Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background/Objectives: Oral mucosal wounds are frequently encountered in daily dental practice and are often difficult to manage because of continuous exposure to saliva, mastication, and mechanical irritation. This technical note describes the clinical practicality of an oral liquid bandage (ORAPLA) as a film-forming protective barrier for traumatic and surgical oral mucosal wounds. Methods: ORAPLA was applied in four clinical scenarios: a traumatic lip bite injury, a postoperative mucosal defect following leukoplakia excision, a biopsy wound for suspected oral squamous cell carcinoma (OSCC), and aphthous stomatitis. Clinical observations included patient-reported symptom relief, film retention, and the clinical appearance of epithelialization at follow-up (1–2 weeks). Results: In all cases, ORAPLA formed a thin protective film immediately after application and was typically observed to remain on the wound surface for approximately 5–6 h under routine daily activities. Patients reported prompt subjective pain relief, and no adverse events were observed. Epithelialization proceeded without clinically evident secondary infection during the follow-up period. Conclusions: In this small descriptive case series, ORAPLA was feasible to apply, well tolerated, and provided temporary mechanical protection with immediate subjective comfort. Controlled studies using standardized outcome measures are warranted....
Background: Effective interpretation of electrocardiogram (ECG) data is a critical skill for primary health care physicians and part of the Family Medicine residency program curriculum. However, there is a lack of data regarding the competency of Primary Health Care Physicians in ECG interpretation in Saudi Arabia. To evaluate the competence of primary healthcare physicians in Saudi Arabia in interpreting common ECG abnormalities. Additionally, it seeks to understand participants’ perspectives on the facilitators and barriers to effective ECG learning. Methods: A cross-sectional study was conducted from 28 September 2023 to 1 November 2024. A validated questionnaire was used to assess the knowledge of primary health care physicians. Results: A total of 257 physicians participated in the study. Nearly half of the participants (51.8%) attended cardiology rotations and completed the Advanced Cardiac Life Support (ACLS) course. Findings revealed that 74.3% of participants demonstrated poor knowledge of ECG interpretation. Factors significantly contributing to ECG competence included completion of the ACLS course (p-value = 0.035), teaching during clinical rotations as a knowledge source (p-value = 0.020), and participation in ECG courses (p-value = 0.031). Barriers identified encompassed inadequate training programs and inconsistent exposure to ECGs. Conclusion: Primary health care physicians demonstrated unsatisfactory performance in ECG interpretation. Completion of ACLS and dedicated ECG courses, as well as exposure to structured teaching during clinical rotations, were significantly associated with higher competency. Therefore, integrating them into core medical curricula is recommended to enhance ECG interpretation skills among primary health care physicians. Further research is warranted to identify the most effective educational strategies for improving competency in this essential clinical skill....
Background/Objectives: Short induction followed by high-dose chemotherapy and autologous stem cell transplantation (HCT-ASCT) is effective in newly diagnosed elderly patients with primary central nervous system lymphoma (PCNSL) but associated with significant toxicity. Geriatric assessments (GAs) may help to predict treatment risk and prognosis, yet no standardized GAs exist for PCNSL. Our aim was to evaluate the impact of GA on HCT-ASCT eligibility and survival. Methods: We analyzed 65 patients > 65 years treated in the MARiTA and MARTA studies. Treatment comprised 2 cycles of rituximab, HD-MTX and cytarabine followed by HCT-ASCT. GAs at diagnosis were analyzed for progression-free survival (PFS), overall survival (OS) and premature end of treatment (pEOT). Results: After median follow-up of 43 months, 12-month PFS/OS were 69.2% (95% CI 56.5–78.9%)/70.8% (58.1–80.2%) from diagnosis and 80.4% (66.6–88.9%)/84.3% (71.1–91.8%) from time of HCT-ASCT. ECOG PS ≥ 2, Lachs geriatric screening (Lachs) ≥30% and Cumulative Illness Rating Scale-Geriatric (CIRS-G) ≥6, ≥7 and ≥8, respectively, were significantly associated with pEOT in univariate analysis (UVA). In multivariate analysis (MVA), CIRS-G remained significant. A composite EBL score (ECOG PS ≥ 2, Barthel Index of Activities of Daily Living (Barthel) < 20, Lachs ≥ 30%) ≤1 predicted successful completion of HCT-ASCT in >90% of patients. ECOG PS ≥ 2 and Barthel < 20 were associated with decreased PFS and OS in UVA; ECOG PS ≥ 2 remained significant in MVA. Conclusions: This is the first study to link GA with treatment feasibility in elderly PCNSL patients undergoing intensive therapy. Our results will be validated in the PRIMA-CNS trial (EudraCT 2020-001181-10)....
Background/Objectives: Antibiotics are among the most commonly prescribed medicines in the Pediatric Emergency Department (PED). The overuse of antibiotics is directly linked to the emergence of resistance. Recent clinical trials have emerged in children in which short courses have proven to be as effective as longer courses. The aim of this study was to analyze the duration of antibiotic treatment prescribed in our PED for the most important and common infections in children and to compare with the best available evidence. Methods: A single-center retrospective study was conducted in the PED of a tertiary hospital. We evaluated outpatients from birth to 16 years who were discharged with antibiotic therapy during a 1-year period (2022) to classify duration of therapy as appropriate or inappropriate. Results: 1972 antibiotic prescriptions were analyzed. 28.3% (560/1972) of the prescriptions were classified as inappropriate according to duration of therapy; 551 (98.3%) were due to longer-than-recommended duration. The condition associated with the highest number of inappropriate prescriptions was Uncomplicated Community-acquired Pneumonia (CAP) (427/560; 76.2%). When focusing on each infectious syndrome, Uncomplicated CAP had also the highest percentage of inappropriate duration (92.6%) comparing with appropriate prescription. Regarding specific types of antibiotics, amoxicillin accounted for the highest number of inappropriate prescriptions (422/560; 75.4%). Conclusions: A longer-than-recommended prescription of antibiotics is frequent in the Pediatric Emergency Department. Uncomplicated CAP is the condition associated with the highest number of inappropriate duration of antibiotics in our setting....
Therapeutic inertia in lipid-lowering treatment remains a striking paradox of modern cardiovascular medicine: at a time when the causal role of LDL-cholesterol in atherosclerotic disease is unequivocal and potent therapies are widely available, a substantial proportion of high- and very-high-risk patients still fail to receive timely treatment intensification. Contemporary European and international data consistently show fewer than one in three patients in secondary prevention achieve guideline-recommended LDL-C targets, revealing a persistent and unacceptable gap between scientific evidence and clinical reality. This narrative review examines therapeutic inertia as a key explanatory framework for this gap, describing its epidemiology, mechanisms, and clinical consequences in secondary cardiovascular prevention. We summarize the main physician-, patient-, and system-level determinants and propose recurrent clinician “phenotypes” of inertia that may help explain why opportunities are missed even in the highest-risk patients. The consequences are profound: therapeutic inertia contributes to what we propose as the conceptual framework of an “avoidable atherosclerotic burden”, the cumulative vascular injury that accrues each period in which LDL-C remains above target, translating into higher rates of avoidable cardiovascular events, and increased healthcare costs. Emerging strategies such as upfront combination therapy, decision-support systems, structured lipid pathways, and the integration of artificial intelligence offer practical tools to shift lipid management from reactive to proactive care. Overcoming therapeutic inertia is therefore not merely a matter of improving process metrics, but a clinical and ethical imperative. Closing the gap between evidence and practice requires transforming optimal lipid management from an exception into a system-level default, ensuring that every patient receives the full benefit of therapies proven to save lives. This work proposes a novel characterization of clinician ‘phenotypes’ and the concept of ‘avoidable atherosclerotic burden’ as a framework to understand and address this gap....
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