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Objectives: A EULAR task force was convened to develop points to consider (PtC) for patient education in physical activity and self-management of pain in young people with juvenile-onset rheumatic and musculoskeletal diseases during transitional care., Methods: A task force of 26 people from 10 European countries followed the EULAR Standardised Operating Procedures to establish overarching principles (OAPs) and PtC based on a literature review and expert consensus. Level of evidence (LoE), grade of recommendation (GoR) and level of agreement (LoA) were determined., Results: Two OAPs and seven PtC were formulated. The OAPs highlight the importance of personalised transitional care in rheumatology, ideally based on shared decision-making and incorporate interactive education to empower young individuals in managing their physical activity and pain. The PtC emphasise the clinical importance of patient education in these areas to improve readiness to transfer from paediatric to adult care. For two PtC, the GoR was moderate (grade B), based on individual cohort study (LoE 2b). For the remaining five PtC, the GoR was weak (grade D), based on expert opinion (LoE 5). The LoA among the task force was high, ranging from 9.4 to 9.8, except for one PtC that was 8.7., Conclusion: These EULAR PtC establish guidance on best practices for delivering patient education in physical activity and self-management of pain during transitional care in rheumatology. The adoption of these PtC in clinical settings is recommended to standardise and optimise transitional care across European healthcare systems. Additionally, the task force expects that these PtC will drive future research and potentially shape policies across Europe., Competing Interests: Competing interests: JC-I: none declared, RP-M: none declared, EB-V: none declared, PA-V: none declared, SA: none declared, JA: none declared, IB: none declared, DC: none declared, MC: none declared, WC: none declared, DDC: none declared, AD: none declared, LL: payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pfizer; AM: none declared, KM: grant/research support from Pfizer, Novartis and Medac, AFM: none declared, AN: none declared, SO: none declared, GP: none declared, ZS: none declared, TV: none declared, NMW: none declared, AZC: none declared, YP: none declared, LC: none declared, FE-L: none declared., (© European Alliance of Associations for Rheumatology, EULAR 2024. Re-use permitted under CC BY-NC-ND. No commercial re-use. No derivatives. See rights and permissions. Published by BMJ on behalf of EULAR.)

Purpose: To evaluate "beezin," a social media trend that involves applying Burt's Bees Lip Balm to the eyelids to induce intoxication, which has the potential to cause ocular problems., Methods: Researchers identified the top TikTok videos about beezin using the search terms "beezing," "beezin," "burtsbees," "Burt's Bees on eyelids," and "burtsbeeschallenge." Researchers watched each video and recorded key information. Descriptive statistics were calculated., Results: Sixty top videos were included in the analysis; they had more than 158 million views and more than 11 million likes. More than half (n = 37, 61%) portrayed the trend positively, 11 (18%) portrayed the trend negatively, and 12 (20%) took a neutral stance on the trend. None of the videos were created by a health care provider., Conclusions: Beezin is a viral social media trend that may cause ocular problems. There is a need for factual TikTok content to combat the trend. Health care providers should consider beezin when adolescent patients present with contact dermatitis, conjunctivitis, or other possible sequelae of beezin. [ J Pediatr Ophthalmol Strabismus . 20XX;XX(X):XXX-XXX.] .

Background: Coronary artery disease (CAD) is a leading cause of mortality worldwide. Treatments such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are crucial for managing CAD. While CABG is often preferred for complex cases, many patients require PCI due to graft failure or new blockages post-CABG. This study evaluates PCI outcomes in Pakistani and Saudi patients with prior CABG, addressing the scarcity of regional data., Objective: The primary objective was to measure the success rate of PCI in post-CABG patients, defined as achieving less than 30% residual stenosis without major complications. Secondary objectives included assessing the incidence of restenosis, repeat revascularization, and major adverse cardiac events (MACEs) over one year., Methods: This one-year prospective cohort study was conducted at multiple tertiary care hospitals in Pakistan and Saudi Arabia, involving 246 participants aged 18 years and older who had previously undergone CABG. Participants underwent PCI using standard procedures. Data were collected on demographic information, clinical characteristics, procedural details, and follow-up outcomes. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with descriptive statistics summarizing the baseline characteristics. The chi-square test or Fisher's exact test compared categorical variables, and the t-test or Mann-Whitney U test was used for continuous variables. A p-value of less than 0.05 was considered statistically significant., Results:  The mean age of the participants was 63.5 ± 10.2 years, with 73.2% being male. The PCI success rate was 91.5% (95% CI: 88.2-94.8%), with most patients achieving less than 30% residual stenosis. There were 15 cases (6.1%) of MACEs, including five myocardial infarctions (2.0%) and 10 urgent revascularizations (4.1%). Restenosis occurred in 20 patients (8.1%; 95% CI: 4.7-11.5%), and repeat revascularization was required in 18 patients (7.3%; 95% CI: 4.0-10.6%). Kaplan-Meier survival analysis indicated no significant difference in MACE-free survival between patients with and without restenosis (log-rank test, p=0.423)., Conclusion: The high success rate of PCI in post-CABG patients across both Pakistan and Saudi Arabia suggests that it is a viable option even in complex cases. These findings can inform clinical practice, emphasizing the importance of consistent follow-up and tailored interventions to enhance patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Sulaiman Alrajhi University, Riphah International University, Khyber Medical University, Lady Reading Hospital, Altamash General Hospital issued approval IRB/RIU/2023/78432, IRB/SAU/2023/10456, IRB/KMU/2023/19234, IRB/AGH/2023/23498, IRB/LRH/2023/56123. The study adheres to ethical recommendations, including obtaining informed consent, ensuring participant confidentiality, minimizing risks, and upholding the right to withdraw from the study at any time. Participants were selected fairly, and any adverse events were promptly reported and addressed. The integrity of the data was preserved, and the potential benefits of the research were carefully weighed against any associated risks. Participants were also provided with access to study results and offered any beneficial treatments following the conclusion of the study. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohammad et al.)

Background: Primary lung signet-ring cell carcinoma (LSRCC) is a rare form of aggressive lung cancer whose clinical features remain inadequately discerned. The objective of this study was to evaluate the clinicopathological characteristics and independent prognostic factors of primary LSRCC., Methods: Overall survival (OS) of patients with LSRCC, lung adenocarcinoma (LAC), and lung mucinous adenocarcinoma (LMAC) in the National Cancer Database from 2004 to 2018 was evaluated using Kaplan-Meier and multivariable Cox proportional hazards modeling. Independent prognostic indicators for patients with LSRCC were determined using multivariable Cox proportional hazards analysis., Results: A total of 1,705 LSRCC, 504,006 LAC, and 15,883 LMAC patients were included in our analysis. LSRCC histology was significantly associated with younger age, male sex, larger and more poorly differentiated tumors, later American Joint Committee on Cancer (AJCC) stage disease, higher clinical T, N, and M status, more use of chemotherapy, and less use of surgery when compared to LAC and LMAC patients. In unadjusted analysis, patients with LSRCC had significantly worse OS when compared to patients with LAC and LMAC. In multivariable analysis, patients with LSRCC experienced significantly worse OS when compared to only patients with LAC. Independent predictors of survival for patients with LSRCC were younger age, later year of diagnosis, lower Charlson/Deyo comorbidity condition scores, lower AJCC stage, higher income, smaller tumors, treatment with surgery, and receipt of chemotherapy., Conclusions: In this national analysis, LSRCC was found to be associated with distinct clinicopathological characteristics from those of LAC., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-102/coif). C.F.J.Y. serves as an unpaid editorial board member of Journal of Thoracic Disease from February 2023 to January 2025. He declares honoraria from AstraZeneca for summit participation and is on the advisory boards for AstraZeneca and Genentech. The other authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Objective: To evaluate the clinical learning environment among undergraduate physical therapy students., Methods: The descriptive, cross-sectional study was conducted from Januar y 23 to May 25, 2023, after approval from the ethics revie w committe e of Imran Id rees Ins titute of Rehabilitation Sciences, Sial kot, Pak istan, an d comprised undergraduate physical therapy students of either gender aged 19-26 years in their 3rd to 5th academic year studying in different institutions in Lahore and Sialkot. Data was collected using the clinical learning evaluation questionnaire. Data was analysed using SPSS 22., Results: Of the 295 students, 269(91.2%) were females and 26(8.8%) were males. The overall mean age was 22.03±1.14 years. There were 210(71.2%) stude nts enrol led in the semester system , w hile 85(28.8%) we re part of the an nual system. The overall mean score was 71.05±10.20. Super vision (76.02±11.80) and motivation (80.21±11.71) were the most satisfying part of clinical learning identified by the students., Conclusions: The clinical learning environment demonstrated high satisfac tion levels in supervision and motivation domains, while im provements were nee ded in the areas of cas es, authenticity and organisation of doctor-patient encounters.

Objective: This research aims to explore the outcome of teaching through integration, on nursing students learning using Harden model (1984) of curriculum strategy., Methods: The study used action research as a methodology. Two modules of Year II BScN curriculum were taught through integration to 120 students at a private nursing institute in Karachi, Pakistan. The Data was collected from February to May 2018. Four focus group discussions (FGD) of six students each were conducted, before and after module implementation. The data were analysed using Creswell method., Results: The study findings consist of three themes "integration adds to contentment", "integration carries challenges and "integration supplements teaching learning strategies" with their respective subthemes as Complete connected and comprehensively concise" Integration carries challenges, added burden, and lacked creativity and logistics., Conclusions: The findings show that teaching through integrated modules help students to become focused and responsible learner, optimize understanding of concepts, and strengthen theory practice integration for delivering holistic care. The study recommends to use integration strategy as a step towards enhanced student learning and better patient outcome.

Background: Despite significant measures, low- and middle-income countries (LMICs), including Pakistan, struggle to curtail non-prescription antibiotic sales, enforce regulations, and implement National Action Plan (NAP) against antimicrobial resistance (AMR). NAP Pakistan entails drug inspectors (DIs) to ensure prescription-based sales of antibiotics. This study seeks to understand the perspective of DIs regarding antimicrobial sales without prescription, underlying factors, and policy implementation status., Methods: A qualitative study employing a semi-structured interview guide using in-depth interviews with purposively selected 17 DIs was conducted. Interviews were transcribed verbatim, and data were analyzed following a thematic analysis framework utilizing MAXQDA 2022 software., Results: Five main themes emerged after data analysis: (1) drug inspector - the regulator of the antimicrobial armamentarium, (2) the policy context, (3) awareness regarding AMR, (4) barriers to combatting AMR, and (5) the way forward: strategies and recommendations., Conclusion: A weak regulatory framework, low level of awareness, quackery, vested interests, and socio-economic factors augment inappropriate antibiotic utilization. Opting for better policies and strengthening the DI fraternity as outlined in NAP Pakistan is recommended. Recognizing drug inspectors as effective surveilling units and mobilizing field force against irrational antibiotic utilization is the need of the hour and requires policy reformation.

Background: Advances in targeted therapies have expanded the treatment options for colorectal cancer (CRC), allowing for more tailored and effective approaches to managing the disease. In targeted therapy, Bevacizumab is a commonly prescribed anti-VEGF monoclonal antibody that has a direct anti-vascular impact in cancer patients. Vascular Endothelial Growth Factors (VEGFs), especially VEGF-A, are significant agents in promoting tumour angiogenesis ., Objective: To assess the impact of adding Bevacizumab to chemotherapy on progression-free survival (PFS) and overall survival (OS) in patients with metastatic colorectal cancer., Methodology: Comprehensive searches have been performed on electronic databases such as PubMed, and Google Scholar using the following terms: colorectal cancer, adenocarcinoma, Bevacizumab, chemotherapy, and monoclonal antibody., Results: In the meta-analysis, 16 out of the 24 included studies were analysed. In the final analysis, incorporating Bevacizumab with chеmothеrapy demonstrated favourable outcomes for OS with a hazard ratio (HR = 0.689,95%CI: 0.51-0.83, I ² = 39%, p <0.01) and for PFS with a hazard ratio (HR = 0.77 95% CI: 0.60-0.96, I² = 54%, p  < 0.01). The subgroup analysis of PFS, categorised by study dеsign (prospеctivе vs rеtrospеctivе), reveals that the Hazard Ratio (HR = 0.82, 95% CI: 0.62-0.97, I ² = 21%, p  < 0.01) and for OS with a hazard ratio (HR = 0.73, 95% CI: 0.52-0.86, I² = 17%, p  < 0.01)., Conclusion: Our findings indicate that combining Bevacizumab with chemotherapy enhances clinical outcomes and results in a significant increase in PFS and OS in patients with metastatic colorectal cancer. Positive outcomes are demonstrated by a substantial 23% increase in PFS and 31% increase in OS in patients with metastatic colorectal cancer who undergo Bevacizumab in conjunction with chemotherapy ., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Purpose: Torasemide is a potassium-sparing loop diuretic used to treat fluid retention associated with congestive heart failure and kidney and hepatic diseases. This systematic review was conducted to combine all accessible data on the pharmacokinetics (PK) of torasemide in healthy and diseased populations, which may help clinicians avert adverse drug reactions and determine the correct dosage regimen., Methods: Four databases were systematically searched to screen for studies associated with the PK of torasemide, and 21 studies met the eligibility criteria. The review protocol was registered in the PROSPERO database (CRD42023390178)., Results: A decrease in maximum plasma concentration (C max ) was observed for torasemide after administration of the prolonged-release formulation in comparison to that after administration of the immediate-release formulation, that is, 1.12 ± 0.17 versus 1.6 ± 0.2 mcg/mL. After administering an oral dose of torasemide, a 2-fold increase in the area under the concentration-time curve (AUC) was reported in patients with congestive heart failure compared with the healthy population. Moreover, the patients with renal failure (clearance < 30 mL/min) showed an increase in value of AUC 0-∞ that is, 42.9 versus 8.091 mcg.h -1 .mL -1 compared with healthy subjects. In addition, some studies have reported interactions with different drugs, in which irbesartan showed a slight increase in the AUC 0-∞ of torasemide, whereas losartan and empagliflozin did not., Conclusions: The current review summarizes all available PK parameters of torasemide that may be beneficial for avoiding drug-drug interactions in subjects with renal and hepatic dysfunction and for predicting doses in patients with different diseases., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The objective of this study was to evaluate the overall survival of patients with ≤8 mm non-small cell lung cancer (NSCLC) who undergo wedge resection versus stereotactic body radiation therapy (SBRT). Kaplan-Meier analysis, multivariable Cox proportional hazards modeling, and propensity score-matched analysis were performed to evaluate the overall survival of patients with ≤8 mm NSCLC in the National Cancer Database (NCDB) from 2004 to 2017 who underwent wedge resection versus patients who underwent SBRT. The above-mentioned matched analyses were repeated for patients with no comorbidities. Patients who were coded in the NCDB as having undergone radiation because surgery was contraindicated due to patient risk factors (e.g., comorbid conditions, advance age, etc.) and those with a history of prior malignancy were excluded from analysis. Of the 1505 patients who had NSCLC ≤8 mm during the study period, 1339 (89%) patients underwent wedge resection, and 166 (11%) patients underwent SBRT. In the unadjusted analysis, multivariable Cox modeling and propensity score-matched analysis, wedge resection was associated with improved survival when compared to SBRT. These results were consistent in a sensitivity analysis limited to patients with no comorbidities.