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Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system and is a chronic disease leading to a reduced quality of life. The objective of the study is the assessing of physical disability in patients with MS and its impact on QoL; the aim is to facilitate the treatment of patients with this pathology.75 patients with multiple sclerosis from the Neurology and Neurogenetic Department of the Ibn Sina University Hospital, Rabat, Morocco were studied. The data was collected using a kit composed of several tools including a sociodemographic and clinical questionnaire, the Expanded Disability Status Scale (EDSS), and quality of life SEP-59.Of the 75 MS patients in the study, females accounted for 77.3% (n = 58) (the female/male ratio being 3.4). The mean age of the population was 38.2913.31 years, Relapsing remitting is most present at 65.3% (n=49), while 56% (n=42) were married. We determined that the average EDSS was 4.067 (SD 1.829) with 54.3% (n = 34) of the patients displaying a moderate level of disability (EDSS between 4 and 6.5). We found that of the role limitations - mental and physique, energy, overall quality of life, emotional well-being, distress, sexual satisfaction, sexual function were the QoL scales affected most (SEP-59). Furthermore EDSS is significantly associated with QoL SEP-59.The results of this study indicate a strong link between disability and the physical and mental health of patients with multiple sclerosis, which causes a deterioration in their quality of life. The involvement of psychological support is essential.

The present study was conducted to investigate occupational stress and general health among university professors, stress is measured by the Walter Gmelch Index (FSI), while general health was screened by the D. Goldberg GHQ-28 test. A collection of qualitative and quantitative data was carried out under the assumption that the stress at work perceived by the person correlates with his general health result.One hundred and twenty-five students (101 men, 20 women; aged 29-62) took part in this study with a kit that includes the two indices (FSI and GHQ-28) and a set of sociodemographic variables.The results revealed that a large part of the participants suffering from chronic stress and almost half of the subjects (48.76%) suffering from psychic disorders or somatization. The study also affirms our starting hypothesis on a significant correlation between the general state of health and the state of perceived stress. Statistical analysis also reveals a correlation between GHQ and certain institutional variables (grade and seniority at work).This study expresses the importance of a psychological first aid kit available to health professionals which makes it possible to estimate the prevalence of psychological distress in a given population and to detect psychosomatic cases which escape the general practitioner.

Multiple Sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system through the destruction of sheaths (myelin), disseminated in space and time. The aim of our work is to study the neurocognitive concept and mood disorders in patients with MS.The study includes in this study 75 cases of MS, collected at the Neurology (B) and Neurogenetics Department of Rabat Ibn Sina Hospital. The study was performed on MS patients using different scales that included: a self-questionnaire (socio-demographic, clinical), Hospital Anxiety and Depression scale (HADS), Rosenberg's Self-Esteem scale (RSE) and Expanded Disability Status Scale (EDSS).The mean age for the onset of the disease was 30-years, with a sex ratio of 3.4. The main clinical signs are: 69.33% and 70.67% of patients had respectively anxious and depressive disorder, which was associated with low self-esteem in 89% of them. The distribution according to the evolutionary forms of MS is 65% Relapsing Remitting (RR), 29% secondary progressive (SP) and 5% Primary Progressive (PP). As for the assessment of disability using EDSS, we note an average 4.071.829.That results of our study concord with other studies on the same age category. It confirms the predominance of women. They are followed by the appearance of psychological disorders such as depression anxiety and cognitive disorders. Remitting MS is the most common when compared to other forms. The anxiety and depression score was strongly correlated with the degree of self-esteem and disability.

Work stress or job-strain and iso-strain are perceived when there is a conflict between the demands placed on a person and their resources to cope with them. They have negative effects on worker health, and organizational productivity and performance. Our study consists of evaluating work stress and its components.102 workers of different functions (senior managers, supervisors, technicians and executing workers) volunteered and were invited to complete anonymously the Karasek questionnaire (JCQ).The analysis of the results showed a significant prevalence of iso-strain and job-strain. Thus, low decision latitude and high psychological demands are the most widespread stress factors.These results show the need to disseminate information and prevention programs against work stress to managers and staff to ensure the effective performance of a company.

Many people today live in urban cities and it is increasing every year, because of their need to live and work and This paper summarizes the solutions and the importance of stability in high-rise buildings and their tolerance of earthquakes and winds, and all that is needed for the stability of the building and to solve the problems that occur in particular and in detail Highlighted are the key connections of the tallest and ultra-slender buildings that have been designed and built for the world's tallest buildings. He talks about high-rise towers in general and about Burj Dubai in particular, and there will be what the engineers said and suggested before, and I will conclude in a simple way.

Background: In the developed countries, pulmonary thromboembolism associated with pregnancy (VTE) continues to be the principal cause of direct maternal death. Despite thorough treatment and preventative recommendations from several national authorities, reductions in mortality due to VTE have been negligible. Anticoagulation is still the cornerstone of prenatal care and has to be given to all patients with proven or high-risk PE. The preferred medication is low molecular weight heparin (LMWH), which has a known pharmacodynamic profile. Despite the massive utilization of these drugs there is actually little evidence supporting their efficiency in recurrent pregnancy loss reduction. Objectives: The study aims to summarize current evidences regarding the usage of anticoagulants and thrombolytics in Pregnancy. Methods: For article selection, the PubMed database and EBSCO Information Services were used. All relevant articles relevant with our topic and other articles were used in our review. Other articles that were not related to this field were excluded. The data was extracted in a specific format that was reviewed by the group members. Conclusion: A common cause of maternal death, pulmonary embolism-related fatalities still occur often in pregnant women with pulmonary embolism. One-third of pregnant women with pulmonary embolism and hemodynamic failure were reported to undergo systemic thrombolysis. There is an urgent need to improve prevention and care techniques for this vulnerable patient population. LMWHs are widely used for several different purposes as well as for the treatment and prevention of VTE during pregnancy and puerperium. Although the medicine has been found to be both safe and effective, there is no scientific proof to support its usage for all indications. In pregnant women with thrombophilia who are at high risk of developing these issues, prenatal prophylactic dalteparin does not prevent venous thromboembolism, pregnancy loss, or placenta-mediated pregnancy difficulties and is linked to an increased risk of mild bleeding. Enoxaparin may not offer any meaningful benefits to people suffering from recurrent abortion. However, in one study, the miscarriage rate was significantly lower when enoxaparin was used compared with untreated controls.

Resume Introduction/objectif Le disfonctionnement des schemas cognitifs et les conduites addictives sont souvent coexistant, ce qui peut provoquer la rechute au cours d’un traitement de desintoxication. L’objectif de cette etude est l’evaluation des schemas precoces inadaptes (SPI) chez les consommateurs d’heroine et leur relation avec la rechute au cours de traitement de substitution par la methadone. Sujet et methodes C’est une etude transversale portee sur 166 consommateurs d’heroine traites par la methadone au centre medicopsychologique au Nord du Maroc pendant 2017, les sujets ont complete le questionnaire de schemas de Young version courte (YQS) et le questionnaire d’Addiction Severity Index (ASI) concu pour mesurer la gravite de la toxicomanie. Resultats Les resultats ont montre que les schemas les plus actives chez la totalite des sujets sont peur de perdre le control, carence affective et echec avec la suractivation de peur de perdre le control conformement avec d’autres etudes, ainsi que la majorite de ces schemas appartiennent a la categorie separation et rejet, ils sont aussi significativement plus actives chez les femmes que chez les aux hommes pour cinq schemas. En ce qui concerne la rechute au cours de traitement, il y avait une correlation positive et significative entre la consommation d’heroine avec dix schemas sur treize signifiant que plus les schemas sont inadaptes plus que la probabilite de rechute est elevee (r = 0,509, p Conclusion L’approche cognitive a mis en evidence le role essentiel des troubles cognitifs dans les conduites addictives que les SPI peuvent etre predicateurs de la rechute au cours de traitement de substitution, et qu’une therapie des schemas en parallele peut attenuer la probabilite de la rechute.

Influenced by digital technologies, the cost of media production has considerably decreased, and the traditional media is faced with new agile, flexible and low-cost media entrepreneurs. This article examines the dynamics of the Iraqi media market transformation with an emphasis on factors that help to merge media entrepreneurs and digital media firms that target an audience on social media. A qualitative method was adopted in this study using open, in-depth interviews with nineteen media entrepreneurs and three managers of media firms. The study revealed that relative freedom and advanced communication technologies have encouraged media entrepreneurs to drive the new media on producing short videos and broadcast them on social media, which has become popular among media consumers. This new era in Iraqi media entrepreneurship has created an abstract space in which media entrepreneurs get involved in the media market, collaborate with international media and deliver values through the use of user-generated content and flexible journalism. This opportunity is shaped by three key interrelated factors: first, the relative freedom of journalism that resulted from the political environment, current regulations and advanced communication technologies that provide more space of freedom; second, the development of communication technologies that allow journalists and media entrepreneurs to employ the media market effectively; third, the emergence of media entrepreneurs themselves who are convinced to seize the opportunities presented by the two previous factors.

Introduction: The current study aimed to investigate if insulin supplemented with phenolic fraction concentrates (PFC) improves chronic hyperglycemia-related behavioral changes by mitigating oxidative stress in diabetic rats exposed to chronic mild stress (CMS). Methods: Experimental type 1 diabetes mellitus (T1DM) was established by a single intraperitoneal injection of streptozotocin (STZ, 65 mg/kg). After diabetes confirmation, rats were treated with insulin supplemented with PFC and exposed to two unpredictable mild stressors per day for 12 weeks. Body weight changes, fasting blood glucose (FBG), and corticosterone levels were evaluated. The behavioral tests were performed to evaluate anhedonia, anxiety, and depressive-like behaviors. Twenty-four hours after behavioral tests, all rats were anesthetized, and the blood was collected for the analysis of lipid, hepatic, and renal parameters. Finally, the brain areas (striatum, hippocampus, and prefrontal cortex), pancreas, and adrenal glands were dissected for the analysis of oxidative stress markers. Results: The results of this study revealed that treatment with insulin supplemented with PFC for 12 weeks significantly enhanced antioxidant defenses (catalase [CAT] and superoxide dismutase [SOD]) and reduced oxidative stress damage (nitric oxide and malondialdehyde [MDA]), especially in brain regions (prefrontal cortex, hippocampus, and striatum) in stressed diabetic rats (P < 0.001). This combination also ameliorated the corticosterone level (P < 0.001) as well as glucose homeostasis (P < 0.001) and lipid parameters (P < 0.001), which are markedly altered in T1D associated with stress. Conclusion: The associated treatment possesses important anxiolytic and antidepressant-like effects in this rat model, which might be mainly mediated by its capacity to protect brain cells against reactive oxygen species (ROS) triggered by T1DM and/or chronic stress.

Introduction: The present work aims to assess if insulin combined with phenolic fraction concentrates (PFCs) prevents diabetes-related cognitive impairments by controlling neuroinflammation in streptozotocin-induced diabetic rats exposed to chronic mild stress (CMS). Methods: Directly after confirming the hyperglycemia, diabetic animals were treated with insulin combined with PFC and were exposed to 2 stressors/day for 12 weeks. Then, four cognitive tests were carried out to assess learning and memory performances. Finally, the rats were anesthetized, blood samples were collected for corticosterone and Tumor necrosis factor alpha (TNF-α) analysis, and the brain regions viz. striatum, hippocampus, and prefrontal-cortex of each hemisphere were dissected out for TNF-α analysis. Results: Both diabetes and stress could induce learning and memory impairments, which were more prominent in stressed diabetic animals, and significantly reversed by insulin treatment supplemented with PFC compared to the insulin monotherapy. Moreover, diabetic rats exposed to CMS displayed disturbances in glucose homeostasis as well as corticosterone secretion. These dysfunctions were linked to the significant increase of TNF-α in the blood as well as in the prefrontal cortex, hippocampus, and striatum. Insulin significantly ameliorated this inflammatory abnormality, while the supplemented treatment showed a significant effect, by stabilizing TNF-α to its normal levels in the hippocampus and in the blood when compared to insulin monotherapy. Conclusion: Insulin supplemented with PFC has a favorable effect over insulin alone on inflammatory aberrations linked with type 1 diabetes and stress in animals, confirming the preference of the combined treatment over insulin for the management of cognitive impairment in stressed diabetic subjects.

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019.Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively.Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries. Funding: Bill & Melinda Gates Foundation.

Background: Ulcerative colitis (UC) is an autoimmune inflammatory bowel disease, characterized by chronic and relapsing inflammation of the intestinal mucosa. Clinical treatments fail to reduce inflammation and induce side effects in nearly 30% of patients. Mesenchymal stem cells (MSCs) are immunomodulatory agents that can encourage tissue repair and regeneration. Aim: To investigate the ability of MSCs to differentiate into enterocytes under the mediation of activin a, fibroblastic growth factor 2, and epidermal growth factors and to study the effect of administering MSCs to rats with acetic acid (AA)-induced UC. Methods: MSCs isolated from the umbilical cord were induced to differentiate into enterocytes. The induced cells were morphologically evaluated by flow cytometry and immunocytochemistry. Forty rats were divided into four groups: control, AA-induced UC, differentiated, and undifferentiated MSC treated groups. The acute UC in rats was induced by 3% AA transrectal administration. Body weight changes, disease activity index (DAI), and histopathological and immunohistochemical CD105 and CD34 staining were recorded. IL-17, IL-10, and TGF- β levels were measured as well. Results: In Both differentiated and undifferentiated MSCs, induced MSCs improved the DAI score and significantly recovered the pathological changes. The favorable effect of MSCs was significantly linked to CD105 overexpression and CD34 low expression. IL-10 and TGF-β levels increased while IL-17 levels decreased. Conclusion: Both differentiated and undifferentiated MSCs showed anti-inflammatory and immunomodulatory effects in our study. Based on our results, MSCs could become potentially useful for regenerative medicine and the clinical treatment of UC.

Cannabis, as the most widely used illicit substance in the world, also remains among the most frequently used psychoactive substances by patients with schizophrenia. It is well known that cannabis use in schizophrenia patients favors relapse, resistance to antipsychotic treatments and therefore more frequent hospitalizations. However, many studies report considerable improvement in cognitive performance in substance users, while others show the opposite. Hence, the aim of our study is to examine the relationship between schizophrenia and cannabis use in clinical and socio-de- mographic aspects. This is a cross-sectional study of patients with schizophrenia hospitalized for relapse at the Ar-Razi psychiatric hospital in Salé, Morocco. A questionnaire was established in order to search for socio- demographic data, evolutionary and prognostic criteria of the disease. Cannabis use was assessed using the Cannabis Abuse Screening Test (CAST), for the severity of schizophrenia symptoms we used the Positive And Negative Syndrome Scale (PANSS) and for perceptual and memory abilities we used the numerical version of the Rey's Complex Figure-A (RCF-A). It was found that in a sample of 115 schizophrenic patients, 47.82% (n=55) were cannabis users. The mean PANSS (negative) and (general psychopathology) scores of non-cannabis users were significantly higher than those of cannabis users with P values of (P

Online teaching has globally become a part of the learning process and has been more well-established in developed countries. In developing countries, online teaching or e-Learning is not practiced or recognized officially by educational organizations and policymakers. On the other hand, it is well-known that computers and technology are the future; in such a case, the advancement of distance-learning or online learning is immensely remarkable. It has reduced teachers' and students' introversion concerning e-learning and technology and has provided a platform for learning new technologies and developing new skills. The recent COVID-19 lockdown impelled governments to start implementing E-learning in schools, which resulted in several challenges. This study attempts to analyze and interpret the challenges and potentials of implementing online learning by surveying through an online questionnaire using 'Google Forms' (N = 968) with responses from high school and primary school English teachers during the first week of March through the last week of April. The findings revealed that most teachers had negative perceptions of implementing e-learning for several reasons, including lack of essential facilities such as electricity, electronic devices, and the absence of required skills. The actual contributions of students and educators are also among the major obstacles. This research suggests introducing Information Communication Technology modules across media platforms and applications in the education departments, opening intensive courses for teachers, and developing educational facilities in the education departments and schools to overcome these limitations and challenges.

Background Despite the clinical benefit of immune checkpoint inhibitors (ICIs), patients with a viral hepatitis have been excluded from clinical trials because of safety concerns. The purpose of this study was to determine the incidence rate of adverse events (AEs) in patients with viral hepatitis who received ICIs for cancer treatment. Materials and Methods We conducted a retrospective study in patients with cancer and concurrent hepatitis B or C, who had undergone treatment with ICI at MD Anderson Cancer Center from January 1, 2010 to December 31, 2019. Results Of the 1076 patients screened, we identified 33 with concurrent hepatitis. All 10 patients with HBV underwent concomitant antiviral therapy during ICI treatment. Sixteen of the 23 patients with HCV received it before the initiation of ICI. The median follow-up time was 33 months (95% CI, 23-45) and the median duration of ICI therapy was 3 months (IQR, 1.9-6.6). Of the 33 patients, 12 (39%) experienced irAEs (immune-related adverse events) of any grade, with 2 (6%) having grade 3 or higher. None of the patients developed hepatitis toxicities. Conclusion ICIs may be a therapeutic option with an acceptable safety profile in patients with cancer and advanced liver disease.

This research is entitled Hajj Mulla Jalizadeh and his fatwas (advisory opinion) on the subject of divorce. It deals with the biography of Hajj Mulla Asaad Julizadeh, who has written many books in the field of legislation, jurisprudence and various sciences. Many distinguished scholars from different regions have graduated on his hands. However, his biography and writings have been forgotten. The importance of studying about him and his books lies in the fact that such studies preserve his writings from being forgotten. The method used in this study is the descriptive, analytical method. The research is divided into two sections: The first section: includes the translation of the life of Hajj Mulla Asaad Julizadeh. The second section studies the fatwas (advisory opinions) of Hajj Mulla Asaad Jalizadeh. He is the only person among his family who passed away outside Kurdistan.

Through an overlook of postmodern American literature, it becomes clear that the most prominent feature of the era is to change the literary view of works, and poetry was the first to be tackled differently during postmodernism. Postmodern poetry is known for breaking verse in order to speak in the speech of the American idioms which Philip Whalen mastered after a long time of experiment and revision. The poet set himself on the task to break the barriers between readers and their being via fragmented language. He benefited from his experience in traditional forms of verse when he was working with high school literary magazines. Hence, the current paper claims that this poetic chaos is deliberate to imitate a rather new society, totally inclusive in opinions and perspectives.

The technique of repetition is a cornerstone among the variable techniques certainty accredits to hit the target. This technique is feathered with multiple types on the level of Arabic sentence structure. A word would be duplicated successively, through repetition which may cover a whole sentence separately. The Glorious Quran uses repetition in all manifestations, with an aid of contextual techniques, to deliver pragmatic meanings reflecting the influence of the situation in this concern. Repetition assists in linking ideas presented in the Glorious Quran constructing for its unity. The current research tries to dig deep into the pragmatic intentions of using repetition in all types in the Sacred Book.

This study examines the ethical conflict of interest that exists in this sphere between journalists and politicians in an age of media entrepreneurship in Iraq, which theoretically would enable journalists to express their own voices and hold a greater stake in the media market. A qualitative method was adopted for this study using open, in-depth interviews with 36 participants. The study found that relative freedom, smartphone applications and social media helped innovative Iraqi journalists to become media entrepreneurs and own media enterprises themselves. These media enterprises are characterized by activities such as publishing material that is critical in tone and satirical in content and accompanied by short videos that are broadcast on social media. This is then easily accessible for media consumers using their smartphones. Media enterprises appear to offer journalists an opportunity for professional and financial independence, but their operation in the Iraqi media space tends to reflect the propagandistic function of traditional media outlets instead of fulfilling this emancipatory role. The findings also showed that there is a dark side to Iraqi digital media enterprise, which involves politicians exploiting journalists to troll and attack activists through anonymous digital media. This in turn harms the freedom of expression and suppresses critical views voice against the political establishment.

COVID-19 is a pandemic disease caused by SARS-CoV-2, which is an RNA virus similar to the hepatitis C virus (HCV) in the replication process. Sofosbuvir/ledipasvir is an approved drug to treat HCV infection. This study investigates the efficacy of Sofosbuvir/ledipasvir as a treatment for patients with moderate COVID-19 infection. This is a single-blinded parallel-randomized controlled trial. The participants were randomized equally into the intervention group that received Sofosbuvir/ledipasvir (S.L. group), and the control group received Oseltamivir, Hydroxychloroquine, and Azithromycin (OCH group). The primary outcomes were the cure rate over time and the incidence of serious adverse events. The secondary outcomes included the laboratory findings. 250 patients were divided equally into each group. Both groups were similar regarding gender, but age was higher in the S.L. group (p=0.001). In the S.L. group, 89 (71.2%) patients were cured, while only 51 (40.8%) patients were cured in the OCH group. The cure rate was significantly higher in the S.L. group (RR=1.75, p

Background: Hepatocellular carcinoma has high recurrence rates after surgery; however, there are no approved standard-of-care neoadjuvant or adjuvant therapies. Immunotherapy has been shown to improve survival in advanced hepatocellular carcinoma; we therefore aimed to evaluate the safety and tolerability of perioperative immunotherapy in resectable hepatocellular carcinoma. Methods: In this single-centre, randomised, open-label, phase 2 trial, patients with resectable hepatocellular carcinoma were randomly assigned (1:1) to receive 240 mg of nivolumab intravenously every 2 weeks (for up to three doses before surgery at 6 weeks) followed in the adjuvant phase by 480 mg of nivolumab intravenously every 4 weeks for 2 years, or 240 mg of nivolumab intravenously every 2 weeks (for up to three doses before surgery) plus one dose of 1 mg/kg of ipilimumab intravenously concurrently with the first preoperative dose of nivolumab, followed in the adjuvant phase by 480 mg of nivolumab intravenously every 4 weeks for up to 2 years plus 1 mg/kg of ipilimumab intravenously every 6 weeks for up to four cycles. Patients were randomly assigned to the treatment groups by use of block randomisation with a random block size. The primary endpoint was the safety and tolerability of nivolumab with or without ipilimumab. Secondary endpoints were the proportion of patients with an overall response, time to progression, and progression-free survival. This trial is registered with ClinicalTrials.gov (NCT03222076) and is completed. Findings: Between Oct 30, 2017, and Dec 3, 2019, 30 patients were enrolled and 27 were randomly assigned: 13 to nivolumab and 14 to nivolumab plus ipilimumab. Grade 3–4 adverse events were higher with nivolumab plus ipilimumab (six [43%] of 14 patients) than with nivolumab alone (three [23%] of 13). The most common treatment-related adverse events of any grade were increased alanine aminotransferase (three [23%] of 13 patients on nivolumab vs seven [50%] of 14 patients on nivolumab plus ipilimumab) and increased aspartate aminotransferase (three [23%] vs seven [50%]). No patients in either group had their surgery delayed due to grade 3 or worse adverse events. Seven of 27 patients had surgical cancellations, but none was due to treatment-related adverse events. Estimated median progression-free survival was 9·4 months (95% CI 1·47–not estimable [NE]) with nivolumab and 19·53 months (2·33–NE) with nivolumab plus ipilimumab (hazard ratio [HR] 0·99, 95% CI 0·31–2·54); median time to progression was 9·4 months (95% CI 1·47–NE) in the nivolumab group and 19·53 months (2·33–NE) in the nivolumab plus ipilimumab group (HR 0·89, 95% CI 0·31–2·54). In an exploratory analysis, three (23%) of 13 patients had an overall response with nivolumab monotherapy, versus none with nivolumab plus ipilimumab. Three (33%) of nine patients had a major pathological response (ie, ≥70% necrosis in the resected tumour area) with nivolumab monotherapy compared with three (27%) of 11 with nivolumab plus ipilimumab. Interpretation: Perioperative nivolumab alone and nivolumab plus ipilimumab appears to be safe and feasible in patients with resectable hepatocellular carcinoma. Our findings support further studies of immunotherapy in the perioperative setting in hepatocellular carcinoma. Funding: Bristol Myers Squibb and the US National Institutes of Health.

The present study has been conducted to investigate the visuospatial constructive cognition and memory among healthy students, as measured by the Rey Complex Figure Test (RCFT). We have compared the data used to draw the figures with the hypothesis that gender and physiological measurements have an impact on neuropsychological skills. One hundred twenty-five students (43 male, 82 female; age 18–32 years) participated in this study with a computerized numerical recording of the digital plot of the RCFT and a set of socio-demographic variables. Results revealed that visual perception and working memory were impacted by social and health determinants. Additionally, this study presents evidence supporting the implication of resting heart rate (RHR) and organizational strategy in working memory performance. Gender effect seems to be significant in physical and physiological differences. Regression analyses revealed a relevant contribution of study institution and sleep time on RCFT Copy score; RCFT Memory predicted by drawing from memory strategy, RHR, periodic medication use and marital status.

To assess the quality of life of patients with chronic end-stage renal failure under hemodialysis, and to determine its main generators in hemodialysis patients. This is a descriptive and analytical cross-sectional study carried out at the regional hospital of Kénitra (Morocco) in the level of the hemodialysis unit during a period of 3 months with 70 hemodialysis patients diagnosed and treated for chronic renal failure. Data were collected using a questionnaire comprising the socio-demographic, clinical, and nutritional characteristics of Hemodialysis patients and a KDQOL scale (Kidney Disease Quality Of Life) that assesses the quality of life. The scores of the KDQOL-36 were used to assess family, social support, and social support from caregivers. The average age was 51.66± 15.96 years with 57.1% of patients who are female. The components of the quality of life studied show an alteration in the quality of life with a decrease in the scores of the “component of physical health” dimensions with a score of 27.64 ± 29.13,“Component of mental health” with a score of 37.81 ± 22.99, “effects of kidney disease on daily life” with a score of 48.41 ± 21.22 and “burdens of kidney disease” with a score of 28.47 ± 21.50. While the dimension “Symptoms / problems of kidney disease” remains close to normal with a score of 64.61 ± 17.98. Our results showed that certain dimensions of the quality of life correlate with age, sex, family situation, level of education, the presence of a transplant plan, the presence of comorbidities and the duration of hemodialysis. Our study also found a correlation between family social support and quality of life in its “Burdens of Kidney Disease”, “Effects of Kidney Disease on Daily Living”, and the overall quality of life score. On the other hand, there is no significant relationship with support from caregivers. The quality of life of hemodialysis patients is deteriorating. It is influenced by several parameters including family and caregiver social support. The involvement of the family and the health care team in the psychological support process is paramount.

Aims: To compare between supine and prone percutaneous nephrolithotomy (PCNL) in the management of renal stones regarding stone free rate, operative time and fluoroscopy time. Methodology: A retrospective analysis was performed in the period between January 2019 and January 2021 for patients underwent PCNL for renal stones 2 cm or more. They were 77 patients divided into two groups, group (A) prone 38 patients and group (B) supine 39 patients. Results: the study demonstrated a significant difference in operation time which was (92.5 ± 24.85 min.) in prone group & (68.3 ± 22.90 min.) in supine group with p-value (

The study aimed to identify the role of mathematical modeling through queuing theory models in improving the quality of services at the port of the free zone in Misurata, to arrive at a proposal to apply one of the queue theory models to raise the level of service quality, and to minimise costs. In order achieve to that was collected daily statistical data and analyzing it using probability theory to reach knowledge of the rate and distribution of ships arrival time and service time. The total viewing time was estimated at one hundred and eighty (183) days. A model (M / M/ 2) (FCFS /∞ / ∞) has been applied using the (Quantitative System for Business Windows) WinQSB program. For Cars ships. And it has been reached can a model that contribute to raising the level of services inside the port. Also proposal model that can minimise the costs, and it can Through the results achieved the study recommends to raise awareness among employees through various means of the importance of caring for operations research, because of its tangible results in the practical aspect, and the importance of using quantitative methods in general and the queuing grow theory in particular, the study recommends that it can be used to rationalize the decisions. Keywords: Queues, Mathematical Modeling, Poisson Distribution, Exponential Distribution.

Municipal Solid Waste (MSW) collection utilizes the highest percentage of the MSW management budget. Additionally, choosing a vehicle route optimization method is complex, difficult and does not always yield the most practical approach. There is limited published information about a decision support system (DSS) that assists in selecting the appropriate route optimization algorithm. This study aims to design and develop a universal DSS framework that suggests effective route optimization method(s). The system consists of 21 optimization data items and four criteria that assess the available constraints and recommends the most suitable optimization method(s). The DSS prototype was validated by testing it on the available literature and observing if the suggested method by the system complies with that utilized by the researchers. It was found that the system was able to predict the method which is used in 73% of studies. Moreover, the system suggested an enhanced version of the methods used in 18% of studies. It could be concluded that the proposed framework can help to select the best algorithms in almost all existing scenarios that have been used during development. Therefore, it is recommended to use the framework for selecting the appropriate route optimization algorithm for MSW collection.

Background: Non-alcoholic fatty liver disease (NAFLD) is important cause of hepatic morbidity worldwide. Recently, a significant association between NAFLD and Cognitive dysfunction has been observed. Objectives: To evaluate the association between NAFLD in patientswith or without chronic hepatitis C virus (HCV) infection and cognitive impairment. Patients and methods: The study included 100 NAFLD participants diagnosed by abdominal ultrasound according to guidelines for the diagnosis and management of non -alcoholic fatty liver disease; 50 of them chronically infected with HCV (Group I) and another 50 patients without chronic HCV infection (Group II). Assessment of cognitive functions was done by the Montreal Cognitive Assessment (MoCA), and Trail Making Test (TMT) (part A and B). Socioeconomic Status assessed by socioeconomic status scale. Magnetic resonant imaging of the brain to calculate periventricular white matter hyperintensities. Results: 16% of Group I patients were deficient in Trail-A, Trail-B, and MoCA, while 18% of group II patients were deficient in Trail-A, Trail-B, and MoCA. There is a statistically significant negative correlation between body mass index (BMI) and MoCA(r = - 0.0243, p-value = 0.015) and a significant positive correlation between BMI and Trail A(r = 0.276, p-value = 0.048). Based on the results of multivariate logistic regression analysis, hypertriglyceridemia, and periventricular white matter hyperintensities were predictive for cognitive impairment. Conclusion: NAFLD, Increased BMI and Hypertriglyceridemia showed significant associations with cognitive dysfunction.

BACKGROUND Vaccination is a critical component of the prevention of communicable diseases and is one of the most effective public health interventions. In today's world, social media is an important source of health and medical information. It is crucial to understand the link between social media involvement and influenza vaccination, since it might be applied to other vaccinations, such as those for COVID-19. OBJECTIVE This study aims to examine public engagement with COVID-19 vaccination across social media in Iraq. METHODS It represents an empirical survey to investigate the public engagement with the COVID-19 vaccine on social media. in Iraq. It has used a web-based questionnaire administered through Google Forms (n=2088) to elicit responses from Iraqi social media users, aged 18 years and over. RESULTS The research empirically revealed a lower level of vaccination engagement across social media and the findings suggested significant differences between public engagement due to level of use of social media and demographic backgrounds, particularly age, educational attainment, and income. Active users and young aged groups with less educational level and income were more likely to have a positive attitude toward vaccination engagement. CONCLUSIONS Theoretically, this group is less powerful and influential in the society compared to the group who are more aged and have higher educational degrees and income. Hence, future studies should address demographics and the extent of using social media factors in public health studies. It is hoped that our findings will support the authorities in terms of using social media in raising health awareness to engage people successfully in the health system.

Endocarditis is a life-threatening infection of the endocardium (inner lining of the heart). It usually affects the left-sided valves more than the right-sided valves and presents classically with a new murmur, fever, and peripheral stigmata. Though in the modern era, we have better antibiotics, better diagnostic imaging, and surgery that might cure infectious endocarditis (IE), it still carries significant mortality and morbidity. Here we present a 52-year-old male patient with hypertension and ischemic heart disease who presented with shivering, fever, and confusion for 2 days, fourteen days after cardiac intervention (PCI). Further trans-esophageal echocardiography was done due to the patient’s fulfillment of three minor and one major of Duke's criteria. Trans-esophageal echocardiography revealed flailing posterior mitral valve leaflets, 1.1 x 0.60 cm of vegetation, and severe eccentric mitral regurgitation. The patient was managed with vancomycin and gentamicin and referred to the cardiovascular surgery center. Post-PCI infective endocarditis is a rare and often missed diagnosis, so there should be a high level of suspension for those who present with signs and symptoms compatible with infective endocarditis.

Additional file 1: Supplemental information.1. Compliance with the Guidlines for Accurate and Transparent Health Estimates Reporting (GATHER). 2. HIV data sources and data processing. 3. Covariate and auxiliary data. 4. Statistical model. 5. References.

Additional file 1. SPUMONI 2 Supplement. This document contains supplementary tables and figures.

Additional file 2: Supplemental tables.Table S1. HIV seroprevalence survey data. Table S2. ANC sentinel surveillance data. Table S3. HIV and covariates surveys excluded from this analysis. Table S4. Sources for pre-existing covariates. Table S5. HIV covariate survey data. Table S6. Fitted model parameters.

Additional file 3: Supplemental figures.Figure S1. Prevalence of male circumcision. Figure S2. Prevalence of signs and symptoms of sexually transmitted infections. Figure S3. Prevalence of marriage or living as married. Figure S4. Prevalence of partner living elsewhere among females. Figure S5. Prevalence of condom use during most recent sexual encounter. Figure S6. Prevalence of sexual activity among young females. Figure S7. Prevalence of multiple partners among males in the past year. Figure S8. Prevalence of multiple partners among females in the past year. Figure S9. HIV prevalence predictions from the boosted regression tree model. Figure S10. HIV prevalence predictions from the generalized additive model. Figure S11. HIV prevalence predictions from the lasso regression model. Figure S12. Modeling regions. Figure S13. Age- and sex-specific vs. adult prevalence modeling. Figure S14. Data sensitivity. Figure S15. Model specification validation. Figure S16. Modeled and re-aggregated adult prevalence comparison. Figure S17. HIV prevalence raking factors for males. Figure S18. HIV prevalence raking factors for females. Figure S19. Age-specific HIV prevalence in males, 2000. Figure S20. Age-specific HIV prevalence in females, 2000. Figure S21. Age-specific HIV prevalence in males, 2005. Figure S22. Age-specific HIV prevalence in females, 2005. Figure S23. Age-specific HIV prevalence in males, 2010. Figure S24. Age-specific HIV prevalence in females, 2010. Figure S25. Age-specific HIV prevalence in males, 2018. Figure S26. Age-specific HIV prevalence in females, 2018. Figure S27. Age-specific uncertainty interval range estimates in males, 2000. Figure S28. Age-specific uncertainty interval range estimates in females, 2000. Figure S29. Age-specific uncertainty interval range estimates in males, 2005. Figure S30. Age-specific uncertainty interval range estimates in females, 2005. Figure S31. Age-specific uncertainty interval range estimates in males, 2010. Figure S32. Age-specific uncertainty interval range estimates in females, 2010. Figure S33. Age-specific uncertainty interval range estimates in males, 2018. Figure S34. Age-specific uncertainty interval range estimates in females, 2018. Figure S35. Change in HIV prevalence in males, 2000-2005. Figure S36. Change in HIV prevalence in females, 2000-2005. Figure S37. Change in HIV prevalence in males, 2005-2010. Figure S38. Change in HIV prevalence in females, 2005-2010. Figure S39. Change in HIV prevalence in males, 2010-2018. Figure S40. Change in HIV prevalence in females, 2010-2018. Figure S41. Space mesh for geostatistical models.

Introduction: Safe and effective delivery of short interfering RNA/short hairpin RNA (siRNA/shRNA) molecules for the purpose of RNA interference was one of the biggest challenges in the past 20 years. Transkingdom RNA interference (tkRNAi) was suggested as an alternative to the traditional delivery protocols. This work aimed to evaluate the efficiency and the potency of an improved bacterial delivery system in inhibiting human papilloma virus 16 (HPV16)-E7-specific mRNA in oral squamous cell carcinoma (OSCC). Method and Results: Firstly, shRNA plasmids were constructed and transformed in the CEQ221 bacteria to construct the delivery vehicles. After bacterial transfection of the tumor cells, the ability of the modified bacteria to penetrate and collect in the tumor cells was confirmed by fluorescent microscopy. Efficiency of shRNA delivery and expression was confirmed by measuring the expression level of small siRNA and target gene mRNA via qRT-PCR; followed by a confirmation via western blot. Significant drop in the IC50 of the CEQ221-E7 targeting HPV16-E7 in oral squamous carcinoma cells as compared to their control counterparts CEQ221-GFP; and higher total apoptosis and activated caspase-3 activation confirmed the functional effect of the bacterial delivery-mediated inhibition of the HPV16-E7. Conclusion: Transkingdom RNA interference is a potent tool to inhibit specific target genes in mammalian cells. It was proved for the first time that tkRNAi is capable of inhibiting HPV16-E7 gene in oral squamous cell carcinoma triggering apoptosis and lowering proliferation activity and eventually leading to target cell death., Sicherer und effektiver Transfer von Short-interfering-RNA-/Short-hairpin-RNA-Molekülen (siRNA/shRNA) zum Zweck der RNA-Interferenz war eine der größten Herausforderungen der vergangenen 20 Jahre. Als Alternative zu den herkömmlichen Transferprotokollen wurde eine Transkingdom-RNA-Interferenz (tkRNAi) vorgeschlagen. Die hier vorgestellte Arbeit hat die Effizienz und Wirksamkeit eines verbesserten Bakterien-Übertragungssystems zur Hemmung der humanpapillomvirus-16-(HPV16)-E7-spezifischen mRNA oraler Plattenepithelkarzinom-Zellen (oral squamous cell carcinoma , OSCC) untersucht. Methodik und Ergebnisse: Zunächst wurden Plasmide konstruiert, welche neben einer therapeutischen shRNA zwei unterschiedliche Proteine kodieren. Das erste „Invasin“ verleiht nichtinvasiven, nichtpathogenen Bakterien einen invasiven Phänotyp. Das zweite Protein „Listeriolysin O“ zeigt sich dafür verantwortlich, dass die therapeutischen shRNA-Moleküle nach bakterieller Invasion in der Zielzelle freigesetzt werden. Nach bakterieller Transfektion der Tumorzellen, wurde die Fähigkeit der modifizierten Bakterien, in Tumorzellen einzudringen und sich dort zu sammeln mittels Fluoreszenzmikrokospie nachgewiesen. Die Effizienz des Transfers und der Expression der shRNA wurde durch die Messung des Expressionsniveaus von kleiner siRNA und der Zielgen-mRNA mit qRT-PCR bestimmt; bestätigt per Western-Blot. Ein signifikanter Abfall des IC50 von anti-HPV16-E7 CEQ221-E7 in oraler Plattenepithelkarzinom-Zellen im Vergleich zu CEQ221-GFP; und eine höhere Gesamtapoptose sowie eine aktivierte Caspase-3-Aktivierung bestätigten den funktionellen Effekt der durch die bakterielle Abgabe vermittelten Hemmung des HPV16-E7. Schlussfolgerungen: Transkingdom-RNA-Interferenz ist ein wirksames Instrument zur Hemmung spezifischer Zielgene in Säugetierzellen. Es wurde zum ersten Mal nachgewiesen, dass tkRNAi das HPV16-E7-Gen beim oralen Plattenepithelkarzinom hemmen, Apoptose auslösen und die Proliferationsaktivität senken kann, was schließlich zum Tod von Zielzellen führt.

Additional file 2. Review history.

Hepatocellular carcinoma (HCC) has limited systemic therapy options when discovered at an advanced stage. Thus, there is a need for accessible and minimally invasive biomarkers of response to guide the selection of patients for treatment. This study investigated the biomarker value of plasma growth hormone (GH) level as a potential biomarker to predict outcome in unresectable HCC patients treated with current standard therapy, atezolizumab plus bevacizumab (Atezo/Bev).Study included unresectable HCC patients scheduled to receive Atezo/Bev. Patients were followed to determine progression-free survival (PFS) and overall survival (OS). Plasma GH levels were measured by ELISA and used to stratify the HCC patients into GH-high and GH-low groups (the cutoff normal GH levels in women and men are ≤3.7 μg/L and ≤0.9 μg/L, respectively). Kaplan-Meier method was used to calculate median OS and PFS and Log rank test was used to compare survival outcomes between GH-high and -low groups.Thirty-seven patients were included in this analysis, of whom 31 were males and 6 females, with a median age of 67 years (range: 37-80). At the time of the analysis, the one-year survival rate was 70% (95% CI: 0.51, 0.96) among GH low patients and 33% (95% CI: 0.16, 0.67) among GH high patients. OS was significantly superior in GH-low compared to GH-high patients (median OS: 18.9 vs. 9.3 months;Plasma GH is a biomarker candidate for predicting treatment outcomes in advanced HCC patients treated with Atezo/Bev. This finding should be further validated in larger randomized clinical trials in advanced HCC patients.

Cancer goes on to be a leading cause of death worldwide. However, Morocco has between 30,000 and 40,000 new cases of cancer each year. But only 20,000 are taken care of. They will therefore be at least 10,000 Moroccans with cancer who do not receive any treatment. Every year 7.2% of deaths in Morocco are attributed to cancer. The purpose of our study is to analyze the psychological consequences of such a disease on the person affected; this one is already confronted with various changes: image of the body, feeling of competences. Our study was carried out on 92 cancer patients consulting the INO Rabat, (national institute of oncology). This prospective study took place during the period from May to July 2015. For data collection, we used a questionnaire with information on socio-demographic characteristics, Life Satisfaction Scale, Rosenberg Self-Esteem Scale and Social Support Questionnaire (ssq6). The analysis of the correlations between scores of life satisfaction, self-esteem and social support scores shows the life satisfaction test is strongly correlated with the availability social support test (r = 0.263; p

Several recent studies designate that individuals with type-1-diabetes (T1D) are at higher risk for cognitive impairment than their peers without T1D. The aim of this study was to determine whether socio-demographic and clinical characteristics, eating attitude and psycho-emotional characteristics can predict visual perception (VP) and working memory (WM) impairment in the Moroccan population with T1D. A cross-sectional analysis was carried out in adult T1D patients (N=140). The Rey-Osterrieth Complex Figure test (electronical version) was used to evaluate the VP and WM. Moreover, patients also completed the 21-item Depression, Anxiety, and Stress Scale to assess their mental health state. In order to evaluate the risk of eating disorders the Eating attitudes Test-26 were used. Finally, anthropometric properties and clinical characteristics were evaluated. Predictors of cognitive dysfunction were determined using the hierarchical regression analysis. The major result was that age, long diabetes duration, glycemia, HbA1c, dieting and bulimia were the potential predictors of low scores in VP and WM. Other significant predictors were cholesterol, triglycerides for visual perception. Although psych-emotional symptoms including stress, anxiety, and depression were not a significant predictors of VP and WM impairment. Furthermore, our findings showed that the more the level of stress increases, the VP and WM scores significantly decrease. This study suggests that it can be helpful for medical practitioners to screen for disordered eating behaviors and emotional symptoms as a supplemental risk factor for cognitive impairment in T1D.

This study examines the determinants of economic empowerment of women in selected Arab countries (Iraq, Qatar, the Kingdom of Saudi Arabia, Jordan, the Arab Republic of Egypt and Algeria) during the period (2000-2018), using the usual small squares method, and in this study we reviewed the concept and the economic determinants that affect empowerment Women, which in turn affect all other variables in these countries, the most important of which are the political and social aspects. In order to know the specific factors for women's economic empowerment, the study adopted the quantitative method to estimate these factors which are (the ratio of women’s enrollment in secondary education to males, average life expectancy at birth for males and females, fertility rate, per capita GDP). The results of the study found that the most important factors affecting the economic empowerment of women in most Arab countries are health, the proportion of women’s enrollment in secondary education to males, average life expectancy at birth for males and females, per capita gross domestic product that had a significant and positive impact, while the fertility rate was found. It appeared morally and negatively.

This study aims to determine the role of job performance in achieving the strategic objectives in the Ministry of Agriculture and Fisheries in the Sultanate of Oman. Where the researcher assumes that there is a statistically significant impact at the level of significance of the role of job performance in achieving strategic objectives in the Ministry of Agriculture and Fisheries in Oman. To achieve the objectives of the research was used descriptive analytical method. The researcher also developed a questionnaire consisting of 28 paragraphs representing an independent variable is the functional performance and a dependent variable, which is the strategic objectives in addition to the personal and functional characteristics of the sample members. The study population included the 3000 employees of the Ministry of Agriculture in the Sultanate of Oman. The researcher selected a sample of 338 employees. Major and minor tools will be used for research such as questionnaires, books, previous studies, publications and others. SPSS will also be used to analyze the results of the questionnaire. Based on the previous studies, the researcher concluded that the job performance has a great impact on the strategic objectives, where the more effective the performance, the higher the percentage of achieving the strategic goals.