Digital Commons Network^™

Life After Ecmo: A Comprehensive Review Of Longterm Complications, Mia Olson Pa-C

Lynchburg Journal of Medical Science

Extracorporeal life support is the ability to temporarily supplement pulmonary and/or cardiac function in the setting of severe organ failure, with the most widely used version of this technology being extracorporeal membrane oxygenation (ECMO). While ECMO acutely improves outcomes in many patients with acute cardiopulmonary failure, evidence shows that survivors are at risk for long-term complications. These may include physical limitations, neurocognitive impairment, and psychological distress, all of which cumulate to impact a patient’s quality of life. The purpose of this research paper is to examine the literature on long-term complications associated with ECMO therapy and their impact on patient …

Continuity Beyond Delivery: A Family Medicine Approach To Racial And Ethnic Equity In Postpartum Care, Dominique J. Tarrant

Lynchburg Journal of Medical Science

This narrative review examines interventions to improve postpartum care continuity, reduce disparities, and advance maternal health equity, emphasizing structured follow-up, care coordination, and family medicine integration. The postpartum period, often called the “fourth trimester,” should connect recovery with lifelong health. However, many women, particularly those from racially and ethnically minoritized populations, encounter missed screenings, inadequate support, and structural barriers that increase their risk of adverse maternal outcomes. Electronic searches of PubMed and Google Scholar were conducted from October 27 through November 7, 2025, using combinations of “postpartum care,” “family medicine integration,” “racial and ethnic disparities,” “health equity,” and “fourth trimester.” …

Multimodal Analgesia For Postoperative Pain Management In Total Shoulder Arthroplasty, Caroline Heramb

Lynchburg Journal of Medical Science

Total shoulder arthroplasty (TSA) is an increasingly common orthopedic procedure, yet postoperative pain management continues to rely heavily on opioid analgesics. Although multimodal analgesia (MMA) has become the standard of care in total hip and knee arthroplasty, consensus regarding the optimal multimodal approach for TSA remains limited. A comprehensive literature search was conducted using PubMed, CINAHL, the Cochrane Library, and Google Scholar. Following screening with inclusion and exclusion criteria, 42 articles were selected for review and synthesized. Current evidence supports MMA pathways incorporating regional anesthesia, non-opioid pharmacologic agents, perioperative corticosteroids, cryotherapy, and patient education to reduce postoperative opioid requirements without …

Sedation Minimization And Early Mobility To Prevent Intensive Care Unit Delirium, Alana M. Kugelard

Lynchburg Journal of Medical Science

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled …

Microbiome-Modulating Dietary Interventions For The Treatment Of Insulin Resistance In Polyendocrine Metabolic Ovarian Syndrome (Pmos), Ashley Davis

Lynchburg Journal of Medical Science

No abstract provided.

Primary Treatment Of Congenital Aortic Stenosis In Infants: A Comparative Analysis Of Balloon Aortic Valvuloplasty And Surgical Aortic Commissurotomy, Kayumov Arabbek Ravshanovich, Sinelnikov Yuriy Semenovich, Amansakhatova Ekaterina Nazarovna, Nalimov Konstantin Aleksandrovich, Roseykin Evgeniy Vladimirovich, Manukian Serezha Nersesovich, Soynov Ilya Aleksandrovich

Journal of the Saudi Heart Association

Objective

To compare the efficacy and safety of balloon aortic valvuloplasty (BAV) and surgical aortic commissurotomy (SAC) as primary treatment strategies for congenital aortic stenosis in infants during the first year of life.

Methods

This retrospective two-center cohort study included 89 infants with congenital aortic stenosis treated between April 2015 and June 2025 at two tertiary centers. Patients were divided according to the initial intervention: BAV (n = 39) and SAC (n = 50). The primary endpoint was any repeat intervention on the aortic valve. Secondary endpoints included hospital and late mortality, recurrent hemodynamically significant aortic stenosis, and clinically significant …

Continuous Pacing During Lbbap With A Lumenless Lead: A Simplified, Zero-Cost Sliding-Contact Technique, Leonardo Marinaccio

Journal of the Saudi Heart Association

Left bundle branch pacing with lumenless leads usually requires disconnecting pacing cables during rotation, creating an electrical blind spot during septal advancement. We describe the "sliding-contact" technique, a zero-cost modification enabling continuous real-time monitoring. Retracting the rubber shroud of a standard sterile alligator pacing clip reduces jaw tension, allowing unrestricted lead pin rotation while preserving electrical continuity. In 42 consecutive cases, LBBAP was successfully performed without complications. Beat-to-beat feedback on QRS morphology, impedance, and injury current was maintained throughout rotation, improving procedural precision and safety without specialized equipment.

Inferior Vena Cava–Left Atrial Connection Hidden Beneath Large Secundum Defect. A Case Report, Alisia Yuana Putri, Muhammad Surya Tiyantara

Journal of the Saudi Heart Association

Inferior vena cava (IVC) drainage into left atrium is an exceptionally rare congenital anomaly and may remain unrecognized when associated with a large atrial septal defect (ASD). A 35-year-old-man presented with progressive exertional dyspnea and fatigue. Transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization demonstrated a large secundum ASD with severe septal malalignment, while systemic venous drainage was interpreted as normal. During surgical ASD repair, an unexpected IVC-to-left atrium connection was identified and redirected to right atrium. Careful assessment of IVC inflow is essential in patients with large malaligned ASD despite normal oxygen saturation.

The Potential Relationship Between Red Complex Tannerella Forsythia And Obstructive Sleep Apnea, Abby Dibble Ms, Kristi M. Soileau

New Orleans Dental Association News

The pathogenesis of periodontitis is no longer attributed to a single infectious organism but rather to a dysbiosis-affiliated microbial community that disrupts host immune response. Within this polymicrobial ecosystem, Tannerella forsythia has emerged as one of the principal periodontal pathogens because of its ability to evade host defenses, promote tissue destruction, and establish cooperative interactions with neighboring microorganisms. As a Gram-negative, obligate anaerobic bacterium belonging to the red complex group, T. forsythia is consistently associated with advanced periodontal disease and is increasingly recognized as an important contributor to both local periodontal destruction and systemic inflammation. A 2024 meta-analysis of ten …

The Commercialization Of Wellness: Gray Market Peptides & Cancer, Bryan M. Burt

Advances in Cancer Education and Quality Improvement

No abstract provided.

Standardized Preprocedure Protocolling Of Stereotactic Breast Biopsies Enables Device-Level Supply Chain Forecasting: A Multisite Quality Improvement Analysis, Megan Kalambo, Mike Everding, Maria Montemayor, Falguni Patel, Mohit Nath

Advances in Cancer Education and Quality Improvement

Background: Breast imaging depends on single-use, vendor-proprietary consumables produced by a concentrated set of manufacturers. During supply shortages in 2026, healthcare organizations faced urgent pressure to shift from reactive to proactive inventory management. Stereotactic breast biopsy needle shortages revealed that traditional forecasting based on procedure volume lacks the granularity needed for device-specific demand. We aimed to enable device-level forecasting through standardized preprocedure protocolling.

Methods: In a retrospective analysis of 1,456 stereotactic biopsies across 4 breast imaging sites (June 2025 to June 2026), compliance with a standardized electronic protocolling tool that captured lesion count and needle size (standard vs. petite) was …

Critical Daily Dose Warning Optimization In An Electronic Health Record At A Tertiary Cancer Center, Mckenzie Erwin, Sadika Eslaminejad, David Perez, Jesni Mathew

Advances in Cancer Education and Quality Improvement

Objectives: Clinical decision support is a form of health information technology utilized by electronic health records (EHRs) to reduce prescribing errors. The challenge of incorporating clinical decision support into medication workflows is balancing alert fatigue with clinical appropriateness. At our 777-bed tertiary cancer center, one form of interruptive clinical decision support is critical dose warnings that appear when the ordered dose deviates by a defined threshold from the maximum dose. Our tertiary cancer center relies on a third-party data vendor to provide maximum dose limits that are integrated into the EHR medication ordering process. At the time of project initiation, …

Complete Atrioventricular Block Revealing Late-Onset Cardiac Fabry Disease: Diagnostic Role Of Native T1 Mapping, Nouhaila Bentama, Lamyae Bakamel, Jalal Tagueniti, Fatiha Ait Yahya, Brahim Meftout

Journal of the Saudi Heart Association

A 63-year-old man presented with symptomatic complete atrioventricular block requiring urgent pacemaker implantation. Evaluation revealed non-obstructive left ventricular hypertrophy with normal coronary arteries. Cardiac magnetic resonance showed diffusely reduced native T1 values and inferolateral late gadolinium enhancement, suggesting Fabry cardiomyopathy; amyloidosis was excluded by bone scintigraphy. Diagnosis was confirmed by markedly reduced alpha-galactosidase A activity, elevated lyso-Gb3, and a pathogenic hemizygous GLA variant (p.Asn215Ser). Enzyme replacement therapy with agalsidase beta was initiated, with early stabilization of myocardial deformation and septal thickness. This case highlights native T1 mapping as a key diagnostic biomarker in unexplained left ventricular hypertrophy.

Murine Typhus In Georgia: Historical Context And A Probable Case Of Resurgence Where Previously-Thought Eradicated, Giovanni Mella-Velazquez, Christopher He, Bolanle Akinsola, Judson Miller

Journal of the Georgia Public Health Association

Background: Murine typhus, caused by Rickettsia typhi, is a flea-borne illness historically endemic to the southeastern United States, with initial cases reported in Atlanta, Georgia in 1913. Following vector control efforts, incidence declined significantly, and the disease was removed from the nationally notifiable disease list in 1987. While recent cases have been reported in select regions, murine typhus has not been documented in Georgia for decades. We present a pediatric case in Atlanta that may represent the first reported instance in nearly 40 years, suggesting possible reemergence in the Southeast.

Methods: We conducted a case report analysis of a pediatric …

Discover To Deliver Pediatric Futures: Viewpoints Of Future Medicine From A Pediatric Health Care System., Vanessa Watkins, Ken Chang, Laura Sarff, Jared Vavroch, Dawn Wolff, Lori A. Erickson

Manuscripts, Articles, Book Chapters and Other Papers

Pediatric health care systems face increasing uncertainty driven by rapid technological change, workforce shifts and shortages, environmental threats, and evolving family and community needs. Pediatrics requires future-focused considerations that go beyond adult systems, including family-centered care, developmental trajectories, and long-term societal impacts on child well-being. While the future cannot be predicted, futures medicine methods offer structured approaches to anticipate change and support proactive, values-driven planning. This Viewpoint describes the application of pediatric futures methods within an academic, independent nonprofit pediatric health system and proposes a practical framework that connects future readiness to strategic decision-making and daily care delivery. Futures medicine …

The Lateral Recovery Position In Medical Vs Dental Emergencies, John Regis, Steven Saxe, Jason Ciccotelli, Saskia Richter, Jessica Immonen

The Journal of Integrative Physiology

The lateral recovery position is widely used in prehospital and clinical settings to help maintain airway patency in unconscious patients who are breathing spontaneously. Tracheal anatomy and asymmetries in respiratory structures, along with gravitational effects on soft tissues, may influence the efficacy and safety of this positioning. Clinical nuances related to the setting and secondary health concerns interestingly create disagreement on preferred side for lateral placement. This article explores the anatomical and physiological considerations that support the lateral recovery position—focusing on tracheal asymmetry and its implications for airway patency—along with emergency medical practices in medical versus dental emergencies. It also …

Comment On “Advancing Lipid Management: Saudi Heart Association Position Statement On Pcsk9-Targeted Therapies In The Primary And Secondary Prevention Of Cardiovascular Disease”, Ali Faris Altebainawi

Journal of the Saudi Heart Association

No abstract provided.

Ribosomal Biogenesis In Acute Myeloid Leukemia: A Less-Attended Process With Profound Implications For Oncogenesis And Therapeutic Vulnerability, Muhammad-Redha Abdullah-Zawawi, Nadiah Abu, Nurul Syakima Ab Mutalib, Farah Azima Abdul Muttlib, Hafiza Alauddin

Saudi Medical Journal

No abstract provided.

Drooling In Children With Cerebral Palsy: A Retrospective Observational Study Of Clinical Characteristics, Severity, And Treatment, Kamel Awadh Alenazi, Lama Dakhakhni, Nancy Hassan, Wejdan Almuhraj

Saudi Medical Journal

Objectives: To report the characteristics, severity, and treatment of drooling in cerebral palsy (CP) children.
Methods: This retrospective observational study included CP children with active complaints of drooling from the Drooling Clinic, Sultan Bin Abdulaziz Humanitarian City (Riyadh, Saudi Arabia). Drooling severity was assessed via the Modified Drooling Questionnaire (MDQ). The functional motor and manual ability levels were classified via the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS).
Results: In total, 122 patients were identified. Mean age was 6.28 ± 2.71 years, and 67/122 (54.9%) were boys. Gastroesophageal reflux disease was noted in 23/122 (18.9%). …

Sinonasal Inverted Papilloma: Demographics, Recurrence Predictors, And Surgical Outcomes — A 10-Year Retrospective Review At A Tertiary Center In Saudi Arabia, Ali J. Asiry, Majed A. Alali, Nasir A. Magboul, Salem A. Alrasheed, Ibraheem M. Alkanhal, Mohammed A. Alabduljabbar, Raid H. Almadi, Abdullah S. Aldughaither, Faisal S. Alfawaz, Ali Majrashi, Saud Alromaih, Ghassan Alokby, Tamadar Al Doheyan

Saudi Medical Journal

Objectives: To characterize the demographic, clinical, and radiological profile of patients with sinonasal inverted papilloma (IP) managed at a tertiary center in Saudi Arabia, to determine recurrence rates in primary versus revision cases, and to identify factors associated with recurrence.
Methods: This retrospective observational study included 59 adult patients with histopathologically confirmed sinonasal inverted papilloma (IP). Demographic, clinical, radiological, and surgical data were extracted from medical records. Tumors were staged using the Krouse system. Patients were stratified into primary or revision cases, and associations with recurrence were evaluated.
Results: Most patients were men (72.9%) and older than 45 (79.7%) years …

Incidence Rate And Factors Predicting The Recurrent Cerebral Ischemic Events After The First-Ever Ischemic Stroke: A Single-Center Exploratory Study From The Eastern Region Of Saudi Arabia, Azra Zafar, Mustafa Al-Qarni

Saudi Medical Journal

Objective: First-ever ischemic stroke (FIS) patients carry a higher risk of recurrent ischemic strokes (RIS). This study reports the incidence rate and describes the factors predicting recurrences in FIS patients.
Methods: This retrospective study, enrolling patients with FIS, was carried out at the King Fahd Hospital. Association between different variables and RIS was determined by estimating the 95% confidence intervals (95% CI) and odds ratio (OR).
Results: The majority of patients were Saudi (74.1%) and male (72.9%). Over a 5-year follow-up study, the incidence rate was 26.1% (95% confidence interval [CI] = 22.2-30.1) for all recurrences and 22.7% (95% CI …

Beyond Chronological Age: Performance Status And Clinical Frailty Predict Survival In Saudi Geriatric Lymphoma Patients: A Competing Risk Analysis, Musa Fares Alzahrani, Ghazi S. Alotaibi, Sarah S. Sewaralthahab, Fatima A. Alshalati, Ibrahim N. Alrumaih, Badraa A. Muharib, Kazi Nur Asfina, Saleh Ahmed Alkholaif, Shaden A. Albassam, Saleh Abdullah Aljanah, Shahad A. Al Hemidin, Ahmed Y. Jamal, Fadi S. Alakeel, Walid A. Alkeridy, Farjah H. Algahtani, Aamer Aleem

Saudi Medical Journal

Objective: To evaluate the prognostic impact of performance status, frailty, and treatment intensity on survival outcomes in a geriatric lymphoma cohort using a competing risk framework. In Saudi Arabia, despite a growing aging population, there is a lack of literature detailing frailty or survival dynamics for geriatric lymphoma patients.
Methods: We conducted retrospective cohort study in Tertiary center in Riyadh, Saudi Arabia. Geriatric patients (≥ 60 years) diagnosed with lymphoma during 2011–2024 were analyzed. Baseline demographics, laboratory parameters, pathology, and frailty status were extracted. Survival dynamics were modeled using cumulative incidence functions to isolate lymphoma-related mortality (LRM) from age-related competing …

Growth, Methodological Evolution, And Clinical Maturity Of Artificial Intelligence Research In Major Medical Journals, 2018–2025: A Longitudinal Bibliometric Study, Abdulraoof Alsaeedi, Norah Alqarni, Ibrahim Rozi, Mohamed Ibrahim

Saudi Medical Journal

Objectives: To quantify changes in the volume, methods, and clinical maturity of artificial intelligence (AI) and machine learning (ML) research in major medical journals from 2018 through 2025.
Methods: We conducted a longitudinal bibliometric study of PubMed-indexed records from 99 leading clinical and general medical journals. The search was conducted on July 2026. Records were deduplicated and classified as empirical AI/ML research, evidence synthesis, AI discourse, or unclassified. Empirical studies were categorized by model family and clinical maturity. Journal-year Poisson generalized estimating equations used total substantive publications as an offset and clustered observations by journal.
Results: Among 6,891 unique publications, …

Barriers To And Needs For The Implementation Of Artificial Intelligence In Radiation Therapy Planning In Saudi Arabia. A Cross-Sectional Survey, Abdulaziz Alshaikh, Ghadah Alqarni, Abdulaziz Alghamdi, Khalid Alrabiah, Nasser Al-Rajhi, Mohammed Aldehaim

Saudi Medical Journal

Objectives: To assess radiation oncology physicians' perceptions of artificial intelligence (AI) in radiation therapy planning in Saudi Arabia and identify barriers to and support needs for its implementation.
Methods: A cross-sectional online survey was distributed through the Saudi Association of Radiation Oncology email list to 142 physicians from April to May 2026. We analyzed responses using descriptive statistics and exploratory 2-sided Fisher exact tests comparing residents with nonresidents.
Results: Forty-three complete responses were analyzed (response rate: 30.3%). A total of 33 (76.7%) respondents agreed or strongly agreed that AI would improve planning accuracy and efficiency. Nineteen (44.2%) reported no workplace …

Artificial Intelligence Readiness Among Paramedics At The Saudi Red Crescent Authority: A Cross-Sectional Study, Mohammed Jamaan Alsahli

Saudi Medical Journal

Objective: To evaluate AI readiness among paramedics working within the Saudi Red Crescent Authority (SRCA) and examine demographic and professional characteristics related to their readiness.
Methods: This cross-sectional study was conducted among SRCA paramedics. Data were collected through a structured online questionnaire covering demographic and professional features and the validated Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), which assesses four dimensions: Cognition, Ability, Vision, and Ethics. Comparisons between groups were performed with the Mann-Whitney U and Kruskal-Wallis tests, while correlations were assessed using Spearman's rank correlation, and a multiple linear regression model examined factors independently related to AI …

Artificial Intelligence In Gastrointestinal Precision Medicine: A Critical Appraisal Through The Lens Of Inflammatory Bowel Disease, Abdulrahman G. Alharbi, Abdulrahman A. Aljabri

Saudi Medical Journal

Artificial intelligence (AI) now supports many facets of gastrointestinal and hepatic care, from lesion recognition during endoscopy to the interpretation of large molecular datasets. This review first outlines AI's broader role across gastroenterology and hepatology, and then uses inflammatory bowel disease (IBD) as a case study for AI-assisted multiomics integration. The review applies a consistent evidentiary framework that distinguishes exploratory, retrospective, and prospective study designs. Retrospective genomic and image-based studies report promising discriminative performance for risk classification and lesion detection, but this evidence remains largely exploratory or retrospective, whereas prospective randomized evidence is currently strongest for AI-assisted endoscopic polyp detection. …

Efficacy And Safety Of Botulinum Toxin For The Treatment Of Psoriasis: A Systematic Review And Meta-Analysis, Rahaf A. Alothman, Hussein M. Alshamrani, Mishari T. Alrubaiaan, Ruba M. Alghanmi, Reshale A. Johar, Lina K. Almutairi, Mohammed H. Abduljabbar, Ahmed M. Baabdullah, Sultan S. Alfaer

Saudi Medical Journal

Objective: To evaluate the current literature on Botulinum toxin (BoNT) use in psoriasis treatment, focusing on efficacy and safety. Botulinum toxin, known for its neuroprotective effects, is a promising therapeutic agent for inflammatory skin diseases.
Methods: We searched electronic databases, including MEDLINE, Web of Science, and Google Scholar, from inception until March 2025 to identify randomized controlled trials and cohort studies in English that enrolled patients with psoriasis treated with BoNT injections over their lesions, reported outcomes related to the clinical question, and included raw numbers of outcomes.
Results: Of the 342 retrieved articles, 166 duplicates were removed. Screening of …

Association Of Kirsten Rat Sarcoma Viral Oncogene Homolog Mutation With The Prognosis Of Colorectal Cancer In Arab Countries And Saudi Arabia: A Systematic Review And Meta-Analysis, Mohammed Ageeli Hakami, Hassan Abdullah Albargy

Saudi Medical Journal

Objectives: To quantify the potential impact of Kirsten rat sarcoma (KRAS) mutation on survival outcomes in colorectal cancer (CRC) patients from Arab countries, particularly in Saudi Arabia. As a chief cause of cancer-associated mortality worldwide, CRC shows a rising incidence across Arab countries. Among molecular drivers, KRAS mutation plays a pivotal role in tumor initiation, resistance to therapies, and disease progression. Nonetheless, the prognostic influence of KRAS mutation in Arab populations remains inconclusive.
Methods: Key databases were searched to find appropriate publications. Eligible studies evaluated KRAS mutation’s association with overall survival (OS) in CRC patients from Arab nations. Hazard ratios …

Evaluating The Diagnostic Performance And Clinical Interpretability Of Explainable Ai (Xai) In Digital Histopathology: A Meta-Analysis Of Diagnostic Performance, Bandar S. Alshreef, Yousif A. Kariri

Saudi Medical Journal

Objective: To explore peer-reviewed research on the application of Explainable Artificial Intelligence (XAI) techniques for histopathology-driven cancer risk evaluation, and to address the limitations delaying its transition into routine clinical pathology practice (such as model reliability, clinical interpretability, and governance oversight).
Methods: We conducted a systematic review with quantitative meta-analysis of studies evaluating explainable artificial intelligence (XAI) in histopathology. Searches were performed in Web of Science, Scopus, PubMed, and Google Scholar through November 2025. Eligible studies were assessed for diagnostic performance, explainability approaches, and methodological quality. Of the 47 included studies, 9 provided sufficient quantitative data for meta-analysis. Post-hoc visual …

Machine Learning And Large Language Model Decision Support For Medication-Error Prevention Across The Medication-Use Process: A Systematic Review With Implications For Saudi Arabia, Emad A. Alsaleh, Maram J. Alnemer, Yousef H. A. Alhassan, Asaad A. A. Khalil, Mohammed A. Kaddoura, Azfar Athar Ishaqui, Muhammad B. Maqsood, Adnan Iqbal

Saudi Medical Journal

Objectives: Medication errors are a major source of preventable harm. We systematically reviewed workflow integrated artificial intelligence (AI) decision support (machine learning [ML], natural language processing, computer vision, and large language models [LLMs]) aimed at detecting, intercepting, or preventing medication errors, and considered implications for Saudi Arabia.
Methods: We searched MEDLINE (PubMed), Embase, Scopus, Web of Science Core Collection, IEEE Xplore, and the Cochrane Library for English language studies published from January 2010 to February 2026. Eligible studies used real clinical/pharmacy data and evaluated an AI component designed to prevent or detect medication errors across prescribing/order verification, dispensing, …