Khan AS, Ahmad F, Khan AA
… +11 more, Khan Z, Ahmed T, Wazir A, Khan HU, Ali A, Khan H, Khan AY, Saqib M, Azad S, Sadiq S, Rehman MEU
Med Princ Pract
· 2026 Feb · PMID 41678431
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OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative cohort studies comparing continuous with intermittent intravenous hydrocortisone in adults with septic...OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative cohort studies comparing continuous with intermittent intravenous hydrocortisone in adults with septic shock. SUBJECTS AND METHODS: Searches of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> were conducted till July 2025. The primary outcome was all-cause mortality; secondary outcomes included hospital and intensive care unit (ICU) length of stay, shock reversal, hypernatremia, hypokalemia, and vasopressor use. Risk of bias was assessed using Cochrane RoB 2.0 for RCTs and the Newcastle-Ottawa Scale for cohort studies. A random-effects model was applied, and certainty of evidence was graded using GRADE. RESULTS: Eight studies (five RCTs, three cohort studies) including 609 patients were analyzed. Continuous infusion was not associated with a significant reduction in mortality compared with intermittent infusion (risk ratio [RR]: 0.83, 95% confidence interval [CI]: 0.65 to 1.06; p = 0.13; I2 = 36%). No significant differences were observed in hospital stay (mean difference [MD]: 0.10 days, 95% CI: -1.40 to 1.61), ICU stay (MD: -0.02 days, 95% CI: -0.63 to 0.58), shock reversal (RR: 0.94, 95% CI: 0.61 to 1.46), hypernatremia (RR: 1.05, 95% CI: 0.51 to 2.16), hypokalemia (RR: 0.64, 95% CI: 0.40 to 1.03), or vasopressor duration (MD: -0.97 days, 95% CI: -4.00 to 2.05). Certainty of evidence ranged from very low to moderate. CONCLUSION: Continuous and intermittent hydrocortisone infusion demonstrated comparable clinical outcomes in septic shock. Large, multicenter RCTs are warranted to determine the optimal administration strategy.
Med Princ Pract
· 2026 · PMID 41662331
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The authors' accepted manuscript "Assessment of Blood Lead Levels in Pre-School Children in Kuwait" [Med Princ Pract. 2025; https://doi.org/10.1159/000549289], by Abdur Rahman Ahmada, Muddanna Rao, Maraheb Alkhalidi, Moh...The authors' accepted manuscript "Assessment of Blood Lead Levels in Pre-School Children in Kuwait" [Med Princ Pract. 2025; https://doi.org/10.1159/000549289], by Abdur Rahman Ahmada, Muddanna Rao, Maraheb Alkhalidi, Mohammad Al Seaidan, Muna Alkhabaz, Anwar Ali, Meshari Alqallaf, Mustafa Al-Zoughool, Maryam Shehab, Armando Chamorro, Reem Jallad, and Janvier Gasana, has been retracted by the Publisher and the Editor. After peer review, the accepted, unedited manuscript was published online as Early View. Before the final Version of Record was published, it was identified that Figures 1 and 2 were the same. The authors provided a revised figure. Review of the revised manuscript resulted in the Editors' decision to rescind their original, provisional acceptance decision and reject the revised manuscript. Consequently, the authors' published accepted manuscript has been retracted.
Alhmoud JF, Alqaraleh M, Dala-Ali SN
… +6 more, Alhiary LS, Dababneh II, Odeh NL, Elzogheir N, Alqudah DA, Al-Rawashde FA
Med Princ Pract
· 2026 · PMID 41615870
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UNLABELLED: <p>Objective: This study assesses microRNA-21 (miR-21) and microRNA-302 (miR-302) levels and examines their association with a nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB) gene singl...UNLABELLED: <p>Objective: This study assesses microRNA-21 (miR-21) and microRNA-302 (miR-302) levels and examines their association with a nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB) gene single nucleotide polymorphism (SNP) in chronic myeloid leukemia (CML) patients, aiming to identify these miRNAs as potential diagnostic biomarkers. The findings could contribute to improved diagnostic and treatment approaches. SUBJECT AND METHODS: This study involved 65 patients with CML at Al-Basheer Hospital, Amman, Jordan, and 30 healthy controls. Hematological parameters were analyzed via complete blood count. Gene expression was assessed by real-time PCR to analyze miRNA and NF-KB SNPs in patients' plasma. RESULTS: A highly significant difference (p < 0.0001) was observed, indicating that miR-21 expression was higher in CML patients compared to the controls. miR-302 levels were lower in CML patients. The NF-κB Del/Del genotype was associated with a higher white blood cell count compared to the Ins/Ins and Ins/Del genotypes. Platelet counts varied among the CML patients with three polymorphisms. CONCLUSION: miR-21 is elevated in CML patients, suggesting an oncogenic role. Our results suggest that miR-302 may serve as a prognostic and diagnostic biomarker. The NF-κB1 gene rs28362491 Del/Del genotype may be associated with an increased risk of CML. Identification of these biomarkers can contribute significantly to improve both diagnosis and treatment strategies. </p>.
Med Princ Pract
· 2026 Jan · PMID 41610057
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OBJECTIVE: The aims of the study were to assess the influence of root canal obturation quality on periapical status after orthodontic treatment and evaluate the association between gender and root resorption. MATERIALS A...OBJECTIVE: The aims of the study were to assess the influence of root canal obturation quality on periapical status after orthodontic treatment and evaluate the association between gender and root resorption. MATERIALS AND METHODS: This retrospective radiographic study included 283 endodontically treated teeth from 199 patients (71 males, 128 females) treated with fixed appliances. Teeth were classified as adequate or inadequate based on the filling length, density/homogeneity, untreated canals, and coronal restoration integrity. Periapical status was assessed using the Periapical Index (PAI) on paired pre- and post-treatment panoramic radiographs. Chi-square, McNemar-Bowker, and Fisher's exact tests were used. Radiographically vital teeth from the same cohort were screened descriptively for incident periapical changes. RESULTS: The PAI score distributions differed between the adequate and inadequate groups before (p = 0.001) and after treatment (p = 0.003). Temporal changes were not statistically significant within the groups (adequate, p = 0.236; inadequate, p = 0.148). After treatment, 26.99% of adequately filled and 60.83% of inadequately filled teeth remained or progressed to pathological PAI scores (3-5). Root resorption was more frequent in males (p < 0.05). In the vital-tooth screening, the baseline PAI was 1; three teeth developed radiolucency (PAI 4), and one developed a new radiopaque lesion. CONCLUSION: Inadequate obturation was associated with a higher proportion of pathological periapical outcomes after orthodontic treatment, and male gender was associated with higher root resorption. These findings support the careful preorthodontic radiographic verification of endodontic quality.
Karayiğit O, Çelik MC, Gök M
… +4 more, Balun A, Karayiğit B, Başyiğit F, Güven Çetin Z
Med Princ Pract
· 2026 · PMID 41587131
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UNLABELLED: <p>Objectives: The endothelial activation and stress index (EASIX) has gained growing recognition as a potential marker for evaluating endothelial dysfunction and survival outcomes across diverse clinical con...UNLABELLED: <p>Objectives: The endothelial activation and stress index (EASIX) has gained growing recognition as a potential marker for evaluating endothelial dysfunction and survival outcomes across diverse clinical conditions. This research aimed to assess the utility of the EASIX score in predicting disease severity and prognosis in patients diagnosed with acute pulmonary embolism (APE). METHODS: A retrospective analysis was carried out on 364 consecutive patients diagnosed with APE at our hospital between 2022 and 2025. The cohort included 193 female (53%), with an average age of 64.8 ± 15.8 years. Based on clinical severity, patients were stratified into three categories: low-risk, intermediate-risk, and high-risk APE. Calculation of the EASIX score was performed using the following formula: lactate dehydrogenase (U/L) × serum creatinine (mg/dL)/platelet count (109/L). RESULTS: Higher EASIX scores independently predicted both the high-risk APE and in-hospital mortality. Additionally, the EASIX score showed positive correlations with the simplified Pulmonary Embolism Severity Index (sPESI), troponin, and N-terminal pro-brain natriuretic peptide. Receiver operating characteristic (ROC) curve analysis identified an optimal EASIX cutoff value of 1.18 for predicting high-risk APE, offering a sensitivity of 77.5% and a specificity of 72.1%, with an area under the curve (AUC) of 0.816. Comparative ROC curve analysis revealed that the EASIX score (AUC = 0.835) exhibited a higher discriminative ability for in-hospital mortality compared to both the sPESI (AUC = 0.710) and Wells (AUC = 0.592) scores. CONCLUSION: The EASIX score appears to be a reliable and easily obtainable marker for assessing both disease severity and prognosis in APE. </p>.
Med Princ Pract
· 2026 Jan · PMID 41569967
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OBJECTIVE: This study aimed to investigate the effects of Mozart's Sonata K.448 on GABAergic activity using the prepulse inhibition (PPI) paradigm and to evaluate its impact on seizure susceptibility in a pentylenetetraz...OBJECTIVE: This study aimed to investigate the effects of Mozart's Sonata K.448 on GABAergic activity using the prepulse inhibition (PPI) paradigm and to evaluate its impact on seizure susceptibility in a pentylenetetrazole (PTZ)-induced epilepsy model. SUBJECT AND METHODS: Thirteen male Wistar albino rats (14 days old) were randomly assigned to control (n = 6) and music (n = 7) groups. The control group was exposed to white noise (65 dB), while the music group was exposed to Mozart's Sonata K.448 (65-75 dB), 12 h/day during the dark cycle for 10 weeks. GABAergic activity was assessed through PPI at 74, 78, and 86 dB intensities. Epileptic seizures were induced by a single intraperitoneal injection of PTZ (60 mg/kg), and seizure latency and severity were recorded. RESULTS: No significant differences were observed between groups in %PPI at 74 dB (p = 0.542), 78 dB (p = 0.889), or 86 dB (p = 0.863). Seizure latency was longer in the control group (903.5 s vs. 80 s), but this difference was not statistically significant (p = 0.098). Seizure severity scores were higher in the music group; however, the difference did not reach significance (p = 0.164). CONCLUSION: Under the present experimental conditions, Mozart K.448 did not significantly modulate GABAergic activity as measured by PPI. The observed trends toward shorter seizure latency and higher seizure severity in the music group may reflect a possible context-dependent increase in excitability, although these findings remain preliminary due to the small sample size. Given the complex nature of music's effects, further studies employing larger cohorts, and complementary neurophysiological methods are warranted.
Acar S, Sabah E, Baran M
… +3 more, Ecevit ÇÖ, Sezak M, Aydoğdu S
Med Princ Pract
· 2026 · PMID 41474653
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UNLABELLED: <p>Objectives: Celiac disease (CD) is an immune-mediated disorder triggered by gluten, often presenting with oral manifestations: dental enamel defects (DEDs) and recurrent aphthous stomatitis (RAS). This stu...UNLABELLED: <p>Objectives: Celiac disease (CD) is an immune-mediated disorder triggered by gluten, often presenting with oral manifestations: dental enamel defects (DEDs) and recurrent aphthous stomatitis (RAS). This study aimed to determine the prevalence of DEDs and RAS in children with CD and to identify the clinical, serological, and histopathological factors associated with their etiology. MATERIALS AND METHODS: Ninety-seven children (6-19 years) with biopsy-confirmed CD and 31 age-matched healthy controls were involved in the study. The CD cohort was stratified by age at diagnosis (<5 years and >5 years) and disease status (newly diagnosed). Data on clinical findings, human leukocyte antigen typing, and biochemical parameters were collected retrospectively. All intestinal biopsies were reevaluated according to the Marsh classification. A single, blinded examiner performed oral examinations to diagnose DEDs and RAS. RESULTS: The prevalences of DEDs (63.9% vs. 16.1%) and RAS (27.8% vs. 22.5%) were significantly higher in the CD group than in controls (p < 0.05). The severity of DEDs was negatively correlated with serum calcium levels (p = 0.022) and positively correlated with the severity of intestinal damage (p < 0.05). A later age at diagnosis was also associated with a higher prevalence of DEDs. RAS was most prevalent in newly diagnosed, untreated patients (47%, p = 0.016) and showed significant remission following a gluten-free diet (p < 0.001). CONCLUSION: DEDs and RAS are significant and common oral manifestations in children with CD. The strong association between DED severity and the degree of intestinal histopathology suggests shared pathogenic pathways. These oral findings can serve as important noninvasive clinical markers in the early detection of undiagnosed CD. </p>.
Guchhait P, Saha T, Chaudhuri BN
… +4 more, Das A, Banerjee RD, Mukherjee S, Das S
Med Princ Pract
· 2026 · PMID 41329621
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UNLABELLED: <p>Objective: The aim of the study was to evaluate the impact of a policy-driven Antimicrobial Stewardship Program (AMSP) on antibiotic consumption, prescribing compliance, infection control, resistance trend...UNLABELLED: <p>Objective: The aim of the study was to evaluate the impact of a policy-driven Antimicrobial Stewardship Program (AMSP) on antibiotic consumption, prescribing compliance, infection control, resistance trends, and clinical outcomes in a tertiary care hospital in India over a 3-year period. SUBJECT AND METHODS: A retrospective cross-sectional study compared pre-AMS (nurse-led) and post-AMS (multidisciplinary) phases (2022-2025). Indicators included antibiotic use, defined daily doses (DDD), days of therapy (DOT), policy compliance, resistance rates, and clinical outcomes. Statistical significance was set at p < 0.05. RESULTS: Overall antibiotic use decreased, with DDD/1,000 patient-days declining from 2,599.3 to 2,413.3 with p = 0.974>0.05 and DOT from 1,474.4 to 1,394.6 with p = 0.991>0.05. Policy compliance rose marginally (78%-80%; p = 0.412) but declined in the second post-AMS year. De-escalation improved initially (46%-80.3%) but later dropped to 65.2%. Surgical prophylaxis agent selection improved (88%-94%; p = 0.044), while duration adherence remained low. Resistance rates for vancomycin-resistant Enterococcus and CRE decreased (44%-26% and 47%-42%, respectively) without statistical significance. Standardized mortality ratio (SMR) declined (1.28-0.62; p < 0.001), but all-cause mortality slightly increased (3.54%-3.63%). Readmissions (60.7-126.5/1,000 discharges) and intensive care unit (ICU) transfers (0.319-0.381/1,000 admissions) rose post-AMS. CONCLUSION: AMSP implementation was associated with process improvements and favourable trends in resistance and SMR, but most changes were not statistically significant. Increased readmissions, ICU transfers, and inconsistent compliance highlight the need for sustained interventions and patient-level risk adjustment. </p>.
Alamri AF, Alamri FF, Alkhiri A
… +8 more, Alturki F, Alatawi Y, Alraddadi EA, Alqahtani MS, Alzahrani MS, Alharbi AR, Alghamdi M, Alghamdi S
Med Princ Pract
· 2026 · PMID 41313727
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UNLABELLED: <p>Objective: The prospective National Institutes of Health Stroke Scale (NIHSS) assessment is the standard for evaluating stroke severity. This study aimed to develop and validate an enhanced retrospective N...UNLABELLED: <p>Objective: The prospective National Institutes of Health Stroke Scale (NIHSS) assessment is the standard for evaluating stroke severity. This study aimed to develop and validate an enhanced retrospective NIHSS (r-NIHSS) scoring method that integrates structured keyword mapping and established neurological scales, the Glasgow Coma Scale (GCS) for consciousness, and the Medical Research Council (MRC) scale for motor strength to enable reliable estimation of stroke severity from medical records. SUBJECTS AND METHODS: We developed a structured chart-based method to estimate NIHSS scores from electronic health records, incorporating the GCS, the MRC scale, and a predefined list of standardized clinical descriptors. Four NIHSS-certified, blinded raters retrospectively evaluated 50 acute ischemic stroke patients with prospectively recorded NIHSS scores. Inter-rater reliability for each domain was analyzed using weighted kappa (K (w)), and agreement between r-NIHSS and prospective NIHSS (p-NIHSS) scores was assessed with the intraclass correlation coefficient (ICC). RESULTS: Inter-rater reliability was almost perfect (ICC = 0.99 [95% CI, 0.99-0.99]). The highest agreement across raters was seen in the level of consciousness domain (K (w) = 0.99 [95% CI, 0.95-1.00]). The total r-NIHSS scores demonstrated near-perfect agreement with p-NIHSS scores (ICC = 0.99 [95% CI, 0.98-0.99]). CONCLUSION: The updated chart-based r-NIHSS method is feasible and highly reliable for assessing stroke severity using routine medical documentation. This tool offers a practical, standardized approach for retrospective and registry-based studies where p-NIHSS assessments are unavailable. </p>.
Acar S, Aksu G, Hameş EE
… +2 more, Karakoyun M, Aydoğdu S
Med Princ Pract
· 2026 · PMID 41269899
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UNLABELLED: <p>Objectives: Celiac disease (CD) is a systemic autoimmune disorder associated with various oral manifestations, including dental enamel defects (DED). This study aimed to investigate the correlation between...UNLABELLED: <p>Objectives: Celiac disease (CD) is a systemic autoimmune disorder associated with various oral manifestations, including dental enamel defects (DED). This study aimed to investigate the correlation between enamel defects, other oral health-related factors, and salivary immunological markers in children with CD. SUBJECT AND METHODS: A total of 128 children, comprising 97 patients diagnosed with CD and 31 healthy controls, were included in this cross-sectional study. All participants underwent a thorough oral examination to assess for DED, caries experience, and recurrent aphthous stomatitis (RAS). Saliva samples were collected to measure stimulated salivary flow rate, buffer capacity, saliva pH, the levels of mutans streptococci and lactobacilli, anti-tissue transglutaminase (tTG) IgA, and anti-gliadin antibody (AGA) IgA. RESULTS: Children with CD showed a significantly higher prevalence of DED and RAS compared to the healthy control group (p < 0.05). Serum IgA and tTG IgA levels positively correlated with salivary IgA and tTG IgA levels (p = 0.02, p = 0.00). A statistically significant positive correlation was found between the presence of enamel defects and the salivary levels of both tTG IgA and AGA IgA (p < 0.05). No significant difference was observed in caries experience between the groups. CONCLUSION: CD is associated with significant oral health disadvantages in children, including a higher prevalence of enamel defects. The correlation between these defects and salivary immunological markers suggests that saliva analysis could serve as a promising, noninvasive tool for monitoring disease-related oral manifestations in pediatric patients. </p>.
Rahman Ahmada A, Rao M, Alkhalidi M
… +9 more, Al Seaidan M, Alkhabaz M, Ali A, Alqallaf M, Al-Zoughool M, Shehab M, Chamorro A, Jallad R, Gasana J
Med Princ Pract
· 2026 Jan · PMID 41166544
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OBJECTIVE: To assess levels of lead in the blood of children aged between 6 and 72 months, who were born and raised in Kuwait. METHODS: This study targeted households with children who met the required age range in all s...OBJECTIVE: To assess levels of lead in the blood of children aged between 6 and 72 months, who were born and raised in Kuwait. METHODS: This study targeted households with children who met the required age range in all six governorates of Kuwait. The sample size formula provided a representative sample of 200 children. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was utilized to analyze for lead. The Shapiro-Wilk and Kolmogorov-Smirnov tests for normality were used to evaluate all variables. The 2-test was used for differences, and logistic regression for associations of the categorical variables. An elevated blood lead level (EBLL) was defined as an EBLL of ≥3.5μg/dL, as defined by the Centers for Disease Control and Prevention (CDC). RESULTS: 157 children, of whom 72 (45.9%) were males and 76 (48.4%) were females, met the inclusion criteria. The mean (SD) age was 5.2 (2.13) years. The prevalence of EBLL was 49.0%. The proportion of EBLL was higher among females than the males. CONCLUSIONS: The study revealed that 49 % of children had EBLL exceeding the CDC's reference value for children. The heavy petrochemical industry, together with one of the highest traffic burdens and the desert climate, makes Kuwait and neighboring Gulf Cooperation Council (GCC) countries a high-risk area for lead (Pb) exposure. Longitudinal studies with more detailed environmental assessments are recommended to determine the presence of lead in an environment where children are likely to be and to implement lead screening programs as preventive control measures.