Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study.

BACKGROUND: Current guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation. METHODS: We conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening. RESULTS: A total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively). CONCLUSIONS: Despite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

Knowledge, attitude, and perception of Arab medical students towards artificial intelligence in medicine and radiology: A multi-national cross-sectional study.

OBJECTIVES: We aimed to assess undergraduate medical students' knowledge, attitude, and perception regarding artificial intelligence (AI) in medicine. METHODS: A multi-national, multi-center cross-sectional study was conducted from March to April 2022, targeting undergraduate medical students in nine Arab countries. The study utilized a web-based questionnaire, with data collection carried out with the help of national leaders and local collaborators. Logistic regression analysis was performed to identify predictors of knowledge, attitude, and perception among the participants. Additionally, cluster analysis was employed to identify shared patterns within their responses. RESULTS: Of the 4492 students surveyed, 92.4% had not received formal AI training. Regarding AI and deep learning (DL), 87.1% exhibited a low level of knowledge. Most students (84.9%) believed AI would revolutionize medicine and radiology, with 48.9% agreeing that it could reduce the need for radiologists. Students with high/moderate AI knowledge and training had higher odds of agreeing to endorse AI replacing radiologists, reducing their numbers, and being less likely to consider radiology as a career compared to those with low knowledge/no AI training. Additionally, the majority agreed that AI would aid in the automated detection and diagnosis of pathologies. CONCLUSIONS: Arab medical students exhibit a notable deficit in their knowledge and training pertaining to AI. Despite this, they hold a positive perception of AI implementation in medicine and radiology, demonstrating a clear understanding of its significance for the healthcare system and medical curriculum. CLINICAL RELEVANCE STATEMENT: This study highlights the need for widespread education and training in artificial intelligence for Arab medical students, indicating its significance for healthcare systems and medical curricula. KEY POINTS: • Arab medical students demonstrate a significant knowledge and training gap when it comes to using AI in the fields of medicine and radiology. • Arab medical students recognize the importance of integrating AI into the medical curriculum. Students with a deeper understanding of AI were more likely to agree that all medical students should receive AI education. However, those with previous AI training were less supportive of this idea. • Students with moderate/high AI knowledge and training displayed increased odds of agreeing that AI has the potential to replace radiologists, reduce the demand for their services, and were less inclined to pursue a career in radiology, when compared to students with low knowledge/no AI training.

Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis.

INTRODUCTION: Open heart surgery is the most common treatment for congenital heart disease. Thoracotomy, sternotomy, or a combination of both are the main approaches used in open heart surgeries. In cardiac surgery, there have been concerns that these surgeries increase the likelihood of spinal deformities. Therefore, this systematic review and meta-analysis provided updated evidence on the prevalence of spinal deformities following congenital heart surgery. METHOD: EMBASE, Medline, ScienceDirect, and Google Scholar were used to search for studies published until 2022. We include randomized clinical trials and observational studies that reported the prevalence of spinal deformities (scoliosis and kyphosis) after congenital heart surgery among participants without these deformities before surgery. Two independent reviewers independently screened literature identified from the databases. Two reviewers independently conducted screening of studies identified during the search, data extraction, and quality assessment of the included studies. RESULTS: In total, 688 studies were screened; 13 retrospective and one prospective cohort studies were included, encompassing 2294 participants. The pooled prevalence of spinal deformities (scoliosis and kyphosis) after open heart surgery performed on skeletally immature patients was 23.1% (95% confidence interval [CI] = 23.1-35.3; I2 = 97.5%). CONCLUSION: This review suggests that the prevalence of spinal deformities was high among patients who underwent sternotomy or thoracotomy.

Effect of Omega-3 fatty acids supplementation on serum level of C-reactive protein in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Omega-3 may alleviate the severity of coronavirus disease 2019 (COVID-19) by reducing the C-reactive protein (CRP) level, a marker for systemic inflammation. Because the scientific evidence indicating such a role is inconsistent, we aimed to evaluate the effect of Omega-3 on CRP change and CRP level in patients with COVID-19. METHODS: We conducted a comprehensive search on four databases (PubMed, Web of Science, EMBASE, and Scopus). We included all RCTs comparing Omega-3 with a control group regarding their effect on the CRP levels in patients with COVID-19. We used version two of the Cochrane risk of bias assessment tool to appraise the included studies. We extracted data to an online data extraction sheet. The primary outcomes were CRP change from baseline and CRP serum levels. RESULTS: We included four randomized controlled trials (RCTs) with 274 patients in this study. The overall effect estimate favored Omega-3 over the control group in terms of CRP change from baseline (mean difference (MD) =- 2.53, 95% confidence interval (CI): - 4.40, - 0.66) and CRP serum levels at the end of the study (MD =- 6.24, 95% CI: - 11.93, - 0.54). CONCLUSION: Omega-3 showed promising effects on systemic inflammation by reducing CRP levels in COVID-19 patients. Based on this finding, we recommend Omega-3 for COVID-19 patients for its anti-inflammatory actions.

Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes.

PURPOSE: Cancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes. METHODS: CC was classified into a four-stage model: no cachexia, pre-cachexia (PC), cachexia and refractory cachexia (RC) with categorisation determined from biochemical and body composition and performance assessment. Associations between the stage of cachexia and chemotherapy outcomes including radiological response, the number of chemotherapy cycles completed and the number of cycles delayed or dose reduced were explored. RESULTS: Twenty-four patients were included with 4 (18%) classified as having no cachexia, 4 (18%) PC, 3 (14%) cachexia (13.6%), and 11 (50%) RC. No association was observed between the stage of cachexia and the radiological response to chemotherapy number of cycles delayed or the number of cycle's dose reduced; however, there was an association with the number of cycles completed (p = 0.030). An association between C-reactive protein (CRP) and the number of chemotherapy cycles completed (p = 0.044) and the number of dose reductions (p = 0.044) was also identified. CONCLUSIONS: Limited conclusions can be drawn given the small sample size. However, the majority of patients presented with some degree of cachexia at diagnosis. A relationship was identified between the increasing severity of cachexia and a lower number of chemotherapy cycles completed, as well as between CRP and the number of chemotherapy cycles completed and the number of dose reductions required, and therefore warrants further exploration in larger studies.

Rationale and Design of an Online Educational Program Using Game-Based Learning to Improve Nutrition and Physical Activity Outcomes Among University Students in the United Kingdom.

OBJECTIVE: To assess the impact of an online game-based educational program on nutrition knowledge and dietary and physical activity habits among university students in the United Kingdom. DESIGN: Randomized controlled trial with pre- and postintervention comparisons. SETTING: Two higher education settings in London, UK. SUBJECTS: Current undergraduate and postgraduate students of two universities (n = 88) aged 18-34 years are randomly allocated to an intervention (n = 44) or a control group (n = 44). INTERVENTION: The intervention group will receive access to an educational website and online quizzes with gamification elements, including information about healthy eating and physical activity. The control group will receive no information. Duration of the intervention will be 10 weeks. MEASURES OF OUTCOME: Primary outcome is nutrition knowledge. Secondary outcomes include dietary and activity habits. Nutrition knowledge and dietary and activity habits will be assessed using questionnaires. Weekly steps will be counted using pedometers. Assessment of anthropometric and metabolic risk factors will take place. ANALYSIS: Quantitative analysis will investigate changes in nutrition knowledge between the two groups of the study population. Linear regression analysis will be used, if the data follow the normal distribution (otherwise binomial regression analysis), to examine whether field of study, residence status, body mass index (BMI), and demographic factors affect nutrition knowledge. Associations between changes in knowledge and dietary and physical activity behavior will be assessed by correlations. CONCLUSIONS/IMPLICATIONS: The study will provide insights with regard to the design and use of online game-playing as a cost-effective approach to improve nutritional knowledge among university students.

The interaction between insulin resistance and Alzheimer's disease: a review article.

Insulin serves multiple functions as a growth-promoting hormone in peripheral tissues. It manages glucose metabolism by promoting glucose uptake into cells and curbing the production of glucose in the liver. Beyond this, insulin fosters cell growth, drives differentiation, aids protein synthesis, and deters degradative processes like glycolysis, lipolysis, and proteolysis. Receptors for insulin and insulin-like growth factor-1 are widely expressed in the central nervous system. Their widespread presence in the brain underscores the varied and critical functions of insulin signaling there. Insulin aids in bolstering cognition, promoting neuron extension, adjusting the release and absorption of catecholamines, and controlling the expression and positioning of gamma-aminobutyric acid (GABA). Importantly, insulin can effortlessly traverse the blood-brain barrier. Furthermore, insulin resistance (IR)-induced alterations in insulin signaling might hasten brain aging, impacting its plasticity and potentially leading to neurodegeneration. Two primary pathways are responsible for insulin signal transmission: the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway, which oversees metabolic responses, and the mitogen-activated protein kinase (MAPK) pathway, which guides cell growth, survival, and gene transcription. This review aimed to explore the potential shared metabolic traits between Alzheimer's disease (AD) and IR disorders. It delves into the relationship between AD and IR disorders, their overlapping genetic markers, and shared metabolic indicators. Additionally, it addresses existing therapeutic interventions targeting these intersecting pathways.

Role of Angular Interface Sign in Characterizing Small Exophytic Renal Masses in Computed Tomography; Prospective Study.

The widespread use of computed tomography (CT) has increased the incidence of small renal cell masses. We aimed to evaluate the usefulness of the angular interface sign (ice cream cone sign) to differentiate a broad spectrum of small renal masses using CT. The prospective study included CT images of patients with exophytic renal masses ≤ 4 cm in maximal dimension. The presence or absence of an angular interface of the renal parenchyma with the deep part of the renal mass was assessed. Correlation with the final pathological diagnosis was performed. The study included 116 patients with renal parenchymal masses of a mean (± SD) diameter of 28 (± 8.8) mm and a mean age of 47.7 (±12.8) years. The final diagnosis showed 101 neoplastic masses [66 renal cell carcinomas (RCC), 29 angiomyolipomas (AML), 3 lymphomas, and 3 oncocytomas] and 15 non-neoplastic masses [11 small abscesses, 2 complicated renal cysts, and 2 granulomas]. Angular interface sign was statistically comparable in neoplastic versus non-neoplastic lesions (37.6% versus 13.3%, respectively, P = 0.065). There was a statistically higher incidence of the sign when comparing benign versus malignant neoplastic masses (56.25 vs. 29%, respectively, P = 0.009). Also, comparing the sign in AML versus RCC was statistically significant (52% of AML versus 29% of RCC, P = 0.032). The angular interface sign seems beneficial in predicting the nature of small renal masses. The sign suggests benign rather than malignant small renal masses.

An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma. CASE PRESENTATION: We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx. CONCLUSION: To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.

Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy.

Background: Wound healing remains among the most concerning complications in aesthetic surgery. The use of hyperbaric oxygen therapy (HBOT) is an accepted method of supporting wound healing. Objectives: The aim of this study is to assess the role of HBOT in postoperative healing and complication rates following facelift surgery. Methods: This case-control study comprised facelift patients who received HBOT and those who did not between 2019 and 2022. Data were extracted from the patients' medical records, with the primary outcomes being the presence of complications, wound-healing duration, and patient satisfaction. Results: The authors recruited 20 female patients who underwent facelift for this study, with 9 patients in the HBOT group and 11 patients in the control group. The average number of HBOT sessions received was 7.22, and each session lasted an average of 78 ± 5 min. The duration of wound healing in the HBOT group ranged from 7 to 30 days (mean of 13.3 days), whereas the control group ranged from 6 to 90 days (mean of 36.9 days). This indicates a statistically significant shorter time to wound healing in the HBOT group compared to the control group (P < .001). Conclusions: Future prospective randomized controlled trials with larger sample sizes and blinding are needed to further evaluate the potential benefits of HBOT in the postoperative period. Nonetheless, our findings suggest that HBOT may be a promising adjunctive therapy for patients undergoing facelift surgery.

Cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome: First case reported in Saudi Arabia.

CODAS syndrome (cerebral, ocular, dental, auricular, skeletal anomalies) is a rare autosomal recessive inherited multisystemic disease that carries an incidence rate of less than 1 in 1,000,000 children worldwide. It has an infancy, neonatal age of onset, characterized by deformities of the central nervous system, eyes, ears, teeth, and skeleton. A 1-year-old female of non-consanguineous parents, first time presented to our pediatrics clinic on November 6, 2021 when she was 4 months of age with developmental delay, as the patient could not support her head and made no eye contact on examination. Microcephaly was observed. She had a positive family history; her sister died at the age of 3 days with microcephaly and diaphragmatic hernia. We recommend that a wider range of centers to get encouraged to report cases of CODAS they might encounter due to the lack of sufficient amounts if solid literature on the topic. To our knowledge, this is the first case to be reported in the literature from Saudi Arabia.

Spindle cell lipoma of the tongue: First case report from the Gulf region and review of the literature.

Spindle cell lipoma is a histological variant of oral lipomas. In this report, we present the first case from the Gulf region with the most comprehensive literature review. Clinicians should consider rare tumors in the differential diagnoses of oral masses.

A rare case of Kasabach Merritt Syndrome presenting with an infantile hemangioma: A case report.

Introduction: and importance: Infantile hemangioma, being a benign tumor of the blood vessel, is part of a triad composed of also thrombocytopenia and hypofibrinogenemia as part of Kasabach Merrit Syndrome. Case presentation: We report the case of a 2 months old female Saudi infant referred due to respiratory distress, thrombocytopenia, and enlarging hemangioma on right upper chest, neck, and lower cheek. Diagnosis of kaposiform hemangioendothelioma complicated by Kasabach Merritt thrombocytopenia was done based on the clinical triad of thrombocytopenia, bleeding tendency, and the presence of a vascular tumor. Conclusion: Vincristine and CTA embolization are lines of management that showed to be the most efficient in the improvement of the clinical picture of KMS in our patient.

Evaluation of Medical Students' Knowledge on Palliative Care: A Single Institution Cross-sectional Study.

Background: Palliative care is the branch of medicine which has a target of setting focus on the improvement of the quality of life of patients, particularly toward their end of life, such as cases of terminal diseases with low prognosis. Despite growing recognition of the importance of palliative care, a gap remains in medical education. Our study aims to evaluate the current level of knowledge of medical students in regard to palliative care. Methods: A cross-sectional descriptive study was conducted in Batterjee Medical College, Jeddah, Saudi Arabia, through a period of three months from December 2021 to March 2022. Results: A total of 254 students participated in our study. Psychosocial and spiritual needs of the patient alongside definition of palliative care were perceived the most important by the students with a mean score of 3.9 each. Conclusion: Our study concludes that there is an overall lack of confidence among medical students in providing palliative care. We recommend further enhancement and implementation of palliative care as part of undergraduate mandatory courses.

Metastatic neuroblastoma presenting without a primary tumor: A case report.

Neuroblastoma is the most common extracranial, intrabdominal, suprarenal solid tumor of childhood. It usually presents with painless abdominal mass with or without abdominal pain. We report an unusual subtle cervical lymph nodes enlargement associated with fever and joint pain. Neuroblastoma usually starts in the adrenal glands. What is unique in our case is that the presentation is without a primary tumor. We present a case of 4-year-old female Egyptian complaining of recurrent pattern of fever and generalized joint pain, with lower neck swelling for 1-month duration. Laboratory investigations revealed a normochromic normocytic anemia and increased inflammatory markers. Immunohistochemistry staining and immunophenotyping of the cervical lymph nodes and bone marrows confirmed the diagnosis of Neuroblastoma. This case report highlights the importance of recognizing the possibility of a metastatic neuroblastoma without primary tumor in children who presented solely of lymphadenopathy.

A case report of interventricular hemorrhage in William-Beuren syndrome.

Background: Williams syndrome (WS) (also as known Williams-Beuren Syndrome) is a neurodevelopmental disorder caused by deletion of chromosomes 7q11.23. WS phenotype is very variable but usually it is associated with a distinctive pattern of cognitive abilities. Case presentation: 9-year-old female patient known case of developmental delay and precocious puberty presented to the emergency department with altered level of consciousness, elevated blood pressure of 230/160 with a provisional diagnosis of hypertensive encephalopathy. Conclusions: In our patient, the strongest indications for establishing the diagnosis included the classic elfin face and multisystemic involvement. Later on genetic analysis confirmed our diagnosis.

Trend of social media use by undergraduate medical students; a comparison between medical students and educators.

Purpose: Social media (SM) is one of the most powerful tools of communication and learning in the recent era. Different types of information can be shared through these social networking sites in the form of texts, videos, pictures, audios, and references (contacts). Due to the constant increase in the use of these social networking sites in our daily routine life especially during the COVID 19 pandemic, their use in teaching and learning has become inevitable. Social media has immense potential to enhance its role in educational settings. Both the students and educators use it for communication, education, sharing and expressing knowledge, and recreation. Therefore, the present study aims to find out the most frequently used social network sites for learning and easy communication between medical students and educators. Objective: This study sought to explore the most frequently used social networking sites by the medical students and educators at Batterjee Medical College. Methods: A cross-sectional study was carried out to assess the trends of usage of SM as an extracurricular way of enhancing learning and teaching experience among medical students and educators in Batterjee Medical College; Saudi Arabia from November 2020 to March 2021.A pre-validated self-administrated questionnaire was built using Google Drive forms and distributed to medical students and educators via emails and WhatsApp. Convenient sampling was used to collect the data. Conclusion: Social media has immense potential to enhance its role in educational settings. Students in our study preferred YouTube and WhatsApp for their learning and communication especially, during COVID 19 pandemic. However, to further enhance their utility choosing the right platform, the amount and quality of the information shared to ensure optimal benefit, providing ethical guides, and professional standards for SM use at institutional levels are the few challenges that need to address.

Choice of medicine program: A single-institution study.

Introduction: The decision to apply for medical school is the first and one of the most important career choices that a physician will ever make and the motives for choosing a career in medicine seem to remain relatively stable during medical school. Our study aimed to investigate what motivated the students, their satisfaction with the PBL curriculum and their plans following graduation. Methods: A cross-sectional descriptive study was carried out from Jan to March 2021 at Batterjee medical college, Jeddah. The data was collected on a questionnaire from undergraduate students of first year till the internship year. Results: Among the 112 students who completed the questionnaire, 85 (75.9%) chose studying medicine to be their own choice, with service to humanity 56 (50%) being the main reason, followed by monetary 20 (18.8%) reasons. Generally 78 (69.6%) of the responders preferred the PBL curriculum over the traditional one. Most of the students 42 (37.5%) planned to undergo the residency program in Saudi Arabia, with general surgery being the specialty preferred by 33 (29.5%) students. Conclusion: The findings in our study suggest that altruism is the most common influencing factor that led students joining a medical college.

Two concomitant thrombotic microangiopathies in the background of systemic lupus erythematosus: A case report.

Introduction and importance: Lupus nephritis is particularly a very concerning occurrence due to the susceptibility for potential renal damage and ultimately renal failure. Cardiac involvement was present as well in the form of pericarditis. Our study reports a case of lupus nephritis that has had a very severe course of fluctuations between relapses and improvements which constantly necessitated an MDT interference at various points. Case presentation: We report a case of a 13-year-old female patient who presented with a 5-day history of fever, dizziness, joint pain, menorrhagia, convulsions, and visual disturbances. Essential diagnostic tests took place and a diagnosis of lupus nephritis was confirmed. Conclusion: In conclusion we found that a combination of various treatment modalities and flexibility in decision making in response to changes in the clinical course are vital to treatment success. Utilization of plasma exchange which resulted in an enormous drop in the percentage of fragmented red blood cells (RBCs) from 9.8% to 1.8%.

Safety and efficacy of adipose-derived mesenchymal stem cells for knee osteoarthritis: A systematic review and m-analysis.

OBJECTIVE: This research aimed to study the safety and efficacy of adipose-derived mesenchymal stem cells (ADMSCs) for knee osteoarthritis (OA). METHODS: We used six databases to search for records and then screened them for eligibility. In both randomized and non-randomized studies, the risk of bias was assessed. The data were then retrieved and used in single-arm and double-arm analyses using Comprehensive Meta-Analysis (CMA) Version 3.0 and RevMan Version 5.3, respectively. RESULTS: Based on the study's inclusion criteria, we included 15 studies with a total of 463 patients. According to our single-arm analyses, there was a significant improvement in quality of life (QOL) among the three dose subgroups (high, medium, and low doses), as measured by SF-36 scores after a year of follow-up [low dose: mean (M)=-23.99; 95% confidence interval (CI) [-31.49 to -16.49]; P<0.001; medium dose: M=-15.96; 95% CI [-23.5 to-8.42]; P<0.001; high dose: M=-19.31; 95% CI [-28.02 to -10.59], P<0.001] and the knee injury and osteoarthritis outcome score (KOOS) QOL sub-score after six months following ADMSCs injection in the low-dose group (M=24.9; 95% CI [4.3 to 45.6]; P<0.05). Moreover, after three months of follow-up, we detected significant pain reduction as measured by the numeric pain rating scale (NPRS), with no significant difference between the low and medium doses (low dose: M=-3.12; 95% CI [-5.09 to -1.14]; P<0.01; medium dose; M=-2.17; 95% CI [-3.13 to -1.21]; P<0.001). However, after a year, the results were no longer significant. Despite finding no significant difference between them after 6 and 12 months post-treatment in the Visual Analogue scale (VAS) scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, double-arm analyses revealed significant pain reduction in the ADMSCs group over the control after 12 months as estimated by the WOMAC pain sub-score (mean difference (MD)=-1.85, 95% CI [-3.55, -0.15], P<0.05). After six months, the low dosage group's knee functions and activity levels improved significantly, as determined by the WOMAC physical function and stiffness subscales (M=-23.79; 95% CI [-38.43 to -9.16]; P=0.001; M=-10.25; 95% CI [-17.31 to -2.59]; P<0.01, respectively), as well as the KOOS scores after a year (P<0.01 for all KOOS subscales). In the ADMSCs injections group, there were no serious adverse effects [event rate (ER)=0.11; 95% CI [0.03-0.3]; P=0.001]. CONCLUSION: In the present single-arm meta-analysis, ADMSCs were associated with significant reduction in pain and improvement in QOL and knee functions in patients with knee OA. However, double arm analyses did not confirm these positive findings, which may be returned to the small sample size of included patients. Therefore, to introduce ADMSCs into clinical practice and establish guidelines for their use, more randomized controlled clinical trials with large sample sizes and long-term follow-ups are needed.