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Abdullah R Alzahrani,1 Doaa I Mohamed,2 Hebatallah H Abo Nahas,3 Dalia Alaa El-Din Aly El-Waseef,4 Abdulmalik S Altamimi,5 Ibrahim H Youssef,6 Ibrahim Abdel Aziz Ibrahim,1 Soha MY Mohamed,7 Yasmine Gamal Sabry,7 Alaa H Falemban,1 Nasser Attia Elhawary,8 Ghazi A Bamagous,1 Mariusz Jaremko,9 Essa M Saied10,11 1Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 3Zoology Department, Faculty of Science, Port Said University, Port Said, Egypt; 4Department of Histology and Cell Biology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 6Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 7Physiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 8Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia; 9Smart-Health Initiative and Red Sea Research Center, Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia; 10Chemistry Department, Faculty of Science, Suez Canal University, Ismailia, Egypt; 11Institute for Chemistry, Humboldt Universität Zu Berlin, Berlin, GermanyCorrespondence: Essa M Saied, Institute for Chemistry, Humboldt Universität zu Berlin, Berlin, 12489, Germany, Email saiedess@hu-berlin.deIntroduction: Pulmonary fibrosis (PF) and tissue remodeling can greatly impair pulmonary function and often lead to fatal outcomes.Methodology: In the present study, we explored a novel molecular interplay of long noncoding (Lnc) RNA CBR3-AS1/ miRNA-29/ FIZZ1 axis in moderating the inflammatory processes, immunological responses, and oxidative stress pathways in bleomycin (BLM)-induced lung fibrosis. Furthermore, we investigated the pharmacological potential of Trimetazidine (TMZ) in ameliorating lung fibrosis.Results: Our results revealed that the BLM-treated group exhibited a significant upregulation in the expression of epigenetic regulators, lncRNA CBR3-AS1 and FIZZ1, compared to the control group (P< 0.0001), along with the downregulation of miRNA-29 expression. Furthermore, Correlation analysis showed a significant positive association between lnc CBR3-AS1 and FIZZ1 (R=0.7723, p< 0.05) and a significant negative association between miRNA-29 and FIZZ1 (R=− 0.7535, p< 0.05), suggesting lnc CBR3-AS1 as an epigenetic regulator of FIZZ1 in lung fibrosis. BLM treatment significantly increased the expression of Notch, Jagged1, Smad3, TGFB1, and hydroxyproline. Interestingly, the administration of TMZ demonstrated the ability to attenuate the deterioration effects caused by BLM treatment, as indicated by biochemical and histological analyses. Our investigations revealed that the therapeutic potential of TMZ as an antifibrotic drug could be ascribed to its ability to directly target the epigenetic regulators lncRNA CBR3-AS1/ miRNA-29/ FIZZ1, which in turn resulted in the mitigation of lung fibrosis. Histological and immunohistochemical analyses further validated the potential antifibrotic effects of TMZ by mitigating the structural damage associated with fibrosis.Discussion: Taken together, our study showed for the first time the interplay between epigenetic lncRNAs CBR3-AS1 and miRNA-29 in lung fibrosis and demonstrated that FIZZ1 could be a downregulatory gene for lncRNA CBR3-AS1 and miRNA-29. Our key findings demonstrate that TMZ significantly reduces the expression of fibrotic, oxidative stress, immunomodulatory, and inflammatory markers, along with epigenetic regulators associated with lung fibrosis. This validates its potential as an effective antifibrotic agent by targeting the CBR3-AS1/miRNA-29/FIZZ1 axis. Keywords: lung fibrosis, long noncoding RNA CBR3-AS1, miRNA-29, FIZZ1, trimetazidine, histopathology

Context: The changing trends have revealed that cardiovascular disease (CVD) has evolved as prime cause of mortality globally, and predicting this prior is of utmost interest in patient management. Objective: To assess the ten-year risk of fatal or non-fatal cardiovascular event using World Health Organization/ International Society of Hypertension (WHO/ISH) risk prediction chart among adults. Material and methods: A cross sectional study was conducted among 226 general medicine Outpatient Department (OPD) attendees of a tertiary care hospital. Their risk of encountering a major cardiovascular event such as myocardial infarction or stroke ten year later was assessed using the WHO/ISH risk prediction charts. Appropriate tests of significance were employed. Results: Among 226 study subjects, 174 (76.9%) at low risk, 36 (15.9%) at moderate risk and 16 (7.0%) were at high risk of developing major cardiovascular event in the next ten years. Risk factors such age above 50 years, male gender, presence of hypertension or diabetes and smoking were found to be significantly associated with increased risk of the predicted major cardiovascular event. Conclusions: WHO/ISH chart is a useful tool in identifying individuals at high-risk of cardiovascular disease (CVD) and could help in planning appropriate strategies to mitigate the estimated CVD burden in future.

Nadia Bassuoni Elsharkawy,1,2 Sayeda Mohamed Mohamed,3 Mohamed Hammam Awad,4 Marwa Mohamed Ahmed Ouda1,5 1Nursing Department, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia; 2Maternal and Newborn Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt; 3Psychiatric Mental Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt; 4Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 5Pediatric Nursing Department, Faculty of Nursing, Damanhur University, EgyptCorrespondence: Nadia Bassuoni ElsharkawyNursing Department, College of Applied Medical Sciences, Jouf University, Sakaka, Jouf, Kingdom of Saudi ArabiaTel +966-554180474Email nelsharkawy@ju.edu.saPurpose: This study investigated the effectiveness of a happiness counseling program on depression, anxiety, and stress in pregnant women with a history of recurrent miscarriage.Patients and Methods: A parallel randomized controlled trial research design was used in this study, which was conducted at the high-risk inpatient unit of the Obstetrics and Gynecology Hospital of Cairo University Hospitals in Cairo, Egypt. A total of 60 pregnant women who had previously experienced multiple miscarriages were randomly assigned to intervention and control groups (n=30 each). The tools used for data collection were demographic and obstetric data questionnaires and the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Happiness counseling sessions were conducted for the intervention group. Data for qualitative variables were analyzed with the chi-squared test, and the Student’s t test for paired samples was used to compare mean DASS-21 scores of the intervention and control groups. The Pearson correlation coefficient was used to analyze the association between variables.Results: The happiness counseling sessions reduced depression, anxiety, and stress in women with recurrent miscarriage, resulting in lower mean DASS-21 scores for the intervention group compared to the control group.Conclusion: The happiness counseling program had a positive effect on reducing depression, anxiety, and stress in women with recurrent miscarriage. We recommend that this program be used as an effective, low-cost, and noninvasive intervention to improve the mental health and overall wellbeing of women with recurrent miscarriage.Keywords: happiness counseling program, depression, anxiety, stress, recurrent miscarriage

Olfat M Hendy,1 Hatem Rabie,1 Amr El Fouly,2 Mohamed Abdel-Samiee,3 Nashwa Abdelmotelb,1 Amr Aly Elshormilisy,4 Mahmoud Allam,3 Samia Taher Ali,5 Nessren Mohamed Bahaa EL-Deen,6 Shimaa Abdelsattar,7 Somia Mokabel Mohamed8 1Clinical Pathology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt; 2Endemic Medicine Department, Helwan University, Cairo, Egypt; 3Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt; 4Internal Medicine Department, Helwan University, Cairo, Egypt; 5Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 6Tropical Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 7Department of Clinical Biochemistry, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt; 8Department of Physiology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EgyptCorrespondence: Mohamed Abdel-SamieeNational Liver Institute, Yassin Abdel-Ghafar Street, Shebin El-Kom, Menoufia 32511, EgyptTel +2048 2222740Fax +2048 2234685Email Drmohammed100@yahoo.comBackground: It remains essential for patient safety to develop non-invasive diagnostic tools to diagnose non-alcoholic fatty liver rather than invasive techniques.Aim: Our case-control study was to address the value of circulating miRNAs as a potential non-invasive biomarker for the diagnosis of non-alcoholic fatty acid diseases (NAFLD) and monitoring of disease progression.Methods: Routine clinical assessment, laboratory tests, anthropometric study, and liver biopsy results reported for 210 patients with NAFLD (124 patients of simple steatosis (SS) and 86 of non-alcoholic steatohepatitis (NASH)). Apparently matched for age and gender, healthy participants (n= 90) were enrolled as a control group. Serum samples were tested for micro-RNAs (−122, −34a and −99a) by quantitative-PCR.Results: By histopathology, 124 of the NAFLD group were of SS and 86 patients were of NASH. Compared with the control subjects, both mi-RNA-122 and −34a levels were increased in NAFLD (p< 001) and at a cut-off = 1.261, mi-RNA-122 had 92% sensitivity, 85% specificity to differentiate NAFLD from healthy controls, while mi-RNA-99a were significantly decreased in NAFLD patients with an observed decrease in disease severity, and at a cut-off = 0.46, miRNA-99a had 94% sensitivity and 96% specificity to discriminate SS from NASH.Conclusion: The integration of a circulating mi-RNA panel to diagnose NAFLD cases and to discriminate between SS and NASH. Large-scale study is still needed to verify the other mi-RNA profiles and their role in NAFLD pathogenesis and targeting therapy.Keywords: NASH, NAFLD, micro-RNA, simple steatosis

Objectives: The evaluation of the outcomes of patients undergoing arthroscopic unilateral meniscus repair on receiving intra-articular injection (IAI) of dexmedetomidine (DXM) alone in dose of 2 µg/kg or in dose of 1 µg/kg with other analgesics. Patients & Methods: 150 patients were randomly distributed between 5-groups: C-Group received saline, Study Group I (SI-Group) received DXM 2 µg/kg, SII, SIII and SIV groups received DXM 1 µg/kg with ketamine 0.5 mg/kg, dexamethasone (DXA) 8-mg or ketorolac 30-mg, respectively, with bupivacaine. Bupivacaine spinal anesthesia was provided, and IAI was injected through an arthroscopic port as a single shot. The study outcome is the efficacy of IAI of DXM as judged by pain scores, duration till requesting morphine, times of requesting, and total dose of morphine used during 12-h after IAI. Results: Pain scores and the cumulative scores were significantly lower in the study groups with lower frequency of requests and the total dose of morphine compared to the C-Group with insignificant difference between study groups. The incidence of adverse events was significantly lower in SIII-Group than in other groups. Patients' and surgeons' satisfaction was higher in the study groups than C-Group. Conclusion: The IAI of DXM alone or in combination with any other analgesic is an effective and safe analgesic modality for post-arthroscopic surgeries. All additives were effective in terms of reduction of pain score and opioid consumption, but the side effects of ketamine and duration of analgesia of ketorolac are questionable. However, DXA is an efficient analgesic with minimal side effects. [ABSTRACT FROM AUTHOR]

Objectives A comparable performance between bulk-fill composites (BFCs) and progressively inserted conventional resin composite (CRC) has been observed in previous studies. However, a significant number of dental institutions in India continue to employ incremental techniques for RC restorations during preclinical studies. But as BFCs are gaining popularity, they may soon be a part of the curriculum for dental students. The aim of this study was to assess the microhardness and the polymerization efficiency of bulk-fill composites versus CRC in class II slot preparations restored by second-year dental students on ivorine mandibular first molar teeth with high-intensity (HI) and low-intensity (LI) light-curing units using the standard mesial slot preparation technique. Material and Methods Fifty preclinical dental students of second year of a dental college were recruited for the study on a voluntary basis. During their preclinical instructions, all participants were taught and made to practice the handling and curing techniques for two-surface RC restorations for 4 months. Each student was asked to perform four RC restorations: CRC-HI, CRC-LI, BFC-HI, and BFC LI. Assessment of microhardness was done using the Vickers microhardness (VMH) test. Statistical analysis One-way and multivariate analysis of variance and Bonferroni 's post hoc test tests were used for data analysis. Results The results showed a significant decrease in the VMH readings in the horizontal axis, progressing from the uppermost to the lowermost positions (p > 0.05). In all the examined groups, the VMH values at the deepest reading locations were found to be higher than 80% of the values observed at the occlusal surface reading locations. Statistically significant associations were seen between the RC type and the light source used in the VMH readings conducted (p > 0.05). However, no significant correlation was identified between the type of light source and the vertical VMH readings (p > 0.05). Conclusion Instructing dental students to place RC restorations using CRC or BFC materials together with both HI and LI light-curing protocols is safe and can be considered for preclinical studies. [ABSTRACT FROM AUTHOR]

Abstract Background In the current treatment landscape for non-small cell lung cancers, epidermal growth factor receptor-tyrosine kinase inhibitors have emerged as a well-established treatment option for patients with advanced or metastatic disease. This is particularly true for those with commonly occurring epidermal growth factor receptor mutations. However, the therapeutic efficacy of these agents for so-called rare epidermal growth factor receptor mutations, and in particular those characterized by a high degree of complexity, such as double mutations, remains a subject of clinical uncertainty. Case presentation In this context, we present the case of a 64-year-old man of Moroccan descent, a lifelong non-smoker, diagnosed with metastatic non-small cell lung cancer characterized by a complex epidermal growth factor receptor mutation encompassing L858R and S768I. The patient subsequently underwent afatinib-based treatment, showing notable clinical results. These included a remarkable overall survival of 51 months, with a median progression-free survival of more than 39 months. Conclusions This case report is a compelling testimony to the evolving therapeutic landscape of non-small cell lung cancers, providing valuable insight into the potential therapeutic efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors in the realm of rare and complex epidermal growth factor receptor mutations.

Fibrosing mediastinitis, also known as sclerosing mediastinitis, is an uncommon condition marked by abnormal proliferation of fibrous tissue in the mediastinum. This condition may accrue either as an idiopathic condition or as a complication of an underlying disease process. Its pathogenesis remains unknown. However, most reported cases are incriminating abnormal immune-mediated hypersensitivity responses to Histoplasma infection. Other rare causes include tuberculosis, blastomycosis, and an idiopathic form that may be associated with other miscellaneous conditions. CT and MR imaging play a vital role in the diagnosis and management of this disease. We present a rare case of fibrosing mediastinitis as a late complication of tuberculosis in a 34-year-old man with a prior history of mediastinal tuberculosis, mimicking initially a neoplastic mediastinal process. We will describe this clinical case in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.

Background: Metabolic syndrome (MetS) is a global health concern, especially for low and middle-income countries with limited resources and information. The study's objective was to assess the prevalence of MetS in Freetown, Sierra Leone, using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF) and Harmonize ATP III. Additionally, we aimed to establish the concordance between these three different criteria used. Methods: This community-based health screening survey was conducted from October 2019 to October 2022. A multistage stratified random design was used to select adults aged 20 years and above. Mean, interquartile range (IQR), and logistic regression were used for statistical analysis. The kappa coefficient statistics resolved the agreement between these defined criteria. Results: The prevalence for NCEP ATP III, Harmonize ATP III and IDF criteria was 11.8 % (95 % CI: 9.0–15.15), 14.3 % (95 % CI: 11.3–18.0), and 8.5 % (95 % CI: 6.2–11.2), respectively for the 2394 selected adults. The kappa coefficient (κ) agreement between the MetS is: Harmonized ATP III and IDF criteria = [(208 (60.8 %); (κ = 0.62)]; Harmonized ATP III and NCEP ATP III = [(201 (58.7 %); (κ = 0.71)]; while IDF and NCEP ATP III was [(132 (38.6 %); (κ = 0.52)]. In the multivariable regression analysis, waist circumference correlated with all three MetS criteria: ATP III [AOR = 0.85; C.I 95 %: (0.40–1.78), p = 0.032], Harmonized ATP III [AOR = 1.14; C.I 95 %: (0.62–2.11), p = 0.024], IDF [AOR = 1.06; C.I 95 % (0.52–2.16), p = 0.018] Conclusion: We reported a high prevalence of MetS in Freetown, Sierra Leone and identified waist circumference as a major risk factor for MetS. This underscores the crucial role of health education and effective management of MetS in Sierra Leone.

Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax.

Objective To investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone.Design This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants.Setting The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone.Participants A total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled.Outcome measure Anthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD.Results The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low.Conclusions This study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.

Background: Head and neck cancer (HNC) encompasses malignant tumors in areas like the oral cavity, pharynx, and larynx. This analysis identifies strengths and deficiencies in HNC research, aiming to improve published papers' quality, quantity, and diversity. It also encourages more participation from oncologists, particularly in Egypt, to bridge the gap with Western healthcare standards. Methods: A systematic search was conducted in databases including PubMed, Scopus, Web of Science, and Embase. The goal was to gather research articles on HNC in Egypt published from January 1, 2000, to December 31, 2022. Results: From 2150 articles, 1329 were screened by title and abstract, leading to 193 for full-text review. Finally, 174 articles were included in the final analysis. 2020 saw the highest number of publications. The majority were primary research articles, with randomized controlled trials being prevalent. Most studies were clinical, focusing on radiotherapy, and involved adult patients, emphasizing service delivery. Publications were predominantly in non-Egyptian journals, with the Egyptian Journal of Radiology and Nuclear Medicine being the most frequent. Research was mainly conducted by Egyptian authors and at Cairo University. Conclusion: The growing prevalence of HNC in Egypt underscores the need for more comprehensive research on its various aspects, including etiology, risk factors, and prevention. There's a call for increased research outputs at different Egyptian universities, multicenter studies, and international collaborations. This approach can improve the understanding and management of HNC, contributing to global discussions and advancing treatment and prevention strategies in Egypt.

Background: We herein report the case of a patient with advanced lung adenocarcinoma who presented a heterogeneous distribution of EGFR mutation. Case report: A 74-year-old Moroccan male former smoker was diagnosed with advanced lung adenocarcinoma, harboring S768I exon 20 substitution mutation confirmed by Real Time PCR and Pyrosequencing, but not detected by direct sequencing despite 70% of tumor cells. The present report describes a case of minor histologic intratumoral heterogeneity with heterogeneous distribution of EGFR mutation. Conclusion: Both sensitivity and specificity of molecular methods can provide evidence of intratumoral heterogeneity, which may explain the mismatch between the validation of oncology biomarkers and predicting therapeutic response to targeted therapy.

Pulmonary re-expansion edema (PRE) was first described by Carlston in 1958. To the knowledge, only one case has been described following pleuropulmonary decortication. The authors present the case of a 19-year-old patient who underwent pleuropulmonary decortication and who presented an PRE intraoperatively. Early diagnosis and the rapidity of treatment allowed a favourable evolution. Therefore, the prognosis of intraoperative PRE depends on the rapidity and efficiency of medical management.

Thymolipoma is a rare benign neoplasm of the thymus containing both mature adipose tissue and thymic tissue. We report a case of a 34‐year‐οld man, presenting a mass of the anterior mediastinum, the radiology investigation and operatory piece diagnosed a thymolipoma.This study highlights the clinical diagnostic and therapeutic features as well as the evolutionary characteristics of this entity.

Objective Our prospective study aims to define the correlation of EGFR (epidermal growth factor receptor) mutations with major histological subtypes of lung adenocarcinoma from resected and non-resected specimens, according to the WHO 2015 classification, in Moroccan North East Population. Methods Epidermal growth factor receptor mutations of 150 primary lung adenocarcinoma were performed using Real-Time PCR or SANGER sequencing. SPSS 21 was used to assess the relationship between histological subtypes of lung adenocarcinoma and EGFR mutation status. Results 25 mutations were detected in the series of 150 lung adenocarcinomas, most of which were found in cases with papillary, acinar, patterns than without these patterns and more frequently occurred in the cases without solid pattern than with this pattern. A significant correlation was observed between EGFR mutation and acinar (P = 0,024), papillary pattern (P = 0,003) and, negative association with a solid pattern (P < 0,001). In females, EGFR mutations were significantly correlated with the acinar pattern (P = 0,02), whereas in males with the papillary pattern (P = 0,01). Association between the histologic component and exon 19 deletions and exon 21 mutations were also evaluated and, we found a significant correlation between the papillary major pattern with exon 19 mutations (P = 0,004) and, ex21 with the acinar component (P = 0,03). Conclusion An analysis of resected and non-resected lung ADC specimens in 150 Moroccan Northeast patients, revealed that acinar and papillary patterns may predict the presence of a mutation in the EGFR gene. While the solid major pattern may indicate a low mutation rate of the EGFR gene.

Primary tumor of the trachea is rare. Although most tumors in adults are malignant, various benign tumors might occur. However, pleomorphic adenoma of the trachea is extremely rare. So far, few cases have been reported in medical literature. We report a case of a 38-year-old man with 6 months history of dyspnea and wheezing; the asthma was the initial diagnosis formulated by his family doctor. However, the symptoms were not improved by asthma treatment. The patient was admitted to the emergency department for respiratory distress, and underwent nasal continuous positive airway pressure. Immediately, after an urgent chest computed tomography (CT) was done and revealed an obstructive tumor of the distal trachea which was homogeneous with a smooth and regular surface suggesting its benignity. The patient was operated urgently, the histological examination of the surgical specimen revealed pleomorphic adenoma. We present this case to inform colleagues that pleomorphic adenoma must be considered in the differential diagnosis of tracheal tumors, especially if we have an appearance on CT suggesting the benignity. Surgery is the treatment of choice of this tumor with the lowest recurrence probability.

Despite having safe and efficacious vaccines against COVID-19, vaccine hesitancy is widespread. Although a trusted source of information, vaccine hesitancy has been reported among healthcare professionals, yet few studies have explored this phenomenon in sub-Saharan Africa. We conducted a cross-sectional survey of healthcare professionals in Sierra Leone from January to March 2022. Measures included sociodemographic/health-related information and COVID-19-related concerns. From the responses, we constructed a hesitancy (VAX) score, with higher scores implying negative attitudes or unwillingness to vaccinate. Multivariate linear regression was used to access factors associated with vaccine hesitancy. Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students). The mean VAX score was 43.27 ± 8.77, with 60.1% of respondents classified as vaccine hesitant (>50th percentile) and 13.8% as highly hesitant (>75th percentile). Worries about unforeseen future effects (76.3%), a preference for natural immunity (59.5%), and profiteering/mistrust of health authorities (53.1%) were the most common concerns. Being a medical student (β = 0.105, p = 0.011) and previously refusing a recommended vaccine (β = 0.177, p < 0.001) were predictors of COVID-19 vaccine hesitancy. Our findings call for addressing vaccine hesitancy among healthcare professionals as an essential component of strategies aimed at increasing COVID-19 vaccine uptake in this setting.

In this paper, a hybrid position/force controller for electrohydraulic servo-actuators is designed in the presence of residual dynamics. The purpose is to apply a cycle of movement that is mostly used in industrial fatigue test applications, which consists in imposing a specified force on a flexible load after a movement to some position. This cycle can be repeated several times with different magnitudes and frequencies of force and position trajectories. Some damages could occur at switching times, especially in the presence of some residual dynamics. To avoid any damages at switching times, a force trajectory generator is designed. Then, our contribution defines a method to automatically generate the switching signal in order to commute between two controllers with any abrupt change of state. To show the effectiveness of the proposed approach, several simulation tests are carried out on the electrohydraulic system.

Abstract Background The occurrence of lung metastasis from benign uterine leiomyomas is rarely reported especially in post menopausal women. The pathogenesis of these metastatic benign tumors still remains a subject of various speculations. Case presentation A 57-year-old woman presented with a chronic cough and dyspnea. She had undergone 8 years previously, hysterectomy for benign leiomyomas. A chest computed tomography scan showed a 4 cm solitary nodular parenchymal tumor that increased in size after 12 months. The histological analysis of the biopsy from this nodule showed a benign tumor with regular spindle cells disposed in intersected fascicles. At immunohistochemical analysis, the tumor cells were positive for smooth muscle markers and oestrogen-progesterone receptors with a low mitotic index assessed by Ki-67. These features were consistent with a benign metastasizing uterine leiomyoma. At the multidisciplinary meeting, prescription of an aromatase inhibitor has been decided for the patient. Conclusions Benign metastasizing uterine leiomyomas of the lung are very rare tumors. Although extremely rare in post menopausal women, their diagnosis should be considered in symptomatic patients with a history of hysterectomy for leiomyomas.

Although parathyroid ectopy in the mediastinum has been the subject of several publications, its location in the posterior mediastinum is very rarely reported. We report a case of a 69-year-old patient who presented with clinical symptoms of malignant hypercalcemia due to a retrotracheal mediastinal parathyroid adenoma. The surgical excision leads to a quick normalisation of the phosphocalcic balance with improvement of the clinical symptoms. Ectopic hypersecreting parathyroid adenoma with life-threatening hypercalcemia should prompt radiological assessment and appropriate surgical management to prevent further clinical complications.

The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 g/kg and clonidine 1g/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 g/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications.Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (P=0.05). Side effects such as respiratory depression, vomiting and bradycardia were similar in both groups. The adjunction of clonidine to fentanyl as additives to bupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

INTRODUCTION: bien que la plupart des principes de réhabilitation précoce post césarienne paraissent applicable dans nos structures de soins, il semble que la mise en èuvre reste e. METHODES: il s'agit d'une enquête structurée par courrier électronique auprès des médecins anesthésistes de la région de Sfax décrivant leurs pratiques habituelles dans les maternités étatiques et privées de la région de Sfax. Nous avons utilisé un questionnaire dans le cadre de prise en charge de la césarienne programmée.

This paper aims to propose and develop an adaptive moving sliding mode controller (AMSMC) that can be applied for nonlinear single-input single-output (SISO) systems with external disturbances. The main contribution of this framework consists to overcome the chattering phenomenon problem. The discontinuous term of the classic sliding mode control is replaced by an adaptive term. Moreover, a moving sliding surface is proposed to have better tracking and to guarantee robustness to the external disturbances. The parameters of the sliding surface and the adaptive law are deduced based on Lyapunov stability analysis. An experimental application of electropneumatic system is treated to validate the theoretical results.

INTRODUCTION: la thoracoscopie est l'exploration endoscopique de la cavité pleurale, des organes avoisinants (diaphragme, péricarde, médiastin) et du poumon. Le but de ce travail se veut d'abord didactique ; décrivant la thoracoscopie, ses techniques ainsi que sa place dans la prise en charge de la pathologie thoracique (indications et perspectives thérapeutiques) et informatif en rapportant l'expérience de notre équipe. METHODES: il s'agit d'une étude rétrospective intéressant 104 thoracoscopies à visée diagnostique et/ou thérapeutique réalisées au service de chirurgie thoracique du Centre Hospitalier Universitaire Hassan II de Fès, sur une période de 04 ans (Août 2008-décembre 2012). Nous avons exclu de notre étude les cas ayant bénéficié d'une médiastinoscopie ainsi que les cas ayant bénéficié d'une thoracoscopie dans le cadre des traumatismes fermés du thorax ou des plaies thoraciques. RESULTATS: l' âge moyen des patients est de 47 ans, avec des extrêmes allant de 18 à 80 ans, et une légère prédominance masculine à 54%.La thoracoscopie est d'ordre pleural chez 86 patients, pulmonaire chez 10 patients et médiastinale chez 8 patients. La thoracoscopie avait une indication à visée diagnostique chez 87 cas et thérapeutique chez 52 patients (talcage dans 45 cas, décortication pleuropulmonaire dans 2 cas, résection de kystepleuro-péricardique dans 2 cas, cure de pneumothorax dans 2 cas et une fenêtre péricardique). L'évolution post opératoire etait marquée par une amélioration clinico-radiologique chez 40 malades, 11 ont présenté une amélioration clinique seule, 6 ont présenté une persistance ou une récidive de l'épanchement. CONCLUSION: la thoracoscopie représente un réel gain en matière de diagnostic de certaines pathologies intra-thoraciques. Son intérêt thérapeutique limité doit être éventuellement étendu grâce à la chirurgie thoracique vidéo assistée, qui est une technique récente fiable avec une limitation de la durée d'hospitalisation et de la morbidité.

L'hyperemesis gravidarum s'accompagne habituellement d'une perte de poids, d'une acétonurie et de troubles hydro-électrolytiques comme il peut également s'accompagner d'anomalies du bilan hépatique. Nous rapportons un cas de vomissements gravidiques à 10 semaines d'aménorrhée non traité et vu tardivement avec des troubles ioniques sévères associés à des répercussions cliniques dans un contexte de cytolyse, de cholestase et d'insuffisance rénale aigue. Ce cas a bien répondu au traitement médical.

Les sarcomes ténosynoviaux ou synovialosarcomes sont des tumeurs malignes des tissus mous, l'atteinte primitive de la paroi thoracique est rare. Nous rapportons l'observation d'un patient suivi pour des douleurs thoraciques avec à l'examen une masse pariétale, le bilan radiologique a montré un développement également endothoracique de la tumeur. L'analyse anatomopathologique de la biopsie de la masse a conclu à un synovialosarcome, le patient a eu une résection de la tumeur associé à une radio chimiothérapie, le suivi a été marqué par la récidive au bout d'un an. A travers cette observation, nous insistons sur la rareté de la localisation, les caractères histologiques, les différentes approches thérapeutiques et le pronostic de ces tumeurs qui reste péjoratif.

Nous rapportons un cas de tuberculose costale chez une patiente de 44ans ayant des antécédents de miliaire tuberculeuse. L’atteinte costale était pseudotumorale ayant conduit à une biopsie exérèse chirurgicale de la masse costale dont l’étude histologique est revenue en faveur d’une tuberculose. Cette observation ainsi que celles de la littérature, confirment les difficultés diagnostiques de cette forme rare de tuberculose.

Les fistules bilio thoraciques post traumatiques sont extrêmement rares, leur traitement peut être conservateur mettant en œuvre des techniques de radiologie et d’endoscopie interventionnelle ou chirurgical si échec du premier. Nous rapportons une observation de fistule bilio pleurale post traumatique où l’indication du traitement chirurgical de première intention a été indiscutable vu le sepsis et l’instabilité hémodynamique.

Les tumeurs desmoides sont des tumeurs rares des tissus mous qui peuvent être très agressives localement. A travers l’expérience de notre service, nous analyserons les résultats du traitement chirurgical de ces tumeurs. De 1980 à 2008, 12 patients ont été opérés pour tumeur desmoide de la paroi thoracique. Le diagnostic a été suspecté sur la base des signes cliniques et radiologiques. Aucun patient n’avait un syndrome de Gardner. L’abord chirurgical a été souvent électif à l’aplomb de la tumeur. La résection a été complète dans 11 cas. La confirmation diagnostique a été apportée par l’étude histologique de la pièce opératoire. La durée du suivi post opératoire variait entre 24 et 180 mois. Une patiente était décédée par insuffisance cardiaque et rénale. 7 cas avaient récidivé, et qui ont été traités par simple résection complète dans 5 cas, dont un avait nécessité une greffe myocutanée ; par ailleurs, deux cas ont été traités par résection incomplète associée à une radiothérapie adjuvante. La chirurgie des tumeurs desmoides de la paroi thoracique doit être aussi large que possible pour diminuer le risque de récidive.

Background: One of the most crucial objectives in the education and treatment of young children with autism spectrum disorder (ASD) is independence in daily living skills (DLS). Therefore, as a child with ASD condition grows, measures of everyday functioning including adaptive behaviors should be more regularly monitored and regulated., Aim: The primary aim of this study was to evaluate the feasibility of a developed theory-based training program and its preliminary effectiveness on the acquisition of DLS among school-age children with ASD., Methods: A preliminary experimental research design (pre- and post-evaluation) was conducted from the beginning of May to the end of July 2023 on 31 children with ASD. The socio-economic status scale, Vineland Adaptive Behavior Scale, and Gilliam Autism Rating Scale were administered before and after a theory-based DLS training program., Results: There was a significant difference in the DLS and motor functioning before and after the implementation of the training program ( p < .001 and p = .021, respectively). In addition, there was a significant difference in the total score of autistic severity before and after the implementation of the training program ( p < .001)., Conclusion: The promising outcomes of the study indicate the need for further testing and expansion of this intervention. These findings contribute to the growing body of evidence highlighting the significance of DLS training program in the comprehensive treatment approach for children with ASD. Consequently, proposing DLS training programs as a cost-effective and efficient nursing intervention is warranted., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: Pulmonary fibrosis is a life threating disease which requires an immediate treatment and due to the limited medications, this study focused on synthesizing a series of quinoline-based pyrimidodiazepines 4a-f as a novel antifibrotic hit. Materials & methods: The target compounds were synthesized via a one-pot reaction then investigated in a rat model of lung fibrosis induced by bleomycin (BLM). Results: Results revealed significant attenuation of the tested pro-inflammatory cytokines, fibrotic genes and apoptotic markers; however, Bcl-2 was upregulated, indicating a protective effect against fibrosis. Moreover, the molecular docking studies highlighted promising interactions between compounds 4b and 4c and specific amino acids within the protein pockets of caspase-3 (ARG341 and THR177), malondialdehyde (LYS195, LYS118 and ARG188) and TNF-α (SER99 and NME102). Conclusion: Compounds 4b and 4c emerge as promising candidates for further preclinical investigation as pulmonary antifibrotic agents.

Diclofenac (DF), a non-steroidal anti-inflammatory drug, is commonly used to relieve pain and inflammation. High doses of DF might induce acute kidney injury (AKI), particularly in elderly, a known vulnerable population., Aim: We aimed to assess the protective role of melatonin (Mel) on DF-induced AKI in aged rats and to highlight the underpinning mechanisms include, oxidative stress and inflammation focusing on microRNA-34a (miR-34a), nuclear factor erythroid-2-related factor-2/hemeoxygenase-1 (Nrf2/HO-1) and NLR family-pyrin domain containing-3 (NLRP3) inflammasome pathways, and to elucidate the possibility of epithelial sodium channel (ENaC) involvement., Materials and Methods: Thirty old male Wistar rats were allocated randomly into 3 groups: Control, DF and Mel-DF groups., Key Findings: Melatonin provided nephroprotective effects against DF-induced AKI via attenuating the expression of renal miR-34a and subsequently promoting the signaling of Nrf2/HO-1 with elevation of the antioxidant defense capacity and suppressing NLRP3 inflammasomes. Melatonin alleviated DF-induced hypernatremia via decreasing the ENaC expression. Renal histopathological examination revealed significant reduction in vascular congestion, mononuclear infiltration, glomerulo-tubular damage, fibrosis and TNF-α optical density., Significance: It can be assumed that melatonin is a promising safe therapeutic agent in controlling DF-induced AKI in elderly., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The safety of blood donation requires screening for transfusion-transmitted infections, including human immunodeficiency virus (HIV), syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). This study aimed to determine the seroprevalence of HIV, HBV, HCV and syphilis in blood donors of Mogadishu Tertiary Care Hospital, Somalia from 2020 to 2022., Methods: The records of 109,385 blood donors who attended our blood center in Mogadishu-Somalia between 2020 and 2022 were examined retrospectively. Serum samples of donors; HBsAg, anti-HCV, anti-HIV and syphilisscreening tests were studied using the microparticleEnzyme-Linked ImmunoSorbent Assay (ELISA)(Vitros, Ortho-Clinical Diagnostics, U.S) method.The distribution of HBsAg, anti-HCV, anti-HIV and syphilis positivity rates of 109,385 blood donors according to years, gender and age were examined. Kolmogorov Smirnov, Skewness, Kurtosis tests and histogram were used for normality analysis. Chi-squared test (χ2) and Fisher Exact test were used to analyze categorical data. Categorical variables were expressed as frequency (percentage). Analysis of continuous data was performed with the Mann Whitney U test. P < 0.05 value was considered statistically significant., Results: HBsAg positivity was found in 0.6% of the donors, anti-HCV positivity in 0.01%, anti-HIV positivity in 0.03% and syphilispositivity in 0.3%. The results showed that among the blood donors, the prevalence of syphilis, HIV, Hepatitis B, and Hepatitis Cwas notably low., Conclusion: The prevalence of HBV, HCV, HIV, and syphilis among blood donors in Somalia was found to be quite low. Even if our found seroprevalence rates are low, to guarantee the safety of blood for recipients, strict selection of blood donors and thorough screening of donors' blood using accepted procedures are strongly advised., (© 2024. The Author(s).)

Background: Research identified preliminary evidence that artificial intelligence (AI) has emerged as a transformative force in healthcare, revolutionising various aspects of healthcare delivery, from diagnostics to treatment planning. However, integrating AI into healthcare systems in Egypt is challenging, particularly concerning healthcare professionals' acceptance and adoption of these technologies. This mixed-method study aimed to explore the sentiment of nurses at different organisational levels towards AI and resistance to change in healthcare organisations., Methods: A mixed-method design was employed, with quantitative data collected through a survey of 500 nurses using the general attitudes towards AI and resistance to change scale and qualitative data from semi-structured interviews with 17 nurses. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed thematically., Results: The survey demonstrated that positive attitudes were inversely correlated with resistance behaviour and resistance to change. Additionally, perceptions of AI's usefulness, ease of use and value were strongly and positively correlated with positive attitudes and negatively correlated with negative attitudes. Moreover, the influence of colleagues' opinions, self-efficacy for change and organisational support showed significant positive correlations with positive attitudes towards AI and negative correlations with negative attitudes. Qualitatively, nurses cited obstacles such as lack of familiarity with AI technologies, biases affecting decision-making, technological challenges, inadequate training and fear of technology replacing human interaction. Readiness for AI integration was associated with the necessity of training and the timing of AI use., Conclusion: Nurses demonstrated varied understanding of AI's applications and benefits. Some acknowledged its potential for efficiency and time-saving, while others highlighted a need for up-to-date knowledge., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

PJVK gene was recently shown to create hypervulnerability to sound in humans and was the first human gene implicated in non-syndromic hearing impairment due to neural defect. Targeted next-generation sequencing of over 150 known deafness genes was performed in the proband. Sanger sequencing was used to validate the PJVK variant and confirm familial segregation of the disease. A minigene-based assay has been performed to assess the impact of the variant on splicing. We identified a novel c.550-6A > G acceptor splice-site variant in the PJVK gene in the homozygous state in a Mauritanian child with severe to profound congenital deafness. The substitution was located in intron 4. The effect of the variation was demonstrated by a minigene assay which showed that the variation, an insertion of an additional 5 bp, created a new splice site resulting in the appearance of a premature stop codon (p.Phe184Tyrfs*26) and likely a truncated protein. This result constitutes a new splice-site variant report in the PJVK gene leading to DFNB59 type associated with autosomal recessive non-syndromic hearing impairment (ARNSHI)., (© 2024. The Author(s).)

Background: Anterior cruciate ligament (ACL) rehabilitation is a common intervention after ACL reconstruction. Since different types of exercise can influence muscle and kinematic parameters in diverse ways, the training order between the knee and ankle joints may also change gait parameters., Purpose: This study aimed to investigate whether the training sequence of the knee and ankle joints (knee followed by ankle training or vice-versa) in an ACL reconstruction (ACLR) rehabilitation program has any effects on knee extension and flexion torques., Methods: Forty-two men (aged 20-30 years) with ACLR participated in this study. They were randomly allocated to receive one of two interventions: (A) knee joint training followed by ankle training or (B) ankle joint training followed by knee training. After five weeks (four weeks of intervention and one-week washout), participants crossed from one group to another for an additional four weeks. Knee extension and flexion torques were assessed during the stance phase of the gait cycle before and after the intervention program., Results: Two-way Mixed-design MANOVA showed that knee extension torque improved significantly in both groups after training (p = 0.001, Cohen's D = 0.65), while the knee flexion torque increased significantly only in group B (p= 0.001, Cohen's D = 0.97). When comparing both groups, patients of group B presented significant improvements in the post-training mean values of all tested variables compared with group A., Conclusion: Starting a post-ACLR rehabilitation program with ankle training followed by knee training is better to improve knee flexion and extension torques during the stance phase of the gait cycle than starting the program by training the knee first, followed by the ankle. Future studies using a mixed-gender sample and different types of ACLR operations are necessary to examine whether similar improvements will happen as well as to test their effects on many sports activities., Competing Interests: Declaration of Competing Interest There is no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Children with ADHD were found to have language impairment in many studies. The way they use language in their everyday life may be affected, namely, the pragmatic aspect of language. Measuring the affected parameters in all aspects of language will help to reach better rehabilitation. Thus, this study set out to observe relationships between hyperactivity/impulsivity and inattention with all language domains in 30 Egyptian Arabic-speaking children with ADHD between 4 and ≤7 years old with the aim of better intervention. Children were evaluated to establish the diagnosis of ADHD and its type following the diagnostic criteria of the DSM-V criteria and the Conners' Parent Rating Scale-Revised. Language abilities were assessed by the Pre-school Language Scale 4th edition (Arabic version), the Arabic articulation test, and the Egyptian Arabic Pragmatic Language Test. This assessment covered receptive and expressive language abilities and phonological and pragmatic skills., Results: Compared to norms, it was found that the ADHD children who participated in this study had non-significant language delays in the parameters of the modified PLS-4 test. 70 % of the ADHD children had total pragmatic test scores below their 5th percentile, while 30 % of the children had total pragmatic test scores above their 5th percentile. 50 % of ADHD children failed to master certain sounds corresponding to their phonological age. A statistically significant negative correlation was observed between each of the inattention and hyperactivity/impulsivity scores and the receptive, expressive, total language ages, and pragmatic language scores., Conclusion: Children with ADHD in this study did not show major difficulties in areas beyond what would be expected in normally developing children. Most children with ADHD in the present study had problems with pragmatic language aspects that are correlated positively to ADHD symptoms. 50 % of ADHD children failed to master certain sounds corresponding to their chronological age., Competing Interests: Declaration of competing interest No competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: We evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy., Methods: Ninety-seven male children, ASA I-II, 1-6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg -1 bupivacaine 0.5% combined with either 1 μg.kg -1 of dexmedetomidine (Group D), 30 mg.kg -1 of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents' satisfaction were recorded for the first 48 h postoperatively., Results: FLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents' satisfaction was greater in Groups D and M than in Group C (p = 0.026)., Conclusion: Dexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy., Competing Interests: Conflicts of interest The authors declare no conflicts of interest. There were no fundings., (Copyright © 2022 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

Background: In agricultural pest management, especially in combatting the invasive red imported fire ant (RIFA, Solenopsis invicta), significant challenges emerge as a consequence of the constraints of solely depending on chemical insecticides or entomopathogenic nematodes (EPNs). The utilization of chemical insecticides carries environmental and ecological hazards, whereas EPNs, when applied independently, might not offer the immediate effectiveness necessary for adequate RIFA suppression. Acknowledging these hurdles, our study investigates a synergistic method that integrates EPNs with chemical insecticides, aiming to fulfill the urgent demand for more efficient and environmentally friendly pest control solutions., Results: Our evaluation focused on the interaction between the highly pathogenic Steinernema riobrave 7-12 EPN strain and prevalent insecticides, specifically beta-cypermethrin and a mixture of bifenthrin and clothianidin, applied at highly diluted recommended concentrations. The findings revealed a notable increase in RIFA mortality rates when EPNs and these insecticides were used together, outperforming the results achieved with each method individually. Remarkably, this enhanced efficacy was especially evident at lower concentrations of the bifenthrin-clothianidin mixture, indicating a valuable approach to minimizing reliance on chemical insecticides in agriculture. Furthermore, the high survival rates of EPNs alongside the tested insecticides indicate their compatibility and potential for sustained use in integrated pest management programs., Conclusion: Our research underscores the effectiveness of merging EPNs with chemical insecticides as a powerful and sustainable strategy for RIFA management. This combined approach not only meets the immediate challenges of pest control in agricultural settings, but also supports wider environmental objectives by reducing the dependency on chemical insecticides. © 2024 Society of Chemical Industry., (© 2024 Society of Chemical Industry.)

Background: Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes., Objective: Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment., Materials and Methods: Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy., Results: The plasma gel group showed a significantly earlier onset of repigmentation and faster healing ( p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group ( p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper., Conclusion: Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Placental Derived Nucleoproteins (PDNs) is commonly associated with the process of angiogenesis, and doesn't affect the healthy vasculature. PDNs are clinically estimated for the treatment of cancer cases and severe hepatic injuries. Thus, the pathophysiological effects of PDNs targeting liver fibrosis is a concern., Objectives: To assess the molecular, histopathological, and chemical impact of PDNs on liver regeneration in Diethylnitrosamine (DEN)-induced mice liver fibrosis., Methods: Normal untreated reference group of ten mice and two groups of induced liver cirrhosis using the recommended weekly dose of Diethylnitrosamine in total of eleven doses, initially 20 mg/kg body weight, and then 30 mg/kg in the third week, followed by 50 mg/kg for the last eight weeks, one of them combined treatment aligned with injection with total dose of extracted PDNs 25 mg/kg, in comparison to PDNs only treated group. An autopsy was performed after 22 weeks of the initial dose of DEN in each group. Molecular characterization of Alpha smooth muscle actin, TGFβ and NF-κB biomarkers for liver then liver function panel were analyzed and finally hepatopathological changes were observed using H&E stain and Sirius red stain., Results: Liver enzymes, total bilirubin and total proteins in tissue in PDNs-DEN treated models were controlled in the direction of normal group and 50 % reduction of fibrosis in comparing to DEN-treated models. The cellular arrangement of fibrosis in the DEN entire groups were differentiated with high significant impact on the survival of mice. Increased levels of the biochemical markers in liver homogenate, loss of tissue architecture, and proliferation were observed in induced groups and down regulation of alpha smooth muscle actin, TGFβ and NF-κB., Conclusion: This finding demonstrates an improvement of Liver tissue induced fibrosis using DEN combined with PDNs. This strategy is to generate an animal model with a lower occurrence of fibrosis in a short time treatment regarding liver regeneration., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objective: Health programs for Indigenous people are most effective, acceptable, and sustainable when Indigenous perspectives are prioritized. Codesign builds on Indigenous people's creativity and propensity to experiment with new technologies and ensures research is designed and implemented in a culturally safe and respectful manner. Limited research has focused on older Indigenous people as partners in digital health. No research has focused on the acceptability and feasibility of older Indigenous people using wearables for heart health monitoring. This study provides insights into the acceptability and feasibility for ≥55-year-old Indigenous people living in remote locations to use wearables (watches and patches) to detect atrial fibrillation (AF) and high blood pressure., Methods: This mixed methods study was codesigned and coimplemented with the local Aboriginal Controlled Health Service in a remote area of New South Wales, Australia. It included active involvement and codesign with the participants. The devices used in this study included a Withings Scan watch and a Biobeat patch., Results: Despite challenging conditions (>36°C) and variable internet connectivity, 11 Indigenous older adults participated in a five-day wearables program in a remote location. Participants indicated that using digital health devices was acceptable and feasible for older Indigenous users. They described high levels of comfort, safety and convenience when using wearables (patches and watches) to detect AF. They were active participants in codesigning the program., Conclusion: Older Indigenous Australians are motivated to use wearable health devices. They are keen to participate in codesign innovative health tech programs to ensure new health technologies are acceptable to Indigenous people and feasible for remote locations., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Immunisation is one of public health's greatest success stories, yet, annually, 20 million children miss out entirely or partially on routine immunisation. National immunisation estimates have the United Arab Emirates (UAE) lagging behind with 4% of children under the age of 1 not having received any vaccines. Vaccine hesitancy is considered one of the biggest barriers to vaccination. This study aims to evaluate the UAE's parents' vaccination attitudes and practices as well as estimate vaccine hesitancy's prevalence and determinants., Methodology: This cross-sectional, descriptive study collected data from parents across the UAE during the months of March and April 2024. The 60-item questionnaire included the Parental Attitudes towards Childhood Vaccines scale (PACV), the Vaccine Hesitancy Scale, and the Digital Vaccine Literacy (DVL) scale. Univariate, bivariate (chi-squared test), and multivariate (logistic regression) analyses were conducted., Results: A total of 550 responses were retained. 84.55% of participants were female (n = 465/550), half were middle-aged (31-45 years old), and 21.09% (n = 116/550) were healthcare workers. 94.36% (n = 519/550) had their child/children receive all mandated vaccines. Only 39.82% (n = 219/550) found their level of knowledge about childhood vaccinations to be good/excellent. 70.11% (n = 386/550) of participants had high digital vaccine literacy. More than 95% had positive attitudes towards measles, meningitis, and pertussis vaccines. 14.00% (n = 77/550) were identified as vaccine-hesitant according to the PACV. Overall, using general practitioner/ paediatrician as a knowledge source, digital vaccine literacy, perceived children's vaccine knowledge, and nationality were associated with lower vaccine hesitancy status., Conclusion: Vaccine hesitancy exists and is prevalent in the UAE; however, the majority of participants reported high trust in vaccines, the local healthcare systems and physicians. Vaccine hesitancy can be tackled but will require tailored solutions and proactive healthcare workers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Barqawi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: The authors report no conflicts of interest in this communication.

Apocynin (APO) is a naturally occurring acetophenone with eminent anti-inflammatory and anti-oxidant peculiarities. It suffers from poor bioavailability due to low aqueous solubility. Herein, APO was loaded in a Clove oil (CO) based Nanostructured lipid carrier (NSLC) system using a simple method (ultrasonic emulsification) guided by a quality-by-design approach (2 3 full factorial design) to optimize the formulated NSLCs. The prepared NSLCs were evaluated regarding particle size (PS), polydispersity index (PDI), zeta potential (ZP), and entrapment efficiency (EE%). The optimal formula (F2) was extensively investigated through transmission electron microscope (TEM), Fourier transform infrared (FT-IR) spectroscopy, Differential scanning calorimetry (DSC), X-ray diffractometry (XRD), in vitro release, and stability studies. Cytotoxicity against human urinary bladder carcinoma (T24) cell line and in vivo activity studies in rats with induced cystitis were also assessed. The results disclosed that the optimal formula (F2) had PS of 214.8 ± 5.8 nm with EE% of 79.3 ± 0.9%. F2 also exhibited a strong cytotoxic effect toward the T24 cancer cells expressed by IC50 value of 5.8 ± 1.3 µg/mL. Pretreatment with the optimal formula (orally) hinted uroprotective effect against cyclophosphamide (CP)-induced hemorrhagic cystitis (HC) in rat models, emphasized by histopathological, immunohistochemical, and biochemical investigations. In consideration of the simple fabrication process, APO-loaded CO-based NSLCs can hold prospective potential in the prophylaxis of oncologic and urologic diseases., (© 2024. The Author(s).)

Background: Determining the role of epigenetics in systemic juvenile idiopathic arthritis (SJIA) provides an opportunity to explore previously unrecognized disease pathways and new therapeutic targets., Aim: We aimed to identify the clinical significance of microRNAs (miRNA-26a, miRNA-223) in SJIA., Materials and Methods: This cross-sectional study was conducted on a group of children with SJIA attending to pediatric rheumatology clinic, at Mansoura University Children's Hospital (MUCH) from December 2021 to November 2022. Patient demographics, and clinical, and laboratory data were collected with the measurement of microRNAs by quantitative real-time PCR. The Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests were used for variable comparison and correlations, besides the receiver operating characteristic (ROC) curve for microRNAs disease activity and treatment non-response discrimination., Results: Forty patients were included in the study. On comparison of miRNA-26a, and miRNA-223 levels to the clinical, assessment measures, and laboratory features, miRNA-26a was statistically higher in cases with systemic manifestations versus those without. Similarly, it was higher in children who did not fulfill the Wallace criteria for inactive disease and the American College of Rheumatology (ACR) 70 criteria for treatment response. Meanwhile, miRNA-223 was not statistically different between cases regarding the studied parameters. The best cut-off value for systemic juvenile arthritis disease activity score-10 (sJADAS-10) and the ability of miRNA-26a, and miRNA-223 to discriminate disease activity and treatment non-response were determined by the (ROC) curve., Conclusion: The significant association of miRNA-26a with SJIA features points out that this molecule may be preferentially assessed in SJIA disease activity and treatment non-response discrimination., (© 2024. The Author(s).)

WHAT IS KNOWN ON THE SUBJECT?: Opioid use disorder (OUD) is a prevalent problem among Egyptian youth, and achieving recovery and abstinence is challenging. Cognitive behavioural therapy (CBT), a well-known approach, can be particularly beneficial when it addresses psychological aspects such as resilience and self-esteem. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Our research is recognized as a trailblazer in integrating a spiritual adaptation of CBT with spiritual elements for treating patients with OUD in the Egyptian context. This innovative approach marks a significant advancement in the field. The study found a statistically significant increase in the mean scores of resilience, self-esteem, and spirituality (p < .001 each) following the spiritual adaptation of CBT sessions compared to the control group. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings can guide psychiatrists and nurses in providing more comprehensive and effective care to patients with OUD by incorporating a spiritual adaptation of CBT with spiritual components into treatment plans., Abstract: INTRODUCTION: Opioid use disorder (OUD) is a prevalent problem among Egyptian youth, and achieving recovery and abstinence is challenging. Cognitive behavioural therapy (CBT), a well-known approach, can be particularly beneficial when it addresses psychological aspects such as resilience, self-esteem and spirituality., Aim: This study aimed to evaluate the effectiveness of a spiritual adaptation of CBT in enhancing these factors among clients with OUD., Methods: A quasi-experimental study with a control group was conducted using a pretest-posttest design. The study included 49 clients with OUD and 46 clients in the control group. The Rosenberg Self-Esteem Scale-Modified Arabic Version, Daily Spiritual Experience Scale, and the Connor-Davidson Resilience Scale were used as measurement tools. CBT was delivered in 60-min group sessions. After 3 months, the questionnaires were re-administered to evaluate the effectiveness of a spiritual adaptation of CBT sessions., Results: The study found a statistically significant increase in the mean scores of resilience, self-esteem and spirituality (p < .001 each) following a spiritual adaptation of CBT sessions compared to the control group., Discussion: A spiritual adaptation of CBT effectively enhanced resilience, self-esteem and spirituality in clients with OUD., Implications for Practice: Understanding the effectiveness of a spiritual adaptation of CBT in enhancing resilience, self-esteem and spirituality can enable psychiatrists and nurses to provide more comprehensive and effective care to patients with OUD., (© 2024 John Wiley & Sons Ltd.)

Background: Depression is a prevalent issue among older adults and can significantly impact their overall quality of life. While traditional treatments may not always be sufficient or suitable for all individuals, the potential of alternative interventions, such as mindful walking, offers a ray of hope. This study aimed to evaluate the impact of mindful walking on rumination, agility, vitality, and mindfulness in geriatric patients with depressive disorders., Method: A prospective quasi-experimental design was employed with a purposive sample of 35 clients in the intervention group and 33 in the control group. This study utilized the Ruminative Responses Scale - Short Form (RRS-SF) and Five Facet Mindfulness Questionnaire (FFMQ) to measure the primary outcome. The Timed Up and Go Test (TUG) and State-Level Version of the Subjective Vitality Scale (SVS) were used to measure the secondary outcomes., Results: Mindful walking significantly affected vitality, mindfulness, and rumination, with effect sizes (ղ 2  = 0.168, 0.137, and 0.127), respectively. On the other hand, the intervention had a less significant effect on agility, with an effect size (ղ 2  = 0.047)., Conclusion: This study revealed that geriatric clients with depressive disorders showed more significant improvements in vitality, followed by improvement in rumination and agility. Integrating mindful walking as a part of care plans for those clients would promote their physical activity and mental well-being., Competing Interests: Declaration of competing interest We declare that this study followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines., (Copyright © 2024 Elsevier Inc. All rights reserved.)