Standard Guidelines Research Articles

Prevalence of Distant Metastases in High-Risk Operable Breast Cancer (HROBC) pT1-2 N2a or Higher at Diagnosis

AbstractCurrent standard guidelines do not recommend a routine staging workup in early operable breast cancer (OBC) as the incidence of de novo metastasis is only 1–2%. Some of these patients are at high risk for relapse based on the higher axillary nodal burden. This prospective study evaluated the presence of de novo asymptomatic distant metastases in HROBC with pT1/2 N2a/N3 on upfront surgery. A single-centre study was carried out in upfront operated OBC patients with four or more axillary nodes positive after definitive surgery. Comprehensive metastatic workup was carried out, including an ultrasound abdomen, bone scan, and CT scan (thorax-abdomen-pelvis) or PET scan before initiating adjuvant treatment. If a distant disease was detected, the adjuvant treatment intent was tailored accordingly. The study accrued a prospective consecutive cohort of 97 women with pT1-2 N2a-3 during 2015–2018 operated upfront for OBC with cT1-2 N0-1. Forty percent of women were premenopausal, 54 (55.6%) had pN2a, and 43 (44.3%) had pN3 disease. Distant disease was seen in 8 of 97 women (8.24%) of these high-risk early cancers, 5 had oligometastatic denovo disease (5.15%), and 3 had polymetastatic (3.09%). Between the 2 groups, the pickup rate of distant disease was higher in pN3 (11.4%) as against pN2a (5.6%), p = NS. Only 3.09% of patients with extensive metastases were treated with palliative intent. The study shows potential to optimize the management of HROBC with heavy nodal disease identified post-primary surgery by selective staging investigations, adequate resource stratification, and thereby improved management, including modifying treatment plans early.

An Uncommon Cause of Peritonitis: Perforation of Undiagnosed Gastric Cancer

Gastric cancer, while common, rarely presents as an acute surgical emergency, with perforation occurring in less than 5% of cases. This report details a 53-year-old male who presented with abdominal pain and vomiting, leading to a diagnosis of perforated gastric adenocarcinoma confirmed by imaging and subsequent total gastrectomy. The case underscores the challenges of diagnosing perforated gastric cancer, which often mimics benign conditions. Effective imaging, especially CT scans, is crucial for timely diagnosis and management. Given the high mortality associated with surgical interventions, further research is needed to establish standardized treatment guidelines for this rare complication.

Retrospective evaluation of prescribing pattern and utilization of antiepileptic drugs in pediatric, neurosurgery, and psychiatry wards: A comparative study to the standard treatment guidelines.

Antiepileptic drugs (AED) are progressively utilized for off-label conditions other than epilepsy, like bipolar disorder and migraine. The objective of this study was to evaluate current prescribing patterns and utilization of AED in pediatric, neurosurgery, and psychiatry wards and to compare them to the standard treatment guidelines. A descriptive, cross-sectional study was conducted in Ayyub Teaching Hospital, Abbottabad from December 1st, 2018 to April 2019. Data on demographic and clinical characteristics, utilization patterns of AED, adherence to standard treatment guidelines, and frequency of potential drug-drug interactions were analyzed using descriptive statistics. Among 410 patients, 54.3% (n = 223) were male, 45.6%(n = 187) were female, and 63.7% (n = 261) were from the 1 to 18 years' age group. The majority 47.3% (n = 194) were from the pediatric ward followed by neurosurgery 28.7%(n = 118). Among the studied patients, 96.1% of them had comorbid conditions other than epilepsy alone. With regards to types of seizures unclassified seizures were the most common seizure type (59.8%; n = 245) followed by generalized tonic clonic seizures 23.4% (n = 96). In this study, the most frequently utilized AED was sodium valproate 59.0% (n = 242) followed by antiepileptic first-generation medicines were commonly used (76.3%). Although a total of 77.6% of the patients showed nonadherence to National Institute for Health and Care Excellence guidelines and 87.6% of them showed drug interactions. Findings from this study showed prescription patterns and utilization of AED in patients with epilepsy and non-epilepsy disorders which may help healthcare providers in making accurate clinical decisions.

Variations in treatment approaches for patients with scapula alata - A national survey across public hospitals in Denmark.

Scapula alata (SA) is a condition characterized by medial winging and reduced upward rotation of the scapula during arm elevation, leading to impaired shoulder function. This study aimed to assess diagnostic and treatment approaches for SA in public hospitals in Denmark. A cross-sectional survey was undertaken using a self-administered questionnaire to healthcare professionals across departments in public hospitals in Denmark. The survey investigated diagnostic practices, including referral to electroneurography (ENG), ICD-10 coding and local treatment practices. A total of 20 hospital departments completed the questionnaire. Six hospitals use ENG as part of their diagnostic practice. Six different ICD-10 codes were reported for SA. Annual patient numbers ranged from 0 to 20, with four hospitals accounting for most of the patients. Doctors and physiotherapists are the primary healthcare providers involved in the diagnostic and treatment process. Only four hospitals reported written local guidelines for SA treatment. Treatment approaches included exercise therapy, brace treatment, surgery, and in some cases, a waiting approach. The survey revealed significant variations in diagnostic and treatment practices for SA across Denmark. This emphasizes the need for further research and national and international consensus, including standardized guidelines for diagnostics and treatment practices.

Antibiotic susceptibility of uropathogens: a 3-year retrospective study at Ho Teaching Hospital of Ghana

BackgroundUrinary tract infection (UTI) remains one of the most treated infections in primary healthcare over the last two decades. The infection is treated with antibiotics. However, there have been reported cases of increasing antibiotic resistance globally, limiting the available antibiotics for the treatment of the infection. The study aimed to determine the frequency of bacterial urinary tract infections and their antibiotic resistance pattern in Ho Teaching Hospital of Ghana from 2019–2021.MethodologyData on urine culture and susceptibility testing and patient demographics from 2019–2021 were collected from the microbiology unit archives with a designed Microsoft Excel 2019 form and later exported to IBM SPSS (v26) for statistical analysis on the uropathogens and their antibiotic resistance pattern. P-value < 0.05 was considered statistically significant.ResultsOut of 4806 records, 1005 bacterial isolates were found, with a total prevalence of 20.91%. The most prevalent group of organisms was the Enterobacteriaceae, with E. coli 409 (40.70%) being the most frequent isolate. Of the 772 isolates subjected to amikacin, 48(6.22%) and 6(0.78%) of the Gram-negative and Gram-positive bacterial organisms showed resistance to the antibiotic respectively. 58.96% (148/251) and 3.59% (9/251) of Gram-negatives and Gram-positives were resistant to cotrimoxazole. Out of the 1005 bacterial isolates, 165(16.42%), 161(16.02%) and 2(0.20%) showed multidrug resistance (MDR), extensively-drug resistance (XDR), and pandrug resistance (PDR) respectively.ConclusionThere was a high antibiotic-resistant pattern among the uropathogens reported in this current study, hence, the Standard Treatment Guidelines may need to be updated to reflect the high rates of antibiotic resistance exhibited by most prevalent isolates.

DevOps Adoption Guidelines, Challenges and Benefits: A Systematic Literature Review

The DevOps methodology in software engineering is currently trending and many software development organisations are adopting it to stay competitive. However, these organisations face difficulties in adopting DevOps due to a lack of common standard guidelines and methodology. We argued that guidelines across multiple platforms are needed to succeed in DevOps implementation. This paper aims to identify the benefits, challenges, and guidelines associated with DevOps adoption using a systematic literature review. The search spanned over ten digital libraries such as ACM Digital Library, ScienceDirect, EBSCOhost, SAGE Journals, Wiley Online Library, and so on. The review also included keyword searches in relevant studies i.e DevOps guidelines, DevOps and guidelines, DevOps benefits, DevOps and benefits, DevOps challenges, DevOps and challenges. Papers written in English and published from 2011 through July 2020 were considered. 33 studies passed the two-step quality assessment. Finally, the data were extracted and analysed based on the themes and research questions, revealing the benefits and challenges of DevOps adoption guidelines. The findings show that improved software delivery speed increases code quality and application quality with frequent releases. It also shows that there was no transparent scientific approach to determining the DevOps capabilities regarding the process, practice, tools, and implementations, cost implications, and insufficient knowledge of the automation process. Finally, the reviewed studies indicated that software quality increases whenever DevOps best practices are adopted. DevOps is about continuous software delivery. Previous studies have not considered the guidelines for scientifically adopting DevOps for organisations that want to migrate. The present review identified the DevOps adoption guideline model represented in a cyclic format that indicates an infinite process representing continuous integration, continuous delivery, and continuous deployment, with an understanding of benefits and challenges.

Cancer Immunotherapy Trials Network 12: Pembrolizumab in HIV-Associated Kaposi Sarcoma.

Cancer Immunotherapy Trials Network 12 demonstrated safety of pembrolizumab in treating advanced cancer in people with HIV. Here, we report results of the Kaposi sarcoma (KS) cohort. In this multicenter phase I trial, we enrolled participants with HIV-associated KS on antiretroviral therapy with CD4+ ≥50 cells/μL and HIV plasma RNA <200 copies/mL. Pembrolizumab 200 mg intravenously was administered once every 3 weeks for up to 35 cycles. The primary end point was safety, and the secondary end point was KS response by modified AIDS Clinical Trials Group Criteria. Thirty-two cisgender men enrolled with baseline median CD4+ T-cell count of 274 cells/µL. All but nine participants had received previous systemic KS therapy. Participants received a median of 11 cycles of pembrolizumab (range, 1-35). Sixty-six percent had grade ≥1 treatment-emergent adverse events, including one death from polyclonal KS herpesvirus-related B-cell lymphoproliferation. Thirty-one percent had ≥one immune-mediated AEs (imAEs) with 25% requiring systemic steroids. In 29 participants with evaluable KS, the overall response rate (ORR) was 62.1% (95% CI, 42.3 to 79.3) and did not differ by CD4+ T-cell count. ORR in the eight participants with evaluable disease without previous KS therapy was 87.5% (95% CI, 47.3 to 99.7). Median duration of response (DOR) was not reached, and the Kaplan-Meier estimate of DOR of ≥12 months was 92.3% (95% CI, 56.6 to 98.8). Median progression-free survival was 28.2 months (95% CI, 4.2 to noncalculable). Pembrolizumab yielded a high rate of durable responses in HIV-associated KS. imAEs were successfully managed with standard guidelines.

Prevalence and Antimicrobial Susceptibility Patterns of Wound and Pus Bacterial Pathogens at a Tertiary Care Hospital in Central Riyadh, Saudi Arabia

The long history and extensive use of antibiotics have caused resistant bacterial pathogens to emerge, increasing mortality and morbidity. The current study was designed to see the prevalence of aerobic bacterial isolates with their antimicrobial resistance pattern from out- and inpatients requested for wound or pus culture. Retrospective study conducted at a tertiary care hospital in central Riyadh from January 2023 to December 2023. Samples were collected and inoculated onto the appropriate media following standard guidelines. Bacterial pathogens were identified by the Vitek2 compact system. Antimicrobial susceptibility was tested using the Kirby–Bauer disk diffusion method as well as by MIC determination through the Vitek2 compact. A total of 1186 subjects were included in the study with a bacterial isolation rate of 691 (58.3%). Out of these, 155 positive cultures had incomplete information or anaerobic or fungal growth and were excluded from the study. With a slight female predominance (54.9%), the majority of subjects (72.2%) were outpatients, and over half of the isolates (55.2%) were Gram-positive. The most common isolate was Staphylococcus spp. (44.4%), followed by E. coli (13.6%) and P. aeruginosa (12.9%). The highest resistance was reported against penicillin followed by fusidic acid against Gram-positive bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 40.5% of Staphylococcus aureus (S. aureus) isolates. Amikacin was the most susceptible antibiotic against all Gram-negative isolates. MDR Gram-negative bacteria accounted for 51.9% of wound infection isolates (95% CI: 45.95 to 58.33) while 6.3% (95% CI: 4.39 to 8.86) were XDR (nonsusceptibility to at least one agent in all but two or fewer antimicrobial categories). A high prevalence of bacterial isolates, with S. aureus as the predominant pathogen, showed high rates of multidrug resistance. This highlights the importance of monitoring antibiotic choices for prophylaxis and treatment in the study area.

Attitudes on, Practices, and Recommendations for Visible Light Protection Amongst Dermatology Practitioners.

Iron oxides, antioxidants, and pigmentary titanium dioxide are sunscreen additive ingredients that enhance visible light protection, reduce associated hyperpigmentation, and protect against certain photosensitive dermatoses There are currently no standardized recommendations for visible light protection with these additive ingredients, leading to varied clinical recommendations. This study aimed to evaluate dermatology practitioners' counseling practices for visible light protection. An electronic survey was distributed to dermatology practitioners. Survey responses were compiled for analysis, and statistical significance was calculated using a standard 95% confidence interval. 91.68% of 974 respondents actively counsel patients about visible light protection, primarily emphasizing its role in exacerbating pigmentation in patients with melanin-rich skin (70.92%). Of these, 10.34% recommended sunscreens with visible light protective additive ingredients specifically for patients with melanin-rich skin, and 48.89% recommended them for managing melasma or post-inflammatory hyperpigmentation. Iron oxide additive ingredients were most frequently recommended (90.92%), followed by antioxidants (69.08%) and pigmentary TiO2, (58.85%). 8.32% of respondents reported not counseling patients about visible light protection, with major reasons encompassing the lack of standardized guidelines (50.62%), challenges in recommending suitably tinted sunscreens (27.16%), limited availability of sunscreen options (23.46%), and insufficient supportive data (18.52%). There is a need for increased education and awareness regarding visible light protection strategies and the identification of patients who may benefit the most from a targeted photoprotective strategy. Establishing standardized guidelines and broadening the availability of sunscreen options conferring visible light protection may help address these gaps. J Drugs Dermatol. 2024;23(11):965-971. doi:10.36849/JDD.8159.

Comprehensive Benefits of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure With Reduced Ejection Fraction: A Literature Review.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed for type 2 diabetes, have emerged as a promising treatment for heart failure with reduced ejection fraction (HFrEF). They show significant cardiovascular benefits, including reduced cardiovascular mortality and heart failure hospitalizations. This review consolidates knowledge on the efficacy of SGLT2 inhibitors in HFrEF, focusing on their mechanisms of action, clinical benefits, and patient outcomes. To consolidate existing knowledge on the efficacy of SGLT2 inhibitors in reducing cardiovascular mortality in HFrEF, with an emphasis on pathophysiology, clinical benefits, and patient outcomes, major medical databases such as PubMed, Scopus, and Web of Science were reviewed, prioritizing research published from 2020 to 2024. Key studies and clinical trials, including DAPA-HF and EMPEROR-Reduced, were analyzed to understand the impacts of SGLT2 inhibitors on HFrEF management. The review highlights the multifaceted mechanisms by which SGLT2 inhibitors exert their cardiovascular benefits, including osmotic diuresis, natriuresis, improved myocardial energetics, and anti-inflammatory and antifibrotic effects. Clinical trials have consistently demonstrated significant reductions in cardiovascular mortality and hospitalizations among HFrEF patients treated with SGLT2 inhibitors. These benefits are observed across diverse demographic and clinical subgroups, indicating their broad applicability in clinical practice. SGLT2 inhibitors significantly advance HFrEF management, reducing cardiovascular mortality and hospitalizations. However, gaps remain in long-term outcomes, early diagnostic indicators, and mechanisms of action. Future research should address these gaps and explore personalized medicine to optimize treatment. Integrating SGLT2 inhibitors into standard HFrEF management guidelines, supported by updated policies and educational initiatives for healthcare providers, will be crucial to maximize their therapeutic potential and improve patient outcomes.

Frailty: A Familiar Challenge or an Unknown Question for Anesthesiologist – Results of an Indian Survey

Abstract Background: Frailty is a public health issue, and with increased life expectancy, more elderly patients are coming for surgical interventions. It is a multidimensional condition, characterized by loss of functional reserve which leads to adverse perioperative outcomes. This novel survey in the Indian scenario not only identifies the knowledge and orientation of the Indian anesthesiologists but also their day-to-day practice of frailty assessment. Methods: This 22-question survey was distributed to mostly Indian anesthesiologists practicing in various cities through electronic media. The first section included the electronic addresses and the informed consent. The second section contains the academic background and demography of the respondents. The third section includes their awareness about frailty and how they perceive it as a clinical entity. The last section focuses on the actual practice of frailty assessment by the participants. Results: We received 306 responses, among them 295 doctors practice anesthesia. Ninety-four percent of respondents agreed that the concept of frailty should be known to all anesthesiologists, 89% of the responses concurred that frailty affects postoperative outcomes. Only 54% respondents were properly trained in this topic during their training days and 45% of all were only confident to diagnose frailty in the preanesthetic check (PAC) clinic. Thirty seven percent of respondents lacked basic knowledge about different frailty tools. Forty-three percent of respondents revealed that they do not report the presence of frailty in patient files during PAC. Only 10% of the respondents have ever used any point-of-care ultrasound for frailty assessment. In 73% of cases, there was no geriatric team available in the hospitals, and 71% said that there is no well-implemented preoperative approach in their hospital for elderly frail patients for elective surgery. Conclusions: Despite the awareness of the importance of frailty in preoperative assessment, there is a huge void in the identification and assessment of frail patients in hospitals. There is an absolute need for a uniform and standardized national guideline.

Analysis of ChatGPT in the Triage of Common Spinal Complaints

ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board examination. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice. Fifteen clinical scenarios were created to mimic spinal complaints common to primary and urgent care scenarios. GPT-4 was instructed to assess the situation as if it was in a primary care office and determine diagnosis, imaging recommendations, and if emergency room (ER) or operative referral was necessary. Answers were recorded and the results compared to those of attending and resident respondents. GPT-4 provided the most likely diagnosis in each scenario. Additionally, it recommended reasonable clinical management of each scenario which would fall within standard practice guidelines. ChatGPT tended toward over-referral to the ER; however, this was not significant. GPT-4 was noninferior in all categories when compared to respondents. ChatGPT is a powerful tool for primary triage of spinal issues. It can rapidly and accurately evaluate clinical scenarios and provide clear diagnostic reasoning. GPT-4 is not designed for medical use and will provide a disclaimer as such. It did tend toward over-referring patients to the ER. With specific training, it is likely that artificial intelligence and natural language processing chatbots will become widely used in primary triage of spinal issues.

Safety of oral mucosal punch biopsy and other oral biospecimen collections in clinical research

ObjectiveOral punch biopsies are frequently used for analysis of lesions since they are minimally invasive, easily performed and assist in diagnosis. Despite broad usage, recent changes in risk classification characterize oral punch biopsies as “greater than minimal risk” for institutional review board purposes. We performed a retrospective review of oral sampling in clinical trials to determine the safety of punch biopsies and other biospecimen collection methods in our oral cancer surveillance program. Study DesignPunch biopsies of 3- and 4-mm were collected following topical and local injection anesthetic. Hemostasis was achieved using pressure and silver nitrate cautery. Other specimens were collected according to standard collection guidelines. Safety and adverse events were determined through consultation with clinical investigator guidelines and were graded with the NCI Common Terminology Criteria for Adverse Events v5. ResultsIn total, 579 samples were collected, 339 of which were oral punch biopsies. There were no adverse events above NCI CTCAE grade 1 for any biospecimen collection. ConclusionThese results support the safety profile of oral punch biopsies and saliva collection. Additionally, these results align with previous research on punch biopsy safety and demonstrate fewer bleeding events. Based on the results and prior research, we believe that punch biopsies should be considered a minimal risk procedure.

Future Directions About Keloid Scars Based on Pathogenesis and Therapies.

Keloids are pathologic scars that pose a significant functional and cosmetic burden. While the literature on keloid management continues to expand, the absence of standardized guidelines or treatment protocols endorsed by academic governing bodies remains a significant challenge. The pathogenesis of keloid scars is not fully elucidated. This review delves into the intricate pathogenesis of keloids, exploring the molecular and cellular mechanisms underlying their formation. Conventional therapies are analyzed in-depth considering their efficacy and limitations, including surgical excision, pharmacotherapies, radiotherapy, cryotherapy, silicone-based product, pressure therapy, and light-based therapy. The emergence of novel therapeutic approaches is discussed, including pharmacotherapies, physical therapies, and biological therapies, shedding light on their potential in treating keloid scars. We also contemplate future directions in the field, encompassing the application of targeted therapies, gene-editing tools, tissue engineering, and regenerative medicine, together with psychosocial support and patient education. In synthesizing current knowledge, scrutinizing therapeutic modalities, and envisioning future avenues, this review aims to provide a comprehensive reference for clinicians, researchers, and stakeholders engaged in the intricate field of keloid management.

COVID-19 hand hygiene practices and its barriers among health care workers in a low-resource setting: a cross-sectional study in Nigeria

Abstract Background Poor hand hygiene (HH) among health care workers (HCWs) in low-resource healthcare settings has continued to increase the spread of infectious diseases, including COVID-19. The present study aimed to assess the knowledge, attitude, adherence, and barriers to HH practices among HCWs during the COVID-19 pandemic in Nigeria. Methods The study was an online cross-sectional survey using a tailored questionnaire distributed through chain referral sampling among southern Nigerian HCWs during the first wave of the COVID-19 pandemic (February to August 2020). The primary outcomes were knowledge, attitude, adherence to HH guidelines, and the barriers limiting compliance with the guidelines. Data were analysed using percentage, frequency, mean, standard deviation, one-way ANOVA, and multiple linear regression. The study timeline was from 15 April to 31 July 2020. Results Four hundred and fifty-four HCWs (236 males and 218 females) participated in the study. The participants had a moderate knowledge of standard HH protocol (mean ± SD) 62.45 ± 10.82%, positive attitude 84.34 ± 11.32%, and high adherence to the standard guidelines 81.21 ± 9.49%. There was no significant difference in knowledge, attitude, and adherence across the healthcare professions. Increasing age (β = 0.186, p &lt; 0.003) and knowledge (β = 0.229, p &lt; 0.001), and decreasing negligence (β = − 0.178, p = 0.004), and forgetfulness (β = − 0.159, p = 0.012) were the significant predictors of effective HH practices. Conclusion Nigerian HCWs had moderate knowledge, a positive attitude, and adhered to the standard HH practices during the COVID-19 pandemic. However, the major barriers were institutional-based factors such as the inadequate supply of HH items, competing job demands, emergencies, increased workload, and personal characteristics such as age, poor knowledge, negligence, and forgetfulness. We recommend that hospital management provide their staff with adequate HH materials and continued infectious disease training.

Development of a Standardized Photo Guideline for Online Hair Transplantation Consultation.

Telemedicine has rapidly advanced in plastic and aesthetic surgery, but obtaining high-quality images during online hair transplantation consultations remains challenging, impeding doctors' visual evaluation. To investigate patients' attitude and satisfaction with online hair transplantation consultations, and to develop a standardized photo guideline to help patients capture high-quality images. We surveyed patients' attitudes and satisfaction with online hair transplantation consultations from November 23, 2023 to May 3, 2024. Meanwhile, five surgeons developed a standardized photo guideline and assessed its effectiveness by comparing image quality between two patient groups: those using the photo guideline and those not using it. We collected 570 responses to the attitude questionnaire, with 76.66% of participants expressing a willingness to undergo online hair transplantation consultations. The patient satisfaction survey yielded an overall satisfaction score of 4.44 ± 0.72 out of 5 for online hair transplantation consultations. Furthermore, all five surgeons rated photographs taken by patients following the photo guideline as higher quality compared to those taken by patients who did not use it. Patients show high satisfaction with online hair transplantation consultations. The standardized photo guideline proves effective in helping patients take high-quality photographs for online consultations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Fabrication of Polypill Pharmaceutical Dosage Forms Using Fused Deposition Modeling 3D Printing: A Systematic Review

Background/Objectives: The pharmacy profession has undergone significant changes driven by advancements in patient care and healthcare systems. The FDA approval of Spritam® (levetiracetam), the first 3D-printed drug, has sparked increased interest in the use of Fused Deposition Modeling (FDM) 3D printing for pharmaceutical applications, particularly in the production of polypills. Methods: This review provides an overview of FDM 3D printing in the development of pharmaceutical dosage forms, focusing on its operation, printing parameters, materials, additives, advantages, and limitations. Key aspects, such as the ability to personalize medication and the challenges associated with the technique, including drug stability at high temperatures, are discussed. Results: Fourteen studies relevant to FDM 3D-printed polypills were analyzed from an initial pool of 60. The increasing number of publications highlights the growing global interest in this technology, with the UK contributing the highest number of studies. Conclusions: FDM 3D printing offers significant potential for personalized medicine by enabling precise control over dosage forms and tailoring treatments to individual patient needs. However, limitations such as high printing temperatures and the lack of standardized GMP guidelines for large-scale production must be addressed to fully realize its potential in pharmaceutical manufacturing.

Hydrochemical Characteristics and Spatial Variability in Coastal Aquifers Southern IraqUtilizing a GIS Technique

The present study investigates water quality regarding drinking and irrigation supplies by gathering and analyzing twelve groundwater samples south of Basrah, south Iraq. Many wells in the area concerned are exploited mainly for various industrial and agricultural activities, impacting the ground water quality. The standard guidelines recommended by the Iraqi Quality Standard limits and the World Health Organization have been used to determine the suitability of drinking. The physicochemica analyses showed that all sampled waters are unsuitable for the drinking supply due to high total dissolved solids (TDS) levels reaching 12925 mg/L. Four valuable indices have been applied for estimating the irrigated water quality, namely, the sodium adsorption ratio (SAR), the soluble sodium percentage (SSP%), the magnesium hazard (MH%), and Kelly’s ratio (KR%). The results of water class as regards the percent of samples showed: SAR results, 25% excellent water, 41.7% good water, and 33.3% doubtful water; SSP% results, 16.7 % good water, 75% permissible water, and 8.3 % doubtful water; MH% results, 100% suitable irrigated water; and KR% results show 41.7% suitable water and 58.3 % unsuitable water. The USSL salinity diagram (Wilcox) result revealed 83.3 % of samples fall in very high salinity-very high sodium hazard class C4S4, and 16.7 % of samples fall in very high salinity-high sodium hazard class C4S3 and very high salinity-medium sodium hazard class C4S2, respectively. Increasing salinity of coastal aquifers has impacted sources such as seawater intrusion and intensive irrigation, and usages of excessive fertilizers and herbicides can largely pollute the groundwater quality.

Intermittent Fasting on Cancer: An Update

Intermittent fasting (IF) has garnered considerable interest as a dietary intervention with potential therapeutic benefits for various medical conditions, particularly cancer. This review provides a comprehensive update on the effects of IF on cancer, emphasizing its impact on metabolic, hormonal, and cellular mechanisms. IF has been shown to improve glycemic control and reduce liver enzyme levels in patients with non-alcoholic fatty liver disease (NAFLD), suggesting a reduction in liver cancer risk. It can significantly reduce tumor growth and enhance apoptosis in breast cancer by lowering insulin-like growth factor 1 (IGF-1) levels. In patients with polycystic ovary syndrome (PCOS), IF offers superior metabolic and hormonal regulation, potentially lowering cancer risk. IF mitigates chemotherapy-related toxicities, thereby improving patient quality of life. It modulates metabolic pathways, reduces inflammation, and enhances drug delivery in cancer therapy. Personalized dietary strategies, including IF and ketogenic diets, are crucial in cancer care. IF also benefits liver conditions by reducing inflammation and fibrosis, preventing the progression to hepatocellular carcinoma. In obesity-induced triple-negative breast cancer, IF disrupts critical processes involved in cancer progression. In addition, aligning IF with circadian rhythms has shown promise in treating lung cancer. Patient perspectives reveal that IF is feasible and acceptable, improving treatment adherence and quality of life. Overall, IF represents a multifaceted approach to cancer prevention and therapy. This review advocates for further research to establish standardized guidelines for implementing IF in oncology, aiming to develop more effective and holistic cancer treatment strategies.

LEGAL ANALYSIS OF THE SHAREHOLDERS’ RIGHTS AND INFORMATION AND COMMUNICATION TECHNOLOGY IN NIGERIA

This study argues that deploying Information and Communication Technology (ICT) in corporate governance will strengthen the rights of shareholders and promote their effective participation in the affairs of the company in Nigeria. Nevertheless, the present corporate law on the right of shareholders in Nigeria are largely defective and inconsistent in creating enabling environment for shareholders to take the benefits of ICT in the exercise of their rights. For instance, section 240(2) of the Companies and Allied Matters Act (CAMA) 2020 promoted electronic meetings for private companies, but restricted public companies that would have needed electronic meetings the most. Besides, there are no rules for determining the specific electronic means that is suitable for the shareholders, thereby allowing company to provide electronic means that may be beyond the reach of the shareholders. Also, the Securities and Exchange Commission established e-dividend regime in 2015, but it is limited to companies listed on the Nigerian Stock Exchange. Therefore, this study analyzed comparative lessons from Canada and Europe, and recommended that the Nigeria’s Corporate Affairs Commission should, as a matter urgency, introduce standard guidelines for ICT and shareholders’ rights in Nigeria.