University of Modern Sciences

Early and accurate detection of acute kidney injury (AKI)in children is difficult because serum creatinine rises late and lacks sensitivity. Serum cystatin C has been proposed as an earlier biomarker, but pediatric evidence has been inconsistent. We performed a systematic review and meta-analysis of studies evaluating serum cystatin C for pediatric acute kidney injury. PubMed, Cochrane Library, Scopus, and Web of Science were searched from inception through June 2025. Eligible studies compared cystatin C against standardized AKI definitions (KDIGO, pRIFLE, or AKIN) and reported sufficient diagnostic accuracy data. Two reviewers independently screened, extracted, and assessed study quality using QUADAS-2. Pooled estimates of sensitivity and specificity were calculated using a bivariate random effects model with hierarchical summary receiver operating characteristic curves. Subgroup and meta-regression analyses explored sources of heterogeneity. Certainty of evidence was assessed with GRADE-DTA. The review was registered with PROSPERO (CRD420251104342). Twenty-six studies comprising 3742 pediatric patients were included. Pooled sensitivity was 78.2% (95% CI 72.6-82.9) and specificity was 79.5% (95% CI 73.5-84.5), with an area under the curve of 0.854, reflecting good overall discriminatory power. Predictive values varied with disease prevalence: at 10% prevalence, the negative predictive value reached 97.0%, while at 40% prevalence, the positive predictive value increased to 71.8%. Bayesian meta-regression identified clinical setting as a significant effect modifier, with higher accuracy in ward-based studies compared with pediatric intensive care unit cohorts. Sensitivity analyses confirmed robustness, and no evidence of publication bias was detected. Certainty of evidence was rated moderate for sensitivity and specificity and high for area under the curve. Serum cystatin C is a reliable biomarker for early pediatric AKI detection, offering superior performance to creatinine and particularly strong rule-out value in lower-prevalence settings. Its clinical utility would be enhanced by standardized cut-offs, cost-effectiveness evaluation, and integration into biomarker panels.

Dutch harbours became key notes in European foreign fat supply in the twentieth century. These imports of oils and fats have had significant economic, social and environmental impacts worldwide. Demand for these resources was driven by food industries, intensive livestock farming and fossil fuel mitigation, and linked domestic practices to global supply chains. This paper investigates the development of Dutch imports of oils and fats over the past century. It examines (1) the scale and geographical distribution of these resources, analysing growth, decline and spatial shifts in supply; and (2) the dependencies between the Netherlands and supplying regions. The study further explores the developments in technology, governance and knowledge that shaped these developments. The article thus highlights the bittersweet global consequences of Dutch reliance on imported oils and fats. This article was published open access under a CC BY 4.0 licence: https://creativecommons.org/licenses/by/4.0/ .

El celebérrimo poema «Torso arcaico de Apolo», que Rilke escribió en 1908, muy probablemente tras observar con detenimiento una escultura alojada en el Louvre, gira en torno a la mirada del espectador. No obstante, dicha mirada se intensifica hasta convertirse en un imperativo categórico: «Debes cambiar tu vida». En otras palabras, la reflexión rebasa los límites de la obra de arte —una obra en parte ausente, incompleta— y se proyecta sobre la existencia del sujeto. A lo largo de las siguientes páginas procuraremos arrojar luz sobre la interpretación de este soneto tomando como punto de partida el inicio de El nacimiento de la tragedia, de Friedrich Nietzsche (1844-1900), cuyo influjo resulta insoslayable, como también su relación con la escultura, a la vida.

In an era of unprecedented environmental catastrophes that have become increasingly difficult to ignore, we often hear the term “Anthropocene”, denoting the profound human-induced planetary changes that have shaped the climate crisis we face today. However, dominant climate change discourses tend to rely on hegemonic Western techno-scientific paradigms of knowledge that deliberately obscure the enduring influence of colonial agendas in the making of ecological violence over centuries. Consequently, this paper emphasizes the urgent need for a critical reframing of the Anthropocene, calling for a transdisciplinary framework to illustrate how unequal power dynamics and cultural factors are deeply embedded in our present planetary predicament. Amitav Ghosh’s The Living Mountain offers a valuable critique, recontextualizing the Anthropocene within a historical framework of colonialism to address the complex interplay between ecological and cultural challenges. Drawing on Indigenous studies and postcolonial theory, this paper delves into how Ghosh’s narrative underscores the ongoing influence of colonial legacies—marked by systematic extraction and exploitation—in shaping today’s unfolding planetary crises. Simultaneously, Ghosh highlights the epistemic violence inherent in colonial worldviews that fundamentally sever human and more-than-human relations, proposing instead the centrality of Indigenous epistemologies for a decolonial understanding of the Anthropocene. Through a close reading of Ghosh’s fable, this paper contends that literature, through a transdisciplinary lens, provides alternative conceptions of the climate crisis beyond Western epistemes that sustain violent legacies of colonialism.

Fever is a prevalent clinical manifestation in pediatrics, representing a significant proportion of emergency department (ED) visits worldwide. While fever is often benign and self-limiting, it can also indicate life-threatening infections requiring immediate intervention, particularly in neonates and immunocompromised children. This comprehensive review delves into the intricate pathophysiology of fever, exploring its dual role as a protective immune mechanism and a potential physiological risk. It critically examines diagnostic challenges, evidence-based management strategies, and global disparities in fever treatment. Special emphasis is placed on parental perceptions, the overuse of antipyretics, and the emerging role of artificial intelligence in fever diagnosis. Future directions include refining diagnostic biomarkers, implementing digital health tools, and advancing antimicrobial stewardship to curb antibiotic resistance. By improving clinical decision-making and public awareness, this review aims to optimize the management of febrile children worldwide and enhance patient outcomes.

BackgroundCongenital heart defects (CHDs) constitute the predominant pediatric congenital anomaly in Yemen, substantially contributing to childhood morbidity and mortality.AimThis study aimed to investigate the outcomes of pediatric cardiac surgery, specifically comparing results between foreign and local surgical teams.MethodA retrospective cohort study was conducted using data from January 2004 to December 2019, sourced from a local electronic database and manual registration system. Demographic information, in-hospital complications, mortality, and length of stay were analyzed. The Aristotle Basic Complexity Score (ABC score) was used to categorize surgical procedures.ResultsThe cohort of 2052 patients experienced an overall complication rate of 36.2% and a mortality rate of 6.4%. Extended hospital stays (> 7 days) were associated with a higher complication rate (p < .001). Less complex procedures demonstrated lower complication and mortality rates. Surgical complexity and prolonged hospital stays were identified as predictors of postoperative complications and mortality. While the local team was a predictor of postoperative complications. Notably, mortality did not significantly differ between foreign and local teams (p = .194).ConclusionLocal teams successfully increased surgery volume while achieving comparable mortality rates to foreign teams. However, higher complication rates and extended hospital stays persist for cases managed by local teams, underscoring the need for targeted training and resource optimization.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13019-025-03586-5.

Abstract Background: The administration of sodium bicarbonate (SB) during pediatric inhospital cardiac arrest (IHCA) is common, yet its efficacy is debated, and current guidelines advise against its routine use. The objective of this study was to conduct a systematic review and meta-analysis to evaluate the impact of SB administration on outcomes in pediatric IHCA. Subjects and Methods: A systematic search was conducted on PubMed, EMBASE, Web of Science, and Scopus databases up to June 2025 for studies comparing outcomes between pediatric IHCA patients who did and did not receive SB. A meta-analysis using a random-effects model was performed to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs). The primary outcomes were survival to hospital discharge, favorable neurological outcome, and return of spontaneous circulation (ROSC). Results: Five studies involving 5662 patients were included. SB administration was associated with a significantly lower likelihood of survival to hospital discharge (RR = 0.60; 95% CI: 0.52–0.68) and a reduced rate of favorable neurological outcomes (RR = 0.58; 95% CI: 0.52–0.64). Furthermore, SB use was linked to a decreased likelihood of achieving ROSC (RR = 0.64; 95% CI: 0.46–0.87) and was more likely to be followed by the use of post-ROSC extracorporeal membrane oxygenation (RR = 2.20; 95% CI: 1.68–2.87). Conclusions: SB administration during pediatric IHCA is associated with significantly poorer survival and neurological outcomes. These findings support current guidelines recommending against the routine use of SB in this setting.

BackgroundThis study investigates the effectiveness of neo-adjuvant chemo-radiotherapy (neo-CRT) in patients with clinical stage II and III mucinous rectal adenocarcinoma (MRA) and compares clinical outcomes with those of non-mucinous rectal adenocarcinoma (NMRA).MethodsA retrospective analysis was performed on patients diagnosed with clinical stage II or III rectal adenocarcinoma, confirmed via pelvic imaging, who underwent curative surgical procedures from January 2009 to December 2023. Exclusion criteria encompassed stage I and IV cases, those treated as emergencies, and patients with inflammatory bowel disease. Patients were classified into neo-adjuvant treatment groups and compared based on tumor type (MRA vs NMRA) using statistical analyses.ResultsOf 550 cases, 359 met inclusion. Most patients were young adults (58% aged 20–30), reflecting unusually early onset in Yemen. Neo-CRT was administered to 180 patients (93 MRA, 87 NMRA), while 179 (87 MRA, 92 NMRA) did not receive it. NMRA tumors were 3.24× more likely to downstage than MRA (P = 0.0007; OR = 3.235). After CRT, yp Stage II occurred in 40.23% of NMRA (95% CI: 30.68–50.68%) versus 17% of MRA (95% CI: 10.99–26.15%), while yp Stage III persisted in 60% versus 82.80% respectively (P = 0.0003). Pathological complete response (pCR) was seen in 11% of NMRA but <2% of MRA. Survival analysis showed MRA as the strongest adverse factor (CSS HR = 2.07, 95% CI: 1.39–3.09, P = 0.0002; OS HR = 1.79, 95% CI: 1.25–2.57, P = 0.0013), with advanced stage also predictive of poorer outcomes (CSS HR = 1.65, P = 0.043; OS HR = 1.87, P = 0.006). Neo-CRT itself conferred no survival benefit (CSS HR = 0.98, P = 0.91; OS HR = 1.24, P = 0.24). Disease-free survival (DFS) was lower in MRA (52% vs 72%, P = 0.004) and local recurrence higher (26% vs 5%, P = 0.0004), while Neo-CRT produced no significant survival benefit (15% vs 19%, P = 0.40).ConclusionBoth MRA stages II and III showed inferior cancer-free and overall survival outcomes. The justification for neo-adjuvant therapy necessitates a careful evaluation of potential benefits versus risks in MRA patients. The younger age of Yemeni colorectal cancer patients warrants further epidemiological studies to explore genetic and environmental risk factors. It also highlights the urgent need for tailored screening protocols, public health interventions, and awareness campaigns.