Archives of Clinical and Biomedical Research

IntroductionDrug Induced Hemolytic Anemia (DIHA), following exposure to hematopathologically profound molecules, presents with variable clinical syndromes, misinterpreted serological results, misdiagnosis, challenging and controversial treatment; and no specific antihemolytic agent. Its treatment could be enhanced by use of natural molecules in some medicinal plants. Therefore, this study is aimed to determination the activities of aqueous extract of T. indica on PHZ-induced hematopathological changes in anemic male Wistar rats. Materials and Methods60mg/kg of Phenylhydrazine (PHZ) was administered for 2 days to induce hemolytic anemia intraperitoneally. 30 male Wistar rats were randomly divided into 5 groups, each with 6 rats. G1-untreated. Anemic rats were divided into G2- G5. G2-untreated, G3-treated with 1mL Ferro B syrup, G4 and G5 treated with 400mg/kg and 800mg/kg of T. indica pulp extract respectively. Test drug and extract were orally administered daily for 7 and 14 days respectively. Cases in G2 - G5 were sacrificed under light ether anesthesia on days 9 and 16 post-therapy, G1 at the end of the experimental period. Blood collected via cardiac puncture were subjected for Red Blood Cells (RBC) histopathology, serum Lactate Dehydrogenase (LDH), and reticulocyte counts. The femur was harvested for bone marrow Histopathology. ResultsPHZ induced hemolytic anemia marked by profound serum LDH elevation & reticulocytosis, marked RBC morphological distortions & bone marrow degenerative changes suggestive of marrow fibrosis & suppression. Marrow regeneration marked by hypercellularity & decreased adipocytes were evident of hematopoiesis induced by the 2 weeks test therapies; significant moderate populations of normal mature peripheral RBCs, serum LDH & reticulocyte % reduction were typical; consistent with significant recovery from the acute hemolytic episode. ConclusionT. indica fruit pulp extract effectively stimulated hematopoiesis in response to drug induced hemolytic effect on the hematopathologic parameters, with significant improvement from hemolytic anemia.

Medical imaging using CT is vital for diagnosing children, but it uses radiation that may increase long-term health risks due to their young age and sensitive bodies. In South Africa (SA), there are currently no national standards for how much radiation should be used for these scans. We conducted this study at a large hospital to audit our current practices and ensure we are keeping our youngest patients as safe as possible while still getting clear diagnostic images. We looked at 543 CT scans performed on children over a 3 year period. We specifically looked at the radiation doses used for the most common scans, such as brain scans, across different age groups. Our results showed that the radiation levels at our hospital are in line with both international safety standards and locally. We also noticed that scans performed afterhours use slightly higher radiation doses than those during the day. These results are encouraging because they show that our hospital is providing safe care that matches global benchmarks. However, the slightly higher doses during after-hours shifts suggest we should focus on more consistent training and standardized settings for all staff, regardless of when the scan is performed.

BackgroundPatient radiation exposure in diagnostic radiology is an important concern for radiation protection and patient safety. Monitoring radiation dose levels during radiographic examinations is essential to ensure compliance with diagnostic reference levels (DRLs) and to optimize radiological practices. ObjectiveThe aim of this study was to evaluate patient radiation dose during conventional lumbar spine radiography and compare the obtained values with diagnostic reference levels. MethodsA descriptive cross-sectional multicenter study was conducted in four hospitals in the Sous Massa region, Morocco, between April and June 2017. Data were collected from 142 patients undergoing lumbar spine radiography examinations and from 20 radiology technicians. Exposure parameters including tube voltage, tube current, exposure time, focus-to-film distance, and field size were recorded. Entrance surface dose (ESD) was estimated using MICADO software, and dose area product (DAP) values were subsequently calculated. The 75th percentile values were determined and compared with diagnostic reference levels. ResultsThe regional 75th percentile ESD values were 5.33 mGy for the anteroposterior projection and 7.38 mGy for the lateral projection. Corresponding DAP values were 1840.9 mGy.cm2 and 2783.65 mGy.cm2, respectively. All obtained values were below the diagnostic reference levels used for comparison. However, variations between hospitals were observed, likely due to differences in imaging protocols and equipment. ConclusionRadiation doses associated with lumbar spine radiography in the evaluated hospitals were within acceptable limits according to diagnostic reference levels. Continuous monitoring of patient radiation exposure and optimization of radiographic techniques remain essential to ensure effective radiation protection.

BackgroundVaping and vitamin D deficiency impact blood coagulation and health. This study aimed to investigate the effects of vitamin D supplementation on coagulation predictors in female rats exposed to E-cigarette vaping. ObjectiveTo examine the effect of vaping alone and vaping with different VD doses on some coagulation predictors, lungs, liver, and kidney functions MethodsForty-two female Wistar rats were divided into six groups, including vaping and non-vaping with high (50,000 IU) and low (1000 IU) vitamin D doses. Blood samples and histopathological analyses were conducted after one and three months. Nicotine, cotinine, Interleukin-6 (IL-6), D-dimer, coagulation factor X (FX), thrombomodulin (TM), Alanine Transaminase (ALT), and Creatinine levels were analyzed. Additionally, histopathological analyses were conducted on the rats liver, kidney, and lung. ResultsExposing rats to vaping for one month caused a significant acute increase in D-dimer, FX, and TM levels to 4402.05 ng/mL {+/-} 785.15, 1.8687 g/mL {+/-} 0.3132, and 34.71 ng/mL {+/-} 8.42, respectively. However, after three months of exposure, those levels decreased significantly compared to the one-month levels. Supplementation of the vape-exposed rats with a high vitamin D dose reduced levels of IL-6, D-dimer, FX, and TM levels to become 93.285 pg/mL {+/-} 12.715, 439.95 ng/mL {+/-} 294.05, 0.647 g/mL, and 17.375 ng/mL {+/-} 3.895, respectively, at the end of the three months. Moreover, vaping rats supplemented with the low and high doses of vitamin D had significantly lower nicotine and cotinine levels than the EC group, with a p-value of <0.0001. The histopathological examination revealed that the rats lung had necrotic pneumonia when exposed to vaping without vitamin D treatment. Moreover, all vaping groups had an alveolar hemorrhage. Bacterial pneumonia was seen in the high-dose vitamin D vape-exposed group. However, the histopathological examination of the liver indicated no major differences between the groups. One month of vaping raised D-dimer, FX, and TM levels, which decreased after three months. High-dose vitamin D supplementation reduced IL-6, D-dimer, and FX levels while increasing TM levels after three months. Vaping rats receiving vitamin D had lower nicotine and cotinine levels. Histopathological findings showed necrotic pneumonia and alveolar hemorrhage in vaping rats, with bacterial pneumonia in the high-dose group. ConclusionVaping activates inflammatory and coagulation pathways, while high-dose vitamin D appears to mitigate inflammation and blood coagulation issues associated with vaping, potentially aiding in reducing nicotine dependence.

BackgroundApproximately one-third of men having undergone gonadotoxic treatment in their childhood experience impaired testicular function for whom autologous transplantation of cryopreserved immature testicular tissue may represent the only opportunity to restore their fertility. Pre-clinical studies have demonstrated successful restoration of spermatogenesis following grafting of immature testicular tissue in various species, including non-human primates. In 2002, our institution pioneered with clinical testicular tissue banking for fertility preservation in boys and adolescents. Over time, this strategy has been increasingly implemented by numerous fertility centres worldwide for patients at high risk of treatment-induced sterility. Here, we report the first human case of autologous transplantation of frozen-thawed immature testicular tissue. PatientIn 2008, testicular tissue was cryopreserved from a pre-pubertal boy diagnosed with sickle cell disease. The procedure was performed after a three-year hydroxyurea treatment and prior to receiving conditioning therapy with busulfan and cyclophosphamide for haematopoietic stem cell transplantation. One testis was surgically removed, sectioned into small fragments, and cryopreserved. Histological analysis confirmed preserved tubular architecture and the presence of spermatogonia. During the period from 2022 to 2024, the patient consistently presented with azoospermia. In December 2024, at the time of transplantation, two abnormal sperm cells were detected after enzymatic digestion. MethodEleven testicular tissue fragments (4-21 mm3) were thawed and autologously grafted to four intra-testicular and four subcutaneous scrotal sites. Over a one-year follow-up period, graft survival, vascularization, hormone profiles, and semen parameters were monitored. One year after transplantation, all grafts were surgically retrieved. ResultsPost-operative recovery was uneventful. No significant changes in endocrine or semen parameters were observed during follow-up. Whereas the intra-testicular grafts exhibited a compact parenchyma that was distinct from the looser surrounding adult parenchyma and remained readily identifiable as graft tissue, the scrotal grafts appeared more fibrotic. Enzymatic digestion of the grafts was required to recover spermatozoa, with one spermatozoon obtained from one of the four intra-testicular grafts. Histological evaluation revealed intact tubular architecture and maturation of somatic cells across all grafts. Spermatogonial stem cells, together with evidence of active spermatogenesis, were identified in two of the four intra-testicular grafts, whereas no germ cells were detected in the subcutaneous scrotal grafts. ConclusionThese findings demonstrate that human immature testicular tissue can survive long-term cryostorage, revascularize after transplantation and establish spermatogenesis in vivo. This study provides essential proof-of-concept for fertility restoration in individuals who banked testicular tissue before puberty. FundingThis study was supported by the Research Programme of FWO Vlaanderen (Research Foundation-Flanders; G0A6U25N) and VUB strategic research program (SRP89). Trial Registration: NCT05414045

BACKGROUND: Prostate cancer (PrCa) is the most commonly diagnosed cancer in men in many countries and is the most heritable of the common cancers. Precision medicine approaches to disease management are not routinely available to most men, yet we know that germline genetic testing can help identify those at high-risk of developing advanced or lethal disease and can influence selection of therapeutics. An integral part of healthcare delivery design is the inclusion of patients/consumers in the development of frameworks for managing health interventions that are tailored to meet their needs. METHODS: In Phase I, we undertook focus group discussions with men previously diagnosed with PrCa (n=20), to determine their opinions, perceptions and expectations of germline genetic testing for PrCa. Focus groups were tape-recorded, transcribed verbatim, coded and then thematically analysed using NVivo. In Phase II, themes were then used to design and development a Precision Medicine in Prostate Cancer Information Toolkit, which was reviewed by patients (n=14), their carers/family members (n=4) and healthcare providers (n=14). RESULTS: In Phase I, knowledge about precision medicine and genetic testing was generally low. The strongest motivation for undertaking testing was to identify family members' risk levels (n=7), and the biggest concern pertained to insurance discrimination (n=5). Phase II data revealed that generally healthcare providers (n=8) found the purpose of the toolkit to be clearer than patients (n=5). Though, patients found the task of imagining the usefulness of the toolkit at the time of diagnosis or beforehand when assessing genetic risk, quite difficult. Participants highlighted that information regarding life insurance, implications for their family and costs associated with testing were of concern. CONCLUSIONS: This study has revealed critical knowledge gaps, preferred communication/support needs, and concerns/risks associated with germline genetic testing in PrCa. Concerns pertaining to family members and insurance discrimination are obvious topics that need to be addressed. Our toolkit may be helpful in addressing knowledge gaps, but further testing is needed to ensure its accessibility across literary and cultural contexts.

Background: Reusable menstrual products provide sustainable and cost effective alternatives to disposable sanitary products; however, their adoption remains limited, even among healthcare professionals. Objectives: To assess awareness, knowledge, perceptions, and utilisation of reusable menstrual products among female medical students and healthcare professionals, and to identify predictors of willingness and use. Design: Cross sectional analytical study. Setting: An online survey was conducted among female medical students and healthcare professionals in Nigeria. Participants: A total of 203 female respondents aged 15 to 55 years. Intervention: Not applicable. Primary Outcome Measures: Utilisation of reusable menstrual products and willingness to adopt their use. Secondary Outcome Measures: Awareness, knowledge, perceptions, and barriers. Methods: Data were collected using a structured questionnaire and analysed using descriptive statistics, chi square tests, and logistic regression. Results: Awareness was high (96.06%), but utilisation was low, with 5.42% ever using and 4.43% currently using reusable products. About 31.53% were willing to use them. Respondent type was not associated with willingness (p = 0.735), although healthcare professionals had higher knowledge (p = 0.024). Positive perception predicted willingness (AOR = 7.58, 95% CI: 3.18 to 18.03, p < 0.001). Good knowledge (AOR = 14.96, p = 0.014) and increasing age (AOR = 1.28, p = 0.004) predicted utilisation. Conclusion: Despite high awareness, utilisation remains low. Perception influences willingness, while knowledge drives use. Targeted behavioural and educational interventions are needed. Keywords: Menstrual hygiene, reusable menstrual products, menstrual cup, sustainability, healthcare professionals

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a serious condition induced by Dengue virus which becomes fatal if not detected early and treated appropriately. So objectives of the present study are to observe the different patterns of presentations, clinical features and outcome of HLH induced by Dengue. MethodsIn this observational study, 14 patients admitted and diagnosed HLH as per diagnostic criteria, were included after informed written consent. Study conducted in a period of six months from 01/07/2025 to 31/12/2025. All patients were followed up till discharge. After collection, all data were analyzed by Microsoft Excel 2010. Ethical clearance was taken from Ethical Review Board of the Medical College. ResultsAmong 14 cases, male were more affected then the female (78.6% VS 21.4%) and majority were in between 20 to 50 years age groups. Clinical data showed, all 14 cases had fever for >7 days, joint pain 3(21.4%), headache 11(78.6%), skin rashes 10(71.4%), retro-orbital pain 2(14.3%), vomiting 11(78.6%),bleeding 10(71.4%), cough 4(28.6%), loose motion 9(64.3%), abdominal pain 7(50.0%), anorexia 2(14.3%), Melaena 2(14.3%), jaundice 4(28.6%) and spleenomegaly 9(64.3%). One(7.1%) case had history of Hypertension. Laboratory data showed different level of Bi or Pancytopenia, high ferritin, high TG, low fibrinogen, raised liver enzymes and low sodium. Dengue RT PCR and serology results showed 8(42.9%) cases were both IG M and Ig G dengue antibody positive, 6 cases were RT PCR positive, 2 cases were IgM and another 4 cases were IgG positive. Outcome of patients revealed, among all 14 cases12(85.8%) patients improved uneventfully and 2 were shifted to ICU where one improved and one died. ConclusionDengue is prevailing for long time and different complications are evolving and HLH is a relatively newer incident among the dengue patients. Infection by different serotypes at different time or multiple dengue serotype infection may be related with HLH and it might be a future subject to explore and to evaluate.

This study analyzes the adoption, barriers, and expectations of French radiologists regarding the use of Artificial Intelligence (AI) solutions in their daily practice. Despite a recognition of AI's potential to make radiology more precise, predictive, and personalized, its adoption remains limited. The main obstacles identified are the high cost of those solutions and the insufficient equipment of French imaging centers with AI technologies. Nevertheless, the survey reveals a strong willingness to adopt, with over 70% of radiologists expressing their desire to use AI and 0% declaring a refusal to use it. Furthermore, the radiologists' fears of being replaced by AI are very low (0 to 8.8%).

Head and neck cancer (HNC) requires accurate tumor delineation for effective radiotherapy planning. Manual segmentation of tumor regions is time-consuming and subject to considerable inter-observer variability. Although several automated approaches have been proposed, many rely on multimodal imaging such as PET/CT, which is expensive, less accessible in many clinical settings, and increases the burden on patients. In this work, we investigate a CT-only three-dimensional segmentation framework that provides a clinically practical and resource-efficient alternative. CT images of 136 head and neck cancer patients from the publicly available HN1 dataset in The Cancer Imaging Archive (TCIA) were used along with 30 additional cases from a private dataset collected at a tertiary care centre, Christian Medical College (CMC), Vellore, India. A fully automated segmentation model was developed to delineate the primary gross tumor volume (GTV) using the 3D nnU-Net framework. The models were trained using the HN1 dataset and an extended HN1+CMC dataset that included the additional private cases. Performance was evaluated using three-fold cross-validation with standard segmentation metrics including Dice Similarity Coefficient (DSC), Intersection over Union (IoU), and the 95th percentile Hausdorff Distance (HD95). The proposed CT-based model achieved a Global Dice of 0.63 and a Median Dice of 0.60 on the HN1 dataset. When the additional CMC cases were incorporated during training, the performance improved to a Global Dice of 0.65 and a Median Dice of 0.71. These results demonstrate that 3D nnU-Net can effectively segment head and neck tumors from CT images alone. The proposed CT-only approach provides a cost-effective and scalable solution that can support radiotherapy treatment planning and help reduce variability in clinical workflows.

AO_SCPLOWBSTRACTC_SCPLOWMany commonly used therapeutic drugs cause biliary toxicity, but it is unclear if they are directly responsible for the increasing incidence of cholangiocarcinoma (CCA). We tested experimentally and analyzed through a cohort approach whether drugs, such as the commonly used antibiotic Augmentin, which is a poster-child of biliary toxicity, are causally linked to CCA development. Using sophisticated analytical tools in cholangiocytes, including single extracellular vesicle (EV) analysis, we found no evidence that Augmentin increases the cholangiocyte malignancy marker YAP1 or phospho-YAP1. Furthermore, we analyzed the CCA incidence in our healthcare system and determined it to be 0.0932% (Augmentin group) and 0.0799% (amoxicillin control group). Although the Augmentin group showed a numerically higher CCA incidence, the association did not reach statistical significance (RR = 1.1669, 95% CI 0.6200-2.1961; Fishers exact test, P = 0.7493). Similarly, we found no evidence for cholangiocarcinoma development with other commonly used drugs, including chlorpromazine, floxuridine, 5-fluorouracil, flucloxacillin and terbinafine. We conclude that there is no direct causal relationship between clinical Augmentin doses and CCA development.

Despite the remarkable progress of artificial intelligence represented by large language models, how AI technologies can contribute to the construction of evidence in evidence-based medicine (EBM) remains an overlooked issue. Now, we need an AI that can be compatible with EBM. In the present paper, we aim to propose an example analysis that may contribute to this approach using variable Vision Transformer.

This small pilot feasibility study shows that reverse phase protein array (RPPA) technology is a useful tool for targeted proteomics analysis in human ovarian follicular fluid. RPPA supplements mass spectrometry approaches that are currently used by providing functional signal transduction data that drive cellular biology. Herein, we present the first report of using RPPA in follicular fluid to elucidate protein signaling pathways. The results show potential associations between follicular fluid proteins measured with RPPA and reproductive outcomes from in vitro fertilization, including oocyte maturity, oocyte fertilization, embryo quality, and pregnancy. This study provides evidence that RPPA is a feasible approach to be used in clinical studies of reproductive endpoints. However, a larger study of RPPA to identify diagnostic and prognostic follicular fluid protein biomarkers of infertility is needed.

Despite questionable accuracy, subjective methods to categorize skin color are heavily relied upon in research and medicine. Objective skin color determination is expensive requiring specialized instrumentation and interpretation. We compare three subjective approaches, i) Fitzpatrick Skin Type Scale (FST), ii) Pantone SkinTone Guide (PST) and, iii) Monk Skin Tone Scale (MST), with objectively measured skin color from a spectrophotometer in 87 volunteers to understand the limitations of each method. In agreement with others, we show that the popular FST questionnaire correlates poorly with the objective approach. However, PST color swatches provide good correlation with spectrophotometer measurements. PST consists of 110+ swatches that are inexpensive and easy to use, however, similar to other reports, the volunteers found the number of swatches overwhelming and/or excessive. We found that the recently introduced MST is not representative of reality with only 3 of the 10 color groups representing our volunteers and published populations of volunteers. In future, we propose using 9 color swatches to split the spectrum of human skin color into 10 groupings (Nottingham Skin Categories - NSC) that are representative of the global population. This new approach would be easy to implement and inexpensive in research, healthcare and cosmetics settings, and maps directly to objective, quantitative, measures taken with a spectrophotometer. For the testing and development of new optical devices, NSC would provide increased comparability between studies and ensure studies are representative of local/global populations. In the clinic NSC would be useful for dermatology, photodynamic therapy and dosage assessment for topical medicine, for example.

BackgroundCompanion canines need advances in therapeutic options for solid tumor malignancies. Prior studies established feasibility of autologous natural killer (NK) cell infusions in canines with solid tumors; however, autologous products are limited by dysfunctional immunity and a manufacturing process that delays care. Allogeneic NK cells offer the possibility of "off-the-shelf" therapy to be administered from healthy donors. MethodsPeripheral blood mononuclear cells (PBMCs) were isolated from healthy canine donors via density gradient separation. NK cells were expanded with recombinant human IL-2 and canine IL-21 with the addition of K562 feeder cells transfected with CD137 ligand and membrane bound human IL-15. Additional experiments included IL-12 in the expansions. In vitro potency was assessed via co-culture with the D17-mKate2 canine osteosarcoma cell line. Three canines were enrolled in a phase 1 trial infusing ex vivo expanded allogeneic NK cells after lymphodepletion. ResultsFlow cytometric analysis confirmed successful expansion of canine NK cells with up to 50% of cells demonstrating NKp46+ after 14 days of expansion. Residual T cell numbers varied based on donor. The addition of IL-12 led to increased NK cell expansion. Incucyte demonstrated potency with increasing osteosarcoma cell death at higher effector to target ratios. Three canines with metastatic/refractory solid tumors were successfully lymphodepleted and infused with allogeneic NK cell products. The canines tolerated the infusions well. ConclusionsCanine allogeneic NK cells were successfully expanded and activated ex vivo, demonstrated potency in vitro, and safety in vivo. Further studies will optimize the NK cell product and escalate dosing to reach the maximal tolerable dose.

ObjectiveMore people than ever before are living with cancer. Patient education is a core component of cancer care, and patients are increasingly using large language models (LLMs), such as ChatGPT, for advice. The objectives of this study were to evaluate the ability of ChatGPT to explain specialist cancer care records (multidisciplinary team (MDT) meeting reports) to patients and to understand key stakeholders views and opinions about the technology. MethodsSix simulated MDT meeting reports were created by cancer clinicians. MDT reports and 184 realistic patient-centred queries were input into ChatGPT4.0 web version. We conducted a mixed-methods study combining qualitative analysis with exploratory quantitative components to evaluate ChatGPTs responses. The study consisted of three stages: (1) Clinician sense-checking, (2) Clinical and non-clinical annotation, (3) focus groups (including cancer patients, caregivers, computer scientists, and clinicians). ResultsChatGPT was able to summarise complex oncology information into simpler language, to provide definitions of complex terms and to answer questions about clinical care. However, clinician sense-checking identified problems with accuracy, language and content. In clinician annotation, 92.6% of ChatGPTs responses were judged problematic. Across all evaluation methods, six recurring themes were identified: accuracy, language, trust, content, personalisation and integration challenges. Patients and clinicians found the summaries and definitions useful; however, the responses were not tailored to the individual patient or to what the report might mean for them. ConclusionThis study highlights current challenges in using LLMs to explain complex cancer diagnoses and treatment records, including inaccurate information, inappropriate language, limited personalisation, AI distrust and challenges in integrating LLMs into clinical workflow. Understanding of the limitations is crucial for clinicians, patients, computer scientists and policy makers. The issues should be addressed before deploying LLMs in clinical settings.

IntroductionThe Japanese Ministry of Health, Labour, and Welfare proposed increased copayments for over-the-counter (OTC)-like drugs, with possible special consideration for certain chronic diseases, although the specific diseases to be included were not clarified as of January 2026. The costs attributable to OTC-like drugs indicated for chronic diseases in adults remain unclear. MethodsUsing the DeSC database (individual-level claims data) in fiscal year 2023, we estimated the average per-person annual costs of the study OTC-like drugs indicated for adults with representative chronic diseases. The estimates were stratified by sex and age. We also computed the national estimates of the numbers of adults with representative chronic diseases who would need OTC-like drugs and the costs attributable to these drugs by applying stratum-specific estimates from the DeSC database to national population counts and aggregated claims data from the National Database of Health Insurance Claims Open Data. The study OTC-like drugs included oral acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical anti-inflammatory patches, oral second-generation antihistamines, and heparinoid-containing topical preparations. ResultsThe average per-person annual costs were several hundred yen for acetaminophen and several thousand yen for the other drug categories, with marked variation by drug category, chronic disease, age, and sex. In the national estimates, the proportion of OTC-like drug users with representative chronic diseases was <10% in every disease-age-sex stratum; nevertheless, the maximum stratum-specific shares of total OTC-like drug costs attributable to these groups were high (up to 50-60% for osteoarthritis for acetaminophen/NSAIDs/patches and up to [~]60% for atopic dermatitis/asteatosis for heparinoids). ConclusionsThe average per-person annual costs for OTC-like drugs varied substantially across drug categories and patient subgroups. Indicated chronic diseases in adults may account for substantial OTC-like drug costs within some strata, despite representing a small fraction of users.

Objectives: Among surgically resected non-small cell lung cancer (NSCLC) patients with similar stage and histopathological characteristics, there is variability in patient outcomes which highlights urgency of identifying biomarkers to predict recurrence. The goal of this study was to systematically develop a pre-surgical CT-based habitat-based radiomics classifier to predict recurrence-of-risk in NSCLC. Methods: This study included 293 NSCLC patients with surgically resected stage IA-IIIA disease that were randomly divided into a training (n = 195) and test cohorts (n = 98). From pre-surgical CT images, tumor habitats were generated using two-level unsupervised clustering and then radiomic features were calculated from the intratumoral region and habitat-defined subregions. Using ridge-regularized logistic regression, separate classifiers were developed to predict 3-year recurrence using intratumoral radiomics, habitat-based radiomics, and a combined model (intratumoral and habitat) which was generated using a stacked learning framework. For each classifier, probability of recurrence was calculated for each patient then numerous statistical and machine learning approaches were utilized to stratify patients for recurrence-free survival. Results: The combined radiomics classifier yielded a superior AUC (0.82) compared to the intratumoral (AUC = 0.75) and habitat radiomics (AUC = 0.81) models. When the classifiers were used to stratify high- versus low-risk patients utilizing a cut-point identified by decision tree analysis, high-risk patients were yielded the largest risk estimate (HR = 8.43; 95% CI 2.47 - 28.81) compared to the habitat (HR = 5.41; 95% CI 2.08 - 14.09) and intratumoral radiomics (HR = 3.54; 95% CI 1.45 - 8.66) models. SHAP analyses indicated that habitat-derived information contributed most strongly to recurrence prediction. Conclusions: This study revealed that habitat-based radiomics provided superior statistical performance than intratumoral radiomics for predicting recurrence in NSCLC.

ObjectiveUrine cultures are frequently requested at an early stage in primary care and outpatient settings, often without a comprehensive clinical assessment. This practice increases healthcare costs and laboratory workload and may lead to misleading results due to asymptomatic bacteriuria and specimen contamination. This study aimed to evaluate whether routinely reported microscopic urinary leukocyte findings can predict urine culture positivity under real-world clinical conditions. The distribution of isolated microorganisms and the frequency of mixed or contaminated growth were assessed. MethodsThis retrospective, laboratory-based diagnostic accuracy study included all urine samples sent for culture over a one-year period at a tertiary care hospital, provided concurrent microscopic urinalysis was available. No additional clinical exclusion criteria were applied to reflect the routine practice. Leukocyte findings were reported semi-quantitatively and analyzed both categorically and as approximate numerical values. The urine culture results were classified as positive, negative, or mixed/contaminated growth. The diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. ResultsA total of 8,478 urine samples were analyzed in this study. Urine culture positivity was detected in 2,666 (31.4%) samples, whereas 5, 812 (68.6%) showed no growth. Culture positivity increased significantly with higher leukocyte levels (p < 0.001), ranging from 13.1% in the lowest category to 83.1% in samples with abundant leukocytes. ROC analysis demonstrated an acceptable discriminative performance (AUC = 0.747). The Youden index identified an optimal threshold of approximately 5.5 leukocytes per high-power field, with a sensitivity of 60.4% and a specificity of 77.8%. Mixed or contaminated growth was the most common finding among culture-positive samples (43.5%), followed by Escherichia coli (29.5%). ConclusionMicroscopic urinary leukocyte findings were significantly associated with urine culture positivity and demonstrated acceptable predictive performance in real-world clinical practice settings. Although leukocyte microscopy alone is not diagnostic, it may support more selective urine culture ordering, reduce contamination, and contribute to rational diagnosis and antimicrobial management in primary care.

COVID-19 has spread rapidly and caused a global pandemic making it one of the deadliest in history. Early identification of patients with coronavirus disease 2019 who may develop critical illness is of immense importance. Therefore, novel biomarkers were needed to identify patients who will suffer rapid disease progression to severe complications and death. Many treatments were adopted including the antiviral Remdesivir, the antiretroviral Lopinavir /Ritonavir and Tocilizumab. Our study aimed not only to specify high-risk factors and biomarkers of fatal outcome in hospitalized subjects with coronavirus but also to compare the efficacy of the three considered treatments to help clinicians better choose a therapeutic strategy and reduce mortality. We divided the population (n=711) into four main groups based according to the WHO ordinal severity scale. The percentage of mortality, in and out the hospital, the length of stay in the hospital, the pulmonary inflammatory lesion and its distribution, the SARS-CoV-2 IgM and IgG variations at admission, the inflammatory markers, the complete blood count, the coagulation factors and enzymes, proteins and electrolytes profile, glucose and lipid profile, and other relevant markers were measured. The significance of the observed variation was assessed by multivariate and ANOVA analyses. We succeeded to establish a novel predictive scoring model of disease progression based on a cohort of Lebanese hospitalized patients relying on the pulmonary inflammatory lesions, inflammation biomarkers such as LDH, D-Dimer, CRP, IL-6 and the lymphocyte count, the number of comorbidities and the age of the patient which all were significantly correlated with the illness severity showing best outcomes with immunomodulatory and anticoagulant treatments by the results. As top tier, Tocilizumab was more efficient than the two other treatments in non-severe cases but none of the used treatments was insanely effective alone to reduce mortality in severe cases.