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Abstract Background Human Papilloma Virus (HPV) infection is a significant public health concern in the Gulf Cooperation Council countries, being widely prevalent and the main risk factor for cervical cancer. We aimed to assess knowledge and perception towards HPV, acceptability of the HPV vaccine, and HPV vaccination rates among university students in Education City, Doha, Qatar. Methods This cross-sectional survey utilized proportional quota-sampling, with quotas based on university, sex, and nationality, to recruit students from seven universities between February and September 2022. The English language questionnaire requested socio-demographic information, knowledge, and attitudes about HPV infection and the vaccine. The chi-square test, Student t-test, Mann-Whitney-Wilcoxon tests and multivariable ordinal logistic regression were used to assess differences in proportion, mean, and median according to broad HPV knowledge categories. Results Three hundred and ninety-eight students were recruited (response rate = 82.3%), of whom 251 (63.1%) were female. Mean age was 21.7 years. Eighty-nine (22.4%, 95% CI 18.4–26.8%) students had poor knowledge about HPV, 220 (55.3%, 95% CI 50.2–60.2%) students had some awareness, and 89 (22.4%, 95% CI 18.4–26.8%) students were knowledgeable. Age, nationality, and field of study influenced the students’ knowledge about HPV. Only 25 (6.3%) students had previously been vaccinated against HPV. However, 71% of the unvaccinated students reported being willing to get vaccinated if recommended by their healthcare provider. Conclusions Overall, 77.7% of the student population had some-to-good levels of knowledge about HPV-related infection, cancer, and vaccination. There are gaps in the student population’s understanding and knowledge about HPV. Increasing knowledge can be key toward shared decision-making for HPV vaccination among eligible populations. Targeted public health campaigns and integration into childhood vaccination programs should be critical first steps, especially as most of the surveyed students had a positive outlook on getting vaccinated. Healthcare professionals should be incentivized to increase their HPV knowledge and communication skills, while policymakers can work toward easing barriers in integrating HPV vaccinations in the immunization schedule and encouraging overall HPV vaccination uptake.

Abstract BRCA1 and BRCA2 pathogenic variant carriers develop breast cancers with distinct pathological characteristics and mutational signatures that may result in differential response to chemotherapy. We compared rates of pathologic complete response (pCR) after NAC between BRCA1/2 variant carriers and noncarriers in a cohort of 1426 women (92 [6.5%] BRCA1 and 73 [5.1%] BRCA2) with clinical stage I–III breast cancer treated with NAC followed by surgery from 11/2013 to 01/2022 at Memorial Sloan Kettering Cancer Center. The majority received doxorubicin/cyclophosphamide/paclitaxel therapy (93%); BRCA1/2 carriers were more likely to receive carboplatin (p

Background The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic had been controlling disease transmission. However, lockdown measures used to mitigate transmission affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances. Methods We comprehensively searched PubMed and the World Health Organization’s global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed. Results Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes. Conclusions The lockdown associated with COVID-19 has largely had a negative impact on the lifestyles of individuals and communities across many countries and cultures. However, some individuals and communities also initiated positive lifestyle-related behavioral changes. If the knowledge generated by studying the impact of COVID-19-related lockdowns on the six lifestyle factors is further consolidated, it could improve chronic disease outcomes. This will help better understand lifestyle behaviors amidst crises and assist in redesigning extreme public health measures such as lockdowns.. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

Introduction: Triplet chemotherapy + bevacizumab (TripletBev) demonstrated an overall survival (OS) benefit for patients with newly diagnosed metastatic colorectal cancer in randomized trials. We aimed to evaluate the uptake and estimate the effectiveness of TripletBev versus doublet chemotherapy + bevacizumab (DoubletBev) in a real-world population in the United States. Methods: We carried out a retrospective cohort study of patients initiating first-line treatment of metastatic colorectal cancer between 23 October 2014 and 31 October 2022 using the Flatiron Health nationwide electronic health record (EHR)-derived de-identified database. The data originated from ∼280 cancer clinics (∼800 sites of care) in the USA. The primary analysis compared OS between patients receiving TripletBev or DoubletBev using a Cox proportional hazards model with adjustment for pre-specified covariates using stabilized inverse probability of treatment weighting. This analysis was also carried out within pre-specified and post hoc subgroups. A secondary analysis used Stürmer-trimming of the propensity score distribution to include patients most likely to be eligible to receive either treatment. Results: Some 391 patients received TripletBev and 9625 received DoubletBev. There was no association between TripletBev and OS in the primary analysis [hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.75-1.13]. TripletBev was associated with lower hazard of death in patients with synchronous metastases (HR 0.79; 95% CI 0.64-0.98; statistically significant) and in the secondary analysis of patients most likely to be eligible to receive either treatment (HR 0.80; 95% CI 0.63-1.02; non-statistically significant). Conclusion: Uptake of TripletBev remains low and the primary analysis did not demonstrate effectiveness in a real-world population in the United States. Patients with synchronous metastases and those most likely to be eligible to receive either treatment may be most likely to benefit from TripletBev.

Abstract Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep–wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students’ health and wellbeing.

Abstract Generally, university students are at risk of burnout. This likely was exacerbated during the COVID-19 pandemic. We aimed to investigate burnout prevalence among university students during the COVID-19 pandemic and examine its distribution across countries, sexes, fields of study, and time-period. PubMed, EMBASE, PsycINFO, World Health Organization’s Global COVID-19 database, Scopus, Epistemonikos, ERIC and Google Scholar were searched (protocol: https://doi.org/10.17605/OSF.IO/BYRXW ). Studies were independently screened and extracted. Random-effects meta-analysis was performed. Study quality was appraised, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We identified 44 primary studies comprising 26,500 students. Global prevalence rates were 56.3% for high emotional exhaustion (EE), 55.3% for high cynicism (CY) and 41.8% for low personal accomplishment (PA). Prevalence of EE, CY, and PA domains varied significantly across fields of study, countries and WHO and World Bank regions, but not sex. All studies demonstrated good internal validity, although substantial heterogeneity existed between studies. The certainty of evidence was rated as moderate. Considering its potentially severe consequences, burnout is a significant public health concern. The development and implementation of evidence-based localized interventions at organizational and individual levels are necessary to mitigate burnout.

Karima Chaabna,1 Anupama Jithesh,1 Jibrail Cheema,2 Jasmine Aboughanem,1 Ravinder Mamtani1 1Institute for Population Health, Weill Cornell Medicine – Qatar, Doha, Qatar; 2Weill Cornell Medicine – Qatar, Doha, QatarCorrespondence: Karima Chaabna, Institute for Population Health, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, P.O Box. 24144, Doha, Qatar, Tel +974 4492-8309, Fax +974 4492 8333, Email kac2047@qatar-med.cornell.eduPurpose: This systematic review aims to assess the use and perception of “Western” medical acupuncture—based on conventional biomedical mechanisms and evidence-based medicine for diagnosis and needle placement—for pain management among athletes and their healthcare providers.Methods: A systematic review is reported based on the PRISMA guidelines. PubMed, Web of Science, SPORTDiscus, Allied and Complementary Medicine databases, and Google Scholar were searched (search: from database inception to July 2023). Two authors independently conducted multi-stage screening, data extraction, and quality assessment. The outcomes of interest were prevalence of acupuncture prescriptions by healthcare professionals, prevalence of acupuncture use by athletes, and perceptions related to acupuncture effectiveness among healthcare professionals and athletes. Only studies wherein “Western” medical acupuncture was used for pain management were included.Results: Our review included 11 observational studies and clinical trials. The prevalence of “Western” medical acupuncture prescription varied from 15.4% (UK) to 58.4% (US) among sports medicine healthcare professionals. Prevalence of acupuncture use among athletes ranged from 2.2% among college athletes in Palestine to 61% among professional football players in the Netherlands. Acupuncture was used for managing delayed-onset of soreness and pain due to various types of musculoskeletal injuries. Both athletes and their healthcare providers reported positive perceptions of acupuncture.Conclusion: Our systematic review identifies a notable research gap in evaluating the practice and perception of “Western” medical acupuncture among healthcare professionals and athletes. Our findings suggest that “Western” medical acupuncture is not only prescribed by sport medicine professionals and used by athletes for diverse musculoskeletal pains but is also generally perceived positively for its effectiveness. Given the positive clinical experience of health professionals, athletes’ favorable perception, and acupuncture’s well-established safety profile, acupuncture should be given serious consideration—as a complementary approach—in the overall management of pain.Registration: Open Science Framework (https://osf.io/qb9gc).Keywords: western medical acupuncture, perception, pain, athletes

Objective: We aimed to investigate the association between university students' dietary patterns, their demographics and lifestyle in a cross-sectional study in Qatar. Participants: 370 students in eight universities in Qatar enrolled between February 2017 and February 2018. Methods: Based on a structured questionnaire, dietary patterns were identified using principal component analysis, and their associations with student characteristics were assessed using logistic regression. Results: Four dietary patterns were identified. The "fast food" pattern was associated with being younger and male (p-values = 0.1). The "traditional diet" pattern was associated with not skipping meals or eating when bored (p-values = 0.1). The "healthy diet" pattern was associated with regular exercise and having time to eat healthy foods (p-values = 0.01). The "protein shake" pattern was associated with being male and engaging in more vigorous physical activity (p-values = 0.01). Conclusions: Our findings provide a roadmap for the prioritization of population-specific interventions in university students within Qatar and the region.

Among the numerous neuropsychiatric manifestations of multiple sclerosis (MS), depression is one of the most common psychiatric comorbidities. Depression has been associated with poor quality of life, aggravation of symptoms of MS, and poor adherence to treatment in MS. Diagnosing and managing depression in MS can be challenging. Psychiatrists, neurologists, and other allied professionals need to collaborate to manage depression effectively. There is a need for greater awareness and vigilance for depression in this vulnerable population. We present a case of MS with recurrent depressive disorder and subsequently discuss the literature relating to depression in MS.

Ophthalmic disorders have psychiatric aspects associated with them at various levels. Psychological factors have a well-documented role in the causation, aggravation, and maintenance of various ophthalmic conditions, including glaucoma, central serous retinopathy, dry eye disease, and retinitis pigmentosa. Many ophthalmic conditions, including blindness, have psychological manifestations as well, which need to be addressed, in addition to the ophthalmic pathology. There is also significant overlap in the treatment of the two disciplines in many ways. For instance, many ophthalmic drugs have psychiatric side effects. Even ophthalmological surgeries have psychiatric aspects associated with them, which primarily include black patch psychosis and anxiety in the operation theater. This review will be useful for psychiatrists and ophthalmologists, for their clinical practice and research. Future research should focus on this interface to give it its well-deserved attention.

ABSTRACTWe present an original geological map of the north-eastern Serre Batholith (southern Italy), together with new field and petrographic data of its main five granitoid units. Our study provides an overall picture of a c. 13-thick floor-to-roof batholith exposure, focusing on the relationships between the magmatic units, which were sequentially emplaced at depth from c. 23 to c. 6 km, in a time interval from c. 297 Ma to c. 292 Ma. Indeed, this composite and zoned batholith, with its crustal scale exposure and large compositional and structural diversity, is a real natural laboratory where to test models of granitoid magma production and batholith construction. The new geological map and related field and petrographic data provide a valuable addition to the existing knowledge of the Serre Batholith and, at the same time, a new starting point for further in-depth multidisciplinary investigations aimed to better understand its architecture and build-up mechanisms.

Objective: University students face high levels of stress-related factors, such as an unfamiliar environment, challenging workload, and uncertainty about their ability to succeed. Participants: A total of 370 students in Qatar who consented to participate between February 2017 and February 2018. Methods: This cross-sectional study assessed perceived stress [using a validated 4-point perceived stress scale (PSS-4)], as well as diet, exercise, body mass index, sleep, and life satisfaction. Results: Among students aged 18-39 (mean = 20.1 ± 3.0 years), PSS-4 scores varied between 0 and 16 (mean = 7.4 ± 3.4). Elevated stress was significantly associated with female sex, country of origin, residing off-campus, eating when bored, lack of self-discipline, disturbed sleep, and low levels of life satisfaction. Furthermore, students with PSS-4 scores above the median level were 2.3 times likelier to report difficulty concentrating on academic work. Conclusion: Elevated stress levels are present in university students in Qatar. Strengthening coping skills may improve health and academic performance.

IntroductionMetastatic urothelial carcinoma (mUC) has poor prognosis. A high unmet need exists for novel treatment for those who are unfit for platinum-based chemotherapy.MethodsWe aimed to describe real-world temporal changes in patient characteristics and 1L treatment selection for mUC patients in the United States following the approval of anti-PD-1/L1 treatments. This study was a retrospective, observational study using anonymized and structured oncology electronic medical record (EMR) data from IQVIA and the US Oncology Network iKnowMed (USON).ResultsAfter approval of 1L anti-PD-1/L1 treatment for mUC, there is a marked increase in the use of 1L anti-PD-1/L1 monotherapies, accompanied by a proportional decrease in 1L platinum-based treatments and non-guideline-based therapy; particularly among the elderly (> 75 years) and those with poor ECOG performance status (ECOG PS 2+).DiscussionAnti-PD-1/L1 monotherapies fulfill the prior unmet need of frail mUC patients who are ineligible for platinum-based therapies.