The ASIDE Health Sciences Journal , a publication of the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE), is dedicated to advancing the fields of healthcare through a lens of diversity, equity, and inclusion. This peer-reviewed, open-access journal publishes a wide range of research articles, reviews, and clinical studies that focus on innovative healthcare solutions, the impact of social determinants on health outcomes, and strategies for enhancing accessibility to medical services for marginalized populations. With a commitment to fostering a more inclusive healthcare environment, the journal serves as a pivotal platform for medical professionals, researchers, and educators worldwide to share insights and discoveries that can lead to more equitable health practices and policies.
American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE)
Cross-Cultural Application of the Beck Depression Inventory (BDI-I/II) for Assessing Adolescent Depression in Low- and Middle-Income Countries: A Critical Review of Evidence from the Last Quarter-Century
Background: The Beck Depression Inventory (BDI-I/II) versions are widely used for identifying depression among adolescents in low- and middle-income countries (LMICs). Nevertheless, their global usage depends on the questionable assumption that symptoms are expressed the same way in different cultures. Methods: This comprehensive review used narrative synthesis to explore the psychometric, conceptual, and ethical aspects of the BDI studies done on adolescents in LMICs. We purposively selected 8 case exemplars from the literature based on a pre-specified framework to illustrate key cross-cultural and methodological issues. A custom rubric was used to weight studies by methodological quality. Invariance evidence was defined as explicit reporting of multi-group confirmatory factor analysis (MGCFA) for configural, metric, or scalar invariance. Results: Although the BDI showed high internal consistency across the 8 exemplar studies (Cronbach’s α: 0.79–0.96), it revealed significant psychometric variation across cultures. Somatic items showed substantial overlap with medical comorbidities (e.g., HIV, malnutrition) in vulnerable populations, confounding diagnostic specificity. Factor structures were inconsistent, and rigorous measurement invariance testing was largely absent. Discussion: The widespread absence of scalar invariance suggests that current cross-cultural score comparisons may reflect measurement artifacts rather than true differences in depression severity. Beyond psychometrics, BDI presents ethical challenges regarding developmentally inappropriate items, particularly concerning sexuality and suicidality, that limit its validity in conservative or resource-limited contexts. Conclusion: Investigations into this issue should focus more on the use of invariance-testing frameworks, the implementation of a mixed-methods strategy, and the recognition of the need for sensitive translation and culturally appropriate assessment techniques.
Low- and Middle-Income Countries (LMICs)
Low- and middle-income countries (LMICs)
Copyright (c) 2026 Anas Al-Qatefy, Abdelrahman Tolba, Zeyad Eldawy, Mahmoud Ghallab https://creativecommons.org/licenses/by/4.0
War Injuries of External Male Genitalia: A Prospective Single-Center Study from the General Military Hospital, Sana’a, Yemen (2022–2024)
Background: War-related external male genital injuries are uncommon but clinically significant, often coexisting with severe pelvic, vascular, and musculoskeletal trauma and causing potential long-term functional, cosmetic, and psychological effects. Methods: This prospective, single-center study at the General Military Hospital, Sana’a, Yemen, included all consecutive male patients presenting with war-related external genital injuries from April 2022 to March 2024. Minor isolated injuries were managed in the emergency department, while severe or associated injuries required admission. Data collected included injury mechanism, management, complications, and short-term outcomes. Primary outcomes were injury patterns, management strategies, and one-month clinical outcomes. Secondary outcomes included complications, erectile function, cosmetic acceptability, and semen analysis at one month. Results: Fifty-two patients (mean age 23.3 ± 4.9 years) were included. Penetrating trauma occurred in 44 (84.6%) and blunt trauma in 8 (15.4%). Penile injuries were seen in 16 (30.8%) and testicular injuries in 46 (88.4%). Isolated genital injuries occurred in 20 (38.4%), with 32 (61.5%) having associated injuries. All patients underwent surgery for penetrating wounds, large hematomas, or hematoceles. At one-month follow-up, early complications occurred in 12/52 patients, including wound infections (15.4%) and urinary tract infections (7.7%). Of 42 patients completing investigations, semen analysis was normal in 71.4%, and 28.6% had abnormal semen parameters. Late complications included testicular atrophy (33.3%), erectile dysfunction (4.8%), and post-operative penile curvature (4.8%). Conclusion: Prompt assessment and timely surgical management are essential. While most patients had satisfactory short-term outcomes, a notable proportion experienced complications, highlighting the need for structured protocols and longer follow-up.
Copyright (c) 2026 Wael Alsaqaf, Khaled Alkohlany, Majdi Alshami , Mahmood Shaif , Abdullah Al-Sakkaf, Ahmed Farei, Aziz Shamsan, Nasser Albaddai https://creativecommons.org/licenses/by/4.0
The Gate for Aspiring Researchers Event 2025 – Towards Precision Medicine
This supplement contains ten scientific abstracts presented at the “Gate for Aspiring Researchers Event 2025 – Towards Precision Medicine,” held at the Faculty of Medicine, Alexandria University, Egypt, on 22 October 2025. The abstracts cover a wide range of topics across clinical medicine, epidemiology, systematic reviews, and meta-analyses, reflecting current research priorities and the growing role of precision medicine in disease prevention, diagnosis, and treatment. All abstracts were reviewed and selected by the scientific committee of the meeting.
Copyright (c) 2025 Organizing Committee of the Gate for Aspiring Researchers Event 2025 https://creativecommons.org/licenses/by/4.0
Search Filters to Identify Automation in HEOR: An Umbrella Review of Performance and Overlap
Background: Search strategies used to identify evidence on automation in Health Economics and Outcomes Research (HEOR) often lack sensitivity and specificity, resulting in information overload or missed studies. This umbrella review evaluated and compared the performance and overlap of search filters commonly used to retrieve automation-related HEOR evidence. Methods: Systematic literature reviews (SLRs) and search filters focusing on any form of automation in HEOR were included. Searches (January 01, 2023–July 03, 2024) were conducted in EMBASE, ISSG Resource, and Google Scholar. Subject headings, search terms, and performance metrics were extracted. Reference lists were cross-checked. Screening was performed by one reviewer, with 20% verified by a second reviewer. The PRESS checklist was used to assess search strategy quality. The protocol was registered with the Open Science Framework (OSF). Results: Seven SLRs and one standalone filter, reporting 11 search strategies, met the inclusion criteria. HEOR relevance was defined by studies applying search filters in contexts of SLRs, indirect treatment comparisons, and economic modeling. Included SLRs retrieved between 5-273 studies. PubMed was the most frequently searched database. Commonly used subject headings included “artificial intelligence,” “deep learning,” “machine learning,” and “natural language processing,” with “artificial intelligence” the most frequent free-text term. Inclusion rates varied: title/abstract (1%–8%), full-text (27%–86%), and final inclusion (0.13%–2.31%). Time to include one study ranged from 0.6-8 hours. Conclusions: Considerable variability in search filter performance was observed, causing lower specificity and inefficient evidence retrieval. Standardized, high-performing search strategies are needed to enhance efficiency and reliability in identifying automation-related HEOR evidence.
Artificial Intelligence in Health Economics
Health Economics and Outcomes Research (HEOR)
Copyright (c) 2025 ASIDE Health Sciences https://creativecommons.org/licenses/by/4.0
Effectiveness of Alcohol Gel-Based Antiseptics Against Multidrug-Resistant Bacteria: An in vitro Experimental Study
Background: Since the 19th century, asepsis has revolutionized public health, and hand hygiene remains a cornerstone of infection control, particularly in healthcare settings with high exposure to resistant microorganisms. This study aimed to evaluate the antimicrobial efficacy of four commercial alcohol-gel brands (A, B, C, and D) against standard ATCC strains of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis, which are prevalent in clinical environments. Methods: The disk-diffusion method was employed on Müeller-Hinton agar, using sterile disks impregnated with each gel sample. Following a 24-hour incubation at 35°C, the resulting halo zones were measured. Results: Significant variability was observed among the brands. Brand C exhibited the highest antimicrobial activity, particularly against P. aeruginosa (11.10 mm), with an overall mean inhibitory activity of 9.8 mm. Brand B demonstrated broad efficacy (mean 9.2 mm), while Brand A showed moderate activity with higher variability (mean 7.9 mm). Brand D demonstrated minimal to no inhibitory activity in the disk-diffusion assay compared to the other tested products (mean 4.3 mm). These differences were statistically significant across all tested bacteria. Conclusions: These findings indicate that alcohol concentration is not the sole determinant of antimicrobial performance. Formulation factors—such as humectants, polymers, and viscosity—substantially impact efficacy. The composition of an alcohol-based hand sanitizer directly governs its antimicrobial power. The study reinforces the importance of selecting validated products, adhering to hygiene protocols, and conducting microbiological surveillance to prevent healthcare-associated infections.
Quality of sepsis management in the Emergency Department at Goulburn Valley Health, Victoria, Australia: A Retrospective Audit
Background: This audit aims to assess the care of sepsis at Goulburn Valley Health by comparing current practice with national benchmarks and the local sepsis protocol. The secondary objectives explore relationships between different clinical factors and sepsis care to provide insights that may guide future studies. Method: The audit was conducted in the Emergency Department at Goulburn Valley Hospital in Shepparton. It involved a retrospective review of both electronic and paper medical records for patients diagnosed with sepsis. Included participants were patients admitted with sepsis or septic shock between January 1, 2023, and March 31, 2023. Key measurements included adherence to the local sepsis pathway, time from triage to intravenous fluids, time from triage to intravenous antibiotics, and compliance with the electronic Therapeutic Guidelines (eTG) for initial treatment. Additional measurements included time from triage to blood cultures, lactate trends, and adequacy of fluid resuscitation. Results: The median time from triage to fluid resuscitation was 51 minutes (IQR 32–91.5). The median time from triage to antimicrobial infusion was 68 minutes (IQR 48–117). Overall, 59% of patients received appropriate antimicrobial coverage, while 41% did not. Conclusion: The median infusion times compared favorably with the national pilot under the definitions used; however, differences in time-zero definitions, selection criteria, and a small sample size limit direct comparison. A notable proportion of patients did not receive appropriate antimicrobial coverage. Based on these findings, improvements in sepsis management are recommended, including implementing a sepsis bundle dashboard and strengthening antimicrobial stewardship efforts.
Socio-Cultural Determinants of Access to HIV Treatment and Care Among Pregnant and Postpartum People: A Systematic Review Protocol
Introduction: HIV-related maternal mortality remains high in many low-resource settings despite global declines. Lifelong antiretroviral therapy (ART) improves maternal and child outcomes, yet ART initiation, retention, and adherence remain suboptimal during pregnancy and postpartum. Socioeconomic, behavioral, and structural determinants influence linkage to care and viral suppression, but evidence describing their impact across the perinatal continuum remains fragmented. This review will synthesize these determinants through an equity lens using the PROGRESS-Plus framework, and reporting will follow PRISMA-E 2012 guidelines. Methods and Analysis: This protocol follows PRISMA-E 2012 guidelines and is registered with PROSPERO (CRD420250650979). A comprehensive search will be conducted across multiple databases for studies published from January 2012 to May 2025. Eligible designs will include quantitative, qualitative, and mixed-methods studies evaluating HIV testing, ART initiation, retention in care, and viral suppression in relation to socio-cultural, economic, behavioral, or health system factors. The PECO framework will be used (Population: pregnant/postpartum individuals with HIV ; Exposure: social/structural determinants; Comparator: not exposed; Outcomes: HIV care cascade indicators). Postpartum will be defined as up to 12 months after delivery, and adolescents aged 15–17 years will be included. Two independent reviewers will screen studies using Rayyan. Quality will be assessed using Joanna Briggs Institute tools. Random-effects meta-analysis will be conducted when feasible. Qualitative findings will undergo thematic synthesis; mixed-methods results will be integrated narratively. Ethics and dissemination: Approval is not required as this review uses publicly available data. Findings will be submitted for publication, presented at guideline meetings, and shared at scientific conferences.
Improving Compliance with the National Early Warning Score 2 (NEWS2) in an Egyptian Central Hospital Emergency Department: A Two-Cycle Clinical Audit
Background: NEWS2 is a standardized assessment tool used to determine illness severity and identify patients at risk of deterioration. However, its effectiveness is limited by systemic barriers. This audit primarily aims to evaluate NEWS2 compliance in an emergency department and implement targeted interventions to address recognized gaps. Methods: A two-cycle clinical audit was conducted at ShubraKhit Central Hospital's ED over a period of three weeks. Cycle 1 (August 18–25, 2025) established a baseline by assessing vital sign documentation, NEWS2 calculation, and escalation practices in 50 patients. The analysis of the root causes successfully identified the key barriers. Targeted interventions were implemented. Cycle 2 (September 1–8, 2025) re-audited the other 50 patients to evaluate the impact of the intervention. Data were analyzed using chi-square or Fisher’s exact tests as appropriate, with effect sizes and 95% CIs. Results: Cycle 1 showed serious and critical drawbacks, with only 2% of patients having a complete set of vital signs documented, and NEWS2 calculated in only 2% of cases. The primary barriers were a lack of equipment (96%) and a 100% lack of awareness of the escalation protocol. Following the suitable intervention, Cycle 2 demonstrated a significant improvement, with 100% of patients having all vital signs documented, and NEWS2 calculated in 96% of cases. Conclusions: A targeted intervention focuses on addressing specific root causes, leading to compliance with the NEWS2 scoring system. This ensures that evidence-based quality improvement can bridge the gap between clinical guidelines and practice.
Environmental Monitoring in a Class D Pharmaceutical Facility: Microbial Load and Hygiene Practices, a Risk-Based Cross-Sectional Study
Background: Environmental monitoring is a crucial current Good Manufacturing Practice (cGMP) tool for assessing the status of the working environment in a Pharmaceutical Manufacturing Facility. Methods: The test was conducted between May 20 and 25, 2025. 90 mm Diameter Settle Plates methods, 4 hours exposure under dynamic conditions, were used as a test method to study the microbial load in controlled and classified areas. The finger dab test was used to assess hygiene and sanitization practices in the plant. The non-viable count was excluded from the study due to limitations, including a lack of facilities for conducting the tests. Result: The result of the environmental monitoring test was below 100 colony-forming units (CFU) in the rooms. The mean value of Total Aerobic Microbial Count and Total Yeast and Mold Count shows a higher microbial count at the Near Return air loop. The p-value of Total aerobic microbial count and Total Yeast and Mold Count was found to be 0.8685 and 0.8716, respectively. The result is not significant at p<0.05. The result of the Finger dab test was below 100 CFU/5 fingerprints in both hands and complies with the internal action limit. Conclusion: The result of the study suggests that the higher load of organisms was found at the “near return loop area”. The result of the Finger dab test was satisfactory according to the in-house limit (100 CFU). The result can serve as a basis for selecting a sample spot for regular Environmental Monitoring in a Manufacturing Facility.
Robotic Versus Laparoscopic Hysterectomy for Extremely Large Uteri: A Systematic Review
Introduction: Hysterectomy for very large uteri is technically challenging and often requires open surgery. Minimally invasive approaches, such as robotic and laparoscopic techniques, provide alternatives, but their comparative safety and effectiveness for extremely large uteri remain uncertain. Methods: A systematic review was conducted following PRISMA 2020 guidelines. “PubMed and Scopus were searched through June 2025 using predefined keywords (e.g., ‘hysterectomy,’ ‘robotic,’ ‘robot-assisted,’ ‘laparoscopic,’ ‘uterus,’ ‘large,’ ‘enlarged,’ ‘size,’ ‘weight’); no prospective or randomized trials were identified.” for studies comparing robotic and laparoscopic hysterectomy in women with large or extremely large uteri Results: Robotic hysterectomy (RH) showed advantages in selected outcomes for extremely large uteri. One study reported a 70-minute reduction in operative time with RH for uteri >1000 g. RH was also associated with lower conversion rates (0–4.3%) compared to laparoscopic hysterectomy (LH) (5.3–10.9%). In moderately large uteri (~500–750 g), RH reduced hemoglobin drops but had longer operative times. Complication rates were generally low, although ureteral injury was more frequent with RH in two studies. Length of hospital stay was similar across approaches. Conclusion: Robotic hysterectomy may offer clinical and economic advantages over conventional laparoscopy for extremely large uteri but the impact of surgical experience should be carefully considered. Limitations include the retrospective design of all four cohorts, small sample sizes, the absence of randomized trials, and clinical and methodological heterogeneity precluding meta-analysis.
Cost-effectiveness in gynecologic surgery
Near-miss Osteomyelitis in an Immunosuppressed Crohn’s Disease Patient: Diagnostic Vigilance Sparked by a Medical Student
Crohn's disease (CD) patients on immunosuppressive therapy are at increased risk of infections, including osteomyelitis, which could be diagnostically challenging. This case highlights the importance of medical student vigilance in making a near-miss diagnosis of osteomyelitis in a CD patient. A 56-year-old CD patient developed left shoulder pain following localized muscle injection and was initially managed as a soft-tissue abscess. The condition worsened despite 21 days of antibiotics. Investigation: Cultures were positive for methicillin-sensitive Staphylococcus aureus (MSSA). Persistent pain and new neurologic complaints prompted an MRI (T1 hypointensity, T2-STIR hyperintensity, post-contrast enhancement) at 60 days, in support of osteomyelitis without bone biopsy. Management/Outcome: The patient received 6 weeks of intravenous vancomycin (1 g every 12 hours), followed by oral antibiotics, resulting in partial relief of pain (pain score: 8/10 to 4/10) and improvement in shoulder function (Constant-Murley score: 30 to 65 at 3 months). Immunotherapy (adalimumab) was restarted after infection control. This case highlights three practical lessons: maintaining a low threshold for advanced imaging in immunosuppressed patients with persistent pain; incorporating diagnostic time-outs to invite trainee perspectives; and seeking early infectious-disease consultation when osteomyelitis is suspected.
Aqueous Basella alba Mitigates Cyclosporine-Induced Nephrotoxicity in Wistar Rats: Relevance in Adjuvant Therapy
Introduction: Cyclosporine A (CsA) is an immunosuppressant agent that is usually considered as a first-line therapy against organ rejection after a transplant procedure. However, its administration is often associated with nephrotoxicity and a compromise of kidney function. There is a paucity of literature on the effects of aqueous Basella alba leaf extract (ABALE) in this condition. This study aimed to bridge the knowledge gap. Methods: Thirty male Wistar rats were divided into 6 groups of 5 rats each, such that the experimental groups received graded doses of ABALE at 100mg/kg, 200mg/kg, and 400mg/kg for 21 consecutive days, after inducing nephrotocity with CsA at 20mg/kg/day (i.p). Results: Treatment with ABALE resulted in a dose-dependent reduction of oxidative stress, inflammation, and elevated plasma markers of kidney dysfunction, with the highest dose showing the greatest protective effect (p < 0.05). Histological analysis of the kidneys also revealed near-normal architecture following ABALE treatment, while CsA administration was associated with marked vacuolation of the kidney interstitium and glomerular atrophy. However, no significant difference was observed between the untreated recovery group and the nephrotoxicity model group. Conclusion: ABALE mitigated cyclosporine-induced nephrotoxicity by suppressing plasma pro-inflammatory cytokines and restoring antioxidant balance. These findings suggest that the extract may serve as a promising adjuvant therapy in CsA-induced nephrotoxicity.
Dual versus Single Ovulation Triggers in In Vitro Fertilization and Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis
Background: Infertility remains a significant global health concern. Optimizing hormonal triggers, such as human chorionic gonadotropin (HCG) with or without gonadotropin-releasing hormone (GnRH) agonists, is crucial to enhance reproductive outcomes. We aim to evaluate and compare the reproductive success rates of dual trigger protocols (HCG + GnRH agonist) versus HCG alone in women undergoing assisted reproductive technologies (IVF/ICSI). Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published up to January 2025. Studies comparing reproductive outcomes in women undergoing IVF/ICSI who received either dual trigger (HCG + GnRH agonist) or HCG alone were included. Data were analyzed using RevMan version 5.4 and R Studio version 4.4.1. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, fertilization rate, and embryo quality metrics. Results: Seventeen studies with a total of 2,239 women were included: 1,118 in the dual trigger group and1,121in the HCG onlygroup.Thedualtriggergroupshowedsignificantlybetteroutcomesinterms of total oocytes retrieved, fertilized oocytes, follicles >15mm on trigger day, viable embryos, two pronuclei (2PN) formation, clinical pregnancy, biochemical pregnancy, live birth rate, good quality embryos, and fertilization rate. Conclusions Dual triggering with HCG and GnRH agonist appears to significantly enhance reproductive outcomes compared to HCG alone in women undergoing IVF or ICSI. These findings support the broader adoption of dual trigger protocols in assisted reproductive practice.
human chorionic gonadotropin hormones (HCG)
Gonadotropin-releasing hormone agonist (GnRH agonist)
Comparative Antimicrobial Efficacy of Cetrimide, Dettol, and Lizol Against Six Different Microbial Species on Epoxy-Coated Pharmaceutical Surfaces Using Surface Challenge Method
Introduction: Disinfectants are vital in the pharmaceutical industry's sanitization process and contamination control programs. However, many pharmaceutical companies lack systematic policies for selecting appropriate disinfectants, often relying solely on manufacturer claims, which may not always be reliable. The complexity of existing disinfectant testing methods further complicates proper evaluation, highlighting the need for practical, efficient approaches. Methods: This study used a simple surface challenge method to mimic real-world pharmaceutical conditions to test disinfectant efficacy. Three disinfectants, 1% Cetrimide, 2.5% Dettol, and 2% Lizol, were evaluated for antimicrobial activity. The test organisms included E. coli ATCC 8739, Salmonella typhimurium ATCC 14028, Pseudomonas aeruginosa ATCC 25619, Bacillus subtilis ATCC 6633, Candida albicans ATCC 10231, and an environmental isolate (Bacillus spp.). All testing was conducted on epoxy-coated floors within pharmaceutical industry premises. Results: All three disinfectants demonstrated excellent antimicrobial activity against the tested organisms. After a 20-minute contact time, each disinfectant achieved a ≥6-log reduction in test organisms. The comparative evaluation indicated that 1% Cetrimide exhibited superior antimicrobial effectiveness compared to 2.5% Dettol and 2% Lizol. Conclusions: The surface challenge method offers a practical approach for assessing disinfectant efficacy under pharmaceutical conditions. Among the disinfectants tested, 1% Cetrimide provided the most effective microbial reduction, suggesting its suitability for contamination control in pharmaceutical environments.
Development and Preliminary Evaluation of a Behavioral Lifestyle Assessment Tool: A Methodological Case Study with Graduate-Level Women
Introduction: Obesity in adults remains a pressing public health issue in the United States, closely linked to modifiable behaviors such as diet, physical activity, stress, sleep, and substance use. This study aimed to develop and pilot a brief, multidimensional assessment tool to identify lifestyle risk factors associated with obesity and inform future prevention efforts. Methods: A 30-item Behavioral Lifestyle Risk Assessment (BLRA) survey was developed to measure six domains: physical activity, diet, screen time, sleep, stress, and substance use. The survey was administered online via Microsoft Forms to a purposive sample of six adults. The small sample size was intentionally selected based on cognitive interviewing methodology, which recommends 5–10 participants for early-stage instrument clarity and feasibility testing. Descriptive statistics were used to summarize behavioral patterns and survey usability. Results: All six participants (100% female, aged 18–33) completed the survey without missing data or technical issues. Half reported low physical activity (1–2 days/week), 33% consumed fewer than two servings of fruits and vegetables daily, and another 33% had screen time exceeding eight hours daily. All participants reported moderate to high stress; 83% consumed alcohol, and 17% reported tobacco use. The average survey completion time was 6.8 minutes (SD = 0.6), with positive feedback on clarity and flow. Conclusion: Pilot findings suggest the BLRA is a feasible and user-friendly tool for assessing obesity-related behavioral risks. Broader testing in larger, diverse populations is recommended to validate its public health application.