Medicina Katastrof
type: channel
description: The journal welcomes all kind of research/review/abstract papers regarding Health Professions (miscellaneous), Emergency Medical Services, Emergency Medicine, Public Health, Environmental and Occupational Health and so on. Medicina Katastrof (ISSN:2070-1004) (E-ISSN:2686-7966) Latest Journal Published Here MK-20-04-2025-2112 / Medicina Katastrof (ISSN:2070-1004) (E-ISSN:2686-7966) Tele-Medical Technologies Usage In Medical Treatment Organizations Of Federal Medical And Biological Agency The main issues of provision of medical help and treatment with usage of tele-medical technologies (TMT) were considered, including victims in emergency situations (ES), in medical treatment organizations (MTO) of Federal Medical and Biological Agency (FMBA of Russia). Noticed that an experience of conducting of tele-medical consultations (TMC) which was made in All-Russian Center of Disaster Medicine “Zashchita” (was handed over to FMBA of Russia in 2020) allowed to increase number of MTO of FMBA of Russia which are participated in conducting of medical consultation by the sche Learn More MK-08-01-2025-2112 / Medicina Katastrof (ISSN:2070-1004) (E-ISSN:2686-7966) Integrating Virtual Reality and Artificial intelligence Tools to Optimize Interprofessional Coordination in Clinical Care Interprofessional coordination breakdowns contribute substantially to adverse events in clinical care, with up to 10% of hospital patients affected and millions of associated deaths worldwide. Emerging technologies—artificial intelligence (AI) and virtual reality (VR)—offer synergistic opportunities to enhance team communication, decision making, and workflow efficiency, yet their combined impact on multidisciplinary coordination has not been systematically evaluated... Learn More MK-07-01-2025-2112 / Medicina Katastrof (ISSN:2070-1004) (E-ISSN:2686-7966) Evaluating Infection‐Control Practice Among Surgical, Anesthesia, and Radiology Teams Healthcare‐associated infections (HAIs) in perioperative and imag…
language: en
publication name: Medicina Katastrof
items: Artificial Intelligence in Medication Safety Systems for the Prevention of Perioperative and Inpatient Medication Errors
items: Psychological Interventions for Post-Traumatic Stress Disorder in Military Personnel using Artificial Intelligence
items: Imaging-Based Changes in Visceral Adipose Tissue and Metabolic Risk: A Systematic Review
items: Prehospital Teleconsultation and Imaging-Guided Destination Choice: A Systematic Review
items: Robotic Chest-Compression Systems with Real-time Physiologic Feedback: A Systematic Review of Closed-Loop and Machine-Learning Approaches
items: Central Line-associated Bloodstream Infection in Surgical Patients: Impact of Ultrasound Guided Insertion
items: Perioperative Pulmonary Rehabilitation Interventions to Reduce Postoperative Pulmonary Complications After Thoracic Surgery
items: Effect of Metformin versus Sodium Glucose Cotransporter-2 Inhibitors in Diabetic Patients with Chronic Kidney Disease: A Systematic Review
items: Fall-Prevention Programs for Older Adults Presenting With an Index Fall: Effectiveness and Safety
items: Mechanical Mobility-Assist Devices and Ergonomic Programs in Nursing Homes for Preventing Staff Musculoskeletal Disorders: A Systematic Review
items: Mechanical Chest Compression Devices Versus Manual Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review
items: Operating Room and Door-Opening Control Strategies to Reduce Intraoperative Microbial Contamination: A Systematic Review
items: Diagnostic Accuracy and Safety of High-Sensitivity Troponin Algorithms for Early Exclusion of Acute Coronary Syndrome
items: SGLT2 Inhibitors Versus Intensive Low-Carbohydrate Dietary Programs for Glycemic Control and Early Detection of Renal Outcomes in Type 2 Diabetes
items: Integrated Sepsis Detection Protocols Using Clinical Scores and Laboratory Triggers Versus Routine Assessment in Adult Emergency Patients
items: De-escalation Training to Reduce Workplace Violence in Emergency Nurses:A Systematic Review
items: Artificial Intelligence Support For Digital Breast Tomosynthesis And 2DMammography: A Systematic Review Of Diagnostic Accuracy
items: Comparative Effectiveness of Video and Direct Laryngoscopy on First-Pass Success andPeri-intubation Events
items: Comparing Devices and Training for Needlestick-Injury Prevention: A SystematicReview
items: Care Pathways Combining Anesthesia Practices and Nursing Interventions forPostoperative Delirium Prevention
items: Digital Morphology for Peripheral Blood Smears in Leukemia Detection:A Systematic Review
items: Acquired Methemoglobinemia from Local Anesthetics Used for Airways:Incidence, Risk Factors, and Management
items: Digital-Era Nurse Leadership and Psychological Empowerment DuringeHealth Implementation: A Systematic Review
items: Impact of Patient-Assisted Compression and Pressure-Guided Paddles onMammography/DBT Performance
items: Emergency Medical Services Use of Capillary Ketone Meters for SuspectedDiabetic Ketoacidosis: A Systematic Review
items: Same-Day Screening of Diabetic Complications in Outpatient Clinics: ASystematic Review
items: Skin and Allergic Conditions Linked to Personal Protective Equipment inHealthcare Workers: Burden, Prevention, and Care
items: Vasopressor Strategy for Neuraxial Related Hypotension During CrashCesarean
items: Pharmacogenomic Guided Pain Management in Surgery: Patient PainOutcomes
items: Influence of Abutment Retention Method on Dental Implant Prosthesis: Implant Stability and Screw Loosening

Artificial Intelligence in Medication Safety Systems for the Prevention of Perioperative and Inpatient Medication Errors
type: item
description: Background: Medication errors are a major source of preventable harm in perioperative and inpatient care, and artificial intelligence (AI) is increasingly used to strengthen medication safety systems. Methods: PubMed was searched from inception to September 2024 for English-language human studies evaluating AI-enabled medication safety interventions in hospital perioperative or inpatient settings. Two reviewers screened records, extracted data in duplicate, and appraised risk of bias using Joanna Briggs Institute checklists; results were synthesized narratively without meta-analysis. Results: Eleven studies, predominantly retrospective cohorts or pre–post implementations, were included across adult wards, intensive care, pediatric/neonatal intensive care, and intravenous administration monitoring, with sample sizes ranging from 311 ICU prescribing episodes to 3,481,634 alert events. Discrimination for identifying high-risk prescriptions or patients was moderate to high (AUROC 0.74–0.97). Improvements were reported in key process measures, including reduced pediatric ICU dosing deviations (RR 0.21; 95% CI 0.05–0.96), higher reconciliation discrepancy yield with admission prioritization (45% vs 21%; RR 2.13; 95% CI 1.40–3.24), and lower alert burden (54.1% reduction at sensitivity 0.99; precision 0.192); one deployment triggered alerts for 0.4% of orders and 43% prompted order changes. Conclusions: AI-enabled medication safety systems were associated with improved identification and management of high-risk medication scenarios and more efficient safety surveillance. Evidence remained heterogeneous, and preventable adverse drug events and longer-term patient outcomes were infrequently measured.
subject: Articles
  topic: section
subject: Medication Errors
  topic: keywords
subject: Patient Safety
  topic: keywords
subject: Artificial Intelligence
  topic: keywords
subject: Machine Learning
  topic: keywords
subject: Clinical Decision Support Systems
  topic: keywords
creator: Mohammed Hudaiban Al-Rashidi¹, Sami Mohammed Alhazemi², Mustafa Jaffer Hyyan³, Mohammed Khalaf Mashan Alharbi⁴, Naemah Rashed Bin Reshedan⁵, Haidar Mohammed Alsaygeh⁶, Nouf Shafi Alshammari⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-11-21
publication date: 2024-11-21

Psychological Interventions for Post-Traumatic Stress Disorder in Military Personnel using Artificial Intelligence
type: item
description: Background: Post-traumatic stress disorder is prevalent in active-duty military personnel and veterans, and access to trauma-focused psychotherapy is limited by workforce capacity, operational demands, and stigma. Artificial intelligence-enabled technologies may enhance delivery and engagement. Methods: PubMed was searched for randomized trials or comparative cohort studies of artificial intelligence–enhanced psychological interventions for post-traumatic stress disorder in active-duty personnel or veterans. Screening, data extraction, and risk-of-bias appraisal were conducted in duplicate, and findings were synthesized narratively without meta-analysis. Results: Eleven studies (9 randomized trials, 2 nonrandomized studies) were included, mainly immersive virtual reality exposure variants and motion-assisted reconsolidation approaches. Virtual reality–graded exposure improved response versus usual care (≥30% Clinician-Administered PTSD Scale reduction: 7/10 vs 1/9; RR 3.2), and motion-assisted therapy in treatment-resistant veterans reduced clinician-rated symptoms versus control (mean difference −9.38 points; 95% CI −17.33 to −1.44). An intensive multicomponent trauma management program reported large improvement (effect size 2.06) and 65.9% no longer meeting diagnostic criteria, while dropout in exposure-based trials reached 4-44%. Conclusions: Artificial intelligence-enabled interventions were associated with clinically meaningful post-traumatic stress disorder symptom reductions, but heterogeneity and adherence constraints limited certainty. Larger pragmatic trials with standardized outcomes, safety reporting, and longer follow-up are needed.
subject: Articles
  topic: section
subject: Post-Traumatic Stress Disorders
  topic: keywords
subject: Military Personnel
  topic: keywords
subject: Artificial Intelligence
  topic: keywords
subject: Treatment Outcome
  topic: keywords
creator: Abdulrahman Saud Alharbi¹, Khalid Abdullah Alahmari¹, Dhafer Ali Alshehri¹, Abdullah Mohammed Alsubaie², Turki Mohammed Albaqami², Nader Marzouq Alotaibi³
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-17
publication date: 2025-12-17

Imaging-Based Changes in Visceral Adipose Tissue and Metabolic Risk: A Systematic Review
type: item
description: Background: Visceral adipose tissue is a high-risk fat compartment linked to insulin resistance, dyslipidaemia, and hepatic steatosis. Imaging enables direct quantification of visceral adipose tissue and depot-specific change. Methods: PubMed was searched for human clinical trials and longitudinal cohorts reporting serial visceral adipose tissue quantified by magnetic resonance imaging, ultrasonography, or dual-energy X-ray absorptiometry and at least one metabolic outcome. Reference lists were hand-searched, screening and data extraction were performed in duplicate, and findings were synthesised narratively without meta-analysis. Results: Thirteen studies (10 trials, 3 cohorts; sample size 32–598; follow-up 8 weeks–2 years) were included, most commonly reporting glycaemic or insulin-resistance indices, lipid profile measures, and hepatic fat. In a cohort, each 10 cm² increase in visceral adipose tissue was associated with higher odds of metabolic syndrome (odds ratio 1.23; 95% confidence interval 1.09–1.39). In randomised trials, dapagliflozin reduced visceral adipose tissue volume by 0.35 L and liver fat by 3.74 percentage points versus placebo (8 weeks), and semaglutide reduced visceral fat mass by 27.4% versus 2.4% (68 weeks). Conclusions: Imaging-detected reductions in visceral adipose tissue were generally accompanied by improved metabolic risk markers, with the most consistent co-improvements in hepatic fat and lipid risk. Standardised imaging protocols and longer multicentre studies are needed to define clinically meaningful thresholds of visceral adipose tissue change across modalities.
subject: Articles
  topic: section
subject: Visceral Fat
  topic: keywords
subject: Magnetic Resonance Imaging
  topic: keywords
subject: Insulin Resistance
  topic: keywords
subject: Metabolic Syndrome
  topic: keywords
creator: Zainab Jawad Aljumah¹, Fatimah Abdulmajeed Ali Almousa², Amal Essa Ali Al Abdulghani³, Arwa Jamal Ali Alameer⁴, Abdullah Eissa Ali Aalsaheeh⁵, Yasir Saeed Almutairi⁶, Ahmed Saleh Serhan Alghamdi⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-16
publication date: 2025-12-16

Prehospital Teleconsultation and Imaging-Guided Destination Choice: A Systematic Review
type: item
description: Background: Prehospital destination decisions determine timely access to definitive imaging and reperfusion pathways for acute stroke, myocardial infarction, and other emergencies. Teleconsultation with prehospital diagnostic transmission may reduce uncertainty and enable direct routing to capable centers. Methods: PubMed was searched for English-language human studies evaluating prehospital teleconsultation plus diagnostic transmission (computed tomography–enabled stroke models, point-of-care imaging, or electrocardiogram transmission) that influenced hospital destination choice or pathway activation. Clinical trials and cohort studies were included, data were extracted in duplicate, and results were synthesized narratively without meta-analysis. Results: Eleven studies were included. In stroke, a mobile computed tomography pathway reduced call-to-therapy-decision time by 41 minutes (35 vs 76 minutes; 95% confidence interval 36–48) and ambulance-based thrombolysis reduced alarm-to-thrombolysis time by 25 minutes (interquartile range 13–34); onset-to-thrombolysis time was 72 vs 108 minutes in a multi-center controlled study. Disability outcomes favored mobile imaging dispatch in large cohorts (common odds ratio for worse disability 0.71; 95% confidence interval 0.58–0.86), and in ST-segment elevation myocardial infarction, telecardiology-supported electrocardiogram transmission increased direct catheterization-laboratory routing to 69.8% and reduced system delay (76 vs 90 minutes) and door-to-balloon time (57.78 vs 141.70 minutes). Conclusions: Teleconsultation paired with actionable diagnostic transmission shortened key system delays and improved destination-pathway alignment, with the most reproducible benefits in imaging-enabled stroke and telecardiology-supported myocardial infarction networks.
subject: Articles
  topic: section
subject: Emergency Medical Services
  topic: keywords
subject: Telemedicine
  topic: keywords
subject: Diagnostic Imaging
  topic: keywords
subject: Stroke
  topic: keywords
creator: Ali Ebrahim Saleh Al-Mahfoodh¹, Majed Dhaifallah Matar Al-Mutairi², Mohamed Alawai Alsaid Ali³, Eman Mohammed Al-Gharqan⁴, Ghanem M. Al-Qahtani⁵, Hydar Abdulla Ali Al-Nahwi⁶, Wala Zaki Al-Jamea⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-17
publication date: 2025-12-17

Robotic Chest-Compression Systems with Real-time Physiologic Feedback: A Systematic Review of Closed-Loop and Machine-Learning Approaches
type: item
description: Background: Mechanical chest-compression devices standardize cardiopulmonary resuscitation (CPR), but fixed compression parameters may not match patient physiology. Robotic and algorithm-driven systems that use real-time physiologic signals could enable closed-loop CPR optimization. Methods: PubMed was searched from database for clinical, preclinical, and modeling studies evaluating robotic/mechanical chest-compression systems incorporating real-time physiologic feedback (e.g., end-tidal carbon dioxide [ETCO₂], arterial pressure, coronary perfusion pressure [CPP], carotid flow) consistent with closed-loop or machine-learning approaches. Eligible studies were synthesized narratively without meta-analysis. Results: Five studies met inclusion: two randomized porcine trials, one porcine machine-learning modeling study (n=7), and two simulation/model studies. A closed-loop machine-controlled CPR system sustained higher CPP at 30 minutes versus guideline CPR (22±3 vs 8±3 mmHg) and preserved carotid blood flow during prolonged resuscitation. An AI-driven CPR robot achieved similar hemodynamics to a standard piston device, with no difference in carotid flow (−23.2±20.2 mL/min; P=0.250) and comparable ROSC (83.3% vs 66.7%; P=1.00). Simulation studies suggested that CPP-targeted controllers improved modeled flow/ETCO₂, and an ML model predicted carotid flow per compression with high accuracy (R²=0.96). Conclusions: Evidence for physiologic-feedback robotic CPR is limited to preclinical and simulation studies, but supports technical feasibility and potential hemodynamic advantages over fixed-parameter CPR. Human feasibility trials with standardized ventilation, safety outcomes, and neurologic endpoints are required before clinical deployment.
subject: Articles
  topic: section
subject: Cardiopulmonary resuscitation
  topic: keywords
subject: Robotics
  topic: keywords
subject: Machine learning
  topic: keywords
subject: Coronary perfusion pressure
  topic: keywords
creator: Salem Ahmed Al-Joud¹, Shadi Ahmed Alghamdi², Fahad Mohammed Alshamrani³, Khaled Hashem Almalawi⁴ Turki Rajah Alharbi⁵, Marwan Hamed Rasheed Alsulami⁶, Bandar Mohammed Al-Zahrani⁷, Sultan Shulaywih Hiraz Alsulami⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-16
publication date: 2025-12-16

Central Line-associated Bloodstream Infection in Surgical Patients: Impact of Ultrasound Guided Insertion
type: item
description: Background: Central line–associated bloodstream infection (CLABSI) remains a major preventable complication in surgical and perioperative care. Ultrasound guidance improves central venous catheter (CVC) placement safety, but its effect on CLABSI is unclear. Methods: PubMed was searched using systematic search strategy with humans and English filters. Randomized trials and cohort studies comparing real-time ultrasound-guided versus landmark CVC insertion in surgical/perioperative or surgical-critical-care patients (adults and children) were included, and findings were synthesised narratively without meta-analysis. Results: Of 1,183 records identified, 273 duplicates were removed; 910 titles/abstracts were screened and 58 full texts assessed, yielding 9 included studies. Ultrasound guidance increased cannulation success with improved first-pass performance, and reduced mechanical complications (e.g., carotid puncture 1.7% vs 8.3%). Infection outcomes were heterogeneous: one trial reported lower catheter-associated bloodstream infection (10.4% vs 16.0%), a prospective cohort found no association (hazard ratio 0.69; 95% CI 0.36–1.30), whereas a post hoc analysis reported higher CRBSI hazard with ultrasound (hazard ratio 2.21; 95% CI 1.17–4.16). Conclusions: Ultrasound-guided CVC insertion consistently improved procedural performance and reduced mechanical harm, while evidence for CLABSI/CRBSI reduction was inconsistent and context dependent. Ultrasound should be implemented as the default insertion approach within comprehensive insertion-and-maintenance bundles for surgical patients.
subject: Articles
  topic: section
subject: Central Venous Catheters
  topic: keywords
subject: Ultrasonography
  topic: keywords
subject: Catheter-Related Infections
  topic: keywords
subject: Bloodstream Infection
  topic: keywords
creator: Mohammed Taher Abdullah Alshabaah¹, Ismail Nori Hassan Albdul Almohsin², Mohammed Essa Hussin Alsarouj³, Hussein Abdulmohsen Hussein Almurahail⁴ Zaher Ahmed Essa Albeladi⁵, Omar Khalaf Alzahrani⁶, Faisal Hassan Ali Alhassan⁷, Mohammed Rajan Al Ajmi⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-15
publication date: 2025-12-15

Perioperative Pulmonary Rehabilitation Interventions to Reduce Postoperative Pulmonary Complications After Thoracic Surgery
type: item
description: Background: Postoperative pulmonary complications are common after thoracic surgery and contribute to morbidity and longer hospital stay. Perioperative pulmonary rehabilitation aims to reduce these complications, but the relative benefit of different approaches is uncertain. Methods: PubMed was searched from inception to July 2025 for comparative clinical trials and cohort studies evaluating perioperative pulmonary rehabilitation interventions in adults undergoing thoracic surgery. Findings were synthesised narratively without meta-analysis; postoperative pulmonary complications were the primary outcome, with length of stay and functional recovery as secondary outcomes. Results: Eleven studies (eight randomised trials, two cohorts, one case-control; sample size range 12–1056) were included. Enhanced recovery after surgery plus pulmonary rehabilitation reduced postoperative pulmonary complications versus enhanced recovery alone (n=374; 18.7% vs 33.2%; hazard ratio 0.52, 95% confidence interval 0.35–0.79). Ultra-early post-anaesthesia care unit rehabilitation reduced atelectasis and/or pneumonia (n=900; 6.7% vs 11.4%; odds ratio 0.53, 95% confidence interval 0.26–0.98), preoperative high-intensity interval training reduced pulmonary complications (n=151; 23% vs 44%), and a pilot preoperative pulmonary rehabilitation programme shortened postoperative stay (7.8 ± 4.8 vs 12.2 ± 3.6 days). Conclusions: Bundled perioperative pulmonary rehabilitation, especially when integrated into enhanced recovery pathways and delivered with very early mobilisation, was associated with fewer postoperative pulmonary complications after thoracic surgery. Standardised endpoint definitions and pragmatic comparative trials are needed to refine patient selection and intervention dosing.
subject: Articles
  topic: section
subject: Thoracic Surgery
  topic: keywords
subject: Pulmonary Rehabilitation
  topic: keywords
subject: Postoperative Complications
  topic: keywords
subject: Preoperative Care
  topic: keywords
creator: Ali Hussain Al Ahmad¹, Dawood Ali Almasoud², Nesren Salman Al Ismail³, Ali Salman Atehaifah⁴ Durgham Ibrahim Alalawi⁵, Khadijah Saeed Alshokai⁶, Randa Ahmed AlRaja⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-13
publication date: 2025-12-13

Effect of Metformin versus Sodium Glucose Cotransporter-2 Inhibitors in Diabetic Patients with Chronic Kidney Disease: A Systematic Review
type: item
description: Background: Diabetic chronic kidney disease carries high risks of kidney failure and cardiovascular events, and clinicians frequently weigh metformin-based care against sodium–glucose cotransporter 2 inhibitor therapy for renoprotection. Methods: PubMed was searched from inception to August 2025 (English-language, human studies) for trials and cohort studies in adults with diabetes and chronic kidney disease evaluating metformin strategies and/or sodium–glucose cotransporter 2 inhibitors. Studies reporting kidney progression and cardiovascular or mortality outcomes were narratively synthesized (no meta-analysis). Results: Six studies were included: three randomized trials (n=4,304; n=4,401; n=6,609) and three population-based cohort studies (n=1,450; n=45,545; n=4,278). Sodium–glucose cotransporter 2 inhibitors reduced composite kidney outcomes in trials (hazard ratios 0.61 [95% confidence interval 0.51–0.72], 0.70 [0.59–0.82], and 0.72 [0.64–0.82]) and lowered kidney-related adverse events in advanced chronic kidney disease (odds ratio 0.48 [0.33–0.71]). In comparative cohorts, metformin plus sodium–glucose cotransporter 2 inhibitors reduced composite kidney outcomes (adjusted hazard ratio 0.65 [0.48–0.87]) and all-cause mortality (0.74 [0.64–0.84]) versus sodium–glucose cotransporter 2 inhibitors alone, with lower severe acute kidney injury (0.72 [0.54–0.96]) and metabolic acidosis (0.58 [0.40–0.83]); stopping metformin at stage 4 chronic kidney disease increased mortality (hazard ratio 1.26 [1.10–1.44]). Conclusions: Sodium–glucose cotransporter 2 inhibitors showed consistent kidney protection, while observational evidence supported continued metformin, especially in combination, when kidney-function–based safety monitoring is feasible in routine practice.
subject: Articles
  topic: section
subject: Chronic kidney disease
  topic: keywords
subject: Diabetes mellitus
  topic: keywords
subject: Metformin
  topic: keywords
subject: Sodium-glucose cotransporter 2 inhibitors
  topic: keywords
creator: Qasim Hussain Mohsen ALHulyami¹, Arwa Ahmed Abdulkareem Alhajji², Mohammed Fahad Abdulwahab Almomen³, Mustafa Ahmed Aish BuSaleh⁴, Bandar Hamdan Mohaimeed Alnefaie⁵, Narjes Ali Nasser AL Shawareb⁶, Mona Ali Alwaif⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-12
publication date: 2025-12-12

Fall-Prevention Programs for Older Adults Presenting With an Index Fall: Effectiveness and Safety
type: item
description: Background: Older adults discharged after an index fall emergency presentation face high risks of recurrent falls, injury, and repeat acute-care use; the effectiveness and safety of emergency-linked prevention programs remains uncertain. Methods: PubMed was searched from inception to July 2025. Randomized controlled trials of fall-prevention programs initiated at, or directly triggered by, the index-fall emergency encounter were included and synthesized narratively. Results: Eight randomized trials (n=2,806; follow-up 6–12 months) assessed emergency-department–initiated interdisciplinary assessment/referral, structured rehabilitation, patient-centred coaching, or emergency-department multidisciplinary consultation. Recurrent falls effects were mixed, ranging from reduced recurrent falling with comprehensive assessment (odds ratio 0.39; 95% CI 0.23–0.66) to no benefit in cognitive impairment/dementia (risk ratio 0.92; 95% CI 0.81–1.05) and neutral referral-based results for fallers (risk ratio 1.11; 95% CI 0.95–1.31). Secondary outcomes showed selective benefit, including reduced falls rate with coaching (incidence rate ratio 0.65; 95% CI 0.43–0.99), fewer fractures (incidence rate ratio 0.37; 95% CI 0.15–0.91), and fewer subsequent ED visits with multidisciplinary consultation (incidence rate ratio 0.47; 95% CI 0.29–0.74) including fall-related ED visits (incidence rate ratio 0.34; 95% CI 0.15–0.76). Conclusions: Emergency-linked fall-prevention programs demonstrated variable effectiveness, with more consistent benefits when risk assessment was coupled with active follow-up and service linkage. Caregiver-integrated pathways may be required for cognitively impaired populations
subject: Articles
  topic: section
subject: Accidental Falls
  topic: keywords
subject: Emergency Service
  topic: keywords
subject: Patient Safety
  topic: keywords
subject: Geriatric Assessment
  topic: keywords
creator: Majed Helal Almutairi¹, Hussain Mohammad Saud Azbaiyel², Mahdy Saeed Alqahtani³, Salha Abdul Aziz Al-Suhaimi⁴, Bashayer Saleh Al-Shammari⁵, Khulud Abdullah Bin Awdhah⁶, Lamis Ahmad Jabali⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-12
publication date: 2025-12-12

Mechanical Mobility-Assist Devices and Ergonomic Programs in Nursing Homes for Preventing Staff Musculoskeletal Disorders: A Systematic Review
type: item
description: Background: Work-related musculoskeletal disorders (MSDs) are common among nursing-home staff and are strongly linked to resident handling, transfers, and repositioning. Mechanical mobility-assist devices and ergonomic safe resident-handling programs are widely implemented, but nursing-home–specific effectiveness remains variably reported. Methods: PubMed was searched from inception to September 2024 for English-language human studies in nursing homes or comparable long-term care facilities. Clinical trials, controlled before–after studies, and cohort evaluations reporting staff MSD outcomes were eligible; risk of bias was assessed using design-appropriate checklists and results were synthesized narratively. Results: Eleven studies were included. A nursing-home best-practices program reduced workers’ compensation claims (rate ratio 0.39; 95% CI 0.29–0.55), recordable injuries (0.54; 95% CI 0.40–0.73), and first reports of injury (0.65; 95% CI 0.50–0.84). Ceiling-lift interventions reduced lifting/transferring injuries by 58% per 100,000 work-hours (p=0.011) with reported payback periods of 0.82–2.50 years, and in a cluster trial (n=594) low back pain days decreased by 0.8 (95% CI −1.19 to −0.38) and worst-pain intensity by 0.4 points (95% CI −0.60 to −0.26) on a 0–10 scale; observational follow-up showed frequent lift use was protective (RR 0.39; 95% CI 0.18–0.84) and physical workload decreased by 24% among nursing assistants. Conclusions: Benefits were most consistent when devices were embedded within sustained ergonomic programs ensuring availability, competency-based training, maintenance, and monitoring
subject: Articles
  topic: section
subject: Nursing Homes
  topic: keywords
subject: Acute Coronary Syndrome
  topic: keywords
subject: Musculoskeletal Diseases
  topic: keywords
subject: Back Pain
  topic: keywords
creator: Yara Mohammed Alanzi¹, Sukut Omar Alanazi 2, Nidaa Abdullah Salamaa Aljuwaybiri 3, Maznh Ibrahim Khazen Alanzi 3, Haneen Ibrahim Alhaddad 3, Dalal Abdullah Salmaa Aljuwaybiri 3, Waad Atallah Aljuhani 3
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-12-10
publication date: 2024-12-10

Mechanical Chest Compression Devices Versus Manual Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review
type: item
description: Background: Out-of-hospital cardiac arrest (OHCA) remains a major cause of global mortality, and high-quality chest compressions are critical for survival. Mechanical chest compression devices were developed to standardize compression depth and rate, reduce rescuer fatigue, and enable continuous compressions during transport. However, their routine clinical effectiveness compared with manual cardiopulmonary resuscitation (CPR) remains uncertain across emergency medical systems. Methods: A systematic review of PubMed and related databases was performed following PRISMA 2020 guidelines. Eligible studies were randomized or comparative cohort designs evaluating mechanical versus manual chest compressions in adult OHCA. Data were extracted independently, and outcomes were summarized narratively without meta-analysis. The primary outcomes were survival to hospital discharge and favourable neurological recovery (Cerebral Performance Category); secondary outcomes included return of spontaneous circulation (ROSC) and CPR process quality. Results: Eleven studies met inclusion criteria (four randomized trials, seven observational cohorts) encompassing more than 20,000 OHCA patients. Across major randomized trials, survival to discharge did not differ significantly (6-11% mechanical vs 7-11% manual; pooled adjusted odds ratio 1.0, 95% confidence interval 0.8-1.3). Neurologically favourable survival showed no consistent benefit, and some registries reported worse outcomes with device use (adjusted relative risk 0.41-0.70). Secondary outcomes demonstrated improved compression fraction but no improvement in ROSC or 30-day survival. Conclusions: Routine mechanical CPR did not improve survival or neurological outcomes compared with high-quality manual CPR. Device use should be reserved for contexts where manual compressions are unsafe or impractical, supported by strict training and monitoring.
subject: Articles
  topic: section
subject: Cardiopulmonary resuscitation
  topic: keywords
subject: mechanical chest compression
  topic: keywords
subject: out-of-hospital cardiac
  topic: keywords
subject: Ultrasonography, Emergency Medical Services, Trauma, Triage, Diagnostic Imaging, Patient Outcome Assessment.
  topic: keywords
subject: survival
  topic: keywords
creator: Raed Thawab Aljuaid¹, Mohammed Salman AL Alsaraie², Sami Ahmed Alzahrani³, Abdulelah Turki Alanazi⁴, Ibrahim Suwailem Alatawi⁵, Ibrahim Mohammed Alnashri⁶, Ahmad Mohammed Abdullah Alahmari⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-11
publication date: 2025-12-11

Operating Room and Door-Opening Control Strategies to Reduce Intraoperative Microbial Contamination: A Systematic Review
type: item
description: Background Microbial contamination of operating room air is a modifiable contributor to surgical site infection risk. Door-opening behaviour and staff traffic are thought to disrupt pressure and airflow, yet the impact of specific door-opening control strategies on intraoperative contamination has remained uncertain. Methods A systematic review of PubMed, Scopus and Web of Science was conducted from inception to May 2025. Clinical trials, quasi-experimental studies and observational cohorts in human operating rooms were eligible if they quantified intraoperative airborne microbial or particle contamination in relation to door-opening frequency or a defined door-opening control strategy. Primary outcomes were intraoperative airborne microbial load (colony-forming units per cubic metre) and particle counts; secondary outcomes included door-opening rate and surgical site infection incidence. Results Ten studies were included across observational cohorts, higher door-opening rates and greater numbers of personnel were consistently associated with increased airborne contamination; one study reported mean 328 CFU/m³ with 84% of samples above 180 CFU/m³ in high-traffic theatres, and another found traffic flow explained 68% of CFU variance. Interventions such as access signage, staff education and multimodal quality-improvement programmes reduced door-opening rates by about 20-40% and lowered particle counts in the sterile field by up to 40%. Conclusions Door-opening frequency and operating room traffic are consistently associated with higher intraoperative airborne contamination, and simple door-control strategies can meaningfully reduce traffic and environmental bioburden; their independent effect on surgical site infections remains uncertain and warrants robust prospective evaluation.
subject: Articles
  topic: section
subject: Operating Rooms
  topic: keywords
subject: Surgical Wound Infection
  topic: keywords
subject: Air Microbiology
  topic: keywords
subject: Infection Control
  topic: keywords
subject: Personnel Staffing and Scheduling
  topic: keywords
creator: Mohammed Awadh Al Mashhur¹, Yousef Abdulhadi F. Alawad², Wesam Talat A. Alnemari³, Raad Mohammed Alghamdi⁴, Jaber Ali Hussain Absi⁵, Dhawi Talaq Dhawi Alotaibi⁶
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-12-09
publication date: 2025-12-09

Diagnostic Accuracy and Safety of High-Sensitivity Troponin Algorithms for Early Exclusion of Acute Coronary Syndrome
type: item
description: Background: High-sensitivity cardiac troponin (hs-cTn) algorithms are increasingly used to rapidly exclude acute coronary syndrome (ACS) in emergency departments, but their diagnostic accuracy, safety and effects on patient flow remain uncertain. Methods: Electronic databases were searched from inception to August 2024 for prospective cohorts and trials of adults with suspected ACS managed using predefined hs-cTn accelerated diagnostic pathways. Studies had to report diagnostic accuracy for myocardial infarction (MI) and at least one short-term safety outcome; data were extracted and risk of bias was judged with QUADAS-2. Results: From 2,743 records, 13 studies (10 cohorts, 3 trials; >80,000 participants) were included. hs-cTn 0/1-hour and 0/2-hour algorithms ruled out MI in roughly 40-60% of emergency-department patients, with rule-out sensitivity 98-100% and negative predictive value 99.0-99.9%. Among rule-out patients, 30-day MI or cardiac death was ≤1.0% (often 0.0-0.4%). Implementation trials showed shorter emergency-department stays (about 10.1 to 6.8 h) and higher direct discharge rates (50-71%) without significant 30-day major adverse cardiac events; performance was weaker in some high-risk subgroups, particularly those with known coronary artery disease. Conclusions: The hs-cTn-based accelerated diagnostic pathways provided very high sensitivity and negative predictive value for early exclusion of MI, with consistently low short-term event rates and improved emergency-department efficiency, but conservative application and local validation are advisable in high-risk populations and new healthcare settings.
subject: Articles
  topic: section
subject: Acute Coronary Syndrome
  topic: keywords
subject: High-Sensitivity Troponin
  topic: keywords
subject: Myocardial Infarction
  topic: keywords
subject: Diagnostic Algorithms
  topic: keywords
subject: Medicina Katastrof
  topic: keywords
creator: Zahra Hussin Eisaa Alhazmi¹, Azizah Nasser hussin Altherwi², Sarah Nasser Hussin Altherwi³, Tuqyah Mohammad Althurwi⁴, Nasser Yahya Mohammed Dubayyi⁵, Amnah Abdouh Ahmad Arishi⁶, Mohammad Esmail Ali Zalzali⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-11-25
publication date: 2024-11-25

SGLT2 Inhibitors Versus Intensive Low-Carbohydrate Dietary Programs for Glycemic Control and Early Detection of Renal Outcomes in Type 2 Diabetes
type: item
description: Background: Type 2 diabetes is highly prevalent and frequently complicated by chronic kidney disease. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) and intensive low-carbohydrate dietary programs both improve glycaemia, but their comparative effects on early renal outcomes remain uncertain. Methods: A systematic search of PubMed and trial registries identified randomized and cohort studies in adults with type 2 diabetes evaluating SGLT2i or intensive low-carbohydrate programs versus usual care or higher-carbohydrate diets. Two reviewers independently screened records, extracted data, assessed risk of bias, and performed narrative synthesis. Results: Of 1,462 records, 9 studies (6 trials, 3 cohort/real-world; >19,000 participants) met inclusion criteria. Intensive low-carbohydrate programs produced larger short-term HbA1c reductions (−0.6 to −1.3 percentage points at 3–12 months) and 7–12 % weight loss, often allowing major de-intensification or discontinuation of insulin. SGLT2i yielded more modest but durable HbA1c reductions (−0.3 to −0.6 percentage points) and 2–4 kg weight loss with blood-pressure lowering. Across outcome trials and cohorts, SGLT2i reduced composite renal endpoints by about 30–40 % (hazard ratios =0.60–0.70; 95 % confidence intervals excluding 1.00), whereas low-carbohydrate interventions appeared renally neutral over 1–2 years. Conclusions: Both SGLT2i and intensive low-carbohydrate programs improved glycaemic control and cardiometabolic risk in adults with type 2 diabetes, but only SGLT2i showed robust renoprotective effects. These strategies may be complementary, and choice should consider renal risk, obesity, treatment goals, and capacity for sustained dietary change.
subject: Articles
  topic: section
subject: Type 2 diabetes mellitus
  topic: keywords
subject: Sodium-glucose cotransporter 2 inhibitors,
  topic: keywords
subject: Low-carbohydrate die
  topic: keywords
subject: Glycemic control
  topic: keywords
creator: Qassim Abdulatif Ahmad Algurairy¹, Hamad Mohammed Hamad Alhamad², Wasel Hassan Taher Alhashem³, Hussain Salman Alhassan⁴, Dalia Hassan Ibrahim Aljabr⁵, Ali Hussain Almeshqab⁶
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-11-25
publication date: 2025-11-25

Integrated Sepsis Detection Protocols Using Clinical Scores and Laboratory Triggers Versus Routine Assessment in Adult Emergency Patients
type: item
description: Background: Integrated sepsis detection protocols combining clinical scores with laboratory triggers are increasingly used in emergency departments, but their added value over routine assessment remains uncertain. Methods: A PubMed search identified studies comparing integrated sepsis detection protocols (clinical score plus laboratory trigger) with routine clinician assessment in adult emergency settings. Two reviewers selected studies, extracted data, and assessed risk of bias. Primary outcomes were time to antibiotics, intensive care unit (ICU) admission, and mortality; secondary outcomes were process measures and length of stay. Results: Fourteen studies (2 randomised or pragmatic trials, 12 cohort or beforeafter; >20,000 patients) were included. Integrated protocols consistently shortened time to first intravenous antibiotics, with median reductions of 2077 minutes versus usual care and 1-hour antibiotic compliance increase. Completion of bundle elements such as lactate measurement and initial fluid bolus improved, with gains of 2030 percentage points. Overall ICU admission rates were largely unchanged, although some studies reported more timely direct ICU transfer. Mortality effects were heterogeneous; several studies showed in-hospital mortality reductions of 411 percentage points, whereas others reported no significant difference. Conclusions: Across emergency care settings, integrated sepsis detection protocols improved timeliness and completeness of early sepsis management and may reduce mortality when linked to effective response pathways. These findings support local adaptation and implementation of integrated protocols as a component of sepsis quality-improvement initiatives in emergency departments.
subject: Articles
  topic: section
subject: Sepsis
  topic: keywords
subject: Emergency Service,
  topic: keywords
subject: Early Diagnosis
  topic: keywords
subject: Quality Improvement
  topic: keywords
creator: Yousef Ali Fahed Alsalem¹, Yousef Hasan Taher Alhashem², Yousef Mohammad Al-Mohammad saleh³, Bader Ahmed Abdulmohsen Alshagageeg⁴, Ahmad Ali Mohammad Alalaiwi⁵, Abdullah Fahed Ahmed Alsalem⁶, Ali Abdullah Alshakhas⁷, Abdullah Saad Alqarni⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-11-25
publication date: 2025-11-25

De-escalation Training to Reduce Workplace Violence in Emergency Nurses:A Systematic Review
type: item
description: Background: Workplace violence against emergency nurses is highly prevalent and threatens staff safety, morale, and retention. De De-escalation training is widely promoted as a core strategy to manage aggression, but its effectiveness in reducing violence and related harms in emergency departments remains uncertain. Methods: A systematic search of databases identified clinical trials and cohort studies evaluating de de-escalation or violenceviolence-prevention training for emergency nurses. Ten studies (randomised cluster trials, controlled cohorts, and pre pre-post designs) were included. Primary outcomes were workplace violence incidence and staff injuries; secondary outcomes were de de-escalation knowledge, confidence, attitudes, reporti ng behaviours, and psychological impacts. Risk of bias was assessed with design design-appropriate tools, and findings were synthesised narratively. Results: The 9 studies enrolled approximately 800 800-1,000 emergency nurses, with follow follow-up ranging from immediately postpost-training to 24 months. A large cluster trial reported a 52 % reduction in physical violence at 6 months (incident rate ratio 0.48; 95 % CI 0.29 0.29-0.80) and 63 % lower injury risk at 24 months (incident rate ratio 0.37; 95 % CI 0.17 0.17-0.83). A quasi quasi-exper imental study found workplace violence prevalence declined from 63.9 % to 46.2 % (18 % absolute risk reduction). Across studies, de de-escalation training consistently improved knowledge, confidence, and attitudes, but effects on incident rates were modest, h eterogeneous, and sometimes short short-lived. Conclusions: De -escalation training substantially enhanced emergency nurses’ competencies and perceived preparedness but only variably reduced workplace violence and injuries, with the most robust benefits observed when training was embedded in multifaceted organisational prevention programmes.
subject: Articles
  topic: section
subject: Workplace Violence
  topic: keywords
subject: Emergency Nursing
  topic: keywords
subject: De escalation
  topic: keywords
subject: Agression
  topic: keywords
creator: Dawood Salman Mohammed Aluthman, Fatima AbdMalik Mohd Aljuraidan, Zahrah Ahmed Hussin Alahmed, Hani Ali Abdullah Al-Hasan, Mariam Ali Mohammed Al-Fajri, Majid Abdullah Alwosaibai, Adraa Ibrahim Alshoreet, Nawal Abdul-Wahab Alibrahim
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-11-26
publication date: 2025-11-26

Artificial Intelligence Support For Digital Breast Tomosynthesis And 2DMammography: A Systematic Review Of Diagnostic Accuracy
type: item
description: Background: Artificial intelligence support for digital breast tomosynthesis and two dimensional mammography is increasingly integrated into breast cancer screening, yet the overall diagnostic accuracy and impact on workflow across clinical settings remain uncertain. Methods: A systematic search of PubMed from inception to May 2024 identified clinical trials and cohort studies evaluating artificial intelligence systems used as standalone readers or as decision support for radiologists in digital mammography or digital breast tomosynthesis. Studies were eligible if they reported diagnostic accuracy outcomes such as sensitivity, specificity, area under the receiver operating characteristic curve, cancer detection rate, or recall rate. Two reviewers performed screening, data extraction, and risk of bias assessment using a standardised tool, with narrative synthesis only. Results: Nine studies, including more than 560,000 mammographic examinations, met the inclusion criteria. Standalone artificial intelligence achieved area under the curve values around 0.84 to 0.94 and was non inferior to average radiologists in several datasets. Concurrent artificial intelligence support increased reader area under the curve by about 0.02 to 0.06, raised sensitivity by approximately 3 to 10 percentage points, and reduced reading time by 20 to 50 percent. In large screening cohorts, cancer detection rates increased by about 14 to 18 percent, while recall rates were either stable or modestly reduced and positive predictive value improved by roughly 3 to 5 percent. Conclusions: Artificial intelligence support for digital mammography and digital breast tomosynthesis shows consistent gains in diagnostic accuracy and efficiency, although effect sizes vary by modality, integration strategy, and case mix, and long term clinical outcomes still require confirmation.
subject: Articles
  topic: section
subject: Breast Neoplasms, Mammography, Tomography X-Ray Computed, Artificial Intelligence, Mass Screening, Computer-Assisted Diagnosis.
  topic: keywords
creator: Hamad Salem Al Yami ¹, Hawraa Hejji Saleh Aljumaiah ², Huda Ridha Alessa ³, Maryem Abdullah Al Alosayif ⁴, Rabab Mansour Al Hashem ⁵, Bashayr Mohammed Musawwid Asiri ⁶
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-11-28
publication date: 2024-11-28

Comparative Effectiveness of Video and Direct Laryngoscopy on First-Pass Success andPeri-intubation Events
type: item
description: Background: First-pass success during tracheal intubation is critical for reducing peri-intubation complications, especially in emergency and critical care settings. Video laryngoscopy may offer advantages over direct laryngoscopy in improving glottic visualization and intubation outcomes. Methods This systematic review included studies comparing video and direct laryngoscopy in adult patients undergoing tracheal intubation in operating rooms, emergency departments, or intensive care units. A comprehensive PubMed search (inception-July 2025) identified randomized clinical trials and cohort studies reporting first-pass success and related outcomes. Results Eight studies (five randomized trials, three cohorts; n = 8,700) met inclusion criteria. First-pass success rates ranged from 61.9% to 98.3% for video laryngoscopy and 59% to 96.2% for direct laryngoscopy. Four studies reported significantly higher success with video (e.g., 85.1% vs 70.8%; risk difference 14.3%, 95% CI 9.9-18.7). Two studies showed no difference, and one favored direct laryngoscopy in a prehospital setting. Video laryngoscopy reduced esophageal intubation (RR 0.44, 95% CI 0.24-0.80) and aspiration risk (RR 0.63, 95% CI 0.41-0.96), with similar rates of hypoxemia and hypotension. Time to intubation was marginally longer with video but not clinically significant. Conclusions Video laryngoscopy improves first-pass success and reduces airway-related complications compared to direct laryngoscopy in most adult emergency and perioperative intubations. Operator training and setting influence effectiveness.
subject: Articles
  topic: section
subject: Video laryngoscopy, direct laryngoscopy, airway management, tracheal intubation, first-pass success, critical care.
  topic: keywords
creator: Anas Ismail Alkhdour¹, Anas Yahia Abdo Alasmari², Abdullah Saad Alshahrani³, Walled Abdullah AlSufyani⁴, Saleh Ghazia Falah Alharbi⁵, Abdulrahman Mohammed Alasmari⁶, Ahmed Mohammed Hadadi⁷, Sultan Khaled Alhussaini⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-11-14
publication date: 2025-11-14

Comparing Devices and Training for Needlestick-Injury Prevention: A SystematicReview
type: item
description: Background: Needlestick injuries are frequent among nurses and dental assistants and carry substantial risk of blood borne infection. Safety engineered devices and education programmes are both promoted for prevention, yet their comparative effectiveness and feasibility for these staff groups remain uncertain. Methods: Studies that evaluated safety engineered needle devices, education or combined interventions to reduce needle related injuries in nurses or dental assistants were identified through PubMed and supplementary databases from inception to August 2025. Clinical trials, quasi experimental studies and cohort designs reporting injury incidence or rates were eligible. Thirteen studies met inclusion criteria, of which ten were clinical trials or cohort studies. Risk of bias was appraised with design appropriate tools, and findings were synthesised narratively. Results: Safety engineered devices consistently reduced injury rates, typically by 40-60 percent relative to conventional needles, for example from 3.39 to 1.50 injuries per 100 full time equivalent staff, or with relative risks around 0.3-0.6. Education alone improved knowledge and reported safe practices but produced smaller and sometimes transient reductions, for example self-reported injury prevalence falling from 40 percent to 15 percent over 3-6 months. Interventions that combined devices and training achieved the largest effects, with odds ratios around 0.3 compared with usual practice. Heterogeneity in design, outcome definition and follow up limited formal pooling. Conclusions: Evidence indicated that passive safety engineered devices substantially reduced needle related injuries, and that combining such devices with structured training offered the greatest protection for nurses and dental assistants. Education alone was beneficial but less effective and required repetition to sustain impact.
subject: Articles
  topic: section
subject: Needlestick Injuries, Safety Devices, Education, Nursing, Dental Assistants, Occupational Exposure.
  topic: keywords
creator: Halima Salman A. Karim Alenaki¹, Safa Habib Alhubail², Azhar Ali Al Omani³, Wejdan Mohammed Al Barrak⁴, Eman Abdullah Yusef Al Abbas⁵, Sakina Yagoub Yousef Al Sulais⁶
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-11-14
publication date: 2025-11-14

Care Pathways Combining Anesthesia Practices and Nursing Interventions forPostoperative Delirium Prevention
type: item
description: Background: Postoperative delirium (POD) is a frequent, harmful complication after surgery. Multicomponent pathways that coordinate anesthesia practices with nurse-led prevention strategies are increasingly adopted, yet their effectiveness across surgical settings remains variably reported. Methods: A systematic search of PubMed (to July 2025) identified studies evaluating integrated anesthesia-nursing pathways for POD prevention in adult inpatients. Randomized and observational designs were eligible. Primary outcome was POD incidence (validated tools); secondary outcomes included delirium duration, length of stay, pain, sleep quality, and early recovery. Results: Thirteen studies met criteria (9 randomized trials and 4 cohorts). Multicomponent pathways frequently reduced POD versus usual care, especially in higher-risk populations. Examples included an antiinflammatory drug bundle in hip-fracture surgery (15% vs 44%; RR =0.33) and esketamine plus dexmedetomidine in thoracic surgery (14.6% vs 30.9%; RR=0.47). A large implementation cohort reported a month-over-month decline in delirium after bundle rollout (adjusted odds ratio 0.96; 95% confidence interval 0.94-0.97). Secondary outcomes generally favored intervention groups, including shorter hospitalization, improved sleep, lower pain, and higher early recovery scores. Conclusions: Integrated perioperative pathways that combine anesthesia optimization with nurse-led nonpharmacologic measures were associated with lower delirium and better recovery metrics, whereas single-component changes often showed limited effect. Adoption should emphasize multicomponent design, staff training, and implementation fidelity, with pragmatic trials to standardize effective elements across surgical contexts.
subject: Articles
  topic: section
subject: Postoperative delirium, perioperative care, anesthesiology, nursing, care bundles, enhanced recovery, outcomes
  topic: keywords
creator: Wasayf Salah Al Muraysel ¹, Mohammed Abdullah Al Khalifah 2, Latifa Mohammed Bubshait 3, Meshari Mohammed Algarzai 4, Turki Abdullah Alzahrani 5, Naifah Abdullah Al Amiri 6, Nabiha Yousf Almudhwi 7, Laila Ibrahim Alsaihati 8
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-10-28
publication date: 2025-10-28

Digital Morphology for Peripheral Blood Smears in Leukemia Detection:A Systematic Review
type: item
description: Background: Peripheral blood smear examination is foundational for leukemia detection, yet manual review is laborintensive and variable. Digital morphology and artificial intelligence (AI) systems promise faster triage and standardized classification. This review synthesized diagnostic accuracy for detecting leukemia on peripheral smears. Methods: PubMed was searched from inception to April 2025. Eligible studies were observational diagnosticaccuracy cohorts evaluating digital morphology or AI on peripheral blood smear images against manual microscopy or integrated clinical diagnosis. The primary outcome was sensitivity/specificity; secondary outcomes included predictive values, agreement, and time to result. Results: Of 1,245 records, 245 duplicates were removed and 1,000 titles/abstracts were screened; 80 full texts were reviewed and 10 cohorts were included. Digital analyzers showed high specificity for common leukocytes (often >90-95%); blast sensitivity varied by platform and case-mix. A compact analyzer reported specificity >94% with blast sensitivity 21-86%. Another platform achieved blast sensitivity 98.4% and specificity 64.0%. AI-assisted APL screening yielded sensitivity 95.8% and specificity 100.0%. Image-classification studies reported sensitivity 97.86% and specificity 100.0% on held-out tests, with APL recall 97.4%. Post-verification correlations for abnormal differentials exceeded 0.93, and PPV/NPV were frequently ≥95%. Conclusions: Digital morphology and AI reliably triaged peripheral smears with high specificity and context-dependent blast sensitivity. They are best deployed as screening tools with mandatory expert confirmation, supported by local validation and external prospective AI verification.
subject: Articles
  topic: section
creator: Shafi Fiyadh Kasb Alshammari¹, Salem Mousa Ahmed Alzahrani², Afnan Abdullah Dhafer Alshehri³, Ramadan Juma’an Ramadan Alzahrani⁴, Abdullah Ahmed Abdullah Alzahrani⁵
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-10-27
publication date: 2025-10-27

Acquired Methemoglobinemia from Local Anesthetics Used for Airways:Incidence, Risk Factors, and Management
type: item
description: Background: Acquired methemoglobinemia from topical/local anesthetics used for airway procedures is uncommon but clinically important. Risk appears highest with benzocaine sprays during transesophageal echocardiography (TEE) or bronchoscopy, whereas standard-dose lidocaine typically yields only minor, asymptomatic methemoglobin (MetHb) changes. Methods: We systematically searched PubMed (to June 2025), screened records in duplicate, and included observational clinical trials or cohort/case-control studies evaluating airway topical/local anesthetics and methemoglobinemia. Data were extracted in duplicate and synthesized narratively without meta-analysis due to heterogeneity in designs, exposures, and outcome definitions. Results: Nine observational studies met eligibility (0 randomized trials). Across mixed procedure cohorts, incidence was low (0.035% overall; 33/94,694 procedures), with higher procedure-specific rates for TEE (0.250%) and bronchoscopy (0.160). A large TEE program reported benzocaine-associated incidence 0.067% (95% CI 0.040-0.100). Inpatient status markedly increased risk (13.7 vs 0.14 per 10,000 for inpatients vs outpatients). Prospective studies of lidocaine topicalization/infiltration showed trivial mean MetHb shifts (e.g., =0.5% to 0.6%) without clinical toxicity. Conclusions: Airway topical/local anesthetic-associated methemoglobinemia is rare and concentrated around benzocaine spray in medically complex inpatients. Routine lidocaine use at standard doses demonstrated minimal clinical risk. Early recognition with co-oximetry and timely methylene blue remain central to excellent outcomes, and risk can be minimized through agent selection and dosing discipline.
subject: Articles
  topic: section
subject: Methemoglobinemia, Airway management, Anesthetics local, Benzocaine, Lidocaine, Transesophageal echocardiography
  topic: keywords
creator: Maher Ahmed Hamad Al Sultan¹, Shaker Ahmed Abdullah Al Faraj², Omar Adel Omar Alsubaie³, Abdullah Shafi Rajeh Alshehri⁴, Bayan Mansour Hamad Almansour⁵ Bashayer Sulaiman Rubayyi Alshammari⁶, Norah Adel Abdulaziz Al Jaber⁷, Zahra Ali Alhazza⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-08-05
publication date: 2025-08-05

Digital-Era Nurse Leadership and Psychological Empowerment DuringeHealth Implementation: A Systematic Review
type: item
description: Background: Hospitals continue to scale telehealth and electronic health records (EHRs), placing nurse leadership and psychological empowerment at the center of successful implementation. Leadership that protects learning time, ensures responsive support, and involves nurses in redesign is theorized to improve adoption and retention. Methods: A systematic search (PubMed) from inception to May 2025 identified studies of hospital-based nurses examining leadership constructs and psychological empowerment during telehealth/EHR implementation. Eligibility required quantitative or mixed-methods designs reporting adoption or retention (intent-to-stay/leave) and empowerment measures. Two reviewers screened, extracted, and synthesized data narratively in line with PRISMA. Results: Nine observational studies (cross-sectional or cohort) were included. Adoption-related findings showed that leadership and empowerment-adjacent factors (competence, autonomy, self-efficacy) were associated with higher readiness and use. Examples included EHR readiness 52.8% (95% CI 47.9-56.6) with higher odds among staff with positive attitudes and technology self-efficacy; comprehensive EHRs were associated with fewer fair/poor quality ratings (OR 0.83; 95% CI 0.71-0.96). Implementation leadership independently predicted nurses’ actual use of mobile health at the point of care (β 0.22; p=0.001). Conclusions: Across diverse hospital settings, digitally competent, supportive leadership that fosters psychological empowerment aligned with higher eHealth adoption and more favorable retention signals. Implementation programs should integrate leadership development, co-design, usability remediation, and protected learning time.
subject: Articles
  topic: section
creator: Farah Abdulaziz Al-Abdrabalnabi¹, Abrar Hassan Al-Abdulaal², Asadiah Hassan Al-Ghazwi ³, Rabab Jaber Al- Hammad⁴, Fatimah Jaber Al-Hammad⁵, Zainab Ali Alrubeh⁶, Noor Jamal Alzayer⁷, Mortadh Jaffar Ali Al-Salem⁸, Sawsan Shareedah Al-Turaiky⁹
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-07-27
publication date: 2025-07-27

Impact of Patient-Assisted Compression and Pressure-Guided Paddles onMammography/DBT Performance
type: item
description: Background: Breast compression optimizes image quality and dose in mammography and digital breast tomosynthesis (DBT), yet pain can deter re-attendance. Patient-assisted compression (PAC) and pressureguided paddles aim to improve tolerability while preserving technical performance. Methods: A PRISMA-conformant PubMed search (inception-31 March 2025) identified English-language human studies comparing PAC or pressure-/shape-guided paddles with technologist-controlled compression. Two reviewers screened/extracted data with calibration (κ=0.84) and used Joanna Briggs Institute tools for risk of bias. No meta-analysis was undertaken. Results: Of 1,063 records (92 duplicates removed), 971 titles/abstracts were screened and 102 full texts assessed; 12 studies were included (3 randomized trials, 9 cohorts; sample sizes 39-25,286). The primary outcome, pain (0-10 scale), was modestly reduced: a multicentre trial of curved paddles showed a mean difference -0.19 (95% CI -0.28 to -0.09); a PAC randomized study reported lower discomfort (P=0.014). A DBT cohort reported mean pain 1.9/10 with 19.3% moderate/severe. Pressure-guided flexible paddles standardized compression, lowering thickness (-3.74 mm craniocaudal; -6.70 mm mediolateral oblique), reducing pressure variability (-55% and -34%), and decreasing average glandular dose (AGD) (-0.13 mGy MLO); 87% would recommend. Implementation studies reduced mean pressure (17.1to12.8 kPa) and “over-compressed” views (26% to 2%). Conclusions: PAC and pressure-guided paddles provided small but consistent gains in patient experience and compression standardization without systematic loss of image quality or dose performance. Implementation should prioritize pressure targets (8-14 kPa), structured PAC coaching, and monitoring of positioning, recalls, dose, and re-attendance.
subject: Articles
  topic: section
subject: mammography, digital breast tomosynthesis, breast compression, patient-assisted compression, pressure-guided paddles, average glandular dose
  topic: keywords
creator: Samar Abdulhameid Alfraij¹, Mazen Alghamdi², Sahar Nasser Albishi³, Ashwag Nasser Othman Albishi⁴ Fatima Obaid Jaber Albishi⁵, Abdulaziz Sulaiman Abdulaziz Al Oraini⁶, Aishah Nasser Almubayyedh⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-07-20
publication date: 2025-07-20

Emergency Medical Services Use of Capillary Ketone Meters for SuspectedDiabetic Ketoacidosis: A Systematic Review
type: item
description: Background: Diabetic ketoacidosis is a time-critical emergency; emergency medical services (EMS) may benefit from capillary β-hydroxybutyrate testing to improve recognition and trigger early care pathways. Methods: PubMed, Scopus, citation lists, and trial registries were searched from inception to 30 September 2024 for clinical trials and cohort studies evaluating EMS-performed capillary ketone measurement in suspected diabetic ketoacidosis. Dual screening, duplicate data extraction, and designappropriate risk-of-bias tools (QUADAS-2/JBI) were used. A narrative synthesis was conducted without meta-analysis. Results: Of 263 records identified, 71 duplicates were removed; 192 titles/abstracts were screened, 29 full texts were assessed, and 1 stepped-wedge feasibility cohort was included. The multicentre United Kingdom study enrolled 388 EMS encounters (control 203; intervention 185) and implemented a “highrisk DKA” bundle triggered by capillary β-hydroxybutyrate ≥3.0 mmol/L. Recognition of suspected highrisk diabetic ketoacidosis increased from 2.5% (5/203) to 6.5% (12/185), a +4.0 percentage-point difference. Among hospital-diagnosed cases, prehospital crystalloid initiation rose from 33.3% (3/9) to 45.5% (5/11). Hospital pre-alerting increased qualitatively, while scene-time effects were not reported. No device-related serious adverse events were described; paramedic and emergency-department staff reported the approach as feasible and acceptable. Large contextual cohorts without prehospital ketone testing were excluded but highlighted the implementation gap. Conclusions: EMS capillary ketone testing appeared feasible and was associated with improved early recognition and pre-arrival actions, though evidence was limited to a single underpowered feasibility cohort. Protocolized implementation with audit is reasonable, and multicentre effectiveness studies reporting patient-centred outcomes are needed.
subject: Articles
  topic: section
subject: Emergency Medical Services, Diabetic Ketoacidosis, β-Hydroxybutyrate, Point-of-Care Testing, Prehospital Care, Diagnostic Pathways
  topic: keywords
creator: Saleh Abdullah Ali Al Dighrir¹, Mujahid Dhafir Saleh Alyami², Amer Saleh Ali Almahri Alyami³, Abdulaziz Ahmed Bin Marshad Alyami⁴, Faris Mahdi Salem Aldighrir⁵, Mansour Saleh Hussein Almahri⁶, Amer Mohammed Alkhurim⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-11-18
publication date: 2024-11-18

Same-Day Screening of Diabetic Complications in Outpatient Clinics: ASystematic Review
type: item
description: Background: Fragmented, multi-visit screening for diabetic retinopathy, kidney disease, and neuropathy in routine care leads to missed tests and delayed referral. Same-day, multi-component screening in outpatient clinics is proposed to improve completion and diagnostic yield. Methods: A PRISMA-guided review searched PubMed from inception to September 2024 (Humans, English). Eligible designs were clinical trials or cohorts evaluating same-day screening bundles assessing ≥2 complication domains (retina, kidney, foot/neuropathy) within one outpatient encounter, versus usual care or pre-implementation periods. Primary outcome was completion of all eligible screens during the visit; secondary outcomes included detection yield, referral/process measures, patient experience, and safety. Results: Ten studies (all observational cohorts; 5 before-after, 3 prospective, 2 quasi-experimental) met criteria, from the UK, Europe, North America, and the Middle East. Sample sizes ranged 236-4,022. Integration models most commonly combined non-mydriatic retinal imaging with foot/neuropathy testing and urine albumin-to-creatinine ratio. Across studies, same-day programs increased multi-domain completion versus prior workflows (reported directionally in 6/10). Detection yields at the index visit were substantial: moderate/high-risk foot 56.6%, new painful neuropathy 25%, peripheral artery disease 19-26%, and sensory neuropathy 3-31%, while retinal imaging identified previously unrecognized diabetic retinopathy in routine primary-care pathways. Conclusions: Same-day, bundled screening in outpatient clinics was feasible and acceptable, with consistent gains in completion and meaningful same-visit detection of microvascular complications. Health systems should pilot co-located models with standardized referral protocols and measure completion, yield per 100 screened, time-to-referral, and costs.
subject: Articles
  topic: section
subject: Diabetes mellitus, Diabetic retinopathy, Diabetic neuropathies, Albuminuria, Point -of-care systems, Primary health care
  topic: keywords
creator: Mohsen Hassan Alwalan¹, Hamad Masoud Alyami², Mansour Saeed Althaibah³, Hadi Ali Mana⁴, Mohamed Hadi Almunyif⁵, Rashed Saleh Saud Almurdif⁶, Rawan Ezzi Abufaia⁷
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-11-17
publication date: 2024-11-17

Skin and Allergic Conditions Linked to Personal Protective Equipment inHealthcare Workers: Burden, Prevention, and Care
type: item
description: Background: Personal protective equipment is essential in healthcare, yet sustained use can provoke irritant and allergic skin conditions that impair comfort, adherence, and work ability. A synthesis focused on burden, prevention, and care is needed to guide procurement and practice. Methods: A protocol driven search of PubMed identified studies from inception to March 2025. Eligible designs were clinical trials and cohort studies that evaluated healthcare workers using gloves, masks, respirators, goggles, or face shields, and reported dermatologic outcomes with explicit definitions. Screening and extraction were performed in duplicate, risk of bias was appraised by design specific tools. No metaanalysis was performed. Results: Fourteen studies met criteria, seven cohorts and three trials, sample sizes ranged from 17 to 2,053, follow up ranged from 3 days to 10 years. In a hospital cohort, hand rub applied on wet skin increased hand eczema risk, odds ratio 1.78, 95 percent confidence interval 1.11 to 2.87. Apprentice cohorts reported new onset eczema with frequent washing, odds ratio 1.5, 90 percent confidence interval 1.0 to 2.3. Longitudinal glove programs still detected latex sensitization at 1.0 per 1,000 person years and allergic contact dermatitis at 2.50 per 1,000 person years. Consecutive respirator wear increased facial transepidermal water loss and corneocyte fragility over three shifts, consistent with early barrier injury. A cluster trial showed greater reduction in Hand Eczema Severity Index with a structured skincare program versus control, while a randomized cross over trial suggested fewer facial reactions with skin protectants under respirators, fit preserved under monitored conditions. Conclusions: Evidence supported modifiable risks, avoid hand rub on wet skin, reduce accelerator and latex exposure, optimize respirator fit and relief schedules, implement moisturization programs compatible with infection prevention.
subject: Articles
  topic: section
subject: Personal Protective Equipment, Healthcare Personnel, Dermatitis, Contact Dermatitis, Latex Hypersensitivity, Respiratory Protective Devices
  topic: keywords
creator: Fatema Abdulaziz Alsaleh¹, Sukinah Ali Alshowikhat², Layla Mousa Al Bashrowi³, Riham Nader Alghurab⁴, Alia Mahdi Almaidani⁵, Maryam Saeed Bawadi⁶, Mezharah Mohammed B. Al Makhalas⁷, Bushra Mohamed Alhamadi⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-07-17
publication date: 2025-07-17

Vasopressor Strategy for Neuraxial Related Hypotension During CrashCesarean
type: item
description: Background: Crash cesarean requires rapid, reliable hemodynamic control. Neuraxial anesthesia frequently precipitates hypotension, therefore optimized vasopressor strategies are central to maternal safety and fetal perfusion. Methods: We conducted a systematic search of PubMed from inception to April 2024. Eligible studies were clinical trials or cohorts evaluating vasopressors for prevention or treatment of neuraxial related hypotension during crash or urgent cesarean. Two reviewers screened records, assessed risk of bias with appropriate tools, and extracted data in duplicate. The primary outcome was the incidence of maternal hypotension. Secondary outcomes were maternal bradycardia, nausea or vomiting, rescue vasopressor use, and neonatal Apgar scores and umbilical arterial pH. No meta-analysis was performed. Results: The search identified 547 records, 72 duplicates were removed, 475 titles and abstracts were screened, 45 full texts were assessed, and 10 studies were included (total n = 1150). Prophylactic infusions reduced hypotension compared with reactive bolus strategies, with absolute risk differences commonly between 30 and 70 percentage points across trials, for example 20% vs 90%, 31–37% vs 67%, and 15.5% vs 71.1. When active agents were compared, norepinephrine and phenylephrine maintained blood pressure similarly, while norepinephrine reduced maternal bradycardia relative to phenylephrine. Ephedrine was associated with more maternal nausea or vomiting, for example 22.2% vs 4.4% with phenylephrine. Neonatal outcomes, including umbilical arterial pH and Apgar scores, did not differ meaningfully across agents. Conclusions: In crash or urgent cesarean under neuraxial anesthesia, protocolized vasopressor infusions provided superior prevention of hypotension compared with bolus only approaches. Agent selection may be individualized, with phenylephrine or norepinephrine as first line and ephedrine reserved for selected physiologic profiles.
subject: Articles
  topic: section
subject: Cesarean section, Spinal anesthesia, Hypotension, Vasoconstrictor agents, Phenylephrine, Norepinephrine
  topic: keywords
creator: Shahad Abdulrahman Alawjan¹; Dalal Bader Almudehem²; Ayed Mulfi Ayed Almajdi³; Maram Eid Alharbi⁴; Nourah Hassan Alamri⁵; Sarah Bader Alanazi⁶; Hamad Salem Hamad Al Alshahi⁷; Amjad Awad Rahan Alyami⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2024-06-16
publication date: 2024-06-16

Pharmacogenomic Guided Pain Management in Surgery: Patient PainOutcomes
type: item
description: Background: Postoperative pain remains common and variable across patients; pharmacogenomic guidance seeks to tailor analgesics to genotype to improve pain control and reduce opioid exposure. Methods: A systematic search of PubMed from inception to 28 Feb 2025 identified randomized and cohort studies in surgical populations where genotyping informed analgesic selection or dosing. The primary outcome was postoperative pain intensity within 24 to 72 hours on validated scales; secondary outcomes included opioid consumption converted to oral morphine equivalents, adverse events, and early recovery. Screening, extraction, and risk appraisal were performed in duplicate; findings were narratively synthesized. Results: Ten studies were included, four randomized trials and six cohorts. Pain effects were mixed. One arthroplasty trial reported lower mean pain over 10 days with genotype guidance, 3.1 vs 4.2 on a 0 to 10 scale, p<0.05, while a knee arthroplasty trial showed no difference at 24 hours, Overall Benefit of Analgesia Score 4.2 vs 4.7, p=0.55. A cohort within an enhanced recovery pathway showed better composite analgesia on postoperative day 1, 3.8 vs 5.4, and roughly 50% lower opioid use, p<0.01. Another randomized study observed lower two week opioid totals, median 200 vs 230 mg, p=0.047, with similar pain. In pediatric adeno- tonsillectomy, a COMT haplotype increased odds of opioid intervention, odds ratio 2.6, 95% confidence interval 1.2 to 5.4. Where reported, adverse effects were fewer with genotype guidance. Conclusions: Across surgical settings, genotype guided prescribing tended to reduce opioid consumption without worsening pain; effects on pain intensity were uncertain. Benefits appeared greatest when actionable phenotypes were targeted and recommendations were implemented reliably.
subject: Articles
  topic: section
subject: Pharmacogenetics, Pharmacogenomics, Postoperative pain, Analgesics, Perioperative care, Genotype
  topic: keywords
creator: Lyale Ali Abdullah Jalood¹; Lamia Saleh Aldossary²; Ola Saad Almutairi³; Eman Mohammed Busaleh⁴; Hawra Hassan Olaiwat⁵; Atiaf Faisal Alkhleef⁶; Rihanah Hassan Almahdi⁷; Naemah Rashed Bin Reshedan⁸
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-07-10
publication date: 2025-07-10

Influence of Abutment Retention Method on Dental Implant Prosthesis: Implant Stability and Screw Loosening
type: item
description: Background: Retention method for implant implant-supported crowns, screw retained or cement retained, may influence prosthesis stability and the risk of screw loosening, while implant survival typically remains high. Clarifying comparative mechanical outcomes can guide prosthodontic planning and maintenance. Methods: A systematic search of PubMed identified clinical trials and cohort studies from inception to 28 Feb 2025 comparing cement cement-retained with screw screw-retained restorations. Eligibility required human in in-vivo data reporting implant stability and screw loosening. Two reviewers screened, extracted data in duplicate, and assessed study quality. No meta meta-analysis was performed; results were synthesised narratively. Results: Ten studies met criteria followfollow-up 2–10 years). Implant survival was high and similar between groups across studies, typically 93–100 percent. Marginal bone changes were small and comparable; one 10-year comparison reported mean bone loss ~1.1 mm for both retention types. Screw loosening occurred more often in screw screw-retained restorations. A cohort reported loosening in 32 percent of screw screw-retained partial prostheses versus 9 per cent of cement cement-retained. A randomised posterior single single-crown trial observed 1 of 28 screw screw-retained crowns loosening (3.6 percent) versus 0 of 28 cement cement-retained at 24 months. External quantitative syntheses within the included evidence indicated lower rete ntionntion-failure risk for cement cement-retained designs (risk ratio 0.26; 95% CI 0.09 0.09–0.74 short term; pooled ~0.31 at ≥5 years). Secondary findings noted rare decementation with modern adhesive protocols and context context-dependent biological complications when excess c ement was not controlled. Conclusions: Choice of retention did not affect implant survival or bone stability; it chiefly altered the complication profile. Cement retention reduced screw loosening, whereas screw retention avoided…
subject: Articles
  topic: section
subject: Keywords: Dental implants, Dental abutments, Screw loosening, Cementation, Prosthesis retention, Treatment outcome
  topic: keywords
creator: Tamer Aljamaan¹; Ahmed Abdulrahman Almuashi²; Noura Adel Aldhamer³; Nourah Yahya Alkhaldi⁴; Maryam Abdullah Abdullah Alhmood⁵; Zakariya Ibrahim Ahmad Alsadah⁶
rights: Copyright (c) 2025 Medicina Katastrof
date: 2025-09-09
publication date: 2025-09-09