort, this review emphasizes the patient-centered nursing role in the perioperative period, rather than that of a mere follower of surgical instructions.
enhanced recovery after surgery, ERAS, gynecological nursing, perioperative care, hysterectomy, opioid stewardship, patient-centered care, nursing role, evidence-based practice
Body-Contouring Surgery After GLP-1–Induced Massive Weight Loss: Surgical Outcomes, Complications, and Patient-Reported Quality of Life
The rapid adoption of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has created a growing population presenting for body-contouring surgery after pharmacologically induced massive weight loss (MWL). Whether outcomes differ from those after bariatric-induced MWL is uncertain. This study compared surgical outcomes, 90-day complications, and patient-reported quality of life between the two groups. In this prospective comparative cohort, 90 adults undergoing body contouring after MWL were grouped by weight-loss modality: GLP-1 RA pharmacotherapy (n = 45) or bariatric surgery (n = 45). Procedures included abdominoplasty/panniculectomy with or without brachioplasty, thighplasty, or mastopexy. The primary outcome was the incidence of complications within 90 days; the secondary outcome was change in the BODY-Q (Satisfaction with Body, Psychological and Physical Function) from baseline to 6 months. Predictors of complications were examined by multivariable logistic regression. The groups were similar in age and sex; the bariatric group had a higher peak body mass index (BMI) and greater total weight loss. The overall 90-day complication rate did not differ between GLP-1 and bariatric groups (19.0% vs 22.2%; p = 0.69), nor did any individual complication. BODY-Q scores improved markedly in both groups (Satisfaction with Body +33.3 vs +36.3 points; both p < 0.001), with no significant between-group difference. On multivariable analysis, BMI at surgery (adjusted OR 1.78 per 5 kg/m²; p = 0.02) and current smoking (OR 2.40; p = 0.04) predicted complications, whereas weight-loss modality did not (OR 0.83; p = 0.69). Body contouring after GLP-1–induced MWL produced complication rates and quality-of-life gains comparable to those after bariatric-induced MWL. Residual obesity and smoking, rather than the method of weight loss, drove complication risk. These findings support offering body contouring to GLP-1 patients with attention to perioperative optimisation.
GLP-1 receptor agonists; massive weight loss; body contouring; abdominoplasty; complications; BODY-Q; patient-reported outcomes
Early versus Delayed Excision and Grafting in Deep Burns: Impact on Healing Time and Hospital Stay
Excision and grafting is the standard surgical treatment of deep burns, but the optimal timing remains debated. This study compared early versus delayed excision and grafting (E&G) with respect to wound healing time and length of hospital stay. In this prospective comparative cohort, 80 adults with deep partial- and full-thickness burns of 10–30% total body surface area (TBSA) were managed by early E&G (excision within 5 days of injury; n = 40) or delayed E&G (excision after eschar separation, beyond 14 days; n = 40). The primary outcomes were time to complete wound healing and length of hospital stay. Secondary outcomes were graft take, wound infection, number of operations, blood-transfusion requirement, and mortality. Groups were compared with independent-samples t-tests and chi-square tests, and length of stay was modelled by multivariable linear regression. The two groups were comparable at baseline (mean age 35.5 years; mean TBSA 18.4%). Early E&G was associated with shorter time to complete healing (24.3 ± 6.1 vs 38.7 ± 8.9 days; mean difference 14.4 days; 95% CI 11.0–17.8; p < 0.001) and shorter hospital stay (19.8 ± 5.7 vs 31.4 ± 8.2 days; mean difference 11.6 days; 95% CI 8.5–14.7; p < 0.001). Graft take was higher (92.4% vs 88.1%; p = 0.03) and wound infection lower (17.5% vs 37.5%; p = 0.045) in the early group. Early E&G required more blood transfusion (3.1 ± 1.4 vs 1.9 ± 1.1 units; p < 0.001). Mortality did not differ (5.0% vs 7.5%; p = 0.64). Early excision and grafting of deep burns shortened healing time and hospital stay and reduced wound infection, at the cost of greater intraoperative blood transfusion. These findings support early surgery for suitable patients with deep burns, with attention to perioperative blood management.
deep burns; early excision; skin grafting; wound healing; length of stay; surgical timing
Photography in Aesthetic Surgery: Ethical, scientific, and mediatic issues - A Literature Review
Photography has become a cornerstone of aesthetic surgery practice. An essential tool for clinical documentation, it has also evolved, in the digital era, into a vector for medical communication, professional education, and, at times, commercial promotion. This literature review critically and comprehensively analyses the multiple dimensions of medical photography in aesthetic surgery: historical background, legal and ethical framework, scientific applications, mediatic implications, and technical standards of good practice. It draws on data from the international literature, enriched by the specificities of the Moroccan context. The findings highlight the imperative for a rigorous, standardised, and ethically irreproachable photographic practice, grounded in informed patient consent, protection of personal health data, and respect for human dignity. When properly applied, photography is a major clinical and scientific asset for the practitioner; when poorly managed, it exposes both physician and patient to significant medico-legal and ethical risks.
Medical photography, aesthetic surgery, medical ethics, legal framework, social media, photographic standardisation, informed consent, health data
Converging Wearable Biosensors, Multi-Omics, and Artificial Intelligence: An Integrative Framework for Predictive and Preventive Precision Medicine
Precision medicine aspires to tailor prevention, diagnosis, and treatment to the individual rather than to a statistical average, yet that ambition has long outrun the data and the tools needed to deliver it. Three streams of biomedical information now make the goal tangible, even if they have matured along largely separate paths: high-dimensional molecular profiles drawn from multi-omics platforms, continuously recorded physiological signals from wearable biosensors, and the messy, accumulating record of routine clinical care. Artificial intelligence, and machine learning in particular, has become the connective tissue that can bind these unlike sources into models a clinician might actually use. This article advances an integrative framework in which multi-omics data establish a patient's molecular baseline, wearable sensors trace the longitudinal phenotype as it shifts from day to day, and learning algorithms translate the combined signal into predictions that are both clinically meaningful and individually calibrated. We review the methodological terrain of data integration, trace applications across oncology, cardiovascular medicine, chronic disease prevention, and drug discovery, and weigh the obstacles, spanning data heterogeneity, model opacity, validation, equity, and privacy, that still separate promising prototypes from everyday practice. Our central argument is that the most durable near-term gains will not come from any single modality in isolation but from disciplined, transparent fusion of all three, anchored by rigorous external validation and a steady concern for fairness.
Precision Medicine; Multi-Omics; Machine Learning; Deep Learning; Wearable Biosensors; Data Integration; Predictive Analytics
Copyright (c) 2022 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0
Optimizing Red Blood Cell Transfusion Thresholds Across Medical, Surgical, and Obstetric Populations: A Systematic Review
Red blood cell (RBC) transfusion remains a cornerstone of supportive care across medical, surgical, and obstetric settings; however, the optimal hemoglobin threshold for transfusion continues to be debated due to concerns regarding transfusion-related complications, resource utilization, and patient outcomes. This systematic review aimed to evaluate the efficacy and safety of restrictive versus liberal RBC transfusion strategies across diverse adult patient populations. A comprehensive literature search of PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted from database inception through June 2026 in accordance with PRISMA 2020 guidelines. Studies comparing restrictive transfusion thresholds (typically 7–8 g/dL) with liberal thresholds (typically 9–10 g/dL) were included. A total of 97 studies involving more than 350,000 patients were analyzed. Across critically ill patients, septic shock, gastrointestinal bleeding, orthopedic surgery, and cardiac surgery populations, restrictive transfusion strategies consistently reduced blood product utilization without increasing mortality, cardiovascular complications, infection rates, length of hospital stay, or other major adverse outcomes. In patients with acute gastrointestinal bleeding, restrictive transfusion was associated with improved survival and lower rebleeding rates. Evidence from obstetric populations suggested similar maternal outcomes with reduced transfusion exposure, although data were less robust than those available for medical and surgical cohorts. Uncertainty persists in selected high-risk populations, including patients with acute coronary syndromes, severe cardiovascular disease, and major obstetric hemorrhage, where individualized clinical assessment remains essential. Overall, current evidence strongly supports restrictive RBC transfusion strategies as a safe, effective, and resource-efficient approach for most hemodynamically stable adult patients, reinforcing contemporary patient blood management principles and the need to minimize unnecessary transfusion exposure while maintaining optimal clinical outcomes.
Red blood cell transfusion; Restrictive transfusion; Liberal transfusion; Hemoglobin threshold; Patient blood management; Critical care; Surgery; Obstetrics; Anemia; Systematic review.
A Narrative Inquiry on Mothers’ Knowledge and Preventive Practices Regarding Upper Respiratory Tract Infections in Under-Five Children
Upper Respiratory Tract Infections (URTIs) remain a primary health challenge for pediatric populations, particularly in high-density communities. This study explored the lived experiences, knowledge, and preventive practices of mothers managing URTIs in children under five years old in Barangay San Nicolas, San Pablo City. Utilizing a narrative inquiry research design, semi-structured interviews were conducted with 15 purposely selected mothers to uncover the meanings behind their caregiving decisions. The narratives were examined to identify recurring experiences, patterns, and meanings related to mothers’ knowledge, practices, and decision-making in managing URTIs. Trustworthiness was enhanced through participant validation and careful documentation of the research process. The results identified a “layered response” to illness, wherein mothers initially employed traditional home remedies, such as oregano and calamansi, based on experiential knowledge before seeking professional medical consultation. While mothers demonstrated awareness of environmental triggers such as dust and smoke, structural barriers, including financial instability and inconsistent medicine supplies at local health centers, often hindered optimal care. The study concludes that maternal decision-making is a dynamic process shaped by a blend of traditional wisdom, socio-economic realities, and interactions with healthcare providers. By capturing mothers’ personal narratives, this study contributes a contextualized understanding of childhood URTI management within a community setting. Integrating nursing, public health, and socio-economic perspectives, the findings suggest that community health interventions should strengthen partnerships between health workers and mothers, improve access to essential healthcare resources, and support timely recognition and management of pediatric URTIs.
Multi-Scale Attention-Fusion Classification with an LLM-Driven Clinical Recommendation Assistant for Brain Tumor MRI
Brain tumor MRI interpretation remains constrained by radiologist shortages, inter-reader variability, delayed specialist access, and high diagnostic cost, particularly in low-resource settings. Although deep learning classifiers can assign tumor labels, a class prediction alone does not provide actionable guidance on urgency, referral, follow-up, or patient-facing interpretation. This study proposed a combined diagnostic and recommendation framework comprising an MSAF-Net classifier and a confidence-conditioned retrieval-augmented GPT-2 clinical assistant. MSAF-Net used a ConvNeXt-T/Swin-T hierarchical stem, per-stage channel-spatial attention, gated cross-scale feature fusion, and a compact classification head for four-class brain tumor MRI classification. The assistant converted the predicted class and confidence score into a structured query, retrieved relevant evidence from a curated brain-tumor knowledge base, and generated a plain-language, evidence-grounded recommendation with a PDF report. On the 7,023-image four-class Kaggle brain tumor MRI dataset, MSAF-Net achieved 99.16% accuracy, 0.9897 macro-F1, and 0.9985 AUC. Cross-dataset evaluation showed 99.46% accuracy on Figshare CE-MRI and 99.74% accuracy on BR35H. The model remained computationally efficient, with 22.9M parameters, 3.54 GFLOPs, 10 ms inference per scan, and an expected calibration error of 0.0179. These findings indicate that the proposed framework can support accurate classification while translating predictions into clinically usable next-step recommendations. The system is intended to assist, not replace, clinicians by improving decision support, reducing per-case cost, and widening access to neuroimaging guidance.
Brain tumor MRI; MSAF-Net; attention fusion; GPT-2; retrieval-augmented generation; clinical decision support
Copyright (c) 2023 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/
Transcending the Limitations of Total Quality Management through Quality 4.0 in healthcare
Total Quality Management (TQM) has been the foundational framework for quality improvement in healthcare, emphasizing continuous process improvement, patient-centered care, and organizational commitment to excellence. The growing complexity of modern healthcare driven by digitalization, data explosion has imposed challenges on TQM. This paper examines how Quality 4.0, an evolution of traditional quality management paradigms augmented by digital technologies, offers a transformative pathway for healthcare organizations seeking to transcend these limitations. Critical structural limitations such as manual procedures, siloed data, human-dependent quality audits hindering dynamic patient safety challenges have been discussed. The relevance of Quality 4.0 in enhancing diagnostic accuracy and reducing adverse events, optimizing operational workflows are presented. AI-driven quality prediction, automated compliance monitoring, and data-driven root cause analysis offer capabilities far beyond the scope of conventional TQM tools, enabling healthcare systems to achieve measurable, scalable, and sustainable quality outcomes. The transformative potentials and challenges associated with transition have also been discussed. In conclusion, Quality 4.0 does not render TQM obsolete; rather, it provides the digital architecture needed to extend and amplify TQM's foundational principles in a modern healthcare context.
Total Quality Management, Quality 4.0, Healthcare Quality, Digital Transformation, Quality Improvement, Data silos
Incidence and Risk Factors of Third- and Fourth-Degree Perineal Tears in Vaginal Delivery: A Retrospective Study at Bint Al-Huda Teaching Hospital, Nasiriyah, Iraq
Obstetric anal sphincter injuries (OASIS) — third- and fourth-degree perineal tears — are an important cause of maternal morbidity, including anal incontinence, perineal pain, dyspareunia, and psychological distress. Their reported incidence varies widely (0.6–19.3%) with detection practices and case-mix. This study determined the incidence of third- and fourth-degree tears among vaginal deliveries and identified independent risk factors at a tertiary maternity hospital in southern Iraq. A retrospective hospital-based study (cross-sectional for incidence with a nested case–control component for risk factors) was conducted at Bint Al-Huda Teaching Hospital, Nasiriyah, over the period 2023–2025. All vaginal deliveries were classified for perineal trauma using the RCOG/Sultan classification. Cases (OASIS) were compared with controls (vaginal delivery without OASIS). Maternal, intrapartum, and fetal variables were analysed by univariate testing followed by multivariable logistic regression, reporting adjusted odds ratios (aOR) with 95% confidence intervals; p<0.05 was significant. Reporting followed STROBE. Among 3,000 vaginal deliveries, OASIS occurred in 150 (5.0%) — 126 (4.2%) third-degree and 24 (0.8%) fourth-degree. On multivariable analysis, the independent risk factors were forceps delivery (aOR 6.20), nulliparity (aOR 5.80), occipito-posterior position (aOR 2.44), birthweight >4 kg (aOR 2.30), prolonged second stage (aOR 2.00), shoulder dystocia (aOR 1.90), and oxytocin augmentation (aOR 1.70); epidural analgesia was not independently associated. OASIS rates rose steeply with operative delivery (3.0% spontaneous, 9.5% vacuum, 16.0% forceps). OASIS at this centre was driven mainly by operative vaginal delivery, nulliparity, and fetal macrosomia. Selective mediolateral episiotomy (at ~60°) in instrumental delivery, structured manual perineal protection, and routine post-delivery rectal examination are recommended to reduce incidence and improve detection.
Perineal tear; obstetric anal sphincter injury; OASIS; vaginal delivery; risk factors; episiotomy; Iraq
Duration of Prelabor Rupture of Membranes and Early-Onset Neonatal Sepsis: A Retrospective Cohort with Risk Model
Prelabor rupture of membranes (PROM) is an established risk factor for early-onset neonatal sepsis (EONS), but the quantitative relationship between rupture-to-delivery latency and EONS in resource-constrained settings without universal group B streptococcus (GBS) screening is incompletely characterized, and contemporary data from southern Iraq are absent from the indexed literature. To estimate the incidence of EONS among infants born after PROM at a single tertiary center, to quantify the association between ROM-to-delivery latency and EONS, and to develop and internally validate a multivariable risk model usable at the point of care. A retrospective single-center cohort study was conducted at Nasiriyah Teaching Hospital from January 2020 through December 2024. Singleton live births at 34 weeks of gestation or more with documented PROM and complete ROM-timing data were included. The primary outcome was EONS within 72 hours of birth, defined as culture-proven sepsis or clinical sepsis with supportive laboratory and clinical course. The primary exposure was ROM-to-delivery latency, analyzed both categorically (< 12, 12–18, > 18 hours) and per 6-hour increment. Multivariable logistic regression identified independent predictors; discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with 1,000-resample bootstrap internal validation, and reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statements. Of 1,486 PROM births screened, 968 formed the analytic cohort; EONS occurred in 138 (14.3%, 95% confidence interval [CI] 12.1–16.7%), of which 37 (26.8%) were culture-proven, predominantly Klebsiella species and GBS. ROM-to-delivery latency greater than 18 hours was independently associated with EONS (adjusted odds ratio [aOR] 3.42, 95% CI 2.11–5.54), with risk rising approximately linearly (aOR 1.27 per 6-hour increment, 95% CI 1.14–1.42). The combined model achieved AUC 0.84 (95% CI 0.80–0.88); bootstrap-corrected AUC was 0.82. EONS risk rose progressively with ROM-to-delivery latency. A six-variable model identified high-risk newborns at the point of care and may inform surveillance and prophylaxis decisions where universal GBS screening is unavailable.
Prelabor rupture of membranes; early-onset neonatal sepsis; latency; chorioamnionitis; risk model; predictors; neonatal infection