To examine the predictive validity of pre-admission variables on students’ performance in a medical school in Saudi Arabia. In this retrospective study, we collected admission and college performance data for 737 students in preclinical and clinical years. Data included high school scores and other standardized test scores, such as those of the National Achievement Test and the General Aptitude Test. Additionally, we included the scores of the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS) exams. Those datasets were then compared with college performance indicators, namely the cumulative Grade Point Average (cGPA) and progress test, using multivariate linear regression analysis. In preclinical years, both the National Achievement Test (p=0.04, B=0.08) and TOEFL (p=0.017, B=0.01) scores were positive predictors of cGPA, whereas the General Aptitude Test (p=0.048, B=-0.05) negatively predicted cGPA. Moreover, none of the pre-admission variables were predictive of progress test performance in the same group. On the other hand, none of the pre-admission variables were predictive of cGPA in clinical years. Overall, cGPA strongly predict-ed students’ progress test performance (p<0.001 and B=19.02). Only the National Achievement Test and TOEFL significantly predicted performance in preclinical years. However, these variables do not predict progress test performance, meaning that they do not predict the functional knowledge reflected in the progress test. We report various strengths and deficiencies in the current medical college admission criteria, and call for employing more sensitive and valid ones that predict student performance and functional knowledge, especially in the clinical years.

Students with varying personality traits are likely to employ diverse learning and study strategies. However, this relationship has never been explored in the medical education context. This study’s aim was to explore the relationship between learning strategies and personality traits among medical students. This study was a cross-sectional study, and a quantitative approach was employed using two self-administered questionnaires: one to assess the personality traits from the Five-Factor Model (Conscientiousness, Neuroticism, Extraversion, Openness, and Agreeableness), and the other to assess 10 learning strategies (Anxiety, Attitude, Concentration, Information Processing, Motivation, Selecting Main Ideas, Self-Testing, Test Strategies, Time Management, and Using Academic Resources). A stratified random sampling technique was used to recruit medical students at Alfaisal University in the preclinical and clinical years (N = 309). Pearson correlation coefficient was used to measure the relationship between variables, and linear regression was used to evaluate how personality traits predicted learning strategy selection. Personality traits predicted the selection of learning strategies, especially Conscientiousness and Neuroticism. Conscientiousness showed a positive correlation with seven learning strategies and was the most important predictor of learning strategies students employ. Neuroticism correlations and predictions were negative. The other three traits showed weaker correlations. These correlations were between Extraversion and Using Academic Resources (r = 0.27), Information Processing (r = 0.23), and Attitude (r = 0.19); Openness and Information Processing (r = 0.29); and Agreeableness and Attitude (r = 0.29). All personality domains influence at least one learning strategy, especially Conscientiousness and Neuroticism. This study helps build a foundation for individualized coaching and mentorship in medical education. NEW & NOTEWORTHY This study aspires to build a foundation for individualized coaching and mentorship in medical education through utilizing personality traits to empower academic success. We demonstrate that all personality domains influence students’ selection of at least one learning strategy, especially Conscientiousness and Neuroticism.

Introduction: Esophagectomy for esophageal cancer traditionally involves delayed postoperative oral feeding due to concerns about complications like anastomotic leakage. Enhanced Recovery After Surgery (ERAS) protocols favor early oral feeding (EOF), but its safety and benefits remain debated. This systematic review and meta-analysis compared EOF versus late oral feeding (LOF) after esophagectomy. Methods: We systematically searched PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library through March 2025 for primary studies comparing EOF (≤7 days post-op) with LOF (>7 days or delayed) in adult patients after esophagectomy. Outcomes included anastomotic leakage, pneumonia, other complications, gastrointestinal recovery, length of hospital stay (LOS), quality of life (QoL), and mortality. Results: Twenty-nine studies involving 3962 patients were included. There was no significant difference in the risk of anastomotic leakage between the two groups (RR: 1.03, 95% CI: 0.80–1.33, p = 0.82, I² = 0%). EOF was associated with a significantly shorter time to first flatus (Cohen’s d: −1.26, 95% CI: −1.93 to −0.58, p < 0.001) and first defecation (Cohen’s d: −0.87, 95% CI: −1.51 to −0.22, p = 0.01) and a shorter LOS (p = 0.01). No significant differences were found for other complications (acute respiratory distress syndrome [ARDS], chyle leak, conduit issues, ileus, sepsis, wound infection) or mortality rates (in-hospital, 30-day, 90-day, overall). QoL assessment suggested potential improvement in emotional function with EOF. Conclusions: EOF after esophagectomy appears safe, as it does not increase the risk of anastomotic leakage or other major complications compared to LOF. It is associated with faster gastrointestinal recovery and shorter hospital stays, supporting its use within ERAS protocols.

Background: Intracerebral hemorrhage management presents clinicians with a significant therapeutic challenge. Maintaining antiplatelet therapy potentially increases the risk of recurrent bleeding, while discontinuation heightens susceptibility to ischemic stroke, particularly during the critical first month after hemorrhage. In contemporary practice, physicians demonstrate considerable hesitancy regarding early antiplatelet reinitiation, complicated by the absence of clear evidence-based treatment guidelines. Aim: This meta-analysis assesses the safety of early antiplatelet resumption following ICH. Methods: We conducted a systematic review by searching Web of Science, Scopus, PubMed, and Cochrane Library from inception to April 2025. Articles were independently screened and data extracted by two reviewers who also assessed study quality. The inclusion criteria are enrollment of adults (≥18 years) with imaging-confirmed intracerebral hemorrhage surviving >24 h, comparing early vs. delayed or withheld antiplatelet therapy. Randomized trials underwent separate evaluation using Cochrane’s Risk of Bias. Statistical analysis was performed using R software (version 4.4.2), with categorical outcomes pooled as risk ratios (RRs) with 95% confidence intervals. Statistical significance was established at p < 0.05. The evidence is limited by the availability of few RCTs, variable antiplatelet regiments, male predominance, and other confounding factors. The review was registered in SFO. Results: Our meta-analysis included 10 studies (8 observational, 2 RCTs) with 5554 patients. Early antiplatelet therapy significantly reduced recurrent intracerebral hemorrhage by 46% (RR 0.54, 95% CI 0.37–0.78, p = 0.001). All-cause mortality showed a non-significant difference (RR 0.81, 95% CI 0.65–1.01, p = 0.06). No significant differences were found for ischemic stroke (RR 0.99, 95% CI 0.60–1.63, p = 0.96), major hemorrhagic events (RR 0.75, 95% CI 0.49–1.13, p = 0.17), or ischemic vascular outcomes (RR 0.71, 95% CI 0.49–1.02, p = 0.60). Conclusions: Our meta-analysis reveals that early antiplatelet therapy following intracerebral hemorrhage significantly reduces recurrent hemorrhagic events (46% reduction) without increasing major ischemic or hemorrhagic complications.

Background: Degenerative spondylolisthesis affects approximately 39 million patients worldwide. While consensus supports decompression with fusion for single-level pathology, optimal surgical approaches for multi-level disease remain disputed. Despite the frequency of this clinical presentation, evidence comparing outcomes between Single-Level versus Multi-Level interbody fusion procedures is surprisingly scarce. This study aims to determine how the level of interbody fusion extent impacts outcomes in patients undergoing lumbar fusion for degenerative spondylolisthesis. Methods: Our systematic review methodology involved comprehensive database searches (Web of Science, Scopus, PubMed, and Cochrane Library) from inception through April 2025. Two independent reviewers performed article screening, data extraction, and quality assessment. Statistical analyses used R software (v4.4.2), with outcomes reported as risk ratios for categorical variables and mean differences for continuous measures (95% CI). The certainty of evidence was assessed using the GRADE approach. Results: Our meta-analysis evaluated 10 studies ( N = 1430 patients; 971 Single-Level, 366 Double-Level, 198 Multi-Level fusions). Single-Level procedures demonstrated 41% lower revision rates (RR = 0.59 [0.40–0.86], p = 0.007). Operative advantages included reduced surgical time (−60.73 min [− 80.89 to − 40.57], p < 0.001), blood loss (-286.99mL [− 496.71 to − 77.27], p = 0.007), and hospitalization (−1.22 days [− 2.09 to − 0.34], p = 0.006). Oswestry Disability Index (ODI) scores showed borderline improvement (-3.90 [− 7.89 to 0.10], p = 0.06). Screw loosening decreased by 84% (RR = 0.16 [0.08–0.34], p < 0.001). We observed no significant differences in lumbar lordosis (-0.01 [− 1.75 to 1.72], p = 0.99), infection rates (RR = 0.49 [0.19–1.25], p = 0.13), adjacent segment deterioration, vascular injuries, or dural tears. The certainty of evidence ranged from low to very low, and high heterogeneity was observed in perioperative outcomes. Conclusions: Single-level fusion may offer a more favorable perioperative profile than double- or multi-level constructs, including lower revision risk, shorter operative time, reduced blood loss, shorter hospitalization, and fewer screw loosening events in pooled analyses. However, complications did not differ significantly between groups. Given substantial heterogeneity for perioperative outcomes and generally low to very low certainty of evidence, these findings should be interpreted cautiously and individualized to patient pathology and surgical context.

Background: C-reactive protein (CRP), a biomarker of systemic inflammation, has been implicated in adverse pregnancy and neonatal outcomes. However, the relationship between maternal CRP and neonatal complications remains unclear. We conducted a systematic review and meta-analysis to synthesize available evidence. Methods: We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library up to July 2025 for observational studies reporting maternal CRP levels in relation to neonatal outcomes. Eligible outcomes included preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), and stillbirth. Random-effects models were used to calculate pooled standardized mean differences (SMD) or odds ratios (OR) with 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I² statistic. Results: The search yielded 6843 records, of which 42 studies (comprising 18,393 pregnant women) met the inclusion criteria. Maternal mean CRP levels were significantly higher in adverse pregnancy outcomes compared with controls (SMD = 0.39; 95% CI 0.08–0.70; p = 0.01; I² = 96.6%). Elevated CRP was strongly associated with PTB (OR = 3.81; 95% CI 2.66–5.47; p < 0.001; I² = 85%; n = 23) and LBW (OR = 2.34; 95% CI 1.35–4.03; p = 0.002; I² = 84.2%; n = 7). No significant associations were observed for SGA (OR = 1.14; 95% CI 0.86–1.49; p = 0.36; I² = 0%; n = 5) or stillbirth (OR = 1.89; 95% CI 0.92–3.90; p = 0.08; I² = 44.9%; n = 4). Conclusion: Maternal CRP is significantly associated with increased risks of preterm birth and low birth weight but not with SGA or stillbirth. These findings support the role of systemic inflammation in adverse neonatal outcomes and highlight the need for prospective studies to clarify causal mechanisms and assess the clinical utility of CRP in pregnancy risk stratification.