Palestinian Nursing Students' Perspective of Clinical Decision-Making.

Introduction: One of the most important aspects of nursing education and practice is clinical decision-making (CDM), which is also crucial to clinical competency. Objective: The study aimed to assess the CDM of undergraduate nursing students by using the CDM nursing scale. Method: The study was cross-sectional and involved 315 nursing student participants. Data collection utilized the Clinical Decision-Making Scale, which comprises domains such as "canvassing of objectives and values," "search for alternatives or options," "evaluation and reevaluation of consequences," and "search for information and unbiased assimilation of new information." Statistical analyses included Pearson correlation, ANOVA, and independent t-tests. Data collection occurred during the second semester of 2023. Results: The results indicated that the mean age of the students was 21.69 (SD = 1.6) years. In terms of gender, the majority were males, constituting 216 (68.6%) of the participants. Among the participants, 105 (33.3%) were from the second year, 108 (34.3%) from the third year, and 102 (32.4%) from the fourth year. The analysis revealed that the average CDM score was 129.8 (SD = 17.5). Additionally, examination of the subscales of CDM showed that the highest subscale score was for "search for information and unbiased assimilation of new information" (M = 33.1, SD = 5.3), while the lowest subscale score was for "search for alternatives or options" (M = 31.8, SD = 6.0). Furthermore, the analysis demonstrated a significant difference between academic year level and the mean CDM scores (p < .05), along with a positive relationship between the CDM score and students' age (r = .67, p = .001). Conclusion: The findings revealed that nursing students exhibit a moderate level of CDM. Moreover, it was revealed that students' CDM is influenced by both their age and academic year level.

The genetic landscape of autosomal dominant polycystic kidney disease in Kuwait.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common renal monogenic disease, characterized by bilateral accumulation of renal fluid-filled cysts leading to progressive renal volume enlargement and gradual impairment of kidney function, often resulting in end-stage renal disease. Kuwait could provide valuable genetic insights about ADPKD, including intrafamilial phenotypic variation, given its large household size. This study aims to provide a comprehensive description of the pathogenic variants linked to ADPKD in the Kuwaiti population using multiple genetic analysis modalities and to describe and analyse the ADPKD phenotypic spectrum in terms of kidney function, kidney volume and renal survival. Methods: A total of 126 ADPKD patients from 11 multiplex families and 25 singletons were recruited into the study. A combination of targeted next-generation sequencing (tNGS), long-range polymerase chain reaction, Sanger sequencing and multiplex ligation-dependent probe amplification were utilized for genetic diagnosis. Clinical evaluation was conducted through renal function testing and ultrasonographic kidney volume analysis. Results: We identified 29 ADPKD pathogenic mutations from 36 families achieving an overall molecular genetic diagnostic rate of 112/126 (88.9%), including 29/36 (80.6%) in families. A total of 28/36 (77.8%) families had pathogenic mutations in PKD1, of which 17/28 (60.7%) were truncating, and 1/36 (2.8%) had a pathogenic variant in the IFT140 gene. A total of 20/29 (69%) of the identified ADPKD mutations were novel and described for the first time, including a TSC2-PKD1 contiguous syndrome. Clinical analysis indicated that genetically unresolved ADPKD cases had no apparent association between kidney volume and age. Conclusion: We describe for the first time the genetic landscape of ADPKD in Kuwait. The observed genetic heterogeneity underlining ADPKD along with the wide phenotypic spectrum reveal the level of complexity in disease pathophysiology. ADPKD genetic testing could improve the care of patients through improved disease prognostication, guided treatment and genetic counselling. However, to fulfil the potential of genetic testing, it is important to overcome the hurdle of genetically unresolved ADPKD cases.

Intranasal delivery of phenytoin-loaded nanoparticles to the brain suppresses pentylenetetrazol-induced generalized tonic clonic seizures in an epilepsy mouse model.

In this work we describe the preparation and characterization of lecithin-chitosan nanoparticles (L10Ci+), and investigate their ability to deliver the anti-epileptic drug phenytoin (PHT) to mouse brain following intranasal (IN) administration. L10Ci+ were retained in the nasal cavity compared to PHT in PEG200 solution (PHT/PEG), which suffered immediate nasal drainage. PHT was detected in the brain after 5 min of IN administration reaching a maximum of 11.84 ± 2.31 %ID g-1 after 48 hours. L10Ci+ were associated with a higher brain/plasma ratio (Cb/p) compared to the experimental control comprising free PHT injected via the intraperitoneal route (PHT-IP) across all tested time points. Additionally, L10Ci+ led to lower PHT accumulation in the liver and spleen compared to PHT-IP, which is vital for lowering the systemic side effects of PHT. The relatively high drug targeting efficiency (DTE%) of 315.46% and the drug targeting percentage (DTP%) of 68.29%, combined with the increasing anterior-to-posterior gradient of PHT in the brain confirmed the direct nose-to-brain transport of PHT from L10Ci+. Electroencephalogram (EEG) analysis was used to monitor seizure progression. L10Ci+ resulted in a complete seizure suppression after 4 hours of administration, and this inhibition persisted even with an 8-fold reduction of the encapsulated dose compared to the required PHT-IP dose to achieve a similar inhibitory effect due to systemic loss. The presented findings confirm the possibility of using L10Ci+ as a non-invasive delivery system of PHT for the management of epilepsy using reduced doses of PHT.

Early Diagnosis of Classic Homocystinuria in Kuwait through Newborn Screening: A 6-Year Experience.

Kuwait is a small Arabian Gulf country with a high rate of consanguinity and where a national newborn screening program was expanded in October 2014 to include a wide range of endocrine and metabolic disorders. A retrospective study conducted between January 2015 and December 2020 revealed a total of 304,086 newborns have been screened in Kuwait. Six newborns were diagnosed with classic homocystinuria with an incidence of 1:50,000, which is not as high as in Qatar but higher than the global incidence. Molecular testing for five of them has revealed three previously reported pathogenic variants in the CBS gene, c.969G>A, p.(Trp323Ter); c.982G>A, p.(Asp328Asn); and the Qatari founder variant c.1006C>T, p.(Arg336Cys). This is the first study to review the screening of newborns in Kuwait for classic homocystinuria, starting with the detection of elevated blood methionine and providing a follow-up strategy for positive results, including plasma total homocysteine and amino acid analyses. Further, we have demonstrated an increase in the specificity of the current newborn screening test for classic homocystinuria by including the methionine to phenylalanine ratio along with the elevated methionine blood levels in first-tier testing. Here, we provide evidence that the newborn screening in Kuwait has led to the early detection of classic homocystinuria cases and enabled the affected individuals to lead active and productive lives.

Retroperitoneal lipoma; a benign condition with frightening presentation.

INTRODUCTION: lipoma is the most frequent soft tissue tumor in adults. Its occurrence in the retroperitoneal region is extremely rare. The aim of this study is to report a case of retroperitoneal lipoma with a literature review. PRESENTATION OF CASE: A 34-year-old female presented with abdominal distension and severe back pain for one year duration. She also reported weight loss and constipation. The examination revealed asymmetrical abdominal distension and everted umbilicus. There was a big irregular mass occupying the whole abdomen reaching into the xiphisternum, firm in consistency, smooth surface, and well defined borders. Abdominal ultrasound demonstrated a large retroperitoneal heterogeneous mass. Computed tomography (CT) scan showed a large well defined hyperechoic mass with fibrous septa extending from the left ovary up to the diaphragm. Exploratory laparotomy revealed a giant clearly demarcated fatty tumor adherent to the retroperitoneal fatty tissues. The histopathological examination of the specimen confirmed the diagnosis of the retroperitoneal lipoma. DISCUSSION: Retroperitoneal lipomas have been reported in various age groups; namely children, middle and old age patients. Based on the characteristic radiological features of the tumor, enormous diagnostic work-up is not justified. CONCLUSION: Retroperitoneal lipoma is a very rare variant of lipoma, presents with various signs and symptoms that may be misleading. Radiologic imaging especially CT scan is the diagnostic tool of choice. Surgical resection is the main modality of management.

Misclassification of pulmonary hypertension in adults with sickle hemoglobinopathies using Doppler echocardiography.

OBJECTIVE: To compare the diagnostic utility of Doppler echocardiography-derived tricuspid regurgitant jet velocity (TRV) ≥ 2.5 m/s to right heart catheterization (RHC) in defining pulmonary hypertension (PH) in adult patients with sickle cell disease (SCD). METHODS: This is a retrospective chart review of adults with SCD who had a TRV ≥ 2.5 m/s and RHC. A TRV ≥ 2.5 m/s is suggestive of PH. Pulmonary arterial hypertension (PAH) was defined as a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg and pulmonary capillary wedge pressure ≤ 15 mm Hg. Pulmonary venous hypertension was defined as an mPAP ≥ 25 mm Hg and pulmonary capillary wedge pressure >15 mm Hg. RESULTS: Twenty-five patients with SCD met the inclusion criteria. Nine of the 25 (36%) patients had an mPAP ≥ 25 mm Hg. Of these 9, 3 (33%) had PAH and 6 (66%) had pulmonary venous hypertension. Patients with PH did not have a higher TRV (3.1 ± 0.68 vs 2.70 ± 0.16 m/s; P = 0.12), but they did have higher cardiac outputs (10.4 ± 2.7 vs 7.81 ± 1.85 L/min; P = 0.012. The specificity of TRV equal to 2.51 m/s in diagnosing PH was 18.8%. At a TRV of 2.88 m/s, the specificity increased to 81%. CONCLUSIONS: In adults with SCD, a TRV of 2.5 m/s lacks specificity for use as a screening tool in the diagnosis of PH. Using a TRV of ≥ 2.88 m/s allows the TRV to be used as a screening tool and reduces the false-positive rate and need for unnecessary RHC.

A 48-year-old man with a solitary pulmonary nodule.

CASE PRESENTATION: A 48-year-old man with a 75-pack-year history of tobacco use was referred to pulmonary clinic for evaluation of an abnormal chest roentgenograph. He had been followed by his primary physician for bronchitis and nonproductive cough over the past year and was recently treated with a course of antibiotics with no change in symptoms. He had no other medical history, was currently smoking two packs of cigarettes per day, and reported working on the docks in a shipyard for five years. On physical examination, he was afebrile with stable vital signs and 97% oxygen saturation on room air. He was well-developed in no apparent distress. On cardiovascular examination, he was in sinus rhythm without murmurs. Chest examination was clear to auscultation. There was no lymphadenopathy. The abdomen was soft and benign. The extremities were without clubbing, cyanosis, or edema. The rest of the physical examination was unremarkable. LABORATORY DATA: Laboratory data demonstrated a white blood cell count of 7,200/ul with a normal differential. Hemoglobin, platelet count, serum electrolytes, liver associated enzymes and coagulation studies were normal. IMAGING STUDIES: The patient had a chest computed tomography (CT) available for review (Fig. 2). What diagnostic study should be performed next?