Articles

<b>Objective:</b> To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. <b>Methods:</b> We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. <b>Results:</b> A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. <b>Conclusion:</b> Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.

<b>Introduction:</b> Severe pre-eclampsia is a multisystem disorder associated with various ocular complications, however postpartum bilateral serous retinal detachment is uncommon and may threaten vision if not early recognized, thus requiring prompt management in order to prevent permanent visual loss. <b>Clinical Description:</b> A case of a 31-year-old woman, G3P0 with an in vitro fertilization and previous miscarriages, developed severe pre-eclampsia at 34 weeks of gestation. She underwent an emergency cesarean section for maternal indication. On the second postoperative day, she develops sudden unilateral blindness and blurred vision in the contralateral eye. Ophthalmological examination showed normal optics discs while MRI revealed bilateral serous retinal detachment. She was managed conservatively with strict blood pressure control, magnesium sulphate therapy and anticoagulation with full recovery of vision over 3 weeks without need of surgical intervention. <b>Discussion:</b> Postpartum retinal detachment is uncommon, most often serous and reversible. This case highlights that conservative management focusing on strict blood pressure control and supportive care was sufficient to avoid surgical intervention. Timely diagnosis and coordinated multidisciplinary management ensured complete visual recovery. <b>Conclusion:</b> Bilateral serous retinal detachment is a rare but reversible postpartum complication of severe pre-eclampsia. With early recognition, close monitoring and conservative management can lead to complete restoration of vision.

<b>Objective:</b> This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. <b>Methods:</b><b> </b>A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively.<b> </b><b>Results:</b><b> </b>PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. <b>Conclusion:</b><b> </b>Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.

Knee osteoarthritis (KOA) is a chronic degenerative joint disorder that significantly impairs mobility and quality of life. While surgical interventions such as total knee arthroplasty (TKA) are effective in severe cases, conservative treatments are critical for early and intermediate disease management. This review evaluates the efficacy, safety, and clinical applications of both conservative and surgical treatment approaches, including lifestyle modifications, physical therapy, pharmacological interventions, regenerative medicine, and surgical procedures. The integration of a multidisciplinary approach is emphasized as a key strategy for optimizing clinical outcomes and tailoring interventions to disease severity.

<b>Background:</b> Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. <b>Methods:</b> This study uses PRISMA guidelines and a systematic approach to identify and evaluate relevant literature. <b>Results and Discussion:</b> Among the 14 studies reviewed, eight emphasized self-management education, while four incorporated multidisciplinary approaches. Findings consistently demonstrated that structured nursing education programs significantly improved self-management behaviors, glycemic control, and patient knowledge. For instance, nurse-led self-management programs resulted in substantial enhancements in self-care skills and diabetes-related knowledge. Moreover, interventions that combined health education with psychological support were particularly effective, leading to better blood glucose control and increased adherence to treatment. Studies that examined quality of life reported reductions in anxiety, improved lifestyle habits, and better overall self-management. These findings highlight the multifaceted benefits of nursing education, suggesting that structured, supportive programs positively impact both clinical and psychological aspects of diabetes care. <b>Conclusion:</b> The review emphasizes the value of comprehensive nursing education that integrates both clinical guidance and psychological support for holistic diabetes management. <b>Implications</b>: Ongoing professional development and culturally sensitive education programs are recommended to address the diverse needs of diabetic patients. Future research should investigate the long-term effects of nursing education and explore innovative strategies to enhance diabetes management outcomes.

Biodiversity Conservation is a priority issue for the scientific community, and a main subject in the Biology and Geology curriculum at secondary school level in Spanish Educational System. In the present didactic proposal, we use the demographic monitoring of an endangered plant species to illustrate a research tool for estimates of biodiversity loos in nature, the local endemic <i>Astragalus tremolsianus</i> Pau. The aim of the proposal is to bring students closer to a real experience, which brings together knowledge of Biology, Algebra and Trigonometry, through Information and Communication Technologies (ICTs). Showing a census to monitor the populations of a threatened high mountain flora species into the classroom is an innovative teaching activity that combines and uses knowledge from different disciplines, as well as demonstrating a real application of the knowledge acquired. The use of mathematical tools encompasses a number of skills that require the application of mathematical principles and processes in the scientific context. The introduction of the structure of scientific texts is another positive aspect of this didactic experience.

<b>Background:</b> Multiple epiphyseal dysplasia (MED) a rare form of skeletal dysplasia with early-onset osteoarthritis affecting the hip and knee joints. There is paucity of evidence regarding the long term outcomes of arthroplasty in this patient cohort. This is the first study to describe the outcomes of bilateral arthroplasty of the hip and knee in patients with MED. <b>Methods:</b> A prospective study of patients with MED who underwent bilateral staged total hip arthroplasty (THA) and bilateral simultaneous total knee arthroplasty (TKA) between July 2013 to April 2014. Preoperative and postoperative clinical and radiographic assessment including functional outcomes namely Merle d’aubigne score, Harris hip score (HHS), Knee society score (KSS) and numeric rating scale (NRS) for pain were recorded in prospective database and evaluated. <b>Results:</b> 3 patients (female - 1 / male - 2) with MED who underwent bilateral lower limb arthroplasty of the hip and knee were reviewed periodically with an average followup of 7.31 years. Mean preoperative Merle d'Aubigné score (6.33 ± 0.58), HHS (31.83 ± 5.31) and KSS (28.67 ± 7.97) increased following bilateral lower limb arthroplasty with mean postoperative Merle d'Aubigné score (16.33 ± 0.58), HHS (84.33 ± 5.99) and KSS (86.33 ± 7.09) (<i>P</i><0.001). Mean NRS decreased from 7.33 ± 0.58 in the preoperative period to 0.67 ± 0.58 at the most recent followup (<i>P</i><0.001). One patient had heterotrophic ossification following<b> </b>THA. There were no revisions.<b> </b><b>Conclusions:</b> Bilateral lower limb arthroplasty of the hip and knee is a good treatment option to restore function and mobility in MED patients with advanced degenerative arthritis. Careful preoperative planning, meticulous surgical techniques, patient focussed postoperative rehabilitation with multidisciplinary team approach are vital to ensure good functional outcomes and implant survivorship.

A short review<b> </b>concerning the<b> </b>distinction between<b> </b>ancient and modern grains or ancient and modern varieties of wheat, cereals and pseudocereals, along with their quality related mainly to human health and that of the environment is provided. Modern plant breeding, especially that started before the Green Revolution, based mainly on gross selection and very few crosses among local varieties/populations may be considered ancient grains, while those obtained after the Green revolution, based on intensive and multiple crosses among local and foreign varieties, including those obtained by induced mutation, may be considered modern grains. According to recent researches, it seems that ancient grains are healthier than the modern ones. The former would also have a lower environmental and agricultural impact than the latter. Since the picture on this topic is not yet clear I was asked to throw on it more light. In fact, most of researchers in the field do not understand difference among ancient and modern varieties. Thus, the objective of this short paper was to clarify and stimulate more research, possibly with a multidisciplinary approach. In Italy, for instance, there are <i>ad hoc</i> research projects that should be more adequately financed and supported, during their development. To make it easy, I have mentioned and listed more than thirty references.

A domain of practical learning over the theoretical is provided in this work, for this several places of natural interest have been studied (Natural Parks), a quality pedagogical training is obtained, through which the students of Vocational Training and Primary and Secondary Education Teachers obtain competences in the management of natural spaces, which are of interest for conservation, competences in flora, plant communities, habitats and interpretation of the landscape. The learning is eminently practical, which allows trained personnel to enter the labor market. The study of natural spaces has been carried out using direct observation techniques, with the participation of specialist teachers in various fields, because the interpretation of vegetation, habitats and landscape requires multidisciplinary techniques. For this, teaching methodologies in Botany are used, how have the phytosociological sampling techniques been; Geology, Edaphology, and Climatology, in the latter case creating future predictive models that allow the student to make decisions about the management of a territory; this study has made it possible to carry out a comprehensive interpretation of the natural environment, with a notable pedagogical improvement in learning.

Although rarely, echinococcosis might present cardiac involvement, with cysts growing inside myocardial structures of arising adjacent to heart. A careful differential diagnosis with other mass formations and rare cardiac tumours is necessary, whenever there is a clinical and radiological suspicion. Imaging studies and serology will establish diagnosis. A multidisciplinary approach is warranted in all cases, with surgical intervention being unavoidable in most settings. Patients generally present with chest pain and dyspnoea. Cases need a close follow up of their postoperative course, while being treated appropriately with albendazole (or mebendazole) for prevention of recurrences.