Background: Non-syndromic combined pituitary hormone deficiency (CPHD) occurs due to defects in transcription factors that govern early pituitary development and the specification of hormone-producing cells. The most common mutations are in the Prophet of Pit-1 (ProP1) gene. This work aims to (1) report findings of genetic analyses of Tunisian patients with non-syndromic CPHD and (2) describe their phenotype patterns and their evolution through life. Methods: Fifteen patients from twelve unrelated families with variable clinical phenotypes were included after excluding autoimmune and acquired forms of non-syndromic CPHD. Detailed pedigree charts and auxological, hormonal, radiological, and therapeutic details were recorded. Sanger sequencing was performed, and sequences were analyzed with a specific focus on coding and splice site regions of the ProP1 gene. Retained variants were classified using several in silico pathogenicity prediction tools and the VarSome platform. Results: We identified the common p.Arg73Cys mutation in seven patients from four unrelated pedigrees. We found a novel homozygous mutation (c.340C>T) in one sporadic case. This mutation generates a truncated ProP1 protein, predicted to be non-functional, lacking the last 112 codons (p.(Gln114Ter)). We confirmed by polymerase chain reaction (PCR) the absence of large exon deletions or insertions in the remaining sporadic patients (7/8). Conclusions: We report two mutations {one newly identified [p.(Gln114Ter)] and one previously reported (p.Arg73Cys)} in five unrelated Tunisian families with non-syndromic CPHD. This work is of clinical importance as it reports the high frequency of the p.Arg73Cys mutation in Tunisian CPHD families. Our study also illuminated the involvement of novel gene(s) in the emergence of non-syndromic CPHD.

Mariam moalla

Ethanol extract of Luffa cylindrica (L.) Roem. Fruit peel was evaluated for antiemetic and anti-inflammatory effects using the chick emesis model and carrageenan-induced rat paw edema. The antiemetic effect was observed at 150 mg /kg body weight whereas the anti-inflammatory effect was observed at doses of 500, 750 and 1000 mg /kg body weight orally. Chlorpromazine 150mg/kg and indomethacin 10mg/kg orally were used as standard anti-emetic and anti-inflammatory drugs. The anti-emetic effect was determined by calculating the mean decrease in the number of retchings compared to those of the control group after 10 minutes of copper sulfate (50mg/kg orally) administration. The degree of paw oedema of all the groups was measured using a plethysmometer at the 5th hour of carrageenan (1% w/v) administration. The extract exhibited statistically significant anti-emetic (P< 0.001) and anti-inflammatory (P< 0.05) effects.

Dr. salman ahmed

Recent reports showed an association between bariatric surgery and the development of acute pancreatitis. This report presents a case of acute pancreatitis following a laparoscopic sleeve gastrectomy (LSG) in a 24-year-old Indian female patient, who presented to the Emergency Department at Hamad General Hospital, Qatar, with severe epigastric pain and persistent vomiting 13 days after LSG. She was diagnosed with acute pancreatitis based on a high level of lipase greater than three times the upper limit of normal, and a computed tomography scan of the abdomen, which was consistent with acute pancreatitis. The patient was treated conservatively with a significant improvement in her symptoms and laboratory tests throughout her admission and consequently was discharged.

Karishma

Monitoring and controlling of clean area environment is of paramount importance to ensure product safety and quality. This comprehensive analysis evaluates environmental monitoring (EM) data from Class C and Class D controlled environments in pharmaceutical manufacturing, utilizing Active Air (AA), Passive Air (PA), and Contact Plate (CP) or Replicate Organism Detection And Counting (RODAC) surface samples. The study aims to identify contamination trends, anomalies, and compliance with ISO 14644-1 and EU GMP Annex 1 standards. Results reveal unexpected findings: Class C Active Air (43 CFU/m³) and RODAC (3 CFU/plate) overall averages are higher than Class D Active Air (34 CFU/m³) and RODAC (2 CFU/plate), respectively, deviating from expected cleanroom classification. Class D Passive Air (22 CFU/plate) is higher than Class C (17 CFU/plate), aligning with expectations. Persistent hotspots were identified in Class C (e.g., location labelled “AA C 12 NG0”AA averages± Standard Deviation (SD): 67.33±17 CFU/m³), indicating localized control failures, while Class D showed extreme individual spikes (e.g., AA D 99 Ac: Max 171 CFU/m³). Sporadic contamination events in Class C suggest transient breaches, necessitating root-cause investigations. The study also highlights limitations of Class D monitoring, which obscures temporal trends and risks missing critical excursions due to long intervals between samples. Recommendations include targeted engineering assessments for high-load zones, enhanced Standard Operating Procedures (SOPs) for cleaning and gowning, adoption of real-time biofluorescent particle counters to replace manual sampling, and increased monitoring frequency in Class D hotspots.

Mostafa eissa

Diabetes mellitus is a common and chronic metabolic disorder. Uncontrolled diabetes mellitus leads to body organ damage if not treated properly. Educational intervention is necessary from health-care providers such as pharmacists to prevent or reduce organ damage and complications among the diabetic patients. Several studies have demonstrated the contribution of pharmacists in achieving a better control of diabetes mellitus. Thus, this study intended to assess the knowledge and practice regarding foot care among Libyan diabetic patients in Al-Bayda city. In addition, to determine the association between knowledge and practice regarding diabetic foot care with selected demographic variables. This is a cross sectional study conducted at Diabetes Center Aljabal Al akhdar in Al-Bayda between April and August, 2022. A total of 400 participants with diabetes were enrolled and interviewed by using a self-design questionnaire for knowledge and practice of foot care after taking verbal agreement. Data was analyzed by using SPSS software version 26.0. In this study, 191 subjects were male (47.8%) and 209 subjects (52.3%) were female. On the topic of foot care, 51.8% of the participants stated they did know how to perform correct foot hygiene and 33.5% stated that drying should consist of passing a towel between their toes. Female subjects statistically had more knowledge than male subjects on the right footwear and correct way of nail cutting (p < 0.01 and p < 0.001, respectively). In relation to practice, the frequency of patients with a good practice was 126 (31.5%) and with poor practice was 274 (68.5%). Evaluating the parameters dry, moisturize and nail cutting, women showed a significant difference in relation to men, with a high significance level in the three parameters. In conclusion, the knowledge and practice of foot care in Libyan patients with diabetes were poor. So, an educational program is recommended to improve the awareness of foot care. Diabetic patients should be provided information about self-care of their feet by health care providers such as pharmacists to prevent and delay onset of foot complications and improve the quality of life.

Mediterranean journal of pharmacy and pharmaceutical sciences

The use of spectroscopic analysis, particularly UV spectrophotometer, is a simple and essential technique for bulk drug estimation, formulation studies, and compatibility assessments of drugs with various excipients. In the pharmaceutical industry, various analytical instruments, including Fourier transform infrared spectroscopy (FTIR), are employed for investigating drug-excipient interactions that can impact the stability of active pharmaceutical ingredients. This study aimed to develop a UV spectrophotometric method for the analysis of Pioglitazone hydrochloride in phosphate buffer (pH 7.4) and methanolic solution, assessing its linearity and compliance with Beer's Law. Furthermore, we aimed to use FTIR to characterize potential interactions between Pioglitazone and common pharmaceutical excipients, such as Guar Gum, Chitosan, and Sodium Alginate. Standard solutions of Pioglitazone were prepared in phosphate buffer (pH 7.4) and methanol. UV spectrophotometer was conducted to determine the maximum absorption wavelength. Calibration curves were constructed to evaluate linearity and adherence to Beer's Law. FTIR analyses were performed to investigate drug-excipient interactions by examining the functional groups. In phosphate buffer (pH 7.4), the maximum absorption wavelength for Pioglitazone hydrochloride was 268 nm. The calibration curve for Pioglitazone in phosphate buffer (pH 7.4) demonstrated linearity in the concentration range of 1–20 μg/ml, with a correlation coefficient of 0.998. In methanol, the maximum absorption wavelength for Pioglitazone hydrochloride was found to be 272 nm. The calibration curve in methanol exhibited linearity in the range of 1–20 μg/ml, with a correlation coefficient of 0.999. FTIR analysis revealed potential drug-excipient interactions, particularly in the case of Guar Gum, Chitosan, and Sodium Alginate, suggesting the formation of stable hydrogen bonds. The developed UV spectrophotometric method for Pioglitazone analysis is a reliable, cost- effective, and reproducible approach, making it a valuable tool for drug development and quality control. Additionally, the FTIR characterization confirmed interactions between Pioglitazone and common pharmaceutical excipients, enhancing our understanding of formulation compatibility,

Archana mehrotra

The identification of isomorphism in epicyclic gear trains has been found a lot of attention by researchers for the last few years. Various methods have been suggested by different authors for the detection of isomorphism in planer kinematic chains and epicyclic gear trains (EGTs), but everyone has found some difficulties to address new issues. In this paper, a modified path matrix approach was presented in order to compare all the distinct geared kinematic mechanisms. A new method based on the matrix approach and corresponding train values is required to identify isomorphism among epicyclic gear trains and their mechanisms. The proposed method was examined on the basis of various examples from four-link, five-link, six links, and eight-link one-degree-of-freedom EGTs and six links two-degree-of-freedom EGTs. All the examples have been found satisfactory results with existing literature.

Jiyaul mustafa

Background and Objectives: The outpatient department (OPD) pharmacy is a section of the hospital pharmacy that helps patients obtain their prescribed medications. However, on-time delivery of medications and patients’ convenient access to the pharmacy are the hallmarks of a well-designed health-care system. Therefore, he aim of this study was to develop a pharmacy triage tool to improve patient flow and reduce waiting time in the fourth-floor pharmacy at Hamad General Hospital (HGH). Methods: This prospective and observational study was conducted on 14,740 patients who attended the OPD pharmacy (HGH, Qatar) between January 15, 2022 and March 15, 2022. This prospective and observational study consisted of three periods: A root cause analysis, a pre-intervention period of 1 month (January 15, 2021–February 14, 2021) and an intervention period of 1 month (15 February–15 March). We developed a pharmacy triage tool to improve patient flow and reduce waiting time by identifying patients who need their medications to be dispensed, as well as classifying patients to get the right patient to the right place and implementing a patient flow system to improve efficiency spends in pharmacy queues. Results: The results of this study showed that the use of the triage system in the pharmacy reduced the average waiting time of patients from 50 min to 15 min. The results were statistically significant at p<0.0001. Conclusion: We concluded that applying the pharmacy triage tool improved quality of services in health-care systems and decreased waiting time in the OPD pharmacy. The pharmacy triage tool is a new approach to enhancing the quality of healthcare and leads to an increase in the efficiency of OPD pharmacies.

Karishma

Anemia is a common health problem among Libyan women. Age, heavy menstruation, and pregnancy are vital risk factors for this problem. In this study, we prospectively examined 60 Libyan women all of which were diagnosed with iron deficiency anemia, their hemoglobin levels were less than 10.0 g/dl. The level of hemoglobin is also analyzed for vegetarian and charcoal-eating women. We found that during pregnancy charcoal-eating women exhibit lower hemoglobin levels than non-eating women. Pregnant young women in the age of 17-27 years have the lowest hemoglobin levels than the other age groups. In addition, vegetarians, heavy coffee and tea drinking, and heavy menstruation in non-pregnant women, as well as breastfeeding, strongly lower hemoglobin levels as measured by their complete blood count.

Mediterranean journal of pharmacy and pharmaceutical sciences

The present study evaluates the efficacy of Vilanterol-Fluticasone Furoate (VI-FF) versus Formoterol-Budesonide (FM-BD) combination therapy in stable asthma. Both regimens led to significant improvements in asthma control, as evidenced by marked increases in FEV1 (% predicted) and ACT scores over time. The demographic characteristics, baseline respiratory symptoms, and treatment outcomes were similar between the groups, indicating that both strategies were equally effective for managing asthma. The findings indicate that both VI-FF once daily and FM-BD twice daily therapies enhance lung function and asthma control. Significant improvements in FEV1 (% predicted) and ACT scores were observed in both groups, as confirmed by intention-to-treat (ITT) and perprotocol (PPA) analyses. The equivalent efficacy of VI-FF and FM-BD, combined with the convenience of once-daily dosing, suggests that VI-FF may be preferable for patients who struggle with a twice-daily regimen. These findings highlight VI-FF as a convenient and reliable treatment, particularly can benefit patients with adherence challenges. In conclusion, our study's findings align well with other studies regarding demographic characteristics, baseline symptoms, exacerbation history, hospitalization history, and spirometry results. This consistency reinforces the validity and reliability of our results, suggesting that both VI-FF and FM-BD are effective options for stable asthma. The comparable efficacy supports flexibility in treatment choices, allowing for personalized asthma management. Future research should explore the long-term benefits and adherence patterns associated with these treatments to further optimize asthma management.

Dr k c yadav

Mushrooms and fenugreek are widely used to reduce hyperglycemia, and fenugreek is also used as a culinary ingredient to enhance flavor and aroma. This study is aimed at investigating the underlying mechanisms of the hypoglycemic effects of mushrooms and fenugreek in a Type 2 diabetic rat model. Adenosine monophosphate (AMP)–activated protein kinase (AMPK) functions to reduce hyperglycemia through insulin-independent pathways and protects beta-cells. Diabetic model rats were administered standard diets supplemented with 5% oyster mushroom powder (mushroom-treated (MT) group) and 5% fenugreek seed powder (fenugreektreated (FT) group) for 8 weeks. The results showed improvements in both glycemic and lipid profiles, with both oyster mushroom and fenugreek enhancing the phosphorylation of AMPK in muscle tissue. However, no effect on insulin secretion was observed. These findings suggest that both substances reduce hyperglycemia through an insulin-independent pathway. In silico analysis of both mushroom and fenugreek seed extracts revealed bioactive compounds having a strong binding affinity to α-glucosidase, which suggests mushroom and fenugreek supplements might control postprandial blood glucose levels.

Arafat hassan razon

Background: Exposure to cigarette smoke has been associated with pulmonary and reproductive dysfunctions; inflammatory response, oxidative stress and oxidative DNA damage induced by polycyclic aromatic hydrocarbons (PAHs) present in cigarette smoke have been implicated in the pathogenesis of these disorders. The peak expiratory flow rate (PEFR), a biomarker of inflammation and oxidative DNA damage (8-hydroxy-2-deoxyguanosine (8-OHdG), tumor necrosis factor alpha (TNF-α)), reproductive hormones (testosterone (TST), luteinizing hormone (LH), follicle stimulating hormone (FSH)) cotinine and urinary PAH metabolite (1- hydroxypyrene (1-HOP)) were estimated in male active smokers. Methods: One hundred men aged 20-47 years, comprising 50 active male smokers and 50 non-smokers, were randomly recruited into this comparative cross-sectional study. The PEFR was measured using a peak flow meter, serum levels of cotinine, FSH, LH, TST, TNF-α, and urine 8-OHdG by enzyme-linked immunosorbent assay and 1-HOP by high-performance liquid chromatography. Data analysis was done using a t-test and correlation analysis at p≤0.05. Results: Smokers had significantly higher cotinine (49.73±31.76 versus 0.51±0.69 ng/ml, p≤0.001), 8-OHdG (16.34±12.10 versus 5.79±2.14 ng/ml, p≤0.001) and lower PEFR (309.20±56.05 versus 452.80±45.76 L/min, p≤0.001) and LH (5.75±2.06 versus 6.97±2.79 mIU/ml, p=0.015) compared to non-smokers. Duration of exposure to cigarette smoke correlated positively with cotinine (r=0.937, p≤0.001) and 1-HOP (r=0.813, p≤0.001) while cotinine correlated positively with 1-HOP (r=0.863, p≤0.001) only in smokers. Conclusion: Reduced lung function and luteinizing hormone and concurrent increase in oxidative DNA damage associated with exposure to cigarette smoke may suggest the involvement of PAH-induced DNA damage in the development of pulmonary and reproductive impairment in smokers.

Eworo raymond

An online travel agent is one of the platforms that has evolved throughout this digital era, including Tiket.com. Unfortunately, when the Covid-19 pandemic hit, online travel agents were affected the most. Now it is time for Tiket.com to evaluate its marketing strategies to increase the customers' purchase decisions. This research aims to analyze which strategies among Perceived Trust, E-Service Quality, Online Rating, and Online Review have the biggest influence on customer’s Purchase Decision on Tiket.com. This study is conducted from September to December 2022, using a quantitative method with purposive sampling by distributing an online questionnaire to 50 customers of Tiket.com. The data is analyzed for multiple regression analysis to find the influence of each independent variable on the dependent variable. Results show that E-Service Quality, Online Rating, and Online Review have a positive and significant influence on Purchase Decision while Perceived Trust has a positive but insignificant influence on Purchase Decision. Further, Online Rating is found to have the biggest influence on Purchase Decision. Thus, it is important for Tiket.com to pay attention to its Online Rating and Review, E-service Quality, and Perceived Trust.

L

Study objectives: The study aimed to evaluate the antitussive effect of aerial parts of ethanolic extract of Caesalpinia pulcherrima (Caesalpiniaceae). Methods: In this study, cough was induced by the sulfur dioxide induction method. Four groups of animals were made, with six animals in each group, and all drugs were administered orally. Group I was used as a control, group II as a standard, and groups III and IV received 200 and 400 mg/kg Caesalpinia pulcherrima aerial parts extract. Results: Caesalpinia pulcherrima aerial parts (CPAP) extract suppressed cough. Doses of 200 and 400 mg/kg Caesalpinia pulcherrima aerial parts extract showed highly significant results compared to the standard at 60 and 90 min of drug administration. Conclusion: From the above results, it can be concluded that plants have significant activity in cough suppression.

Dr. salman ahmed

Internship activities are carried out in universities to introduce the working world to students in the future. This is important to be examined, especially in terms of the effectiveness of the program that has been implemented. By conducting a survey of students who have undergone the internship process, a clearer picture can be obtained of overall student satisfaction in response to the placement process during the internship. There are five factors emerge from the data analysis, namely interpersonal skills, work environment, culture, challenges, and benefit.

L

The aim of this work was to prepare chitosan nanoparticles loaded with antineoplastic drug Lomustine (LCNPs), by ionic-gelation method with homogenization. The nanoparticles were characterized for particle size, polydispersity index (PDI), surface morphology, encapsulation efficiency, in-vitro drug release and cytotoxicity on human lung cancer cell line L132 by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The particle size, zeta potential and encapsulation efficiency of prepared nanoparticles ranged from 75±1.1 to 637±1.6 nm (PDI from 0.05±0.001 to 0.18±0.007), 37.2±0.21 to 53.8±0.18 mV and 66.74±1.4 to 98.0±1.8% re- spectively. The particles were spherical in shape with smooth surface in scanning electron microscopy (SEM) and transmission electron microscopy (TEM) images. Mechanical shearing by homogenization treatment significantly changed the nanoparticle size. The drug release rate was biphasic and diffusion controlled over the 8 h. LCNPs greatly inhibited the growth of the L132 cancer cell line used in this study in comparison to the native Lomustine (LMT).

Archana mehrotra

Obsessive-compulsive disorder (OCD) is a mental disorder that causes repeated unwanted thoughts or sensations, or do something over and over again. It is affecting all ages in the world. It is unusual for symptoms to begin after the age of 35 and half of people develop problems before 20. This making university students a target of OCD. This study investigates the prevalence of symptoms of OCD and identifies possible risk factors among pharmacy students of University of Tripoli, Libya. 80 pharmacy students registered in the final academic year 2019/2020 were enrolled in this study. All the participants were females ranging of 22 to 24 years old of a same environmental background. This study is based on a validated questionnaire for screening of OCD as mentioned by the American Psychiatric Association without modification. A total of 63 students have returned the questionnaire (response rate, 78.8%). The study shows that OCD symptom is relatively common among pharmacy students. The most common symptoms are losing something of importance (71%) and checking things over and over or repeat actions many times to be sure they are done properly (63%). Among OCD symptoms, the most common associated trigger factors were stress and phobia which representing 62% of the participated students. This study indicates that pharmacy students are at risk of being susceptible to getting OCD. OCD affects academic performance and quality of student life, therefore, a psychological and health services for university students should be implanted.

Mediterranean journal of pharmacy and pharmaceutical sciences

The aim of this study was to evaluate the proximate and micronutrient composition, physical, biochemical and sensory properties of the bread produced from blends of wheat, acha, uzaaku and unere composite flours. Six samples (A-F) were produced in the following ratios A= 100:0:0 (100% Wheat), B= 80% wheat flour, 10% acha, 5% uzaaku flour, 5% unere; C = 70% wheat flour, 10% acha, 10% uzaaku flour, 10% unere; D = 60% wheat flour, 15% acha, 15% uzaaku flour, 10% unere; E = 50% wheat flour, 20% acha, 15% uzaaku flour, 15% unere; F = 40% wheat flour, 20% acha, 20% uzaaku flour, 20% unere. The parameters were analyzed using standard methods. The proximate composition of the bread showed significant increase (p<0.05) in protein, fat, crude fibre, ash, and caloric (energy) value which ranged between 7.69-18.32%, 2.41-3.70%, 2.473.86%, 3.09-4.03%, and 285.25-304.06 (Kcal/kg) and a significant decrease (p<0.05) in moisture content (20.72-26.14%) and carbohydrate (49.37-58.20%), respectively. The micronutrient content showed increase in calcium, magnesium, potassium, iron, zinc, phosphorus, vitamin B1, B2, B3, A and C as the amount of substituted flour blends increases. The result of the physical properties showed decrease in the loaf weight, loaf height, loaf volume and specific volume ranged from 240.60-218.80 g, 3.33-6.66 cm, 155.00-205.00 cm3, 0.71-0.85 cm3/g, respectively. The result of the serum biochemical parameters of rats fed the composite bread samples showed significant decrease (p<0.05) in AST, ALT, ALP, Bilirubin, creatine, urea and albumin values, respectively. The sensory attributes of the bread showed significant differences (p<0.05) in colour, aroma, taste, crumb texture and general acceptability such that the values obtained ranged from 6.05-8.90, 6.008.45, 6.40-8.60, 5.85-8.30 and 6.10-8.35, respectively. The findings of the study showed that supplementation of wheat with 10% acha, 10% uzaaku and 10% unere flour blends could produce well accepted bread samples.

Okechukwu obed chukwuemeka

The coexistence of Moyamoya syndrome (MMS) and Graves’ disease (GD) is uncommon. Here, we report a case of a 41-year-old Filipino female, who presented with thyrotoxicosis and acute ischemic stroke. Based on her clinical presentation, cerebral computed tomography angiography, and thyroid function tests, she was diagnosed with MMS and GD. Her Burch-Wartofsky point scale score was 30, suggesting an impending thyroid storm. Antithyroid therapy was started with her neurological status deterioration initially, but after controlling the thyroid storm, the patient’s neurological status stabilized. She remained stable till she travelled to her country. We hypothesized that MMS in a patient with GD is mediated through anti-dsDNA antibodies, by altering key biological mechanisms, that is, inflammation, neutrophil extracellular traps, and apoptosis that drive a distinctive and coordinated immune and vascular activation. To the best of our knowledge, this is the first case of MMS associated with GD reported in Qatar.

Karishma

Background: Acute and chronic heart or kidney failure affect each other in cardiorenal syndromes (CRS). In CRS, hemodynamic and non-hemodynamic changes occur, causing acute or progressive renal and cardiac failures. CRS is classified into five types based on the first organ failure and causes failure of the other organ. We believe that the current CRS classification is not the correct one that effectively describes the underlying cause of CRS. Hence, we consider it better to be classified into three categories (cardiorenal, renocardiac, and cardio-reno-cardiac syndrome) and then subdivided into acute and chronic types or types 1 and 2 (respectively, according to the onset of the underlying type of failure (i.e., acute or chronic). Other subtypes that occur inthe heart and dysfunction occur simultaneously are acute cardio-reno-cardiac syndrome (type 5) and Chronic cardio-reno-cardiac syndrome (type 6). Aim: In Part 1 of the review series, the pathophysiological mechanisms and clinical and therapeutic applications of all types of CRS will be narratively discussed and updated. Furthermore, we provide a comprehensive review of diagnostic biomarkers and their clinical significance in the identification, outcome prediction, and treatment of all CRS types. Method: An extensive search of PubMed, Google, EMBASE, Scopus, and Google Scholar was conducted for review articles, original articles, and commentaries published between Jan 2010 and Aug 2024 using different phrases, texts, and keywords, such as CRS, renocardiac syndrome, and CRS. The topics included secondary CRS, CRS pathogenesis, CRS therapy, SLGT inhibitor use in CRS, novel therapy in CRS types, and prevention of CRSs. Conclusion: Renal and cardiac failure in patients with CRS seem to have different pathophysiological mechanisms. Early detection and treatment can improve the outcomes of CRS. Clinical manifestations and therapy protocols vary according to pathophysiology. Hence, new guidelines and research on universal diagnostic and treatment techniques are urgently required. Moreover, the current nomenclature for CRS is confusing; therefore, we believe that a new nomenclature system should be introduced, reducing confusion and making differentiation between CRS types easier and less confusing.

Karishma