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BackgroundVolunteering positively affects overall health of both volunteers and recipients through social interaction, support and physical activity. Health professionals’ volunteering has considerable potential to improve health outcomes in communities.ObjectivesThis study aimed to summarize published scientific literature regarding volunteering by health professionals.MethodMedine, Embase, Scopus, PsycINFO and CINAHLdatabases were searched to identify eligible studies published between 2010 and 2023. Data on study methods and findings were extracted and synthesized.ResultsOf the 144 eligible studies, 80 (56%) used quantitative methods, 46 (32%) used qualitative, 18 (12%) used mixed methods and 8 (6%) were interventional. Doctors (74 studies, 51%) and nurses (n = 40, 28%) were the professions with most reports of volunteering. Half the studies were from USA (n = 77, 53%), followed by UK (n = 19, 13%), Canada (n = 12, 8%), and Australia/New Zealand (n = 11, 8%). International volunteering in low-to-middle-income countries was reported in 64 studies (44%). Providing service and training were the dominant types of activities (n = 90, 62.5%), with health promotion reported in only 4 studies (3%). Studies reported positive impact from volunteering, both professionally and personally. Time and family commitments were the main barriers. Enablers, barriers and impact were summarized in a socio-ecological map.ConclusionHealth professionals volunteer in diverse activities and report multifaceted benefits. Studies of volunteering interventions could enable new, sustainable approaches to health promotion.

Summary: Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1–59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016–June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted

Abstract Background This study explores the difference in COVID-19 corpse handling protocol rejection before and after the innovation in rapid molecular test (RMT) postmortem examination and providing negative pressure mortuary rooms. This study is a retrospective observational study. Each of the corpse’s immediate family was explained the procedure for handling the body based on the fatwa of the religious institution and the hospital’s standard operating system. The acceptance or rejection of the protocol, general characteristics of the corpse, and the reasons for refusal are documented. Results From March to May 2020, there were 16 probable COVID-19 corpses and 3 confirmed COVID-19 corpses. Rejection of the COVID-19 corpse protocol occurred six times. The main reason for rejection is that the death might not necessarily be caused by COVID-19, the body’s handling in the hospital is not following religious law, and the negative stigma of COVID-19. From June to August 2020, there were 42 probable COVID-19 corpses and 49 confirmed COVID-19 corpses. Rejection of the COVID-19 corpse protocol occurred eight times. The most rejection reason is that the deceased families do not believe the deceased died because of COVID-19. Conclusions The decline in the COVID-19 corpse protocol rejection has occurred after applying RMT and providing a negative pressure mortuary room. This decline proves that religious conservative groups can accept this innovation to reduce rejection on religious grounds.

Objetivo: determinar cómo debería distribuirse la responsabilidad sobre las actividades entre enfermería profesional y medicina familiar y comunitaria en un equipo de primer nivel de atención. Método: estudio exploratorio de consulta a expertos de la academia. Resultados: participaron nueve expertas de enfermería comunitaria de la Facultad de Enfermería y once expertos de medicina familiar y comunitaria de la Facultad de Medicina de la UDELAR. Se identificaron similitudes y diferencias entre ambos grupos de expertos sobre cómo distribuir la responsabilidad de cada profesión en la realización de un grupo de actividades a desarrollarse en el primer nivel de atención. Conclusiones: por primera vez en el país se analizó la distribución de funciones de dos disciplinas de la salud en forma conjunta. Se encontró un alto grado de acuerdo en las actividades que deben desarrollar los equipos de atención de primer nivel. Los expertos identificaron un importante número de actividades que pueden y/o deben ser desarrolladas por ambas profesiones, con igual responsabilidad y un bajo número preferente o exclusivo de cada profesión. La distribución de funciones y actividades entre estos profesionales en forma suplementaria, complementaria o sustituta, aportaría a la definición de modelos de dotación que mejoren la calidad y los costos de atención.

Background: The orthodontic treatment should aim to maintain the inter-canine and inter-molar width to that of the pre-treatment values. The study was conducted with objective to evaluate arch width changes in Class I and Class II patients treated with fixed orthodontics. Methods: This was a hospital-based cross-sectional study with two study groups. The first group included patients with Class I malocclusion, treated with four first premolar extractions and the second group included patients with Class II Div 1 malocclusion, treated with upper two first premolar extractions. The inter-canine and inter-molar width of the pre and post-treatment study model were measured. To compare the changes observed amongst two groups, independent samples t-test was performed. A paired sample t-test was used to evaluate the treatment changes within each group. Results: There was significant increase in inter-canine width in both maxillary and mandibular arches in both the groups. In Class I extraction group there was significant decrease in the inter-molar width in both maxillary and mandibular arches. The Class II Div1 maxillary extraction group also showed significant increase in inter-canine width in both maxillary and mandibular arches. In the same group there was decrease in post treatment Methods: This was a hospital-based cross-sectional study with two study groups. The first group included patients with Class I malocclusion, treated with four first premolar extractions and the second group included patients with Class II Div 1 malocclusion, treated with upper two first premolar extractions. The inter-canine and inter-molar width of the pre and post-treatment study model were measured. To compare the changes observed amongst two groups, independent samples t-test was performed. A paired sample t-test was used to evaluate the treatment changes within each group. Results: There was significant increase in inter-canine width in both maxillary and mandibular arches in both the groups. In Class I extraction group there was significant decrease in the inter-molar width in both maxillary and mandibular arches. The Class II Div1 maxillary extraction group also showed significant increase in inter-canine width in both maxillary and mandibular arches. In the same group there was decrease in post-treatment inter-molar width in both arches with significant decrease in the maxillary inter-molar width. Conclusion: There was increase in inter-canine width in both Class I extraction group and Class II Div 1 maxillary extraction group with decrease in inter-molar width in both the groups.

Objetivo: determinar cuáles son las actividades que deberían desarrollar las enfermeras profesionales en el primer nivel de atención (PNA), en el marco de la estrategia de atención primaria en salud (APS). Método: estudio exploratorio de consulta a expertos de la academia, en dos etapas. Resultados: participaron nueve expertas de enfermería comunitaria de la Facultad de Enfermería de la Universidad de la República Oriental del Uruguay. Los principales resultados consistieron en la obtención de un consenso de expertos de la academia, sobre las actividades que debe desarrollar la enfermería profesional en el PNA. Conclusiones: la amplitud de las actividades que las enfermeras profesionales pueden realizar en el PNA y la incorporación del marco conceptual de la APS reafirma la importancia de esta profesión como integrante del equipo de salud para impulsar el cambio de modelo de atención propuesto por el Sistema Nacional Integrado de Salud (SNIS). Establecer las actividades de la profesión de enfermería en el PNA permitirá definir mejor su rol en el equipo de salud y potenciar su desarrollo. Es importante conocer los resultados de la investigación de actividades de los médicos de familia, las opiniones que tiene cada grupo respecto de ambas profesiones y continuar investigando el desarrollo complementario, suplementario o sustituto de las actividades de estas y otras profesiones del equipo de salud.

Objetivo: determinar cuáles son las actividades que deberían o podrían desarrollar los médicos de familia y comunidad en el Primer Nivel de Atención (PNA), en el marco de la estrategia de Atención Primaria en Salud (APS), en Uruguay. Método: estudio exploratorio de consulta a expertos de la academia, en dos etapas. Resultados: participaron once expertas de medicina familiar y comunitaria de la Facultad de Medicina de la Universidad de la República Oriental del Uruguay. Los principales resultados, consistieron en la obtención de un consenso nacional, sobre las actividades que debe o pueden desarrollar la medicina familiar y comunitaria en el primer nivel de atención. Conclusiones: los médicos de familia y comunidad integran diversas actividades clínicas y de gestión con enfoque familiar y comunitario y de gestión clínica. Aparecen diferencias en el enfoque de las actividades comunitarias que deberían desarrollar. Establecer las actividades de la medicina familiar y comunitaria permitirá definir mejor su rol en el equipo de salud y potenciar su desarrollo.

Background: Calcaneal quantitative ultrasound (QUS) is widely used in osteoporosis screening, but the cut-off values for risk stratification remain unclear. This study validates the performance of a calcaneal QUS device (CM-200) using dual-energy X-ray absorptiometry (DXA) as the reference and establishes a new set of cut-off values for CM-200 in identifying subjects with osteoporosis. Methods: The bone health status of Malaysians aged ≥40 years was assessed using CM-200 and DXA. Sensitivity, specificity, area under the curve (AUC) and the optimal cut-off values for risk stratification of CM-200 were determined using receiver operating characteristic (ROC) curves and Youden’s index (J). Results: From the data of 786 subjects, CM-200 (QUS T-score p < 0.001). At QUS T-score ≤−2.5, CM-200 was ineffective in identifying subjects with osteoporosis (DXA T-score ≤−2.5) (sensitivity 14.4% (95% CI: 8.1−23.0%); specificity 96.1% (95% CI: 94.4−97.4%); AUC 0.553 (95% CI: 0.488−0.617); p > 0.05). Modified cut-off values for the QUS T-score improved the performance of CM-200 in identifying subjects with osteopenia (sensitivity 67.7% (95% CI: 62.8−72.3%); specificity 72.8% (95% CI: 68.1−77.2%); J = 0.405; AUC 0.702 (95% CI: 0.666−0.739); p < 0.001) and osteoporosis (sensitivity 79.4% (95% CI: 70.0−86.9%); specificity 61.8% (95% CI: 58.1−65.5%); J = 0.412; AUC 0.706 (95% CI: 0.654−0.758); p < 0.001). Conclusion: The modified cut-off values significantly improved the performance of CM-200 in identifying individuals with osteoporosis. Since these values are device-specific, optimization is necessary for accurate detection of individuals at risk for osteoporosis using QUS.

Objectives: This study aimed to develop a scale that can measure the role competency of oncology nurses during shared decision-making process. Methods: A total of 226 oncology nurses who actively provide direct care to patients from inpatient and outpatient oncology units in the Midwest and Pacific Northwest completed the online or mail survey. Exploratory factor analysis and parallel analysis showed the multidimensionality of the role competency scale on shared decision-making nurses. Results: The role competency scale on shared decision-making nurses revealed four dimensions: knowledge, attitudes, communication, and adaptability. The 22 items have excellent internal consistency with a Cronbach’s alpha of 0.91. The four subscales also have adequate reliability with Cronbach’s alpha >0.70 as well as greater than 0.70 Spearman–Brown’s correlation coefficients in split-half reliability testing for each subscale. Conclusion: The new scale has the potential to be used as a clinical tool to assess the need for shared decision-making education and training in oncology nurses.

En Uruguay se registran 351 nuevos casos de cáncer de cuello uterino y mueren en promedio 140 mujeres por esta causa. Se dispone de un Programa de Prevención Secundaria del Cáncer de Cuello Uterino cuyo test de tamizaje es el Papanicolaou convencional, que ofrece la disponibilidad del test para las usuarias de la Administración de los Servicios de Salud del Estado y existen también normas estatales que obligan a los prestadores del sistema de salud privada a brindarlo sin costo a sus usuarias. No obstante ello, se comprueba un importante número de mujeres que consultan en estadios avanzados de la enfermedad, con pocas posibilidades de curación. Objetivo: determinar los conocimientos, las actitudes, las prácticas y el estadio de la enfermedad en usuarias del Centro Hospitalario Pereira Rossell y del Hospital de Clínicas con el diagnóstico de cáncer cuello uterino invasor realizado durante el año 2009. Material y método: estudio observacional, descriptivo, aplicado a todas las mujeres con diagnóstico de cáncer de cuello uterino invasor a través de una encuesta y revisión de historias clínicas, realizado entre junio de 2010 y setiembre de 2011. Resultados: se entrevistaron 68 pacientes, el 75% de las usuarias contestó en forma adecuada sobre la utilidad del test, el mismo porcentaje declaró que no se hacía el test por falta de motivación. En la práctica solo 13% de las pacientes se realizó el Papanicolaou por control. Las principales barreras declaradas fueron las demoras en la sala de espera y en acceder a la fecha y hora para realizarse el estudio en los servicios de salud. El 47% de los casos encuestados iniciaron su tratamiento en estadios avanzados de la enfermedad. Conclusión: se determina que las usuarias no asumen una conducta preventiva a pesar de tener el conocimiento adecuado. El sistema de salud debería implementar estrategias de información adecuadas para que utilicen en el momento oportuno y frecuencia recomendada los exámenes de tamizaje.

La reforma de la salud, incluye pagar por el cumplimiento de metas asistenciales. En 1996 se implementó un programa de mejora de la calidad, la Acreditación de servicios de salud en Buenas Prácticas de Alimentación (BPA), que en 2009 el Ministerio de Salud Pública lo incorporó como meta. El objetivo de este trabajo fue estudiar los resultados de las BPA. Se realizó un análisis secundario de los datos de encuestas aplicadas por UNICEF sobre una muestra representativa de la población. Se procesaron las tasas de lactancia exclusiva al sexto mes sobre las bases de los años 1996, 1999, 2003, 2007 y 2011. Se calculó la evolución de las tasas por acreditación de los prestadores de salud, tipo de prestador y región. Posteriormente se aplicó un modelo binario probit, para medir los factores asociados al resultado de lactancia. Los resultados muestran un incremento en la lactancia en los servicios que aplican BPA en todo el período (37% a 67%). La regresión probit muestra a la acreditación en BPA como la variable que mayormente incrementa la probabilidad de lactancia exclusiva al 6 mes, llegando a un 17% con un desvío estándar de alrededor 2% (p

AbstrakPenelitian ini bertujuan mengetahui korelasi indeks massa tubuh (IMT) dengan estimated Glomerular Filtration Rate (eGFR) berdasarkan formula MDRD pada populasi sehat di kota Padang. Penelitian analitik dengan rancangan potong lintang ini mengikutsertakan 121 orang peserta medical check up pada beberapa rumah sakit di Kota Padang pada bulan Agustus 2013-Oktober 2014. Nilai eGFR dihitung menurut persamaan MDRD, kadar kreatinin diperiksa dengan metode enzimatik yang telah distandarisasi. Korelasi IMT dengan eGFR berdasarkan formula MDRD dianalisis menggunakan korelasi Pearson. Kemaknaan secara statistik ditentukan jika nilai p < 0,05. Korelasi IMT dengan eGFR berdasarkan formula MDRD adalah korelasi negatif yang sangat lemah dan tidak bermakna (r = -0,19 ; p > 0,05). Simpulan: tidak didapatkan korelasi antara IMT dengan eGFR berdasarkan formula MDRD.AbstractThe purpose of this study was to evaluate the correlation between BMI and eGFR by MDRD formula among healthy population in Padang. This cross-sectional analytic study enrolled 121 participants taking medical check-up in several hospitals in Padang from August 2013 to October 2014. Value of eGFR was determined by MDRD formula, and a standardized enzimatic method was used for measuring creatinine levels. The correlation between BMI and eGFR by MDRD formula was analyzed using Pearson correlation. Statistical significancy was concluded if the value of p < 0.05. The correlation of BMI and eGFR by MDRD formula was found very weak, negative, and not significant (r = -0.19, p >0.05). Thus, there was no correlation between BMI and eGFR by MDRD formula.

AbstrakLatar belakang: Hantavirus hidup dan berkembang biak di tubuh hewan pengerat, salah satunya Rattus norvegicus yang banyak ditemukan di daerah kepulauan di Indonesia. Hantavirus spesies Seoul virus (SEOV) adalah virus RNA negatif rantai tunggal yang termasuk dalam keluarga Bunyaviridae, mempunyai beberapa gen spesifik terutama gen S yang dapat dikembangkan untuk uji diagnostik. Tujuan penelitian ini ialah untuk mengetahui karakter dari gen S dari Hantavirus spesies Seoulvirus.Metode:Pada penelitian ini dilakukan sekuensing gen S yang berasal dari jaringan paru-paru rodensia. Fragmen DNA yang disekuensing menggunakan primer DNA SEOS-28F danSEOS -360R,VNS-1501F dan VNS-CSR. Hasil sekuensing dianalisis menggunakan program seqscapedan dianalisis menggunakan program Bioedit dan Mega5. Analisis filogenetik untuk homologi nukleotida dan asam amino dari ketiga strain Kepulauan Seribu tersebut dibandingkan dengan spesies hantavirus lainnya yang diambil dari genebank. Hasil:Analisis Homologi nukleotida dan asam amino antara strain Kepulauan Seribu dengan SEOV menunjukkan homologi nukleotida tertinggi pada strain KS74 (88,4%) dan terendah pada KS90 (87,2%), sedangkan homologi asam amino tertinggi adalah strain KS74 (91.3%) dan terendah pada strain KS90 (89,5%). Kesimpulan:Karakter gen S virus yang ditemukan di Kepulauan Seribu sebanding dengan virus SEOV yang ditemukan di Singapura dan Korea. (Health Science Indones 2014;1:1-6)Kata kunci:Seoul virus, gen S, Kepulauan Seribu, IndonesiaAbstractBackground: Hantavirus lives and reproduces in the body of rodents. Rattus norvegicuswas one found in the Kepulauan Seribu islands of Indonesia. Hantavirus species Seoul virus (SEOV) is a negative single chain RNA viruses included in the family Bunyaviridae. It has a few specific genes, especially genes S that can be developed for a diagnostic test. The aim of this study was to ascertain the character of gene S of hantavirus species Seoul virus. Methods: Gene sequencing of S Seoul virus from lung tissue of rodents was conducted. DNA fragment sequencing used primer pairs of SEOS-28F and SEOS -360R, VNS-1501F and VNS-CSR. The results of sequencing were analyze by seqscapeprogram to obtain a sequence of nucleotides, and analyzed by Mega5 programs. Phylogenetic analysis was done for homology nucleotides and amino acids which were compared to other hanta virus species from the gene bank. Results: The comparison analysis showed, the highest homology from strain KS74 was 88.4% and the lowest from strain KS90 was 87.2%. The highest homology of amino acids sequence compared with Seoul virus came from strain KS74 was 91.3% and the lowest came from strain KS90 was 89.5%. Conclusion: Gene S of viruses was found in Kepulauan Seribu in Indonesia and it was comparable to that found in Singapore and Korea. (Health Science Indones 2014;1:1- 6). Key words: Seoul virus, S segment, Kepulauan Seribu

Background and objectives: Obesity is associated with poor vascular function and may lead to future cardiovascular disease (CVD). Obesity is also related to increased inflammation and a low testosterone level. This study was conducted to determine the relationship between inflammation, testosterone level, and vascular function among subjects with an increased body mass index (BMI) and to determine whether both low testosterone and high inflammation have synergistic effects towards vascular dysfunction. Materials and Methods: A total of 303 men aged 40−80 years were recruited from Klang Valley, Malaysia. Their height, weight, blood pressure (BP), lipid, blood glucose level, total testosterone (TT), free testosterone (FT), and C-reactive protein (CRP) were measured. The carotid femoral pulse wave velocity (PWVCF) and augmentation index (AI) were also recorded as markers of vascular function. Results: The mean age of all the subjects was 54.46 ± 9.77 years. Subjects were divided into a low/normal body mass index (BMI) group (BMI < 25 kg/m2; NG, n = 154) and high BMI group (BMI ≥ 25 kg/m2; OG, n = 149). The mean BMI for NG was 22.20 ± 1.94 kg/m2 while for OG was 28.87 ± 3.24 kg/m2 (p < 0.01). The level of TT (OG = 21.13 ± 6.44 versus NG = 16.18 ± 6.16 nmol/L, p < 0.01) and FT (OG = 0.34 ± 0.12 versus NG = 0.39 ± 0.11 nmol/L, p < 0.01) were reduced while the level of CRP [OG = 1.05 (2.80) versus NG = 0.50 (1.50) mmol/L, p = 0.01] was increased in OG compared to NG. PWVCF (OG = 8.55 ± 1.34 versus NG = 8.52 ± 1.42 m/s, p = 0.02) and AI (OG = 16.91% ± 6.00% versus 15.88% ± 5.58%, p < 0.01) were significantly increased in OG after adjustment for other CVD risk factors. The subjects that had both a low FT and an increased CRP had higher AI when compared to those with a high CRP and high FT (p < 0.01). Conclusions: The increased BMI was associated with vascular dysfunction, mediated by a low testosterone level and increased inflammation. Furthermore, having both conditions concurrently lead to higher vascular dysfunction. Weight loss, testosterone supplementation, and the anti-inflammatory agent may be beneficial for men to prevent vascular dysfunction.

OBJECTIVE: Accelerated bone loss that occurs in postmenopausal women has been linked to oxidative stress and increased free radicals. We propose the use of antioxidants to prevent and reverse postmenopausal osteoporosis. This study aimed to examine the effects of tocotrienol, a vitamin E analog, on bone loss due to estrogen deficiency. Our previous study showed that tocotrienol increased the trabecular bone volume and trabecular number in ovariectomized rats. In the current study, we investigated the effects of tocotrienol supplementation on various biochemical parameters in a postmenopausal osteoporosis rat model. MATERIALS AND METHODS: A total of 32 female Wistar rats were randomly divided into four groups. The baseline group was sacrificed at the start of the study, and another group was sham operated. The remaining rats were ovariectomized and either given olive oil as a vehicle or treated with tocotrienol at a dose of 60 mg/kg body weight. After four weeks of treatment, blood was withdrawn for the measurement of interleukin-1 (IL1) and interleukin-6 (IL6) (bone resorbing cytokines), serum osteocalcin (a bone formation marker) and pyridinoline (a bone resorption marker). RESULTS: Tocotrienol supplementation in ovariectomized rats significantly reduced the levels of osteocalcin, IL1 and IL6. However, it did not alter the serum pyridinoline level. CONCLUSION: Tocotrienol prevented osteoporotic bone loss by reducing the high bone turnover rate associated with estrogen deficiency. Therefore, tocotrienol has the potential to be used as an anti-osteoporotic agent in postmenopausal women.

OBJECTIVES: Variations in the prevalence of sex-hormone-related diseases have been observed between Asian ethnic groups living in the same country; however, available data concerning their sex hormone levels are limited. The present study aimed to determine the influence of ethnicity and age on the sex hormone levels of Malay and Chinese men in Malaysia. METHODS: A total of 547 males of Malay and Chinese ethnicity residing in the Klang Valley Malaysia underwent a detailed screening, and their blood was collected for sex hormones analyses. RESULTS: Testosterone levels were normally distributed in the men (total, free and non-sex hormone-binding globulin (SHBG) bound fractions), and significant ethnic differences were observed (p

OBJECTIVE: Osteoporosis increases the risk of bone fractures and may impair fracture healing. The aim of this study was to investigate whether alpha-tocopherol can improve the late-phase fracture healing of osteoporotic bones in ovariectomized rats. METHOD: In total, 24 female Sprague-Dawley rats were divided into three groups. The first group was sham-operated, and the other two groups were ovariectomized. After two months, the right femora of the rats were fractured under anesthesia and internally repaired with K-wires. The sham-operated and ovariectomized control rat groups were administered olive oil (a vehicle), whereas 60 mg/kg of alpha-tocopherol was administered via oral gavage to the alpha-tocopherol group for six days per week over the course of 8 weeks. The rats were sacrificed, and the femora were dissected out. Computed tomography scans and X-rays were performed to assess fracture healing and callus staging, followed by the assessment of callus strengths through the biomechanical testing of the bones. RESULTS: Significantly higher callus volume and callus staging were observed in the ovariectomized control group compared with the sham-operated and alpha-tocopherol groups. The ovariectomized control group also had significantly lower fracture healing scores than the sham-operated group. There were no differences between the alpha-tocopherol and sham-operated groups with respect to the above parameters. The healed femora of the ovariectomized control group demonstrated significantly lower load and strain parameters than the healed femora of the sham-operated group. Alpha-tocopherol supplementation was not able to restore these biomechanical properties. CONCLUSION: Alpha-tocopherol supplementation appeared to promote bone fracture healing in osteoporotic rats but failed to restore the strength of the fractured bone.

OBJECTIVES: Variations in sex hormones and the calcium balance can influence bone health in men. The present study aimed to examine the relationship between the calcaneal speed of sound and biochemical determinants of bone mass, such as sex hormones, parathyroid hormones and serum calcium. METHODS: Data from 549 subjects from the Malaysian Aging Male Study, which included Malay and Chinese men aged 20 years and older residing in the Klang Valley, were used for analysis. The subjects' calcaneal speed of sound was measured, and their blood was collected for biochemical analysis. Two sets of multiple regression models were generated for the total/bioavailable testosterone and estradiol to avoid multicollinearity. RESULTS: The multiple regression results revealed that bioavailable testosterone and serum total calcium were significant predictors of the calcaneal speed of sound in the adjusted model. After adjustment for ethnicity and body mass index, only bioavailable testosterone remained significant; the total serum calcium was marginally insignificant. In a separate model, the total testosterone and sex hormone-binding globulin were significant predictors, whereas the total serum calcium was marginally insignificant. After adjustment for ethnicity and body mass index (BMI), the significance persisted for total testosterone and SHBG. After further adjustment for age, none of the serum biochemical determinants was a significant predictor of the calcaneal speed of sound. CONCLUSION: There is a significant age-dependent relationship between the calcaneal speed of sound and total testosterone, bioavailable testosterone and sex hormone-binding globulin in Chinese and Malay men in Malaysia. The relationship between total serum calcium and calcaneal speed of sound is ethnicity-dependent.

OBJECTIVE: The objective of this study was to evaluate the effects of Tualang honey on trabecular structure and compare these effects with those of calcium supplementation in ovariectomized rats. METHODS: Forty female, Sprague-Dawley rats were randomly divided into five groups (n =8): four controls and one test arm. The control arm comprised a baseline control, sham-operated control, ovariectomized control, and ovariectomized calcium-treated rats (receiving 1% calcium in drinking water ad libitum). The test arm was composed of ovariectomized, Tualang honey-treated rats (received 0.2 g/kg body weight of Tualang honey). Both the sham-operated control and ovariectomized control groups received vehicle treatment (deionized water), and the baseline control group was sacrificed without treatment. RESULTS: All rats were orally gavaged daily for six weeks after day one post-surgery. The bone structural analysis of rats in the test arm group showed a significant increase in the bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th) and trabecular number (Tb.N) and a significant decrease in inter-trabecular space (Tb.Sp) compared with the ovariectomized control group. The trabecular thickness (Tb.Th) in the test arm group was significantly higher compared with the ovariectomized-calcium treated group, and the inter-trabecular space (Tb.Sp) in the test arm group was significantly narrower compared with the ovariectomized-calcium treated group. CONCLUSION: In conclusion, ovariectomized rats that received Tualang honey showed more improvements in trabecular bone structure than the rats that received calcium.

Background: Long-term glucocorticoid therapy causes secondary osteoporosis leading to pathological fractures. Glucocorticoid action in bone is dependant upon the activity of 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1). Piper sarmentosum is a local herb that possesses the ability to inhibit 11-βHSD1 enzyme activity. We aimed to determine the effects of Piper sarmentosum water extract on 11-βHSD1 expressions and activity in the bones of glucocorticoid-treated adrenalectomized rats. Methods: Forty male Sprague–Dawley rats (200-250 g) were used. Twenty-four animals were adrenalectomized and received intramuscular injection of dexamethasone (120 μg/kg/day). They were simultaneously administered with either Piper sarmentosum water extract (125 mg/kg/day), GCA (120 mg/kg/day) or distilled water as vehicle by oral gavage for two months. Eight animals were sham-operated and given vehicle daily, i.e. intramuscular olive oil and oral distilled water. Results: Following two months treatment, dexamethasone-treated adrenalectomized rats had significantly lower 11β-HSD1 dehydrogenase activity and higher 11β-HSD1 expression in the femoral bones compared to the sham-operated and baseline group. The rats supplemented with Piper sarmentosum water extract had significantly higher 11β-HSD1 dehydrogenase activity and lower 11β-HSD1 expression in the bones. Conclusion: The results showed that Piper sarmentosum water extract had the ability to prevent glucocorcoticoid excess in the bones of glucocorticoid-treated adrenalectomized rats through the local modulation of 11β-HSD1 expression and activity, and may be used as prophylaxis for osteoporosis in patients on long-term glucocorticoid treatment.

Background: The fracture healing is impaired in osteoporosis. Piper sarmentosum is a plant, which contains potent antioxidant, naringenin that may enhance fracture healing. The present histological study aimed to determine the effects of water extract of Piper sarmentosum on the late phase of frac-ture healing in estrogen-deficient rats. Methods: Twenty four female Sprague-Dawley rats (200-250 gm) were obtained. Six rats underwent sham operation and the rest were ovariectomized. Six weeks post-ovariectomy all the rats were fractured at the mid-diaphysis of the right femur and a K-wire was inserted for internal fixation. The sham group was given vehicle (normal saline) and the ovariectomized group was randomly subdivided into three groups: (i) ovariectomized-control group supplemented with vehicle; (ii) ovariectomized+estrogen replacement therapy group treated with es-trogen (100 µg/kg/day) and (iii) ovariectomized+Piper sarmentosum group treated with Piper sarmentosum water extract (125 mg/kg). Following six weeks of treatment, the rats were sacrificed and the right femora were harvested for histological assessment of fracture callus. Results: The ovariectomized-control group showed a significant delay in fracture healing compared to the sham, ovariectomized-estrogen replacement therapy and ovariectomized-Piper sarmentosum groups. The median callus score for the ovariectomized-Piper sarmentosum group was 4.50 (range, 4-5), which was significantly higher than the median callus score 3.50 (range, 3-4) for the ovariectomized-control group (P=0.019). However, there was no significant (P>0.05) difference in the callus score among the sham, ovariectomized-estrogen replacement therapy and ovariectomized-Piper sarmentosum groups groups. Conclusion: Treatment with water extract of Piper sarmentosum proved beneficial in the fracture healing in estrogen-deficient rats.

INTRODUCTION: Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties. OBJECTIVES: To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state. METHODS: A total of 24 female Sprague-Dawley rats (200-250 g) were randomly divided into 4 groups: (i) the sham-operated group; (ii) the ovariectomized-control group; (iii) the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy) group, which was supplemented with estrogen (100 μg/kg/day); and (iv) the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum) group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg). Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment. RESULTS: The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2 + 11.74 mm³) than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4 + 4.05, 22.4 + 4.14 and 17.5 + 3.68 mm³, respectively). The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value) as 1.0 (0 - 2), 1.0 (1 - 2) and 1.0 (1 - 2), respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3). The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4), 3.0 (2 - 3) and 3.0 (2 - 3), respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2) (p

OBJECTIVES: Previous studies have reported that osteoporosis due to estrogen deficiency influences fracture healing. Transforming growth factor (TGF-b) has been found to be involved in fracture healing via the regulation of the differentiation and activation of osteoblasts and osteoclasts. The current study aimed to determine the effects of estrogen on the expression of TGF-β1 during fracture healing in ovariectomized rats. METHODS: Thirty female Sprague-Dawley rats weighing 200-250 g were assigned to: (i) a sham-operated group that was given a normal saline; (ii) an ovariectomized control group that was given a normal saline; or (iii) an ovariectomized + estrogen (100 mg/kg/day) group that was treated with conjugated equine estrogen. The right femur of all rats was fractured, and a Kirschner wire was inserted six weeks post-ovariectomy. Treatment with estrogen was given for another six weeks post-fracture. At the end of the study, blood samples were taken, and the right femur was harvested and subjected to biomechanical strength testing. RESULTS: The percentage change in the plasma TGF-β1 level before treatment was significantly lower in the ovariectomized control and estrogen groups when compared with the sham group (p

INTRODUCTION: Prolonged steroid treatment administered to any patient can cause visceral obesity, which is associated with metabolic disease and Cushing's syndrome. Glucocorticoids have a profound negative effect on adipose tissue mass, giving rise to obesity, which in turn is regulated by the 11β-hydroxysteroid dehydrogenase type 1 enzyme. Adrenalectomized rats treated with dexamethasone exhibited an increase in visceral fat deposition but not in body weight. OBJECTIVES: The main aim of this study was to determine the effect of dexamethasone on the histomorphometric characteristics of perirenal adipocytes of adrenalectomized, dexamethasone-treated rats (ADR+Dexa) and the association of dexamethasone treatment with the expression and activity of 11 β-hydroxysteroid dehydrogenase type 1 (11 β-hydroxysteroid dehydrogenase type 1). METHODS: A total of 20 male Sprague Dawley rats were divided into 3 groups: a baseline control group (n = 6), a sham-operated group (n = 7) and an adrenalectomized group (n=7). The adrenalectomized group was given intramuscular dexamethasone (ADR+Dexa) 2 weeks post adrenalectomy, and the rats from the sham-operated group were administered intramuscular vehicle (olive oil). RESULTS: Treatment with 120 μg/kg intramuscular dexamethasone for 8 weeks resulted in a significant decrease in the diameter of the perirenal adipocytes (p

La reforma de la salud, incluye pagar por el cumplimiento de metas asistenciales. En 1996 se implementó un programa de mejora de la calidad, la Acreditación de servicios de salud en Buenas Prácticas de Alimentación (BPA), que en 2009 el Ministerio de Salud Pública lo incorporó como meta. El objetivo de este trabajo fue estudiar los resultados de las BPA. Se realizó un análisis secundario de los datos de encuestas aplicadas por UNICEF sobre una muestra representativa de la población. Se procesaron las tasas de lactancia exclusiva al sexto mes sobre las bases de los años 1996, 1999, 2003, 2007 y 2011. Se calculó la evolución de las tasas por acreditación de los prestadores de salud, tipo de prestador y región. Posteriormente se aplicó un modelo binario probit, para medir los factores asociados al resultado de lactancia. Los resultados muestran un incremento en la lactancia en los servicios que aplican BPA en todo el período (37% a 67%). La regresión probit muestra a la acreditación en BPA como la variable que mayormente incrementa la probabilidad de lactancia exclusiva al 6 mes, llegando a un 17% con un desvío estándar de alrededor 2% (p

OBJECTIVES: Variations in the prevalence of sex-hormone-related diseases have been observed between Asian ethnic groups living in the same country; however, available data concerning their sex hormone levels are limited. The present study aimed to determine the influence of ethnicity and age on the sex hormone levels of Malay and Chinese men in Malaysia. METHODS: A total of 547 males of Malay and Chinese ethnicity residing in the Klang Valley Malaysia underwent a detailed screening, and their blood was collected for sex hormones analyses. RESULTS: Testosterone levels were normally distributed in the men (total, free and non-sex hormone-binding globulin (SHBG) bound fractions), and significant ethnic differences were observed (p

Background: This study aims to investigate the effects of carob (Ceratonia siliqua L.) pod extract (CPE) on theviability of human endometrial mesenchymal stromal/stem cells (EnMSCs) and its impact on mRNA and protein expressionsof DNA methyltransferases (DNMT1, DNMT3A, and DNMT3B), histone deacetylase 1 (HDAC1), matrixmetalloproteinase-2 (MMP2), and cyclooxygenase-2 (COX-2) in endometriotic patients.Materials and Methods: In this experimental study, EnMSCs were derived from endometrium of patients with ovarianendometrioma (OMA-EnMSCs group) and deep infiltrative endometriosis (DIE) samples of 10 endometriosisassociatedinfertility (EAI) women (E-EnMSCs group) and compared to EnMSCs derived from the endometrium ofan endometriosis-free, normal woman as the control group (C-EnMSCs). The metabolic activity of the control andcase groups were evaluated by treating them with different concentrations of CPE. Cell viability was analysed byMTT. Real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were used to evaluatethe expression of specific genes at the mRNA and protein levels, respectively.Results: Treatment with 0.8 and 2 μg/mL of CPE downregulated COX-2 and HDAC1 in the E-EnMSC groupcompared to the C-EnMSCs group. Treatment with 0.8 μg/mL of CPE also decreased MMP2 and DNMT3B geneexpressions. The COX-2 and DNMT3A genes were significantly upregulated after treatment with 2 μg/mL of CPE.Expressions of the COX-2, HDAC1, DNMT1, DNMT3A, and DNMT3B peptides decreased in the all three groups after treatment with 0.8 and 2 μg/mL of CPE. Gas chromatography-mass spectroscopy (GC-MS) analysis of CPEidentified 14 bioactive compounds. Molecular docking showed the best position of each bioactive compound on thedifferent target proteins that are involved in the process of apoptosis in EnMSCs.Conclusion: In vitro and in silico analyses of CPE bioactive compounds show that they may downregulate the cellinflammatory pathway involved in the pathophysiology of endometriosis.

Objective(s): The health sectors in developing countries are facing challenges such as rising of costs and diminishing resources. Therefore, outsourcing appears to be an effective solution. Considering that Iran is confronted with challenges such as the lack of a strong private sector, lack of managerial skills in contract negotiation, and weak supervision, it is essential to have supervision, success indicators, and results dissemination for the successful implementation of outsourcing in hospitals and healthcare organizations. The aim of this study was to examine outsourced imaging units and pharmacies affiliated with Shahid Beheshti University of Medical Sciences using economic indicators, accessibility, and quality. Methods: This descriptive cross-sectional study was conducted in 2020-2021. The research population included all imaging centers and outsourced pharmacies affiliated with Shahid Beheshti University of Medical Sciences, Tehran. Initially, a format was designed in the intelligent hospital information management system for the outsourced units. Then, the units completed and extracted the data. The data included economic indicators, access to services, and service quality for all outsourced imaging centers and pharmacies from 2009 to 2020. The results were reported using descriptive statistics. Results: Based on the results of this study, in all indicators, only two teaching hospital (the Imam Hussein Hospital's imaging unit and Loghman Hospital's pharmacy) showed satisfactory results. For all other centers the results were not satisfactory. Conclusion: In this study, all outsourced units had average or, in some cases, weak service quality based on indicators examined. The findings suggest continuous evaluation and assessment of outsourced units are necessary and a decision should be made for outsource centers affiliated with Shahid Beheshti University of Medical Sciences in order to improve service delivery.

Maximilian Andreas Storz,1 Rintaro Imafuku2 1Department of Internal Medicine II, Centre for Complementary Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; 2Medical Education Development Center, Gifu University, Gifu City, JapanCorrespondence: Maximilian Andreas Storz, Department of Internal Medicine II, Faculty of Medicine, Centre for Complementary Medicine, Medical Center, University of Freiburg, Freiburg, Germany, Tel +4915754543852, Email maximilian.storz@uniklinik-freiburg.deBackground: International medical electives (IMEs) are considered high-impact practice in global health education. Nevertheless, international medical elective (IME) research remains scarce, with only a few new publications appearing each year. The discrepancy between the many unanswered questions regarding IMEs and the lack of opportunities to perform research in this field has been further aggravated by the COVID-19 pandemic. Elective databases cataloguing structured IME reports/testimonies could offer a viable solution here. This narrative review provides a balanced and objective evaluation of the strengths and weaknesses of elective databases, summarizing their potential usefulness in IME research.Methods: The methodology employed was a multidisciplinary narrative review of the published and grey literature on databases cataloguing IME testimonies.Results: Elective databases offer numerous benefits to the IME researcher. Their size allows for large analyses, built on hundreds of equally structured elective testimonies. Pre-defined outcomes, such as the elective destination, elective discipline or duration, are queried in a standardized way, allowing for a broad set of research questions. Elective databases are usually open-access, not confined to a single university, and free to use. Most databases also offer user-friendly filter functions, permitting targeted analyses centered around a particular outcome. A major drawback is that reports are rarely verified. Subject to several forms of bias (eg, recall and reporting bias), elective databases may not be suitable for all types of research questions, and the report quality is often inhomogeneous. Above all, they rarely allow for an informational depth that may result from qualitative face-to-face interviews.Conclusion: Elective databases could be a valuable supplement to interview-based elective research, potentially allowing for larger and broader analyses not confined to single institutions.Keywords: international medical elective, abroad elective, medical education, global health, learning, research

Abstract Background Purine nucleoside phosphorylase (PNP) deficiency is a rare, autosomal recessive, inborn error of immunity. It is characterized by progressive immune abnormalities ranging from severe combined immunodeficiency (SCID) to combined immunodeficiency less profound than SCID, neurological abnormalities and autoimmunity. Early detection and diagnosis before the development of life-threatening complications are crucial. Methods Immune cell subsets were assessed by flow cytometry, serum immunoglobulins and uric acid levels were evaluated, and genetic testing was performed for all patients. Results Herein, we present six Egyptian PNP deficiency patients from four different families. We describe the patients’ clinical phenotypes, their immunological profile as well as their genetic results. Sequence analysis results detected 4 different variants in the PNP gene; 1 likely pathogenic frameshift deletion c.452del; p.Asn151MetfsTer20 was found in one family, 1 pathogenic nonsense variant c.172C > T; p.Arg58Ter, and 2 likely pathogenic missense variants c.682G > C; p.Ala228Pro and c.722T > C; pIle2241Thr. Conclusion In conclusion, PNP deficiency is a variable immunodeficiency and should be considered in various clinical contexts, with or without neurological manifestations. Hematopoietic stem cell transplantation offers a good treatment option, with excellent clinical outcomes, when performed in a timely manner.

Laila A Alharbi,1 Mohamed Cheikh,2 Manal E Alotaibi,1 Amal A Alkhotani,1 Hussam M Alim,1 Fahd Almalki,1 Mohammed S Samannodi,1 Hadeel A Khadawardi,1 Ahmad A Imam,1 Yosra A Turkistani,1 Fozya B Bashal,1 Abdullah Tawakul,1 Adeeb A Bulkhi,1 Mohammad S Dairi,1 Rania Zaini,3 Hani M Almoallim1 1Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia; 2Department of Medicine, Al Salama Hospital, Jeddah, Saudi Arabia; 3Department of Community Medicine, Umm Al-Qura University (UQU), Makkah, Saudi ArabiaCorrespondence: Hani M Almoallim, Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, Email hmmoalim@uqu.edu.saBackground: Entrustable professional activities (EPAs) define the core tasks that a graduating rheumatologist needs to perform independently in practice. The objective of this study was to develop and validate EPAs for rheumatology fellowship training programs in Saudi Arabia.Methods: Experts met to develop an initial set of potential end-of-training EPAs by conducting a comprehensive literature review of EPAs and studying the Saudi rheumatology fellowship curriculum. Then, to validate the EPAs, we conducted two rounds of the modified Delphi technique among rheumatology experts in Saudi Arabia. A response rate of 80% was considered and the minimum number of experts needed to be 25 to 30. Descriptive statistics were utilized to describe participants’ demographic characteristics and group responses to each statement in all rounds. The experts were asked to rate the relevancy of each EPA using a 5-point Likert scale in both Delphi rounds.Results: In the preliminary phase, four rheumatologists developed an initial set of 36 core EPAs for rheumatology training program in Saudi Arabia. For the two-rounds Delphi techniques, 32 experts were invited to complete the study. The response rate of the first and second round were, 78.12% (25) and 93.75% (30), respectively. The first-round Delphi resulted in a robust consensus on 31 EPAs for rheumatology training. Five EPAs were excluded, and one new EPA was proposed. In the subsequent round, all 32 EPAs achieved strong consensus. The eliminated EPAs likely fell short in one or more of the following areas: relevance to rheumatology practice in Saudi Arabia, overlapping with other EPAs, or practical challenges in the implementation.Conclusion: We have developed and validated a core set of EPAs for rheumatology fellowship training programs in Saudi Arabia. Mapping and identifying milestones for these EPAs are essential steps to follow to enhance workplace curriculum development.Keywords: entrustable professional activities, EPAs, rheumatology, training programs, fellowship, Saudi Arabia, curriculum, workplace

Ziyad S Almalki,1 Abdullah M Alrashdi,1 Dalal E AlHuzaimi,2 Joud O Alotaibi,2 Malek M Alqahtani,1 Ruba D Alzahrani,2 Shahad A Alajmi,2 Rami R AlOsaimi,2 Salman M Majrashi,1 Abdullah K Alahmari,1 Ahmed M Alshehri,1 Abdulaziz I Alzarea,3 Mohammad Tarique Imam,1 Areej A Alshlowi2 1Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 2College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Aljouf, Saudi ArabiaCorrespondence: Ziyad S Almalki, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia, Tel +966 11 588 6059, Email z.almalki@psau.edu.saPurpose: This study aimed to explore the Willingness To Pay (WTP) of uninsured individuals in Saudi Arabia and the factors influencing their decisions regarding telemedicine services.Patients and Methods: This study used a cross-sectional survey design and convenience sampling to gather data from respondents aged 18 years or older who had visited healthcare facilities at least once in the past year and were uninsured. WTP was determined using the contingent valuation method, and a two-part regression model was applied to analyze the factors influencing WTP.Results: The study included 4232 participants and discovered that approximately 17.41% were willing to pay for telemedicine services. Those aged 60 and older, employed in the government or private sector, in higher socioeconomic quintiles, and experiencing chronic health issues showed a positive association with their WTP value. Conversely, individuals aged between 30 and 44 years, married, and unemployed exhibited a negative association with a lower WTP value.Conclusion: The findings indicate that most respondents hesitated to pay for telemedicine services, with a significant influence from sociodemographic characteristics, underscoring the need to promote telemedicine use among underserved populations and address health disparities.Keywords: healthcare, sociodemographic, questionnaire, contingent valuation method

Abstract Handling missing data in clinical prognostic studies is an essential yet challenging task. This study aimed to provide a comprehensive assessment of the effectiveness and reliability of different machine learning (ML) imputation methods across various analytical perspectives. Specifically, it focused on three distinct classes of performance metrics used to evaluate ML imputation methods: post-imputation bias of regression estimates, post-imputation predictive accuracy, and substantive model-free metrics. As an illustration, we applied data from a real-world breast cancer survival study. This comprehensive approach aimed to provide a thorough assessment of the effectiveness and reliability of ML imputation methods across various analytical perspectives. A simulated dataset with 30% Missing At Random (MAR) values was used. A number of single imputation (SI) methods - specifically KNN, missMDA, CART, missForest, missRanger, missCforest - and multiple imputation (MI) methods - specifically miceCART and miceRF - were evaluated. The performance metrics used were Gower’s distance, estimation bias, empirical standard error, coverage rate, length of confidence interval, predictive accuracy, proportion of falsely classified (PFC), normalized root mean squared error (NRMSE), AUC, and C-index scores. The analysis revealed that in terms of Gower’s distance, CART and missForest were the most accurate, while missMDA and CART excelled for binary covariates; missForest and miceCART were superior for continuous covariates. When assessing bias and accuracy in regression estimates, miceCART and miceRF exhibited the least bias. Overall, the various imputation methods demonstrated greater efficiency than complete-case analysis (CCA), with MICE methods providing optimal confidence interval coverage. In terms of predictive accuracy for Cox models, missMDA and missForest had superior AUC and C-index scores. Despite offering better predictive accuracy, the study found that SI methods introduced more bias into the regression coefficients compared to MI methods. This study underlines the importance of selecting appropriate imputation methods based on study goals and data types in time-to-event research. The varying effectiveness of methods across the different performance metrics studied highlights the value of using advanced machine learning algorithms within a multiple imputation framework to enhance research integrity and the robustness of findings.

Abstract Background The distinction between normal and high blood pressure remains a debated topic, with varying guidelines on when to start medication. Contemporary guidelines advocate for the initiation of antihypertensive therapy in individuals who present with high-normal blood pressure, particularly those exhibiting elevated 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores. Despite these recommendations, there is a notable lack of direct evidence supporting the efficacy of treating high-normal blood pressure to prevent major adverse cardiovascular events (MACE). Methods The PRINT-TAHA9 trial, a unicentric, randomized, open-label, controlled, parallel clinical study, seeks to explore the effects of intensive blood pressure control on MACE in participants with high-normal blood pressure. We will enroll 1620 adults aged 18 years and above with a systolic blood pressure range of 130–140 mmHg, diastolic blood pressure under 90 mmHg, and atherosclerotic cardiovascular disease (ASCVD) risk score exceeding 7.5%. The study will be executed in five distinct phases, with each phase enrolling between 300 and 400 participants. Participants will be randomly assigned to either the treatment group receiving antihypertensive medication (amlodipine/valsartan) and a low-salt/low-fat diet or to the control group receiving a similar diet. Follow-up visits are scheduled every 6 months over a 3-year period to monitor blood pressure, evaluate medication adherence, document any adverse events, and adjust the intervention as necessary. Cox proportional hazards regression analysis will be employed to examine the disparities between the two arms. Discussion Despite guidelines promoting early treatment of elevated blood pressure, the debate continues due to insufficient evidence that such interventions significantly reduce the occurrence of MACE. This trial seeks to address this critical evidence gap. Trial registration The PRINT-TAHA9 trial was registered in October 2019 with the Iranian Registry of Clinical Trials (IRCT.ir) under the registration number IRCT20191002044961N1. https://irct.behdasht.gov.ir/trial/43092 .

Abstract Background Acute leukemia may present with extramedullary (EM) tissues. Myeloid sarcoma (MS) and leukemia cutis (LC) are considered extramedullary diseases. This study aims to evaluate the incidence, clinical characteristics, and prognostic factors affecting the outcome of pediatric patients with myeloid sarcoma at the pediatric oncology center from July 2007 to December 2017. Radiological imaging was used to stage the tumor, biopsy was done for pathological diagnosis, and bone marrow aspirate for morphology, flow cytometry, cytogenetics, and molecular analysis. Patients received chemotherapy protocols based on those used by the Children's Cancer Group for acute myeloid leukemia (AML). Result The study included 91 (13.2%) of 687 pediatric patients with acute myeloid leukemia, with a male-to-female ratio of 1.9 to 1. Prognostic factors that improved the patient’s 5-year overall survival (OS) were age > 5 years old, molecular and cytogenetic detection of t (8; 21), inv 16, presence of a single and small size lesion

Abstract Background Gaucher disease (GD), an autosomal recessive, lysosomal storage disorder, is caused due to mutations in the glucocerebrosidase (GBA) gene. GD can occur at any age and is classified as type 1 (non-neurologic), type 2 (infantile form, with acute early neurologic manifestation), and type 3 (subacute/chronic neuropathic form). The rarity of the disease and its overlapping symptoms with other diseases increase the delay in diagnosis. The Egyptian cohort of patients with GD is specifically different regarding the prevalence of type 3 as well as the severity and progression of the disease. The unavailability of precise diagnostic tests and lack of awareness among clinicians are the current challenges associated with diagnosing and managing GD in Egypt. Method An expert panel meeting was convened with 19 experts from Egypt to address the current unmet challenges in the diagnosis and management of GD from the region and to develop country-specific diagnostic algorithms based on the existing literature for pediatric and adult groups. In addition, management strategies and preventive measures were also discussed. Result The algorithms presented in this review can be implemented in clinical practice for the timely diagnosis of patients with GD in Egypt. Early diagnosis is crucial in selecting the best treatment for patients with GD, and evidence suggests that early initiation of therapy can result in better outcomes. Conclusion The evidence-based expert opinion presented in this review will help clinicians in the early initial diagnosis of GD in Egypt, leading to appropriate management of the disease.

Abstract Background Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established. Methods This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 h of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 h will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient-reported quality of life measures. Discussion In vitro and in vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms. Trial registration ClinicalTrials.gov NCT04217551. Registered on 30 December 2019.

Abstract Vascular tissue engineering is a promising approach for regenerating damaged blood vessels and developing new therapeutic approaches for heart disease treatment. To date, different sources of cells have been recognized that offer assistance within the recovery of heart supply routes and veins with distinctive capacities and are compelling for heart regeneration. However, some challenges still remain that need to be overcome to establish the full potential application of these cells. In this paper, we review the different cell sources used for vascular tissue engineering, focusing on extraembryonic tissue-derived cells (ESCs), and elucidate their roles in cardiovascular disease. In addition, we highlight the intricate interplay between mechanical and biochemical factors in regulating mesenchymal stem cell (MSC) differentiation, offering insights into optimizing their application in vascular tissues.

Summary: Background: Crimean-Congo Haemorrhagic Fever (CCHF) is a viral haemorrhagic fever with a case fatality rate of 5–25% that has been prioritised for research and development by the World Health Organisation. There are no CCHF rapid diagnostic tests (RDTs) commercially available. We describe the development and evaluation of an antigen-targeting lateral flow immunoassay RDT for CCHF. Methods: Prospective clinical samples were collected and tested between July and October 2023 in Türkiye. Retrospective stored samples were obtained from the Central Public Health Laboratory, Baghdad, Iraq. The sensitivity and specificity of the CCHF RDT was compared to reverse transcription quantitative polymerase chain reaction assays. Findings: On prospective clinical samples in Türkiye, the sensitivity and specificity of the CCHF RDT was 90.4% [95% CI 81.5–95.3%] (n = 73) and 96.2% [95% CI 87.0–99.3%] (n = 52), respectively with a sensitivity of 92.9% [95% CI 84.3–96.9%] (n = 70) in samples with a cycle threshold (Ct) ≤30. On retrospective stored samples in Iraq, sensitivity and specificity of the RDT was 71.7% [95% CI 59.2–81.5%] (n = 60) and 92.5% [95% CI 80.1–97.8%] (n = 40), respectively with a sensitivity of 82.2% [95% CI 68.7–90.7%] (n = 45) in samples of Ct ≤30. Interpretation: The CCHF RDT was an effective rapid diagnostic test in this preliminary clinical evaluation, showing this RDT has the potential diagnostic capability for use at the point-of-care. Definitive evaluation is now required to ensure the RDT meets the regulatory requirements for commercialisation. Funding: The Liverpool School of Tropical Medicine, National Institute for Health Research Health Protection Research Unit in Emerging Zoonotic Infections, The Medical Research Council and The Pandemic Institute.

Introduction Research is important for the advancement of the medical field. Integrating research in the undergraduate medical curricula is crucial. Previous studies have explored medical students’ knowledge of, attitude towards, and barriers to medical research in different countries. We aim in this study to evaluate the knowledge, attitude, and barriers of medical students towards research in a Moroccan medical school. Methods We conducted a cross-sectional study including all medical students at Oujda Medical School from the first year to their seventh year. Data were collected using an anonymous, self-administered online questionnaire that had been pilot-tested beforehand. The questionnaire was designed to evaluate students’ knowledge, attitude, and perceived barriers regarding research. Additionally, we analyzed how students’ attitude, knowledge and barriers scores correlated with various sociodemographic variables. Results We received 754 completed responses in total. The knowledge score was relatively low, with a median of 2 (IQR 1-3) across 8 questions, indicating limited understanding of research basics. However, the majority of students expressed a positive attitude towards scientific research, with a median score of 3.26 (IQR 3.04-3.5) on ATR scale. Numerous challenges were identified by the students, including time constraints (75.6%), insufficient funding (75%), and inadequate laboratory facilities (72.6%). Conclusion Moroccan students displayed a high level of attitude towards research, yet a low knowledge score. This discrepancy may be explained by several perceived obstacles towards research. To enhance students’ engagement in undergraduate research, these barriers must be addressed.

Introduction Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data.Results 1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16–88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management.Discussion Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) ‘extremely likely or likely’ to recommend the service.Conclusion The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.

Abstract BackgroundSocial media (SoMe) have taken a major place in the medical field, and younger generations are increasingly using them as their primary source to find information. ObjectiveThis study aimed to describe the use of SoMe for medical education among French medical students and assess the prevalence of smartphone addiction in this population. MethodsA cross-sectional web-based survey was conducted among French medical students (second to sixth year of study). The questionnaire collected information on SoMe use for medical education and professional behavior. Smartphone addiction was assessed using the Smartphone Addiction Scale Short-Version (SAS-SV) score. ResultsA total of 762 medical students responded to the survey. Of these, 762 (100%) were SoMe users, spending a median of 120 (IQR 60‐150) minutes per day on SoMe; 656 (86.1%) used SoMe for medical education, with YouTube, Instagram, and Facebook being the most popular platforms. The misuse of SoMe in a professional context was also identified; 27.2% (207/762) of students posted hospital internship content, and 10.8% (82/762) searched for a patient’s name on SoMe. Smartphone addiction was prevalent among 29.1% (222/762) of respondents, with a significant correlation between increased SoMe use and SAS-SV score (rPPP ConclusionsOur findings reveal the extensive use of SoMe for medical education among French medical students, alongside a notable prevalence of smartphone addiction. These results highlight the need for medical schools and educators to address the responsible use of SoMe and develop strategies to mitigate the risks associated with excessive use and addiction.

Summary: Background: Small-quantity lipid-based nutrient supplements (SQ-LNS), which has been widely tested to reduce child stunting, has largely modest effects to date, but the mechanisms underlying these modest effects are unclear. Child stunting is a longstanding indicator of chronic undernutrition and it remains a prevalent public health problem. The infant gut microbiome may be a key contributor to stunting; and mother and infant fucosyltransferase (FUT) phenotypes are important determinants of infant microbiome composition. Methods: We investigated whether mother-infant FUT status (n = 792) and infant gut microbiome composition (n = 354 fecal specimens from 172 infants) modified the impact of an infant and young child feeding (IYCF) intervention, that included SQ-LNS, on stunting at age 18 months in secondary analysis of a randomized trial in rural Zimbabwe. Findings: We found that the impact of the IYCF intervention on stunting was modified by: (i) mother-infant FUT2+/FUT3− phenotype (difference-in-differences −32.6% [95% CI: −55.3%, −9.9%]); (ii) changes in species composition that reflected microbiome maturation (difference-in-differences −68.1% [95% CI: −99.0%, −28.5%); and (iii) greater relative abundance of B. longum (differences-in-differences 49.1% [95% CI: 26.6%, 73.6%]). The dominant strains of B. longum when the intervention started were most similar to the proficient milk oligosaccharide utilizer subspecies infantis, which decreased with infant age and differed by mother-infant FUT2+/FUT3− phenotypes. Interpretation: These findings indicate that a persistently “younger” microbiome at initiation of the intervention reduced its benefits on stunting in areas with a high prevalence of growth restriction. Funding: Bill and Melinda Gates Foundation, UK DFID/Aid, Wellcome Trust, Swiss Agency for Development and Cooperation, US National Institutes of Health, UNICEF, and Nutricia Research Foundation.

Background Current injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.Objective To address this gap, we developed a new data-driven, customisable approach based on the principles of risk management. We collaborated with key stakeholders to identify focus areas for injury and illness prevention and determine their priorities.Setting The team medical and coaching staff included members from 17 professional football clubs, the national team and a youth football academy in Qatar.Methods In 2015, we launched a series of annual workshops under the Aspetar Sports Injury and Illness Prevention Programme. The workshops included club medical personnel and fitness coaches in a process to develop team-specific programmes for injury and illness prevention based on the principle of risk management. Over 2 years, workshops refined focus areas through discussions, surveys and small-group presentations, culminating in the creation a novel programme for football injury prevention.Results Out of 44 focus areas first identified, 23 were selected as priorities for inclusion in multimodal injury and illness prevention programmes. The identified focus areas represent a variety of aspects, including social/behavioural/lifestyle, exercise programmes/training, load management, recovery and equipment. The top priorities included communication, the Nordic hamstring exercise, training load, recovery strategies, nutrition, sleep, warm-up, the Copenhagen adduction exercise and core and dynamic stability.Conclusion We have developed a comprehensive framework for preventing injuries and illnesses in football grounded in the general principles of risk management. This framework has proven feasible and led to the creation of a new multicomponent programme, The Aspetar IP2 (Injury and Illness Prevention for Performance) NetWork, focusing on a range of areas beyond preventive exercise programmes only.

Cerebrovascular events are linked to ankylosing spondylitis. Accelerated atherosclerosis and endothelial dysfunction against a backdrop of inflammation have been widely blamed for the increased cerebrovascular risk in ankylosing spondylitis. The absence of a comprehensive review encouraged us to consider the link between ankylosing spondylitis and cerebrovascular diseases. Web of Science, PubMed, Medline, Scopus, and EMBASE were searched to identify studies published from 2000 to June 10, 2023. All observational and cohort studies reporting myocardial infarction or stroke and considering classic cerebrovascular risk in ankylosing spondylitis patients and healthy controls were included. Most of the included studies reported that the risk of cerebrovascular disorders was greater in ankylosing spondylitis than in the general population. Also, most studies showed that for both sexes, the prevalence of cardiovascular illnesses rose with age, and this trend was consistent across all subgroups of cardiovascular disorders. Also, most studies reported that the rate of cerebrovascular accidents in ankylosing spondylitis patients was higher than in control groups. Some studies reported that the risk of developing an ischemic stroke was higher in young patients with ankylosing spondylitis, while others did not. Our systematic analysis found that most studies agreed that ankylosing spondylitis patients had a higher risk of cerebrovascular diseases than the general population. Still, this increased risk was influenced by several factors that need further research exploration.

Individual identification is a critical focus of forensic research, aiming to achieve heightened accuracy in the identification process. Particularly in cases involving fragmented and damaged skeletal remains, sex determination plays a pivotal role. It is imperative to establish the precision of cadaver bones in such scenarios. This research aimed to evaluate sex-based differences and assess age using bimastoid width measured through digital computed tomography images. The study included a total of 153 adults (77 males and 76 females) aged between 15 and 50. Bimastoid breadth measurements were obtained from CT scan images of the skull base, revealing that bimastoid distance is larger in males compared to females. The study observed significant differences in bimastoid breadth between men and women, with an average mastoid width of 132.371 in men and 121.724 in women. The findings indicate that the measurement of bimastoid breadth does not significantly change with increasing age. However, substantial differences were found between men and women in bimastoid breadth measurements, which can be utilized to determine sex in forensic investigations.

Objective(s): Hospital staff performance in management positions significantly affects cost-effectiveness, service productivity, and the hospital’s success. Evaluating management performance at different levels could identify their strengths and weaknesses and discover their training needs. The current study aims to evaluate the performance of hospital managers in Ahvaz, Iran. Methods: In this cross-sectional study, which was conducted in 13 public (teaching and non-teaching) and private hospitals, 11 top managers and 162 middle and operational managers were selected using census and stratified sampling methods, respectively. The data was collected by a questionnaire. The questionnaire consisted of two sections: demographics and the study main variables (planning, decision making, organizing, coordinating, communicating, controlling, leadership and budgeting). The data were analyzed using the 23rd version of the SPSS software. Results: The mean and standard deviation of the planning, decision-making, organizing, coordinating, communicating, leadership, controlling, and budgeting were (3.91±0.75), (3.98± 0.64), (4.06±0.71), (4.05±0.67), (4.03±0.62), (4.00±0.74), (3.99±0.67), and (2.99±1.21) respectively. In general, the mean overall performance of Ahvaz hospital managers was 3.88 out of 5. The best reported were in organizing and coordinating, and the weakest were in planning and budgeting performance. Conclusion: In general, the self-reported performance of Ahvaz hospital managers was relatively good. However, more training, especially in planning and budgeting, is suggested.

Background and Aim: Students' learning during their study period is one of the most important educational goals in the universities. During the corona pandemic, universities were forced to change traditional methods and turn to virtual education. However, this new method had not been investigated comprehensibly. Therefore, we conducted this study to compare the learning efficiency of students in virtual versus face-to-face education during the outbreak of the corona pandemic in the faculties of health and paramedicine of Gonabad University of Medical Sciences. Materials and methods: This cross-sectional study included 210 students with different disciplines via convenient sampling. For data collection we used a two-part questionnaire: demographic data including nine questions and a standard learning efficiency questionnaire consisting of 45 questions. Data were entered into SPSS version22 software and analyzed by appropriate statistical tests. Results: The mean scores of learning efficiency in face-to-face and virtual training were 165.96 ± 32.07 and 104.79 ± 25.39, respectively, and there was a statistically significant difference between the two training methods (P=0.000). Based on the Wilcoxon test, the total score of learning efficiency and all indexes in the questionnaire were significantly higher in the face-to-face training group compared to those in the virtual training group (p