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Patient and Observer Scar Assessment Scale Version 3.0 (POSAS 3.0) is a robust instrument for scar evaluation. Currently, no validated POSAS 3.0 in the Malay language is available. This study aimed to translate, culturally adapt, and psychometrically evaluate POSAS 3.0 for Malay-speaking populations in Malaysia. Malaysian patients were recruited between 31 October 2023, to 31 December 2024. Translation was conducted using a forward and backward translation approach. Reliability was assessed using internal consistency (Cronbach's alpha) and test–retest. Face validity was addressed with 10 patients, and content validity was evaluated by four clinical specialists. Content validity was evaluated using the item-content validity index (I-CVI) and content validity ratio (CVR). Construct validity was assessed using exploratory factor analysis (EFA). Seventy-eight participants with facial (n = 39, 50.0%) and non-facial (n = 39, 50.0%) soft tissue scars were recruited for the EFA. The Malay POSAS-O demonstrated acceptable internal consistency (α = 0.75) and excellent inter-rater reliability, with item-level intraclass correlation coefficient (ICCs) ranging from 0.91 to 1.00 and total score ICC of 0.99. Agreement for categorical scar severity ratings was almost perfect (κ = 0.89). The Malay POSAS-P showed excellent internal consistency (α = 0.89), and test–retest reliability for the total score was good to excellent (ICC = 0.89). Intermittent symptom items (painful, shooting, burning and fragile) exhibited lower stability, reflecting natural symptom variability. Content validity was excellent, with all items achieving I-CVI and CVR values of 1.00. EFA supported construct validity, with adequate Kaiser-Meyer-Olkin (KMO) values (POSAS-O: 0.88; POSAS-P: 0.85), significant Bartlett's tests, strong communalities and factor loadings. The cumulative variance explained was 79.05% for POSAS-O and 68.19% for POSAS-P. The Malay version of the POSAS 3.0 is a reliable, valid, and culturally appropriate instrument for scar assessment. Its strong psychometric properties support its application in clinical practice and research involving Malay-speaking populations.
Kidney transplant recipients are at increased risk of surgical site infections (SSIs) due to procedural complexity and immunosuppression. This retrospective single-centre study examines the influence of BMI on SSI risk and identifies common pathogens. A total of 230 renal transplant patients were included in this analysis 2017 and 2019. All patients received a cephalosporin for prophylaxis, and wound swabs were taken from those who developed SSIs. SSIs occurred in 45 patients (19.6%) and were not significantly associated with age, sex or donor type. The most common organisms were coagulase-negative staphylococci (26.7%), Staphylococcus epidermidis (24.4%), Enterococcus faecalis (22.2%) and Candida albicans (22.2%). SSIs were significantly linked to surgical revision (p < 0.001) and higher BMI (p = 0.027). A BMI ≥ 28.1 was associated with threefold higher odds of SSIs (OR = 3.0; p = 0.001). Each one-unit increase in BMI was associated with a 7.2% increase in the odds of SSI occurrence (OR = 1.072; p = 0.020). Staphylococcus (p = 0.019) and Enterococcus (p = 0.048) infections were more common in patients with BMI > 28.1. Therefore, SSIs are a frequent complication posttransplant and are strongly associated with high BMI. Standard antibiotic regimens may not cover all relevant pathogens in obese patients, underscoring the need for tailored prophylactic strategies.
Pressure injuries are largely preventable yet remain common in hospital care. This multi-hospital study assessed nurses' knowledge, attitudes and practices for prevention in governmental, private and charitable hospitals in Nablus, Palestine, and examined links with professional characteristics. A descriptive cross-sectional study was conducted in six hospitals in Nablus city, Palestine. A total of 231 registered nurses were recruited using convenience sampling and completed a content-validated, self-administered questionnaire assessing demographics, knowledge (20 items), attitudes (11 items), and practices (17 items). Data were analysed using descriptive statistics, one-way analysis of variance with Tukey post hoc tests, and binary logistic regression for adequate knowledge and practice (≥ 80%). Overall, 64.5% demonstrated adequate knowledge, and 58.0% expressed a favourable attitude. Practice adherence averaged 70.9 ± 16.3 out of 100. Only 31.6% achieved ≥ 80%, indicating suboptimal practice in most participants. Key gaps involved massage avoidance and the use of lifting devices. Knowledge was higher with recent PI training (1–2 years vs never: OR = 4.110, 95% CI 1.622–10.414, p = 0.003; 2–3 years vs never: OR = 3.047, 95% CI 1.208–7.687, p = 0.018). Practice adequacy was higher with training < 1 year ago vs never (OR = 4.146, 95% CI 1.636–10.512, p = 0.003). Other adjusted associations were imprecise and treated as exploratory. Nurses showed generally adequate knowledge, whereas routine preventive practice remained less consistent. Recent training was associated with better knowledge and practice, suggesting that targeted education, supervised skills training, unit-level protocols and audit with feedback may support improvement.
Burns are a major cause of morbidity in Yemen, and their prevention relies heavily on community knowledge and safe practices. Understanding gaps in awareness and behaviour is essential for designing effective interventions. This study assessed the knowledge, attitudes and practices (KAP) regarding burn prevention and first aid among a Yemeni community. A cross-sectional survey was conducted among 380 participants using a structured questionnaire distributed via social media and community networks. Data were collected on demographics, educational level, occupation, residential area and KAP related to household, electrical and chemical burns. Associations between participant characteristics and burn-related KAPs were analysed. Participants were predominantly female (63.7%), aged 15–45 years (79.8%), urban residents (92.9%) and university-educated (82.1%). Healthcare workers comprised 50.8% of respondents. Knowledge of burn prevention and first aid was highest among university-educated and healthcare participants, with 84.6% correctly identifying initial burn management. Unsafe practices, such as applying honey or toothpaste and improper handling of chemical or electrical injuries, were more common among less-educated, rural and nonhealthcare respondents. Urban participants demonstrated better preventive practices, while cultural reliance on traditional remedies persisted across all groups. Among predominantly urban and educated populations in Yemen, knowledge and attitudes toward burn prevention and first aid are generally favourable; however, gaps persist, particularly in rural and less-educated communities. Cultural practices and misconceptions continue to limit optimal care. These findings underscore the urgent need for culturally sensitive, literacy-appropriate, community-based interventions to improve burn prevention, first aid practices and equitable health outcomes.
Keloids are chronic fibroproliferative skin disorders with high recurrence rates and limited treatment options, yet reliable diagnostic biomarkers are lacking. Current classification systems rely heavily on clinical observation, underscoring the need for objective, noninvasive tools. In this exploratory study, serum-based 1H nuclear magnetic resonance (NMR) measurement combined with short-time Fourier transform (STFT) for time-frequency analysis was performed, followed by principal component analysis (PCA), to investigate potential patient subgroups. Serum samples from 29 patients were analysed and PC1 scores suggested two potential patient subgroups. Retrospective analysis showed that these subgroups differed primarily in keloid aetiology: one group predominantly included cases arising from unclear or minimal causes (e.g., acne, folliculitis), whereas the other comprised cases following clear traumatic events (e.g., surgery). Although most clinical variables showed no significant differences, significant differences in aetiology and Japan Scar Workshop Scar Scale (JSS) scores support the biological relevance of this separation of subgroups. These findings suggest that the time-frequency features of NMR signals from serum samples capture systemic characteristics associated with keloid pathophysiology. If validated in larger cohorts, this approach may serve as a noninvasive adjunct to clinical assessment and lay the foundation for objective patient stratification and precision-guided treatment strategies.
Burn injuries are a significant cause of morbidity and mortality globally; however, limited data are available from low- and middle-income countries such as Jordan. This study aimed to describe burn patient presentation, initial management and factors associated with in-hospital mortality. A retrospective descriptive study was conducted using records of 493 patients admitted to a national referral centre in Jordan between 2018 and 2022. The sample was predominantly male (61.5%) with a mean age of 19.6 years (SD = 21); children under 18 years comprised 58.4%. The mean total body surface area (TBSA) burned was 18%. Flame (50.1%) and scald (44.6%) injuries were most common. Inhalation injury occurred in 25.8% and 21.3% required mechanical ventilation. The hospital mortality rate was 15.6%, significantly associated with TBSA, age, inhalation injury and low serum total protein. Baux and revised Baux scores showed high predictive accuracy (AUC = 0.902 and 0.918). Logistic regression identified TBSA, age, inhalation injury and total protein level as independent predictors of mortality. Burn injuries in Jordan disproportionately affect children and are associated with substantial mortality. Early identification of high-risk patients using validated scores and prompt nutritional and respiratory interventions are essential. Multicentre studies and a national burn registry are recommended to guide future policy and care improvements.
The number of patients requiring wound care is increasing, placing a burden on healthcare institutions and clinicians. While negative pressure wound therapy (NPWT) use has become increasingly common, Middle East-specific wound care guidelines are limited. An in-person meeting was held in Dubai with 15 wound care experts to develop guidelines for NPWT and NPWT with instillation and dwell (NPWTi-d) use for the Middle East. A literature search was performed using PubMed, Science Direct and Cochrane Reviews. Prior to the meeting, panel members reviewed literature and existing guidelines on NPWT and/or NPWTi-d use. A wound management treatment algorithm was created. Patient and wound assessment at presentation and throughout the treatment plan was recommended. Primary closure was recommended for simple wounds, and NPWT use was suggested for complex wounds requiring wound bed preparation. NPWTi-d use was advised when wound cleansing is required, if the patient is unsuitable for surgical debridement, or if surgical debridement is delayed. When NPWTi-d is unavailable, panel members recommended NPWT. Panel members recommended NPWT for wound bed preparation and NPWTi-d when wound cleansing is needed. These recommendations provide general guidance for NPWT and NPWTi-d use and should be updated as more clinical evidence becomes available.
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