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
The Impact of Transformational and Transactional Leadership Styles on Job Satisfaction among Healthcare Workers in Oman: A Systematic Review
Healthcare leadership is a central factor influencing workforce satisfaction, retention and service quality, particularly in health systems undergoing reform. Effective leadership, workforce stability and culturally responsive management is a value that has been introduced in Oman through healthcare transformation as part of Oman Vision 2040. A systematic review was done to establish the impact of transformational and transactional leadership styles on job satisfaction among Omani healthcare workers. The research used was systematic review that was guided by the PICO framework. The population of interest was Omani healthcare workers, the exposure was transformational and transactional leadership, the comparison was other leadership/management styles, and the outcome was job satisfaction. An evidence base provided went through a PRISMA-informed selection process. Thirty-eight records were identified and screened, 28 full-text reports were assessed for eligibility, and 15 studies were included in the narrative synthesis. The evidence included was categorized into direct Oman healthcare evidence, GCC healthcare evidence, international healthcare evidence and indirect organisational evidence. Quality of the studies was evaluated based on CASP-based principles of appraisal, such as the study design, relevance, sampling, measurement, bias and transferability. Meta-analysis was not done because the studies vary greatly in terms of design, population, outcome measures and statistical reporting. The findings indicated that transformational leadership was more effective in predicting positive job satisfaction particularly through motivation, communication, recognition, professional development, trust and organisational commitment. The correlation between transactional leadership and job satisfaction was conditional; it can help to increase satisfaction when applied to increase clarity of roles, accountability and fair feedback, but can decrease satisfaction when applied in a controlling or punitive manner. The review has also determined that there are wider organisational influences like workload, supervision, communication, pay, promotion and organisational culture, which influence job satisfaction. The review concludes that the healthcare industry in Oman needs to concentrate on culturally oriented leadership development that entails transformational support through appropriate transactional structure. The longitudinal and intervention studies unique to Oman must be carried out in the future to strengthen the causal evidence to help in meta-analysis in the future.
Transformational leadership, transactional leadership, job satisfaction, healthcare workers, Oman, systematic review.
Copyright (c) 2026 Journal of Medical and Health Studies
Human-Centered Artificial Intelligence for Healthcare, Education, Business, and Assistive Technologies
Artificial intelligence increasingly mediates consequential human decisions across healthcare, education, business, assistive technologies, digital health, and organizational management. Yet the dominant evaluation paradigm—predictive accuracy—inadequately captures the properties most relevant to human welfare: interpretability, usability, accessibility, fairness, privacy, and the quality of human-AI collaboration. Human-centered AI reframes AI development as a socio-technical design discipline in which model outputs must support—rather than supplant—human expertise, judgment, and agency. This structured critical review synthesizes an eight-axis human-centered taxonomy covering domain, function, data modality, architecture family, design concern, deployment pathway, evidence role, and evidence maturity. Seven human-centered domains are examined: healthcare and biomedical decision support, education and adaptive learning, assistive technologies and accessibility, neuro-affective and mental-health AI, business and organizational decision-making, human-facing IoT and smart infrastructure, and cybersecurity and trustworthy digital systems. Synthesis reveals that while AI architectures have advanced substantially across vision transformers, hybrid ensembles, graph neural networks, and federated systems, human-centered design properties—validated explainability, inclusive design, privacy-preserving deployment, affective ambiguity management, and governance accountability—remain inconsistently addressed. An eleven-direction research agenda emphasizes human-centered evaluation, user-driven validation, fairness-aware design, accessible deployment, and governance-ready AI systems across all critical domains.
privacy-preserving AI, federated learning, edge-cloud computing, distributed intelligence, scalable decision support, critical applications, trustworthy AI, deployment readiness
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0
Deployable AI Systems for Healthcare, Industry, Business, and Smart Infrastructure: A Cross-Domain Review
Artificial intelligence has progressed from laboratory benchmark systems to operational tools embedded in healthcare diagnostics, industrial monitoring, business analytics, smart infrastructure, agriculture, cybersecurity, and assistive technologies. However, the transition from a high-performing model to a deployable AI system remains a persistent challenge: clinical, industrial, and organizational deployment requires far more than predictive accuracy, demanding workflow integration, data interoperability, real-time feasibility, explainability, privacy, security, governance, and sustained post-deployment maintenance. This structured critical review synthesizes using a six-axis deployment-centered taxonomy encompassing application domain, data modality, architecture family, deployment pathway, deployment-readiness concern, and decision-support function. Seven application domains are examined: healthcare and biomedical AI, human-centered and assistive AI, industrial monitoring and cyber-physical systems, smart infrastructure and IoT, agriculture and sustainability, business and enterprise analytics, and cybersecurity and distributed intelligence. Eight architecture families are characterized, from conventional machine learning and CNNs through vision transformers, graph neural networks, Bayesian physics-guided models, generative AI, and federated learning systems, each associated with distinct deployment constraints and trustworthiness requirements. Synthesis identifies recurrent cross-domain deployment gaps including validated explainability, uncertainty quantification, privacy-preserving inference at scale, lightweight edge deployment, evidence maturity, and governance-aligned reporting. A structured future research agenda addresses these gaps with actionable directions and evaluation requirements. This review provides researchers, engineers, and practitioners with a deployment-focused roadmap for building AI systems that are not only capable but trustworthy, sustainable, and ready for real-world use.
Deployable AI, AI deployment, Clinical AI, Edge AI, Federated learning; Explainable AI, Industrial AI, Cross-domain deployment taxonomy.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by-nc/4.0
AI-Enabled Resilient Systems: Healthcare, Sustainability, Cybersecurity, Energy, and Organizational Decision-Making
Resilience, the ability of a system to support continuity, adaptation, risk awareness, and recovery under uncertainty or disruption, has emerged as a central requirement for AI-enabled decision systems across critical domains. Healthcare systems must sustain diagnostic accuracy and patient privacy under data constraints and clinical heterogeneity. Energy and infrastructure systems must maintain monitoring reliability under sensor drift and communication instability. Cybersecurity systems must protect data and detect threats in adversarial environments. Agricultural and sustainability systems must function in variable field conditions with constrained hardware. Business and organizational systems must remain agile under economic volatility and pressure of governance. Human-centered AI systems must preserve accessibility, personalization, and ethical oversight for vulnerable users. This structured critical review synthesizes a curated corpus using a seven-axis resilience taxonomy encompassing resilience domain, resilience function, data modality, architecture family, system layer, deployment concern, and decision-support level. Seven resilience domains are examined and mapped across architecture families from conventional ML and CNNs through vision transformers, graph neural networks, physics-guided Bayesian models, generative AI, and federated privacy-preserving systems. Synthesis reveals that while AI capability has advanced substantially, resilience-specific properties robustness, uncertainty quantification, privacy-preserving collaboration, post-deployment monitoring, and governance accountability—remain inconsistently addressed. A twelve-direction research agenda addresses these gaps with actionable future directions and evaluation requirements for AI-enabled resilient systems.
AI resilience; Healthcare AI, Sustainability AI, Cybersecurity AI, Federated learning, Trustworthy AI, Organizational decision-making, Cross-domain AI taxonomy
Magnetic Resonance Imaging Patterns of Complex Anal Fistula: A Case Series- MRI of complex anal fistula
Complex anal fistula requires accurate preoperative mapping because unrecognized secondary tracts, supralevator extension, and abscesses increase the risk of persistent sepsis and recurrence. Magnetic resonance imaging (MRI) is central to defining fistula anatomy and guiding surgical planning. Case presentation: We describe four male patients aged 17-46 years who presented with persistent or recurrent perianal discharge. Pelvic MRI demonstrated transsphincteric fistulas in all cases. The imaging spectrum included multiple internal openings, bilateral external openings, branching secondary tracts, extension to the levator ani, pelvic sidewall or periprostatic region, circumferential perirectal inflammatory collections, perineal abscess close to the corpus spongiosum, gas-containing fistulous tracts, and horseshoe abscess involving the intersphincteric and supralevator spaces. MRI consistently depicted low signal intensity on T1-weighted images, high signal intensity on T2-weighted and fat-suppressed T2-weighted images, and marked rim or wall enhancement after gadolinium administration. Surgical management was individualized and included abscess drainage, excision of fibrotic fistula tracts, seton placement, and laser fistula treatment. Conclusion: This case series highlights the wide anatomical variability of complex anal fistulas and the practical value of MRI in demonstrating occult branches and abscesses. Structured MRI reporting using clock-face location, relationship to sphincters and levator ani, internal and external openings, and associated collections can improve communication between radiologists and surgeons.
Anal fistula; perianal fistula; magnetic resonance imaging; transsphincteric fistula; horseshoe abscess
Healing Beyond Medicine: Lived Experiences of Individuals Seeking Folk Healing in Kinabuhayan Dolores, Quezon Province
Folk healing remains a significant component of health-seeking behavior in many Filipino communities, where spiritual beliefs, cultural traditions, and social relationships shape perception of illness and recovery anchored in Madeleine Leininger’s Transcultural Nursing Theory and Health Belief Model, which explains how beliefs influence health-related decisions, this study explored the lived experiences of individuals seeking folk healing in Kinabuhayan, Dolores, Quezon Province, a community known for its sacred healing traditions associated with Mt. Banahaw. A qualitative Hermeneutic Phenomenological design was utilized to capture the meaning of the participants attributed their healing joints. Twelve (12) adult participants aged thirty (30) years and above were selected through purposive sampling based on their direct experience with folk healing practices. Data were collected through semi-structured interviews and analyzed using Max Van Manen’s phenomenological approach, employing holistic, selective, and detailed reading to interpret the essence of participants' narratives. Findings revealed that individuals were drawn to folk healing due to family traditions, economic barriers to biomedical care and chronic recurring illnesses, and spiritual beliefs regarding illness causation. Participants describe healing as a holistic experience and shaped by ritual practices, sacred landscape, and trusting healer-seeker relationships. Recovery was interpreted through embodied signs of improvement, renewed strong and strengthened faith rather than biomedical diagnosis. Participants also demonstrated a flexible approach to health-seeking by navigating between folk and biomedical systems. This study is limited by its sample size and focus on a single community which may limit transferability. Nevertheless, the findings contributed to a deeper understanding of culturally-grounded health practices and highlighted the importance of culturally-sensitive and holistic nursing care that respectfully bridges traditional and biomedical health systems.
Folk Healing; Experiences; Individuals; Kinabuhayan
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/
Autoantibody-Mediated Synaptopathy: Redefining Neuropsychiatric SLE as a Disorder of Neuroimmune Synapse
Neuropsychiatric systemic lupus erythematosus (NPSLE) constitutes a severe and often refractory dimension of SLE, manifesting as clinically heterogeneous syndromes—including cognitive impairment, psychosis, and mood disorders—that follow a relapsing–remitting course. Vascular and inflammatory mediator models were developed to explain focal NPSLE and global encephalopathy, respectively. They were never designed to account for the circuit specific, often reversible symptoms of diffuse NPSLE—and they should not be faulted for failing to do so. The fault lies in our continued reliance on them as exclusive frameworks. Converging evidence now positions pathogenic autoantibodies targeting neuronal surface antigens as direct effectors of synaptic dysfunction. This Review synthesizes recent advances to propose a unifying ‘synaptopathy’ model for diffuse NPSLE pathogenesis. We propose the following four-step pathogenic cascade: (i) autoantibody access to the CNS following blood–brain barrier (BBB) compromise; (ii) acute synaptic dysfunction via receptor binding; (iii) complement-dependent synaptic tagging, amplified by DAMPs such as HMGB1; and (iv) irreversible synaptic loss driven by microglial pruning. These four steps define distinct therapeutic windows: steps (i) and (ii) are potentially fully reversible, step (iii) marks the transition to structural tagging, and step (iv) represents fixed-circuit damage. We aligned these windows with stage-specific biomarker profiles and targeted interventions. We then mapped these cellular events onto specific neural circuit disruptions (hippocampal, prefrontal-limbic, and cortico-thalamo-cortical), directly linking molecular pathology to clinical phenotypes. We operationalize this framework into a precision medicine strategy: three CSF biomarker profiles distinguish reversible synaptic dysfunction from irreversible structural loss, and a stage-matched therapeutic algorithm—B-cell depletion for antibody-driven disease, complement inhibition for synaptic tagging, and neuromodulation for fixed circuit deficits—is aligned with the four-step cascade. This framework reframes diffuse NPSLE as a mechanistically tractable disorder of the neuroimmune synapse—a conceptual advance that opens new avenues for biomarker discovery and targeted intervention.
Systemic Lupus Erythematosus, Neuropsychiatric Lupus, Autoantibodies, NMDA Receptor, Synaptic Pruning, Microglia
Systemic Congestion in a Young Patient: A Case of a Rare Infiltrative Disease
We report the case of a 26 year old male with no known chronic medical illness who presented to the emergency department with progressive shortness of breath and generalized body swelling over two weeks. Symptoms began gradually with reduced exercise tolerance and mild lower limb edema, followed by worsening breathlessness and abdominal distension. He had no history of chest pain, fever, recent infection, or prior cardiac or renal disease. There was no relevant family history of cardiomyopathy or inherited disorders. On arrival, he was hemodynamically stable but clinically congested with elevated jugular venous pressure, bilateral basal crackles, peripheral edema, and ascites. Point of care ultrasound demonstrated a dilated inferior vena cava with minimal respiratory variation and abdominal fluid, while chest radiography showed cardiomegaly with pulmonary congestion. Initial investigations showed mild renal impairment and elevated natriuretic peptides, supporting a congestive state, while electrocardiography revealed sinus tachycardia without ischemic changes. Given the patient’s young age and severity of presentation, the findings were considered atypical for conventional heart failure, raising suspicion for an underlying cardiomyopathy, particularly an infiltrative or storage disorder. The patient was started on intravenous diuretics with fluid and salt restriction, resulting in partial clinical improvement, although significant congestion persisted. Further evaluation at a tertiary center included transthoracic echocardiography and cardiac magnetic resonance imaging, which demonstrated features consistent with an infiltrative cardiomyopathy. Subsequent metabolic and genetic testing confirmed Fabry disease as the underlying diagnosis. Enzyme assays showed reduced alpha galactosidase A activity, and genetic analysis confirmed the diagnosis. This case highlights an uncommon presentation of Fabry disease manifesting as severe systemic congestion in a young adult with no prior medical history. The presence of marked jugular venous distension, dilated inferior vena cava, cardiomegaly, and ascites provided important early clues to significant cardiac involvement. Early recognition of an atypical pattern of heart failure in a young patient was essential in prompting further evaluation for infiltrative disease. The case emphasizes the importance of considering Fabry disease in young patients presenting with unexplained congestion and cardiomyopathy. Early use of bedside ultrasound and echocardiography played a key role in identifying the severity of volume overload and guiding further investigation. Confirmation of the diagnosis allowed initiation of disease specific therapy, including consideration of enzyme replacement treatment. In conclusion, Fabry disease should be considered in the differential diagnosis of young patients presenting with severe systemic congestion, particularly when imaging and clinical findings suggest cardiomyopathy without conventional risk factors. Early diagnosis is essential to allow timely treatment and prevent progressive organ damage.
Volume Overload, Systemic Congestion, Jugular Venous Pressure, Heart Failure, Cardiomyopathy, Infiltration, Fabry Disease.
Rare Coexistence of Abdominal Aortic Aneurysm and Pericardial Effusion: A Case Report.
We report the case of a 59-year-old male who presented to the emergency department with a two-week history of progressive shortness of breath, intermittent fever, fatigue, and reduced exercise tolerance. He later developed non exertional central chest discomfort, vague abdominal pain, and poor appetite with unintentional weight loss. There was no history of recent invasive procedures or known cardiac disease. On presentation, he was febrile, tachycardic, and mildly hypoxemic, with elevated jugular venous pressure, bilateral basal crackles, and a subtle early diastolic cardiac sound. Abdominal examination revealed a suspected pulsatile mass. Initial investigations showed raised inflammatory markers and leukocytosis. Chest radiography demonstrated cardiomegaly, while bedside ultrasound revealed a moderate pericardial effusion and a fusiform infrarenal abdominal aortic dilatation. Computed tomography of the abdomen confirmed an abdominal aortic aneurysm with features suggestive of infective involvement. Blood cultures later grew a streptococcal species consistent with infective endocarditis. The patient was managed with targeted intravenous antibiotics after initial empirical therapy, along with close hemodynamic monitoring. Cardiology input supported conservative management of the pericardial effusion as there were no signs of tamponade. Vascular surgery recommended initial non operative management of the suspected mycotic aneurysm with strict blood pressure control and prolonged antibiotic therapy. Multidisciplinary care was central to management, including infectious diseases, cardiology, and vascular surgery teams. This case highlights an unusual presentation of infective endocarditis complicated by both pericardial effusion and abdominal aortic aneurysm, emphasizing the importance of early imaging, blood culture diagnosis, and multidisciplinary coordination in detecting and managing systemic infectious vascular complications.
Aortic Aneurysm, Pericardial effusion, Arteritis, Vasculitis, Serositis, Pericarditis, Infective Endocarditis.
Formulation, In-vitro and Antifungal Activity of Fluconazole by Absorbant Solid Dispersion
Fluconazole is a antifungal drug used for numerous systemic and artificial fungal infections. However, it has many boundaries when directed in the form of oral solid dosage forms due to its poor aqueous solubility and dissolution profile, which is a major effort in reaching adequate oral bioavailability. Adsorbent solid dispersion (ASD) is one of the highly promising methods for ameliorating the wettability and solubility of medications having low aqueous solubility. The current research aims to improve the dissolution and solubility profile of fluconazole using the ASD approach. Polyethylene glycol 6000 (PEG 6000), Poloxamer 188 and Poloxamer 407 were applied as water- soluble polymeric carriers to trap the drug in an amorphous state and improve dissolution profile. In addition, Aerosil 200 and Aerosil 300 were utilized as highly porous carriers (adsorbents) to drastically increase the drug's contact area with dissolution media. Six adsorbent solid dispersion formulas (ASDF1 - ASDF6) were prepared using the melting method in a ratio of 0.25:0.25:0.25 (drug: carrier: adsorbent). The prepared mixtures were evaluated for saturated solubility, drug content, percentage yield, in-vitro release and antifungal activity. The prepared formulations showed an improvement in the drug's solubility. The greatest result was achieved with formulation Flu4(Poloxamer407, Aerosil 3000 and Fluconazole), which showed an increase in solubility associated with pure fluconazole. This enhancement is attributed to the alteration of the drug into an amorphous state and the massive surface area providing by the porous carriers.
Fluconazole, Adsorbent solid dispersions, PEG 6000, Poloxamer 407, Poloxamer 188, Aerosil 300, Aerosil 200.
Epidemiological Trends of Healthcare-Associated Infections in Chile: A National Descriptive Study (2015–2022)
Healthcare-associated infections continue to represent a significant challenge for healthcare systems, particularly in resource-constrained settings. Evaluating national trends is essential to support infection prevention and control strategies, especially during periods of increased healthcare demand such as the COVID-19 pandemic. We conducted a retrospective ecological analysis using aggregated national surveillance data from medium- and high-complexity public hospitals in Chile between 2015 and 2022. Temporal trends in major HAIs, including ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), central line–associated bloodstream infections (CLABSI), and surgical site infections (SSI), were analyzed using descriptive statistics. A total of 43,478 HAIs were reported. Gram-negative microorganisms predominated overall, particularly in VAP and CAUTI, while Gram-positive organisms predominated in CLABSI and SSI. Although the total number of infections increased during the COVID-19 pandemic, the proportional distribution of major etiological groups remained relatively stable over time. Despite increased infection burden during the pandemic period, national surveillance data suggest stability in the overall distribution of major etiological groups. These findings highlight the importance of sustained surveillance systems to monitor infection trends and support infection control strategies in developing countries.
Ethical Governance of Bioinformatics and Genomic AI Systems: From Compliance to Institutional Legitimacy
Bioinformatics and genomic artificial intelligence (AI) systems are increasingly embedded in clinical and organizational decision-making. However, ethical analysis in this area remains dominated by regulatory compliance, privacy protection, and technical control. Although these approaches are necessary, they are analytically insufficient because they do not adequately explain how ethical governance is enacted within organizations, how technological practices mediate governance, or why formally compliant systems may still fail to achieve institutional acceptance. This article develops a conceptual framework through interdisciplinary analysis of biomedical informatics governance scholarship, socio-technical systems theory, organizational theory, and legitimacy theory. Its aim is not merely to synthesize these literatures, but to address an explanatory gap concerning how ethical governance is organizationally produced and how its effectiveness should be evaluated. The proposed Culture–Technology–Ethics–Legitimacy (CTEL) framework links four interdependent domains: organizational culture, bioinformatics technology practices, ethical governance practices, and legitimacy outcomes. The framework makes three conceptual contributions. First, it redefines ethical governance as a cross-level socio-technical process rather than a compliance endpoint. Second, it conceptualizes technology as an ethical mediator through which organizational norms are translated into operational practice. Third, it positions legitimacy as the key downstream outcome of governance and distinguishes scientific, clinical, social, and moral legitimacy as analytically distinct but interacting forms of institutional acceptance. By repositioning legitimacy as the central evaluative outcome of ethical governance, the framework advances biomedical informatics ethics beyond compliance-driven approaches and offers a stronger explanatory account of why some bioinformatics and genomic AI systems become institutionally trusted while others do not. The framework therefore offers a distinct conceptual contribution and a foundation for future empirical investigation
Bioinformatics; Genomic AI; Ethical governance; Legitimacy; Organizational culture; Biomedical ethics
Rule-Based Artificial Intelligence for Health Information Management, Governance, and Healthcare Quality
Health information governance weaknesses can create operational risks in digital healthcare environments, including incomplete documentation, duplicate patient records, weak access control, poor interoperability, absent audit trails, and delayed reporting. These risks may affect data quality, information security, care continuity, accountability, reporting reliability, healthcare quality, and community-level planning. This paper proposes an artificial intelligence rule-based information governance framework for classifying such risks in health information management and health information systems. Using a scenario-based design-science approach, the framework defines governance input variables, maps them to health information management and health information system mechanisms, applies explicit IF-THEN rules, assigns risk classes, generates explanation traces, and produces governance recommendations. The framework is demonstrated through six synthetic scenarios covering duplicate records, unauthorized access, incomplete referral information, missing clinical documentation, weak audit trails, and delayed public health reporting. The demonstration shows how governance weaknesses can be converted into structured inputs, interpretable risk outputs, and corrective actions. The study does not claim empirical validation or deployment as a software system. Instead, it specifies a structured design artifact that can support future simulation, expert validation, rule-engine implementation, and empirical testing using real health information system data
Rule-Based Artificial Intelligence; Health Information Governance; Health Information Management; Health Information Systems; Healthcare Quality; Scenario-Based Analysis
Management of Vascular and Ischemic Complications in Aesthetic Injectables: A Retrospective Study of 52 Consecutive Cases and Proposal of a Standardized Rapid-Response Protocol
Vascular occlusion and ischemic complications after aesthetic injectable procedures are uncommon but may be disastrous, and can result in skin necrosis, permanent scarring, blindness or stroke. In this retrospective study, 52 consecutive real-world cases were analyzed and treated between January 2022 and December 2025 and assessed the safety and efficacy of a new standardized Rapid-Response Protocol created by the author. The MARYNA Rapid-Response Protocol of immediate high-dose pulsed hyaluronidase (450-1500 IU, every 30-60 minutes) combined with vigorous massage, universal antiplatelet therapy, ultrasound guidance when available, adjunctive vasodilators, and dedicated ocular emergency pathway were used to treat all cases of vascular or ischemic complications (primarily hyaluronic acid fillers, 92.3%). Clinical and photographic outcomes were measured at standardized intervals at a maximum of 90 days. Early intervention (within 4 hours of symptom onset) occurred in 73.1% of cases and resulted in 100% full recovery without permanent sequelae. In total, 94.2% of patients had no cutaneous necrosis, scarring, blindness, or cerebrovascular events and achieved full recovery. The mean hyaluronidase dose was 875 IU. Late presentations (>12 hours) were associated with a slightly increased rate of mild atrophic scarring (5.8% overall). There were no adverse reactions to hyaluronidase. The MARYNA Rapid-Response Protocol provides superior practical results and provides a basic and easily reproducible, evidence-based algorithm that can be immediately embraced by aesthetic practitioners around the globe. These results confirm that aggressive, timely and standardized intervention can minimize the permanent complications of aesthetic injectables to the levels of near zero, which is the new standard of patient safety in the area.
Vascular occlusion, dermal fillers, hyaluronic acid, hyaluronidase, ischemic complications, skin necrosis, rapid-response protocol, aesthetic injectables, ultrasound-guided reversal, ocular emergency
Assessing the Nexus between Digital Maturity and Institutional Accountability in Bangladesh’s Public Health System: A 2022 Cross-Sectional Analysis
In the 2022 post-pandemic landscape, the digitalization of health services in the Global South has transitioned toward increased institutionalization. This research investigates the statistical association between perceived facility-level digital governance maturity and institutional accountability across a stratified sample of 450 public healthcare facilities in Bangladesh. Employing a cross-sectional quantitative design, the study sampled health administrators across eight divisions to evaluate digital literacy, infrastructure maturity, and policy knowledge as observed correlates of accountability performance. Data were analyzed using Ordinal Logistic Regression (OLR). Results indicate that higher levels of digital literacy (OR=3.64, 95% CI [2.89, 4.60]) and infrastructure maturity (OR=2.81, 95% CI [2.21, 3.58]) are positively associated with achievement of higher accountability tiers. These association patterns suggest a "policy dissemination gap," in which technical adoption has outpaced administrative understanding of data governance standards. While these findings suggest that digital maturity correlates with transparency, the study is limited by its cross-sectional design, reliance on self-reported administrative perceptions, and lack of external validation against objective system audit logs. The associations provide an empirical basis for refining the 2023-2027 Digital Health Strategy by prioritizing human capital and policy clarity alongside hardware expansion.
Artificial Intelligence, Big Data Analytics, Wearable Health, Multi-Omics, Precision Medicine, Predictive Modeling, Biomedical Innovation, Sustainability
Copyright (c) 2022 https://creativecommons.org/licenses/by/4.0/
Comparative analysis of explainable machine learning models for cancer classification using cytological features
Breast cancer is among the causes of cancer related deaths globally with the greatest impact being in the low resource and high volume health care facilities where timely and accurate screening is paramount. This research report is a explainable machine learning model of breast cancer diagnosis based on quantitative features of fine needle aspirate images of breast masses. The data set contains 569 samples and 30 real-valued predictors of cell nuclei morphology, and it does not contain missing values, and the class distribution is moderate. It uses a structured preprocessing pipeline, such as the division of data into training and held-out test sets, feature normalization, and the careful management of class imbalance.Several classification models are compared, among them, Random Forest and Gaussian Naive Bayes, to compare the predictive accuracy and reliability of the model. Experimental outcomes have shown that the Random Forest model obtains the best performance with an accuracy of 0.96 on the held out test set, and balanced precision and recall on the benign and malignant classes. The confusion matrix shows that there is low misclassification rate and only false positive and false negative are three and three respectively. Contrastingly, Gaussian Naive Bayes has a higher accuracy of 0.93, and is less sensitive to malignant cases because of its independence assumptions which are not completely met in the dataset as verified by correlation analysis. These results are also supported by receiver operating characteristic analysis, whose area under the curve value is 1.00 in random forest and 0.99 in Gaussian naive bayes.The findings emphasize the role of model selection in clinical decision support systems, especially in cases where false negatives have to be minimized. The suggested structure focuses on interpretability and high practical use thus appropriate in deployment-oriented screening processes in resource-constrained settings. This paper shows that explainable machine learning models are trained on structured cytological features and can give effective and reliable support in early detection of breast cancer.
Breast cancer classification, explainable machine learning, fine needle aspirate cytology, cytological feature analysis, Random Forest, Gaussian Naive Bayes
Copyright (c) 2023 https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/
Diagnostic Value of Ultrasound-Guided Core Needle Biopsy in the Diagnosis of Pulmonary Masses at Ho Chi Minh City Oncology Hospital
Histopathological confirmation is essential for the diagnosis of pulmonary masses. Although computed tomography (CT)-guided transthoracic biopsy is widely used, it remains associated with a relatively high complication rate, especially pneumothorax. Ultrasound-guided core needle biopsy is a practical alternative for peripheral lung lesions abutting the pleura. This study aims to evaluate the diagnostic performance and safety of ultrasound-guided core needle biopsy for pulmonary masses at Ho Chi Minh City Oncology Hospital. A cross-sectional descriptive study was conducted in 136 consecutive patients with peripheral pulmonary masses visible on ultrasound who underwent ultrasound-guided core needle biopsy from July 2024 to February 2025. Demographic characteristics, lesion size, depth, pleural contact length (PCL), procedure time, number of tissue cores, pathological results, and complications were analyzed. The mean age was 62.3 ± 11.1 years, and 72.8% of patients were male. Definitive histopathological diagnosis was achieved in 128/136 cases (94.1%). Malignancy was identified in 107 cases (78.7%), including 90 primary lung malignancies and 17 metastatic lesions. Mean procedure time was 15.6 minutes, and a mean of 4.9 ± 1.17 cores was obtained per patient. Pneumothorax occurred in 10 patients (7.4%), all mild and self-limited, and mild hemoptysis occurred in 2 patients (1.5%). No severe complications or procedure-related deaths were observed. Ultrasound-guided core needle biopsy is a safe, efficient, and accurate technique for diagnosing peripheral pulmonary masses. It provides a high diagnostic yield with a low complication rate and is a valuable first-line biopsy approach for appropriately selected pleural-based lung lesions.
ultrasound-guided biopsy; core needle biopsy; lung mass; peripheral pulmonary lesion; diagnostic yield; pneumothorax
Therapeutic Effects of “Phu Thao Khang – PTP” Solution in the Treatment of Vaginitis and Cervicitis Caused by Mixed Bacterial Infection
This study evaluated the adjunctive effect of Phu Thao Khang-PTP solution on selected paraclinical outcomes in women with vaginitis and cervicitis caused by mixed bacterial infection. An open-label controlled clinical intervention was conducted in 60 sexually active women aged >18 years who were diagnosed with vaginitis and/or cervicitis at Tue Tinh Hospital from April 2025 to March 2026. Participants were allocated into a study group receiving daily genital cleansing with Phu Thao Khang-PTP plus one Polygynax vaginal capsule daily for 10 days, or a control group receiving Polygynax alone for 10 days. Outcomes were assessed at baseline (D0) and day 10 (D10) using cervical examination, vaginal discharge characteristics, Candida testing, and Gram staining. After treatment, the study group achieved higher rates of normalization of cervical findings (86.7% vs. 56.7%), Candida clearance (100% vs. 86.7%), Gram-positive bacterial clearance (96.7% vs. 83.3%), Gram-negative bacterial clearance (93.3% vs. 76.7%), and overall grade A response (83.3% vs. 56.7%). No adverse effects were observed. Phu Thao Khang-PTP combined with Polygynax may be an effective and safe adjunctive treatment for mixed vaginitis and cervicitis.
Vaginitis; Cervicitis; Mixed bacterial infection; Phu Thao Khang-PTP; Polygynax
Factors Influencing Infection in Intracerebral Hemorrhage Patients: A Literature Review
Infectious complications represent the primary non-neurological challenge for individuals diagnosed with Intracerebral Haemorrhage (ICH), acting as a major driver for unfavourable clinical results, extended ICU stays, and heightened healthcare costs. This literature review offers a systematic analysis of the varied elements that contribute to infection in ICH cases, spanning from innate physiological vulnerabilities to risks acquired within the hospital setting. By integrating findings from 20 contemporary journals (2021–2026) and 3 core medical textbooks, this research highlights essential risk determinants such as diminished Glasgow Coma Scale (GCS) scores, total hematoma volume, and metabolic imbalances like hyperglycaemia upon admission. Furthermore, the review investigates Stroke-Induced Immunodepression Syndrome (SIDS) as a fundamental biological mechanism. These insights emphasize the urgency of early risk categorization and focused preventive measures to curb infectious setbacks in specialized clinical environments, such as Universitas Airlangga Hospital.
Intracerebral Hemorrhage, Post-Stroke Pneumonia, Risk Determinants, Immunosuppression, Literature Review, Hospital- Acquired Infection
Direct-to-Consumer Prescription Drug Advertising in the United States: A Narrative Review of Clinical, Public-Health, Ethical, and Economic Implications
Background. Direct-to-consumer advertising (DTCA) of prescription drugs is permitted in only two high-income countries — the United States and New Zealand — and represents a multi-billion-dollar component of the U.S. health-care environment. Recent policy debates and proposals have focused on whether and how to tighten regulatory oversight of DTCA, particularly as digital and social-media promotion have grown. Approach. This narrative review and policy analysis synthesizes peer-reviewed empirical research, government reports, and primary regulatory documents addressing DTCA’s effects on patient and clinician behavior, public health, ethics, and the health-care economy. Key Findings. Across multiple study designs, DTCA increases information seeking, patient requests, and prescribing of advertised products, with measurable effects on diagnosis rates and class-level utilization. Patients who specifically request a DTCA-promoted drug receive a prescription substantially more often than those who do not. Higher promotional spending tends to be directed toward branded products with comparatively low added clinical benefit. Modeling analyses suggest that meaningful changes in DTCA spending translate into measurable, though modest, changes in national prescription drug spending. Conclusions. DTCA is a clinical, ethical, public-health, and economic phenomenon, not merely a marketing practice. Clinicians can mitigate harms through structured response to ad-driven requests and shared decision-making. Health systems can integrate DTCA awareness into clinician education and decision support. Policymakers continue to weigh a range of options, including stricter risk-presentation standards, broader oversight of digital promotion, and fiscal levers such as limits on tax deductibility for DTCA expenditures.
Ultrasound and Mammographic Features of Ductal Carcinoma in Situ: A Retrospective Review of 70 Ultrasound-Guided Core Needle Biopsy Cases at Ho Chi Minh City Oncology Hospital
Background: Ductal carcinoma in situ (DCIS) is a heterogeneous breast malignancy with variable mammographic and sonographic appearances. Although mammography remains the primary modality for detecting DCIS, especially calcified lesions, ultrasound is particularly useful in dense breasts, non-calcified lesions, and biopsy guidance. Upgrade from DCIS diagnosed on core needle biopsy (CNB) to invasive carcinoma on surgical pathology remains clinically important because it may alter surgical planning. Methods: We conducted a retrospective review of ultrasound-guided 14-gauge CNB cases diagnosed as DCIS at the Department of Endoscopy and Ultrasound, Ho Chi Minh City Oncology Hospital, from June 2024 to December 2024. Among 153 CNB-proven DCIS cases, 70 had complete ultrasound, mammography, CNB pathology, and surgical pathology data and were included in the final analysis. Results: Of the 70 included cases, 24 were upgraded to invasive carcinoma on surgical pathology, yielding an upgrade rate of 34.0%. On mammography, the most common presentation was a mass with calcifications (50.0%), followed by non-calcified mass lesions (21.4%) and calcifications alone (14.3%). On ultrasound, 55 lesions (78.6%) appeared as masses and 15 (21.4%) as non-mass lesions. Among upgraded cases, 21 of 24 (87.5%) were mass-forming lesions. Large lesion size (≥20 mm) and multifocality were the most notable features associated with upgrade. Conclusion: DCIS shows diverse mammographic and ultrasound appearances in ultrasound-guided biopsy practice, with a predominance of mass-forming lesions. Lesion size of at least 20 mm and multifocality appear to be useful clues for predicting upgrade from DCIS to invasive carcinoma.
Ductal carcinoma in situ, DCIS, mammography, ultrasound, core needle biopsy, upgrade, breast cancer
Evaluating the Relationship Between Second-hand Smoke Exposure and Recurrent Otitis Media in Children Under Five
Recurrent otitis media (ROM) is a major health problem in the world, among young children, as it causes hearing impairment, delayed speech, and heavy expenses of medical care. Environmental risk factors have been considered to be a major determinant of ROM susceptibility and second-hand smoke (SHS) is one such commonly occurring and potentially controllable exposure. Past literature has some limitations of not having consistent diagnostic criteria, poor control of confounding factors, and not having factored in new sources of exposure like the electronic cigarette vapor, leaving an essential gap in research. The main strength of this study is that it presents a current, modified measurement of the relationship between SHS exposure and ROM in the susceptible under-five group in particular. A hospital-based case-control study is done involving 215 children with ROM and 222 healthy controls of three tertiary care hospitals. The validated caregiver questionnaires are used to gather data on SHS exposure and possible confounders that are then verified by medical record review. Multivariate logistic regression analysis is utilized to estimate adjusted odds ratio and control daycare attendance, breastfeeding history, number of siblings, use of pacifier and socioeconomic status. The exposure to SHS is reported in 61.9 versus 31.1 in the cases and controls respectively. When the SHS exposure is adjusted to control the confounders, there is a significant relationship between SHS exposure and ROM (adjusted odds ratio = 3.42; 95% confidence interval: 1.86-6.28; p < 0.001). It shows a definite relation between dose and response, also the adjusted odds ratio is getting bigger as the number of smokers in the house more than one smoker is 2.84 and more than two smokers is 4.37. These results support the fact that SHS exposure is an important and independent risk factor of ROM in children younger than five and the need to implement specific preventive measures is paramount.
Children under five; Odds ratio; Passive smoking; Recurrent otitis media; Second-hand smoke.
Admission Blood Glucose as a Predictor of Mortality and Severe Outcomes in Acute Organophosphorus Poisoning: A Systematic Review and Meta-Analysis
Acute organophosphorus poisoning remains a major toxicologic emergency and cause of morbidity and mortality, especially in agricultural and resource-limited settings. Early identification of patients at risk of deterioration is essential. Admission blood glucose has been proposed as a simple prognostic marker, but the evidence has not been synthesized in a focused review. This study aims to evaluate the association between admission blood glucose and mortality and severe clinical outcomes in acute organophosphorus poisoning. A systematic review and meta-analysis was conducted using PubMed and a supplementary Google Scholar search. PubMed yielded 157 records, and the first 200 Google Scholar records sorted by relevance were also screened. After title and abstract screening, full-text review, and exclusion of ineligible reports, 5 observational studies were included in the qualitative synthesis and 3 studies in the quantitative synthesis. The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation or respiratory failure and poisoning severity. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel random-effects model. Results from the included studies showed that elevated admission glucose was associated with significantly increased odds of mortality (OR 5.68, 95% CI 3.55-9.07; I² = 0%) and mechanical ventilation or respiratory failure (OR 4.46, 95% CI 3.02-6.59; I² = 0%). Narrative synthesis of the remaining studies also supported the association between higher admission glucose and greater poisoning severity. These findings point towards admission glucose being a simple and clinically useful early prognostic marker, although the available evidence is limited by observational design and variation in glycemic cut-offs.
The Impact of Transformational Leadership on Nurse Burnout: A Systematic Literature Review
The impact of transformational leadership is a methodological literature review on nurse burnout in the healthcare environment at the global level, i.e., in the Gulf Cooperation Council (GCC) area. Nurse burnout, which is potentially characterised as emotional exhaustion, depersonalisation, and the absence of personal accomplishment, can become one of the gravest foretellers of the risks to safety, manpower shortages, and poor healthcare. Peer-reviewed articles published in 2020-25 in PubMed, CINAHL, Scopus, Web of Science, and Google Scholar were searched. The review of the evidence is what synthesises the results and suggests the correlation between transformational leadership and nurse burnout by including the mediating variables of job satisfaction, empowerment, and working environment and moderating variables of the healthcare setting, according to the PRISMA principles of systematic reviews and meta-analyses. The results show the existence of a stable negative association between transformational leaders and three dimensions of burnout as measured by the Maslach Burnout Inventory. Transformational leaders can alleviate the effects of emotional exhaustion with inspirational motivation and identifying the employee personally and depersonalisation with professional development, encouragement and shared decision-making (Boamah, 2022; Montenegro Mendez et al., 2025). The writers of this association found that job satisfaction, structural power, and favorable working environments (Alruwaili, 2025; Al Sabei et al., 2023). The suggested solutions to prevent nurse burnout presented by the review are the investment in transformational leadership development programs, an empowerment-based management strategy, and the solving of structural workload problems. Future studies ought to use the longitudinal design to investigate the existence of cultural moderators in the GCC healthcare systems.
Transformational leadership, nurse burnout, emotional exhaustion, depersonalization, systematic review, Maslach Burnout Inventory, job satisfaction, empowerment, work environment, healthcare leadership, GCC, nurse retention, PRISMA
The Hidden Cost of Manual Equipment Management in Ambulatory Surgery Centers: A Quantitative Analysis of Financial Leakage and Operational Inefficiency
The growing financial and operational environments of Ambulatory Surgery Centers (ASCs) make efficiency and cost control of paramount importance to sustainability. Even though there has been a technological improvement in healthcare technology, most ASCs still use manual equipment management systems that feature paper-based tracking, disjointed documentation, and processes that are human operated. This paper explores this concealed cost of such hand-based practices by performing a quantitative investigation on financial leakage and inefficiency of operations. The analysis of the main performance indicators such as the frequency of downtimes, delays in maintenance, and misallocation of resources is conducted on the basis of data obtained based on the records on the utilization of equipment, maintenance records, and financial reports. The results indicate that the manual management of equipment is one of the contributing factors to the hidden financial losses in the form of long equipment downtime, ineffective inventory management, long lagging maintenance cycles, and inaccurate billing. Regression analysis shows that the relationship between the intensity of manual tracking and financial leakage is strong and positive and equipment utilization is negatively related to the operational costs. In addition, the paper pinpoints the systemic inefficiencies that interfere with the operations of the surgery, lower patient throughput, and burden administration. The findings highlight the necessity of moving to automated equipment management tools based on data with predictive maintenance, real-time tracking, and built-in financial monitoring. These systems can reduce the unseen losses, improve the functioning and general resource optimization in ASCs. The research paper is added to the existing literature on the topic of efficiency of healthcare operations, as it is based on real evidence of financial and operational threats of out-of-date manual systems and it outlines the practical directions of going digital.
Ambulatory Surgery Centers (ASCs); Equipment Management; Financial Leakage; Operational Inefficiency; Predictive Maintenance; Healthcare Analytics; Resource Utilization; Cost Optimization
A Structured Protocol for Sustainable Goal Achievement: Development and Application of the Open G.A.T.E.S Model
Goal achievement remains a central focus within coaching, counseling, and holistic health practices; however, many existing frameworks lack a structured approach that integrates feasibility, contextual awareness, and long-term sustainability. This paper introduces and expands upon the Open G.A.T.E.S Model, a structured protocol developed by Leslie Bereiter and Nicholas Bereiter, designed to guide individuals toward meaningful and sustainable goal attainment. The model is built upon five core components: Goals, Achievability, Timeframe, Environmental Impact, and Support and Sustainability. Each component provides a systematic lens through which clients can define their objectives, evaluate feasibility, establish realistic timelines, consider the broader impact of their goals, and ensure long-term maintenance through appropriate support systems. The protocol begins with clear goal identification and progresses through a sequential process that emphasizes practical achievability, structured time planning, and alignment with both personal and environmental contexts. A key feature of the model is its emphasis on environmental impact and sustainability, encouraging individuals to consider how their goals influence their immediate surroundings, including family, work, and community. The application of the Open G.A.T.E.S Model in professional practice was observed among a group of 12 practitioners, including life coaches, therapists, and counselors, who implemented the protocol with approximately 1,600 clients. Reported outcomes indicated a 90% success rate in goal achievement, suggesting strong practical effectiveness and adaptability across diverse client needs. The findings highlight the potential of the Open G.A.T.E.S Model as a comprehensive, structured approach to goal-setting that extends beyond traditional frameworks by incorporating holistic, sustainability-focused considerations. This protocol provides a practical, scalable tool for professionals seeking to enhance client outcomes in coaching and counseling settings.
Open G.A.T.E.S Model, Goal-Setting Framework, Sustainable Goal Achievement, Coaching and Counseling, Behavioral Change, Holistic Development, Personal Development Protocol
Explainable and Trustworthy Deep Learning for MRI-Based Auxiliary Diagnosis of Alzheimer’s Disease
Alzheimer’s disease (AD) and its prodromal stage, mild cognitive impairment (MCI), are characterized by a long preclinical phase. Early identification is crucial for timely intervention and prognostic assessment. Structural MRI has become an important imaging modality for auxiliary diagnosis of AD due to its non-invasive nature, repeatability, and strong clinical accessibility. Deep learning has made significant progress in AD/MCI/CN classification, staging, differential diagnosis, and clinical risk prediction. However, the “black-box” nature of these models, insufficient cross-center generalization, and lack of trustworthy explanations severely limit their clinical translation. This review focuses on four main threads—“model pipeline—explanation methods—explanation evaluation—generalization and deployment”—to systematically summarize representative directions of MRI-based deep learning in AD-related tasks. It also outlines the primary pathways of explainable artificial intelligence (XAI) (saliency attribution, counterfactual explanation, and inherently interpretable architectures) and the key dimensions of trustworthiness assessment (fidelity, stability, anatomical/pathological plausibility, and human-factor usability). Methodological risks such as real-world data challenges, domain generalization, cross-scanner harmonization, and data leakage are discussed in depth. Key contributions include: (1) emphasizing that “explainability ≠ heatmap visualization” and proposing an explanation evaluation framework centered on fidelity and stability; (2) integrating risks such as shortcut learning, data leakage, and cross-scanner differences into a unified discussion of explainability and generalization; and (3) summarizing clinically translatable pathways from the perspectives of real-world application and privacy compliance. MRI-based deep learning is shifting from “pursuing accuracy” toward “trustworthy explanation + cross-center generalization + clinical usability.” Promising future directions include standardized explanation evaluation, domain generalization and harmonization techniques tailored to real-world distribution shifts, and human-interpretable explanations validated through multi-center real-world studies.
Alzheimer’s disease; structural MRI; deep learning; explainable artificial intelligence; trustworthiness assessment; generalization and real-world application
Incidence, Risk Factors, and Outcomes of VTE in Surgical and Obstetric Patients: A Systematic Review
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality in hospitalized patients. Surgery and pregnancy are well-established high-risk conditions, but incidence, risk factors, and outcomes vary across populations. To systematically review the incidence, risk factors, and outcomes of VTE in surgical and obstetric patients. Following PRISMA guidelines, we searched Medline/PubMed, Embase, and Cochrane Library for studies (1990–2025) reporting VTE in surgical or obstetric populations. Cohort, case-control, and clinical studies providing data on incidence, risk factors, and outcomes were included. Data were abstracted on patient characteristics, VTE incidence, risk factors, and clinical outcomes. Postoperative VTE incidence ranges from 0.2–2% in general surgical populations and up to 4.5% in high-risk orthopedic patients without prophylaxis. Advanced age, active cancer, prolonged operative time, and major trauma are consistent surgical risk factors. Pregnancy-associated VTE is rare (~0.6–1.4 per 1000 pregnancies) but increases 3–10-fold antepartum and 12–35-fold postpartum, with cesarean delivery, thrombophilia, obesity, and infection as major contributors. VTE significantly impacts outcomes: 30-day mortality is 10–30% in surgical patients and PE accounts for 10–15% of maternal deaths. Post-thrombotic syndrome and recurrent VTE are common sequelae. VTE remains a clinically important complication in surgical and obstetric populations. Awareness of patient-specific and procedure-specific risk factors, along with adherence to prophylaxis guidelines, is critical to reduce morbidity and mortality.
nous thromboembolism, deep vein thrombosis, pulmonary embolism, surgery, pregnancy, postpartum, risk factors, incidence.
The Bloody Pericardium: Cardiac Tamponade Unmasking an Undiagnosed Malignancy: A Case Report
We report the case of a 58 year old male who presented to the emergency department with progressive shortness of breath, generalized weakness, and chest heaviness over one week, culminating in acute deterioration on the day of admission. He had no known history of malignancy but was a former smoker with a background of hypertension. On arrival, he appeared acutely unwell, with hypotension, tachycardia, and labored breathing. Physical examination revealed jugular venous distension, soft heart sounds, and reduced peripheral perfusion, raising concern for hemodynamic compromise. Initial electrocardiogram showed sinus tachycardia without ischemic changes, while chest radiography demonstrated marked enlargement of the cardiac silhouette suggestive of a large pericardial effusion. Urgent bedside echocardiography confirmed moderate to severe pericardial effusion with right sided chamber collapse, consistent with cardiac tamponade. The patient underwent immediate ultrasound guided pericardiocentesis, yielding approximately 400 milliliters of hemorrhagic fluid, with rapid clinical improvement in symptoms and hemodynamic parameters. A pericardial drain was left in situ for continued drainage. Laboratory analysis of the pericardial fluid revealed malignant cells. Subsequent imaging identified a suspicious lung lesion with mediastinal lymphadenopathy, suggestive of primary lung malignancy with pericardial involvement. The patient stabilized clinically following intervention and was discharged with plans for oncological evaluation and further diagnostic workup. This case highlights cardiac tamponade as a rare initial presentation of lung cancer and emphasizes the importance of early bedside echocardiography, prompt pericardial drainage, and consideration of malignancy in unexplained hemorrhagic pericardial effusion.
Malignant Pericardial Effusion, Malignancy, Pericardium, Tamponade, Cytology, Lung Cancer, Metastasis.
Vitamin D Status in North Batinah, Oman: Prevalence and Temporal Trends (2018-2022)
Background: Vitamin D plays a critical role in skeletal health and has important functions in immune regulation and chronic disease prevention. Despite abundant sunlight in the Middle East, vitamin D deficiency and insufficiency remain widely reported, with limited population-based data available from Oman. This study aimed to evaluate the prevalence and temporal trends of vitamin D status in North Batinah, Oman, and to identify demographic groups at increased risk of insufficiency and deficiency. Methods: A retrospective cross-sectional study was conducted using laboratory and clinical data from Suhar Hospital, the central referral laboratory in North Batinah. The study included 3,081 individuals of all ages who underwent serum 25-hydroxyvitamin D testing between January 2018 and November 2022. Vitamin D status was classified as deficient (<30 nmol/L), insufficient (30–50 nmol/L), or sufficient (>50 nmol/L). Demographic variables and vitamin D levels were analyzed, and temporal trends were assessed over the five-year period. Results: The overall mean vitamin D level was 82.5 ± 28.0 nmol/L. Vitamin D sufficiency was observed in 88.2% of adults and 89.0% of the pediatric population, while deficiency was rare (<1%). Insufficiency was more prevalent among females, particularly those aged 18–38 years (14.9%), and among adolescents aged 10–15 years (15.7%). Males had significantly higher vitamin D levels than females (p < 0.001). Temporal analysis demonstrated a significant decline in sufficiency from 93.1% in 2018 to 79.9% in 2021, followed by recovery to 91.0% in 2022 (p < 0.001), corresponding with reduced outdoor activity during the coronavirus pandemic period. Conclusion: Vitamin D sufficiency was high in this population, contrasting with commonly reported regional trends. However, insufficiency remains a clinically relevant concern, particularly among women and adolescents. These findings support a shift toward targeted, risk-based screening and highlight the importance of sustained public health strategies to maintain optimal vitamin D status.