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Background: The circadian clock regulates the function of the immune system, the replication of viruses, and the magnitude of infections. The aim of this study was to analyse whether hospital attendance in Coronavirus disease 2019 (COVID-19) patients presents a diurnal variation., Methods: Data from the electronic medical records of 1094 COVID-19 patients who presented to a Health Centre in Qatar during the month of July 2020 was retrospectively analysed. The following demographic (i.e. time of day (TOD), sex, age), clinical (i.e. cycle threshold (CT), temperature, oxy-haemoglobin saturation and resting heart-rate), biochemical (i.e. uraemia, glycaemia and albuminia) and haematological (i.e. leukocytes, erythrocytes ad platelets) parameters were collected., Results: Univariate analysis showed a significant effect of TOD on hospital admission ( p  < 0.001), with patients attending the health care centre more during the active behavioural phase (08h00-00h00) compared to the resting phase (00h00-08h00). COVID-19 infection blunted the circadian rhythms of core body temperature, neutrophils and leukocytes family and shifted the circadian rhythms of resting heart-rate and uraemia. Correlation analysis showed a near perfect negative correlation between the age of patients and the TOD ( r =-0.97), with older patients attending the care centre earlier during the day., Conclusion: COVID-19 infection affected the circadian rhythms of the host through disrupting the circadian rhythms of core temperature and innate immunity mediators. Old patients attend the health care centre earlier compared to younger ones. However, CT during polymerase chain reaction-test was unaffected by the TOD, which limits the conclusion that COVID-19 viral infection exhibits diurnal variation.

The validity of the GLI-2021 norms for SLVs in healthy Algerian adults has not been assessed. To ascertain how well do the GLI-2021 norms fit to contemporary SLVs data in Algerian adults. This was a cross-sectional study involving 481 (n = 242 females) healthy non-smoking adults recruited from the Algiers general population. All participants underwent a clinical examination and a plethysmography. Z-scores for slow vital capacity (SVC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), expiratory reserve volume (ERV), inspiratory capacity (IC), and RV/TLC were calculated. The mean difference between the determined and the predicted values (∆value) of SLVs were calculated. The GLI-2021 norms would be considered as reflective of contemporary Algerian SLVs if the total sample mean z-scores were in the normal range ( ie ; -0.5 to +0.5). The participants' means ± SDs of age and height were 46.4 ± 16.4 years and 166 ± 10 cm, respectively. The determined SLVs were significantly different from those predicted (∆values means ± SDs were -170 ± 470 ml for IC, -100 ± 490 ml for SVC, 170 ± 400 ml for ERV, 240 ± 620 ml for TLC, 370 ± 340 ml for RV, 480 ± 480 ml for FRC, and 5.28 ± 4.38% for RV/TLC). The means ± SDs z-scores for IC, SVC, ERV, and TLC were in the normal range (-0.29 ± 0.88, -0.17 ± 0.94, 0.29 ± 0.77, and 0.35 ± 0.86, respectively), but those of RV, FRC, and RV/TLC were out of the normal range (0.74 ± 0.66, 0.75 ± 0.72, and 0.83 ± 0.75, respectively). In healthy Algerian adults, the GLI-2021 norms fit well to SVC, TLC, ERV, and IC, but they do not fit to FRC, RV, and RV/TLC.

Background In addition to the cardiorespiratory, muscular, and neurological manifestations, coronavirus disease 2019 (COVID-19) alters patients' health-related quality of life (HRQoL), induces a large variety of psychiatric manifestations, and reduces mobility and motor activity. Several studies have raised the impact of a pulmonary rehabilitation program (PRP) on social disadvantage ( e.g., HRQoL, anxiety, depression) and physical activity of COVID-19 patients, but very few have been performed in low-income countries. This study aimed to investigate the impact of a PRP on post-COVID-19 HRQoL, hospital anxiety and depression (HAD), and physical activity in Tunisian post-COVID19-patients. Methods This was a cross-sectional study in an outpatient care setting. Patients with post-COVID-19 were included. They completed an interview (including three questionnaires) before and after a PRP (three sessions/week for four weeks, each session was 70 minutes in duration, PRP items: aerobic cycle endurance, strength training, and education). The VQ11 questionnaire assessed functional dimension, psychological dimension, relational dimension, and total score; HAD appraised depression and anxiety; and Voorrips physical activity assessed daily activity, physical activity, leisure activity, and total scores. Data were expressed as mean±standard deviation in PRP change (PRP change=after-PRP values - before-PRP values). Results In total, 14 moderate to severe post-COVID-19 patients (61±4 years) were included. The PRP significantly improved the i) functional, psychological, and relational dimensions, and the VQ11 total score by 1.79±1.58 (p=0.0033), 2.00±2.15 (p=0.0108), 1.57±1.50 (p=0.0077), and 5.36±3.97 (p=0.0015), respectively; ii) HAD anxiety and depression scores by 2.07±2.40 (p=0.0076), and 2.57±3.08 (p=0.0058); and iii) physical activity and total scores by 1.75±2.44 (p=0.0251), and 1.78±2.65 (p=0.0341), respectively. Conclusion The PRP improved HRQoL, HAD, and physical activity of Tunisian post-COVID-19 patients., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 BENZARTI W et al.)

Objective: To determine the predictive factors of nebulized morphine (nMOR) failure in patients with chest trauma., Research Design and Methods: This was an interventional clinical study. Patients admitted with isolated chest trauma with a pain visual analog score > 4 were included. Each patient received 10 mg nMOR. If pain was still > 4 after 10 minutes of nebulization, the latter was repeated every 10 minutes until pain was relieved (i.e. ≤ 4). If pain was > 4 at 30 minutes, nMOR was considered a failure. Patients were divided into two groups: MOR (+) and MOR (-) (good response to and nMOR failure, respectively)., Results: Seventy-five patients were included. Analysis of the risk factors revealed that road traffic accidents (relative risk (RR): 0.117 [0.031-0.443]; p = 0.002), number of fractured ribs > 4 (RR: 0.317 [0.092-0.543]; p = 0.006), bilateral injury (RR: 0.114 [0.037-0.349]; p < 0.001), flail chest (RR: 0.120 [0.037-0.386]; p < 0.001), hemothorax (RR: 0.203 [0.062-0.660]; p = 0.008), pulmonary contusion (RR: 0.202 [0.069-0.589]; p = 0.003), and pain at admission > 7 (RR: 0.363 [0.147-0.579]; p = 0.004) were predictors of nMOR failure., Conclusion: Our results can help optimize the analgesic management of chest trauma patients by identifying the most eligible patients to benefit from nMOR., Clinical Trial Registration: www.clinicaltrials.gov identifier is NCT03580187.

Maintaining the quality and stability of functional meat products during storage is one of the major challenges of these products. The aim of this study was to evaluate the potential of polysaccharides extracted from green alga Bryopsis plumosa as a new natural additive in the formulation of beef sausages. In order to evaluate the impact of the incorporation of polysaccharides in beef sausages formulation, the physico-chemical, microbiological, and antioxidant properties were investigated during 12 days of storage at 4°C. Obtained data illustrated that the addition of this polymer in the formulation of beef sausages leads to a distinct antioxidant activity during 12 days of storage (4°C) with lower values in terms of lipid peroxidation compared to untreated samples. In addition, samples formulated with polysaccharides reduced the oxidation of Myoglobin, which consequently improved the color stability of meat during refrigerated storage. Furthermore, as compared to standard formulation, the addition of polysaccharides appears to have interesting antimicrobial potential that maintains sausage quality within a shelf life of 12 days. In conclusion, our results prove the efficiency of polysaccharides in providing more hygienic and safer meat products, which may suggest that PS could be used as a natural additive in functional foods.

Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients' hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points ( p < 0.001), forced expiratory volume in one second by 110 ± 180 ml ( p = 0.04), 6-min walk distance by 35 ± 42 m ( p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg ( p = 0.048), resting heart-rate by 7 ± 9 bpm ( p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg ( p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer IL declared to the handling editor a shared affiliation with all authors besides AA at the time of review., (Copyright © 2022 Toulgui, Benzarti, Rahmani, Aissa, Ghannouchi, Knaz, Sayhi, Sellami, Mahmoudi, Jemni, Gargouri, Hayouni, Ouanes, Ammar and Ben saad.)

Background: Among Indigenous Australians, studies examining the clinical significance of airway bronchodilator responsiveness (BDR) are limited. In this retrospective study, we examined the nature of underlying lung disease in adult Indigenous patients with BDR referred for lung function testing (LFT) in the Top End Health Service region of the Northern Territory of Australia., Methods: Presence or absence of BDR as per usual (FVC or FEV 1 change pre to post ≥12% and ≥0.2L) and updated (2021 ">10% predicted) ATS/ERS criteria among Indigenous and non-Indigenous Australians was determined. The radiological findings in the Indigenous study participants with and without BDR were next assessed for the presence of underlying chronic airway/lung disease., Results: We found that 123/742 (17%) Indigenous and 578/4579 (13%) non-Indigenous patients had a significant BDR. Indigenous patients with BDR were younger (mean difference 7 years), with a greater proportion of females (52 vs 32%), underweight (15 vs 4%) and current smokers (52 vs 25%). Indigenous patients with BDR displayed lower LFT values, and a higher proportion exhibited FVC BDR compared to non-Indigenous (34 vs 20%). Almost half (46%) of Indigenous patients with BDR had evidence of COPD and/or bronchiectasis on radiology. Adjusting for the presence of radiologic or spirometric evidence of COPD, the presence of BDR was similar between Indigenous and non-Indigenous patients (5-8 vs 7-11%), irrespective of which BDR criteria was used., Conclusion: BDR was higher overall among Indigenous in comparison to non-Indigenous patients; however, a significant proportion of Indigenous patients demonstrating BDR had evidence of underlying COPD/bronchiectasis. This study highlights that although presence of BDR among Indigenous people may indicate asthma, it may also be observed among patients with COPD/bronchiectasis or could represent asthma/COPD/bronchiectasis overlap. Hence, a combination of clinical history, LFT and radiology should be considered for precise diagnosis of lung disease in this population., Competing Interests: All authors declare no conflicts of interest for this study., (© 2022 Heraganahally et al.)

Objective: Daytime melatonin ingestion is known to induce sleep at rest, which may affect arousal and vigilance. Physical exercise is known to produce an increase in core temperature and circulating cortisol which can enhance arousal and vigilance. The effect of submaximal exercise on vigilance and arousal following acute melatonin ingestion has not yet been studied. The present study aimed at investigating the effect of submaximal exercise on vigilance and arousal following daytime melatonin ingestion., Patients and Methods: Eight physical education students undertook 45 min of submaximal exercise (at 60% of maximal aerobic speed) on a treadmill after melatonin-(6 mg) or placebo ingestion, in a randomized and counterbalanced order., Results: Heart rate (HR), rectal temperature (Tre), felt arousal scale (FAS), and thermal sensations (TS) were recorded at baseline (pre-exercise), immediately after exercise (post-exercise), and after 30 min of recovery (30 min post-exercise). Blood was sampled for lactate and cortisol. At 30 min post-exercise, the Tre, HR, blood pressure, lactate, FAS, and TS were measured. The participants performed vigilance tests pre-exercise, post-exercise and 30 min post-exercise. Daytime melatonin ingestion affected arousal and vigilance in the pre-exercise period (p < 0.05) but had no effect on Tre, HR, blood pressure, lactate, TS, arousal, and vigilance measured 30 min post-exercise (p > 0.05)., Conclusions: The negative effects of melatonin ingestion on vigilance and arousal vanished after a 45 min of submaximal exercise. The hypnotic effect of melatonin observed in the pre-exercise dissipated in the post-exercise period, possibly due to the significant elevation of Tre, HR, and cortisol at the end of submaximal exercise.

Coronavirus disease 2019 (COVID-19) resulted in sporting event suspensions and cancellations, affecting competition calendars worldwide during 2020 and 2021. This challenged high-performance athletes' capacity to complete physical, technical, or tactical training during restricted movement measures (lockdown). With the Football World Cup organized in the last quarter of 2022, the past period of training and match disturbances challenged footballers concerning their performance and potential higher risk of injury at official matches' resumption. There has been considerable debate about the management of resuming professional football (soccer) during the COVID-19 pandemic. Governing bodies worldwide implemented measures to ensure a safe resumption of football. These precautionary measures aimed to protect the health of players, their support staff, and officials around the pitch and ensure the enjoyment of the event by spectators in the football stadiums. We have therefore narratively reviewed scientific papers about how football has resumed on the pitch and in the stands with special focus on the COVID-19 infection control strategies allowing footballers to perform again and supporters to enjoy the game after the 2020 global stop to sport.

The COVID-19 outbreak resulted in the shutdown of athletic training facilities. Although the effects of these restrictions on daily activity and sleep patterns have been widely analyzed, the employed tools often lacked accuracy, and were based on subjective measures. This study assessed the effects of home confinement on objective physical activity (PA), physiological and sleep parameters in active individuals. Sixteen male elite fitness coaches (age: 29±3 years; height: 183±6 cm; body mass: 82±5 kg, body mass index: 24.7±1.8 kg/m 2 ) participated in this retrospective study. One-way analysis of variance was conducted to analyze selected PA, physiological and sleep parameters collected by smartwatch (Garmin Fenix 6 pro, USA) data during four consecutive months [ i.e ., pre-confinement, 1 st and 2 nd months of confinement, and post-confinement, year 2020]. Ramadan intermittent fasting (RIF) month occurred during the 2 nd month of confinement. Compared to pre-confinement, significant changes were registered for almost all parameters during the 1 st and/or the 2 nd month of confinements (p<0.001), with (i) higher values for resting heart rate, sleep latency, and total, light and rapid eye movements sleep times (% change=7-523 %), and (ii) lower values for PA parameters, calories/day spent, average and highest respiratory rates, and deep sleep time during the home confinement period (% change=5-36 %). During the post-confinement month, all parameters regained pre-confinement values. In conclusion, home confinement-induced detraining negatively influenced the objective measurements of cardiorespiratory and sleep parameters among fitness coaches with a deeper effect during the 2 nd month of home confinement, possibly due to the effect of RIF., (Copyright © 2022 Dergaa et al.)

Introduction: Although lung damages are among the leading causes of death from Rheumatoid Arthritis (RA), few studies have assessed the spirometric and plethysmographic data and profile of patients with RA, particularly those with Anti-Citrullinated Peptides Antibodies Positive (ACPA+)., Aim: To compare the spirometric and plethysmographic data and profile of RA patients ACPA+ and ACPA-., Methods: This comparative pilot study was performed over a two-year period (2018-2019) in Algiers (Algeria). The study included two groups of RA non-smoker patients: 26 ACPA+ and 33 ACPA-.RA was diagnosed according to the ACR/EULAR 2010 RA classification criteria. Spirometry and plethysmography were performed. The following definitions were applied: Obstructive Ventilatory Impairment (OVI): FEV1/FVC z-score < -1.645; Restrictive Ventilatory Impairment (RVI): Total Lung Capacity (TLC) z-score< -1.645; Mixed Ventilatory Impairment (MVI): FEV1/FVC z-score < -1.645 and TLC z-score < -1.645; lung- hyperinflation: residual volume z-score > +1.645; Nonspecific Ventilatory Impairment (NSVI): FEV1z-score < -1.645, FVC z-score < -1.645, FEV1 /FVC z-score ≥ -1.645, and TLC z-score ≥ -1.645., Results: The ACPA-group was older than the ACPA+ one by ~ 10 years (63±13 vs. 53±12 years, p=0.0025; respectively). The ACPA+ and ACPA-groups included comparative percentages of patients having RVI, MVI, and NSVI (23.1 vs. 45.5%, p=0.0745; 3.8 vs. 3.0%, p=0.8654; and 7.7 vs. 6.1%, p=0.8086; respectively). Compared to the ACPA- group, the ACPA+ group included a higher percentage of patients having OVI and lung-hyperinflation (9.1 vs. 38.5%, p=0.0069; 9.1 vs. 42.3%, p=0.0029; respectively)., Conclusion: Compared to the ACPA-group, the ACPA+ one had more lung-hyperinflation and OVI, and comparative percentages of RVI, MVI, and NSVI.

Ethical foundations related to the use of human beings in medical research, already existed in the oldest texts. The historical evolution of regulations (in terms of texts and codes) had always drawn its legitimacy and its logic from the historical context. The main aim of these regulations was to satisfy a need to restore moral or physical prejudices, by hoping by means of the law, that these abuses would not be repeated. Although they were the main victims of medical experimentation, prisoners were rarely specifically identified in these legislations. This history note, the third in a series on medical experimentation on prisoners, aims to describe the major founding texts of ethics in medical experimentation, drawing attention to the historical context as well as the issues that shaped these documents.

Purpose: To investigate differences in athletes' knowledge, beliefs, and training practices during COVID-19 lockdowns with reference to sport classification and sex. This work extends an initial descriptive evaluation focusing on athlete classification., Methods: Athletes (12,526; 66% male; 142 countries) completed an online survey (May-July 2020) assessing knowledge, beliefs, and practices toward training. Sports were classified as team sports (45%), endurance (20%), power/technical (10%), combat (9%), aquatic (6%), recreational (4%), racquet (3%), precision (2%), parasports (1%), and others (1%). Further analysis by sex was performed., Results: During lockdown, athletes practiced body-weight-based exercises routinely (67% females and 64% males), ranging from 50% (precision) to 78% (parasports). More sport-specific technical skills were performed in combat, parasports, and precision (∼50%) than other sports (∼35%). Most athletes (range: 50% [parasports] to 75% [endurance]) performed cardiorespiratory training (trivial sex differences). Compared to prelockdown, perceived training intensity was reduced by 29% to 41%, depending on sport (largest decline: ∼38% in team sports, unaffected by sex). Some athletes (range: 7%-49%) maintained their training intensity for strength, endurance, speed, plyometric, change-of-direction, and technical training. Athletes who previously trained ≥5 sessions per week reduced their volume (range: 18%-28%) during lockdown. The proportion of athletes (81%) training ≥60 min/session reduced by 31% to 43% during lockdown. Males and females had comparable moderate levels of training knowledge (56% vs 58%) and beliefs/attitudes (54% vs 56%)., Conclusions: Changes in athletes' training practices were sport-specific, with few or no sex differences. Team-based sports were generally more susceptible to changes than individual sports. Policy makers should provide athletes with specific training arrangements and educational resources to facilitate remote and/or home-based training during lockdown-type events.

Objective: Disrupted sleep and training behaviors in athletes have been reported during the COVID-19 pandemic. We aimed at investigating the combined effects of Ramadan observance and COVID-19 related lockdown in Muslim athletes., Methods: From an international sample of athletes ( n = 3,911), 1,681 Muslim athletes (from 44 countries; 25.1 ± 8.7 years, 38% females, 41% elite, 51% team sport athletes) answered a retrospective, cross-sectional questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: ( i ) Pittsburgh sleep quality index (PSQI); ( ii ) insomnia severity index (ISI); ( iii ) bespoke questions about training, napping, and eating behaviors, and ( iv ) questions related to training and sleep behaviors during-lockdown and Ramadan compared to lockdown outside of Ramadan. The survey was disseminated predominately through social media, opening 8 July and closing 30 September 2020., Results: The lockdown reduced sleep quality and increased insomnia severity (both p < 0.001). Compared to non-Muslim ( n = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both p < 0.001), but not pre-lockdown ( p > 0.05). Muslim athletes reported longer ( p < 0.001; d = 0.29) and later ( p < 0.001; d = 0.14) daytime naps, and an increase in late-night meals ( p < 0.001; d = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ 2 = 222.6; p < 0.001) and training volume (χ 2 = 342.4; p < 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes., Conclusion: Muslim athletes reported lower sleep quality and higher insomnia severity during- compared to pre-lockdown, and this was exacerbated by Ramadan observance. Therefore, further attention to Muslim athletes is warranted when a circadian disrupter (e.g., lockdown) occurs during Ramadan., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Romdhani, Ammar, Trabelsi, Chtourou, Vitale, Masmoudi, Nédélec, Rae, Al Horani, Ben Saad, Bragazzi, Dönmez, Dergaa, Driss, Farooq, Hammouda, Harroum, Hassanmirzaei, Khalladi, Khemila, Mataruna-Dos-Santos, Moussa-Chamari, Mujika, Muñoz Helú, Norouzi Fashkhami, Paineiras-Domingos, Khaneghah, Saita, Souabni, Souissi, Washif, Weber, Zmijewski, Taylor, Garbarino and Chamari.)

Introduction: Physicians involved in medical errors (MEs) can experience loss of self-esteem and negative psychological experiences. They are called "second victims" of the ME., Aims: To i) describe the profile, the types and the severity of MEs, and ii) explore the psychological impact on "second victims" to better understand how they cope., Methods: It was a cross sectional retrospective study conducted from March to August 2018. All physicians working at Farhat Hached and Sahloul University hospitals were asked to complete a questionnaire about their possible MEs. The impact of MEs was evaluated using the Impact of Event Scale-Revised (IES-R) (scoring, 0-88) (subscales ranges; intrusion, (0-32); avoidance, (0-32); hyperarousal, (0-24)). The diagnosis of post-traumatic stress disorder (PTSD) was made when the total IES-R score exceeded 33. The coping strategies were evaluated using Ways of Coping Checklist Revised (WCC-R) scale (scoring, problem-focused, (10-40); emotion focused, (9-36); seeking social support, (8-32))., Results: Among 393 responders, 268(68.2%) reported MEs. Wrong diagnosis (40.5%), faulty treatment (34.6%), preventive errors (13.5%) and faulty communication (6.4%) were the main frequent types of MEs. The most common related causes of MEs were inexperience (47.3%) and job overload (40.2%). The physicians' median (range) score of the IES-R was 19(0-69). According to the IES-R score, the most frequent psychological impacts were median (range): intrusion, 7(0-28) and avoidance symptoms, 7(0-24). PTSD symptoms affected 23.5% of physicians. Female sex and serious MEs were identified as predictors of PTSD. On the WCC-R check list, coping was balanced between the three coping strategies median (range), problem focused, 28.5(10-40); emotion-focused, 24(9-36) and seeking social support 21(8-32)., Conclusion: There is a relatively high impact of ME within these North-African university hospital physicians. Coping was balanced within different three strategies as reported worldwide. Physicians adopted more likely constructive changes than defensive ones., (© 2022. The Author(s).)

Objective: To investigate the effect of 1) lockdown duration and 2) training intensity on sleep quality and insomnia symptoms in elite athletes. Methods: 1,454 elite athletes (24.1 ± 6.7 years; 42% female; 41% individual sports) from 40 countries answered a retrospective, cross-sectional, web-based questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: 1) Pittsburgh sleep quality index (PSQI); 2) Insomnia severity index (ISI); bespoke questions about 3) napping; and 4) training behaviors. The association between dependent (PSQI and ISI) and independent variables (sleep, napping and training behaviors) was determined with multiple regression and is reported as semi-partial correlation coefficient squared (in percentage). Results: 15% of the sample spent < 1 month, 27% spent 1-2 months and 58% spent > 2 months in lockdown. 29% self-reported maintaining the same training intensity during-lockdown whilst 71% reduced training intensity. PSQI (4.1 ± 2.4 to 5.8 ± 3.1; mean difference (MD): 1.7; 95% confidence interval of the difference (95% CI): 1.6-1.9) and ISI (5.1 ± 4.7 to 7.7 ± 6.4; MD: 2.6; 95% CI: 2.3-2.9) scores were higher during-compared to pre-lockdown, associated (all p < 0.001) with longer sleep onset latency (PSQI: 28%; ISI: 23%), later bedtime (PSQI: 13%; ISI: 14%) and later preferred time of day to train (PSQI: 9%; ISI: 5%) during-lockdown. Those who reduced training intensity during-lockdown showed higher PSQI ( p < 0.001; MD: 1.25; 95% CI: 0.87-1.63) and ISI ( p < 0.001; MD: 2.5; 95% CI: 1.72-3.27) scores compared to those who maintained training intensity. Although PSQI score was not affected by the lockdown duration, ISI score was higher in athletes who spent > 2 months confined compared to those who spent < 1 month ( p < 0.001; MD: 1.28; 95% CI: 0.26-2.3). Conclusion: Reducing training intensity during the COVID-19-induced lockdown was associated with lower sleep quality and higher insomnia severity in elite athletes. Lockdown duration had further disrupting effects on elite athletes' sleep behavior. These findings could be of relevance in future lockdown or lockdown-like situations (e.g., prolonged illness, injury, and quarantine after international travel)., Competing Interests: Author ID was employed by the company Primary Health Care Corporation (PHCC). Authors ANF and MRK were employed by the company Esteghlal Physiotherapy Clinic, EPC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Romdhani, Fullagar, Vitale, Nédélec, Rae, Ammar, Chtourou, Al Horani, Ben Saad, Bragazzi, Dönmez, Dergaa, Driss, Farooq, Hammouda, Harroum, Hassanmirzaei, Khalladi, Khemila, Mataruna-Dos-Santos, Moussa-Chamari, Mujika, Muñoz Helú, Norouzi Fashkhami, Paineiras-Domingos, Khaneghah, Saita, Souissi, Trabelsi, Washif, Weber, Zmijewski, Taylor, Garbarino and Chamari.)

Aim: To evaluate the effects of eight weeks of mat Pilates training on selected hematological parameters, i.e. white blood cell, neutrophils, monocyte, lymphocyte, hematocrit, hemoglobin as well as plasma volume variations in healthy, active women., Methods: Twenty-eight women physical education students volunteered to participate in the present investigation. They were assigned to two groups: a Pilates training group (n = 14) that followed an 8-week Pilates training program, and a control group (n = 14). Blood samples were collected at rest at two separate occasions before and after Pilates training., Results: The Pilates training group had higher values of plasma volume variations and lower values of white blood cell (19.4%), neutrophils (32%), hematocrit (4.3%) and hemoglobin (4.6%) compared to control group (p<0.05)., Conclusion: The results of the present study suggested that Pilates training could be an effective strategy for increasing plasma volume variations and boosting immune system in healthy active women., Competing Interests: The authors have declared that no competing interests exist.

Competing Interests: There are no conflicts of interest.

Objective: In a convenience sample of athletes, we conducted a survey of COVID-19-mediated lockdown (termed 'lockdown' from this point forward) effects on: (i) circadian rhythms; (ii) sleep; (iii) eating; and (iv) training behaviors., Methods: In total, 3911 athletes [mean age: 25.1 (range 18-61) years, 1764 female (45%), 2427 team-sport (63%) and 1442 elite (37%) athletes] from 49 countries completed a multilingual cross-sectional survey including the Pittsburgh Sleep Quality Index and Insomnia Severity Index questionnaires, alongside bespoke questions about napping, training, and nutrition behaviors., Results: Pittsburgh Sleep Quality Index (4.3 ± 2.4 to 5.8 ± 3.1) and Insomnia Severity Index (4.8 ± 4.7 to 7.2 ± 6.4) scores increased from pre- to during lockdown (p < 0.001). Pittsburgh Sleep Quality Index was predominantly influenced by sleep-onset latency (p < 0.001; + 29.8%), sleep efficiency (p < 0.001; - 21.1%), and total sleep time (p < 0.001; - 20.1%), whilst Insomnia Severity Index was affected by sleep-onset latency (p < 0.001; + 21.4%), bedtime (p < 0.001; + 9.4%), and eating after midnight (p < 0.001; + 9.1%). During lockdown, athletes reported fewer training sessions per week (- 29.1%; d = 0.99). Athletes went to bed (+ 75 min; 5.4%; d = 1.14) and woke up (+ 150 min; 34.5%; d = 1.71) later during lockdown with an increased total sleep time (+ 48 min; 10.6%; d = 0.83). Lockdown-mediated circadian disruption had more deleterious effects on the sleep quality of individual-sport athletes compared with team-sport athletes (p < 0.001; d = 0.41), elite compared with non-elite athletes (p = 0.028; d = 0.44) and older compared with younger (p = 0.008; d = 0.46) athletes., Conclusions: These lockdown-induced behavioral changes reduced sleep quality and increased insomnia in athletes. Data-driven and evidence-based recommendations to counter these include, but are not limited to: (i) early outdoor training; (ii) regular meal scheduling (whilst avoiding meals prior to bedtime and caffeine in the evening) with appropriate composition; (iii) regular bedtimes and wake-up times; and (iv) avoidance of long and/or late naps., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

COVID-19 restrictions are associated with poor physical-activity (PA). Less is known about the relationship between the combination of these restrictions with Ramadan intermittent fasting (RIF), PA, mental health, and sleep-quality. The present study aimed to evaluate whether COVID-19 restrictions and RIF during the fourth wave of the COVID-19 pandemic in Iran are associated with poor PA, anxiety, well-being, and sleep-quality outcomes. A total of 510 individuals participated in an online questionnaire that was disseminated to adults (≥18 years) residing in Iran from 13 May 2021 to 16 May 2021 (~3 days), just after the end of Ramadan 2021. PA behavior (Godin-Shephard Leisure-Time Exercise Questionnaire), anxiety (General Anxiety Disorder-7), well-being (Mental Health Continuum-Short Form), and sleep-quality (Pittsburgh Sleep Quality Index). Of 510 individuals included in the study (331 female (64.9%); mean ± SD, 31 ± 12 years), 172 (33.7%) reported less PA during the Ramadan 2021. PA was associated with better well-being and sleep-quality outcomes. Regardless of PA, participants who fasted for all of Ramadan had less anxiety and better well-being outcomes than those who fasted part of Ramadan or did not fast at all. However, the fasting part of Ramadan decreased the sleep-quality of active participants. The Ramadan 2021 was associated with poor PA, well-being, and sleep-quality of Iranians. However, PA was associated with better well-being and sleep-quality outcomes, and those who fasted all Ramadan had better anxiety and well-being outcomes. Therefore, PA during Ramadan might be an essential and scalable mental health resilience builder during COVID-19 restrictions which should be encouraged.

Background: Comparison of spirometry parameters between Indigenous and non-Indigenous patients with underlying chronic obstructive pulmonary disease (COPD) has been sparsely reported in the past. In this study, differences in the lung function parameters (LFPs), in particular spirometry values for forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ) and FEV 1 /FVC ratio between Indigenous and non-Indigenous patients with COPD were assessed., Methods: In this retrospective study, Indigenous and non-Indigenous patients with a diagnosis of COPD between 2012-2020 according to spirometry criteria (ie; post-bronchodilator (BD) FEV 1 /FVC < 0.7) were included. A further analysis was undertaken to compare the differences in the spirometry parameters, including lower limit of normal (LLN) values matching for age, sex, height and smoking status between these two diverse ethnic populations., Results: A total of 240/742 (32%) Indigenous and 873/4579 (19%) non-Indigenous patients were identified to fit the criteria for COPD. Indigenous patients were significantly younger (mean difference 9.9 years), with a greater proportion of females (50% vs 33%), underweight (20% vs 8%) and current smokers (47% vs 32%). Prior to matching, Indigenous patients' post-BD percent predicted values for FVC, FEV 1 , and FEV 1 /FVC ratio were 17, 17%, and -2 points lower (Hedges G measure of effect size large (0.91), large (0.87), and small (0.25), respectively). Among the matched cohort (111 Indigenous and non-Indigenous), Indigenous patients LFPs remained significantly lower, with a mean difference of 16%, 16%, and -4, respectively (Hedges G large (0.94), large (0.92) and small (0.41), respectively). The differences persisted despite no significant differences in LLN values for these parameters., Conclusion: Indigenous Australian patients with COPD display a significantly different demographic and clinical profile than non-Indigenous patients. LFPs were significantly lower, which may or may not equate to greater severity of disease in the absence of normative predictive lung function reference values specific to this population., Competing Interests: All authors declare no conflicts of interest for this study., (© 2022 Sze et al.)

The aim of this systematic review was to report the impacts of Ramadan intermittent fasting (RIF) on salivary flow-rate (SFR) and metabolic parameters. A thorough literature search was carried out using the databases PubMed and Scopus from their inception up to 15 July 2021. The Boolean connectors used in PubMed were (Saliva [Mesh] AND Fasting [Mesh]). The same keywords were used in Scopus . Inclusion criteria were defined using PICOS. The research included all original studies involving "healthy" adults and published in English. Methodological quality assessment was performed utilizing the Joanna Briggs Institute Critical Appraisal Tool, which allows attributing scores from 1 to 11 to the selected studies. Two authors carried out the literature search, study selection, and data extraction. Differences on issues were resolved by a third author if necessary. The systematic review protocol was registered within the "Open Science Framework" (Doi: 10.17605/OSF.IO/DE7BH). Six articles met the inclusion criteria. All studies were heterogeneous and had a high score of bias and several methodological differences. The following parameters were collected: SFR, melatonin, cortisol, glucose, immunoglobulin A (IgA), uric-acid, alkaline phosphatase (ALP), and aspartate aminotransferase (AST). The SFR decreased by 10% during Ramadan in fasting subjects. The circadian pattern of melatonin remained unchanged during Ramadan, but melatonin levels dropped significantly from baseline. The salivary cortisol levels were unchanged or increased during Ramadan. The salivary glucose levels were decreased. ALP increased significantly, whilst uric-acid and AST decreased significantly. Salivary IgA decreased during the last week of Ramadan. To conclude, there is a trend toward a decrease in SFR and the content of the majority of the biomarkers investigated, with the exception of ALP and uric-acid. These changes cannot be easily attributed to any single factor (hydration status, dietary habits, physical activity, or hygiene habits). Systematic Review Registration: [https://osf.io/de7bh/], identifier [Doi: 10.17605/OSF.IO/DE7B]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Besbes, Khemiss, Bragazzi and Ben Saad.)

Objective: Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Methods: Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March-June 2020)., Results: Overall, 85% of athletes wanted to "maintain training," and 79% disagreed with the statement that it is "okay to not train during lockdown," with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered "coaching by correspondence (remote coaching)" to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], plyometric exercise [30%]) at pre-lockdown levels (higher among world-class, international, and national athletes), with most (83%) training for "general fitness and health maintenance" during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification., Conclusions: COVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to "maintain" training and the greatest opposition to "not training" during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered "coaching by correspondence" as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes' physical capacities and were also likely detrimental to athletes' mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness)., (© 2021. The Author(s).)

Autoimmune rheumatic-related diseases (ARRDs) have physical and psychological impact on patients, including their sexual life. While many studies have investigated fertility problems in females, data on males-related fertility are scarce, which explains the lack of guidance. The main objective of this systematic review was to evaluate the reproductive health in males with ARRDs. This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed and Scopus, published until September 16, 2021, and tackling the effects of ARRDs and/or ARRDs treatments on male fertility and/or pregnancy outcomes, were included. A total of twenty-five studies met the inclusion criteria. They were published between 1981 and 2018. The studied ARRDs were spondyloarthritis (n = 9), systematic lupus erythematosus (SLE, n = 6), Behcet disease (BD, n = 5), rheumatoid arthritis (RA, n = 5), antiphospholipid syndrome (n = 1), and dermatomyositis (n = 1). The most reported effects of ARRDs on fertility are i) high levels of reproductive hormones, mainly in RA and SLE; ii) impaired semen quality in SLE, spondyloarthritis, and BD; and iii) higher rate of varicocele in BD and spondyloarthritis. Regarding the treatments effects, i) conventional synthetic disease-modifying anti-rheumatic drugs (e.g.; methotrexate and salazopyrine) increase testosterone level, ii) cyclophosphamide impairs fertility, iii) anti-tumor necrosis factor agents are associated with improvement in semen quality, and iv) no increased number of miscarriages or congenital abnormalities in children fathered by BD was reported. To conclude, both ARRDs and their treatments alter fertility in males with ARRDs. In practice, in addition to the conventional semen analysis, screening for infertility seems legitimate in males with ARRDs., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Studies assessing normative values and sex differences in pulmonary function test parameters (PFTPs) among Indigenous populations are sparse., Methods: PFTPs were compared between male and female Indigenous Australian adults with and without chest radiologically proven chronic airway diseases (CADs)., Results: 485 adults (56% were female) with no significant difference in age, body mass index or smoking status between sexes were included. Females displayed a higher prevalence of radiology without CADs compared to males (66 vs. 52%, respectively). Among patients without CADs, after adjustment for age, stature and smoking, males displayed significantly higher absolute values of Forced Vital Capacity (FVC) (mean difference, 0.41L (0.21,0.62), p<0.001) and Forced Expiratory Volume in one second (FEV1) (mean difference 0.27L (0.07,0.47), p<0.001), with no significant difference in FEV1/FVC ratio (mean difference -0.02 (-0.06, 0.02), p = 0.174). Male and female patients with radiologically proven CADs demonstrated lower FEV1/FVC values. However, compared to females, males showed significantly greater reductions in pre- [-0.53 (-0.74, -0.32) vs. -0.29 (-0.42, -0.16), p = 0.045] and post- [-0.51 (-0.72, -0.3) vs. -0.27 (-0.39, -0.14), p = 0.049] bronchodilator FEV1., Conclusions: There are significant sex differences in the PFTPs among Indigenous Australians. Recognising these differences may be of value in the accurate diagnosis, management, monitoring and prognostication of CADs in this population., Competing Interests: The authors have declared that no competing interests exist.

Introduction: GST non-functional genotypes can lead to the accumulation of toxic intermediates, resulting in liver damage and increasing susceptibility to ATDH., Aim: To investigate the impact of GST Mu (GSTM1), GST Theta (GSTT1) null genotypes, and GST Pi (GSTP1; adenosine (A) > guanine (G), rs1695) variant allele on the development of ATDH in Tunisian patients treated with anti-tuberculosis therapy., Methods: This was a case-control study including patients receiving anti-tuberculosis regimen. Cases (n = 23) were tuberculosis patients presenting ATDH during two months of anti-tuberculosis drug therapy. Controls (n = 30) were patients treated for tuberculosis, but presenting no ATDH. Genotyping was performed using a polymerase chain reaction-restriction fragment length polymorphism., Results: No statistically significant association was observed between GSTM1 and GSTT1 homozygous null genotypes, and the risk of ATDH. A statistically significant association between GSTM1 and GSTT1 double null genotypes, and the risk of ATDH was found (p = 0.033) between cases and controls. For GSTP1, the distribution of GG homozygous mutant genotype was significantly associated with ATDH compared with the wild and the transition A to G (AA + AG) genotypes., Conclusion: Double deletion of GSTM1 and GSTT1 may predispose to ATDH in a Tunisian population. Moreover, GSTP1 rs1695 (A > G) genotyping can predict susceptibility to developing ATDH., (Copyright © 2021 Elsevier B.V. All rights reserved.)

(1) Background: ESports is a new trend of sports, which has gained considerable popularity worldwide. There is a scarcity of evidence that focuses on the lifestyle of ESports players (eSP) particularly on symptoms of nomophobia, level of anxiety, sleep quality, food consumption and physical activity. (2) Objective: to determine the prevalence and relationship between symptoms of nomophobia, psychological aspects, insomnia and physical activity of eSP in Saudi Arabia. (3) Methods: A cross-sectional study was conducted between March and April 2021 using a convenient self-selection adult sample. A total of 893 (216 eSP vs. 677 non-eSP (NeSP)) participants aged over 18 years were included. All participants answered a seven-part validated questionnaire that included: (i) sociodemographic questions; (ii) a symptoms of nomophobia questionnaire; (iii) general anxiety disorder questions, (iv) an insomnia severity index, (v) an Internet addiction scale, (vi) the Yale food addiction scale 2.0 short form and (vii) an international physical activity questionnaire. (4) Results: Among the entire population, the prevalence of moderate to severe nomophobia, anxiety, insomnia, Internet addiction and low physical activity were 29.8%, 13.9%, 63.3%, 27% and 2.8%, respectively. The eSP and NeSP differed significantly in nomophobia scale, anxiety and insomnia values. Compared to NeSP, eSP had a higher level of severe nomophobia p = 0.003, a severe level of anxiety p = 0.025 and symptoms of insomnia p = 0.018. Except for food addiction and physical activity, a positive correlation was identified between symptoms of nomophobia, anxiety and insomnia among eSP. (5) Conclusion: This study reported high prevalence of nomophobia, anxiety and insomnia among eSP compared to NeSP.

Competing Interests: The author declares personal fees received from AstraZeneca, Saiph, Teriak, Opalia Recordati, and Chiesi.

The developing World has the largest number of prisoners globally, but their situation is considered «opaque». In recent years, there has been a growing interest from pharmaceutical companies in this part of the world. A growing number of voices is denouncing the spectrum of medical exploitation of prisoners. In Tunisia, there is a great legislative effort to ensure the protection of this vulnerable population. The present history note, the sixth in a series on medical experimentation on prisoners, intended to discuss the situation of medical experimentation in prisons in Africa, the Middle East and part of the Arab world, Tunisia in particular.

The involvement of physicians as an executive tool in the excesses of medical experimentation in prisons continues to raise questions and incomprehension. From the depths of the extermination camps under the Nazi regime to the iterative exploitation scandals after the Second World War, the ability of certain physicians to overstep the foundations of the Hippocratic Oath of «do no harm» and associate themselves with so many atrocities will always surprise. The answers to this question seem ambiguous because the excesses of medical experimentation in prisons should be reconsidered in their associated historical-political context. This history note, the second in a series on medical experimentation in prisons, aims to relieve the excesses attributed to physicians during medical experimentation on prisoners.

Aim: To evaluate the effects of dry cupping therapy (DCT) and creatine supplementation (CS) on cardiovascular and inflammatory responses to the Wingate test., Methods: In this quasi-experimental study, 12 male handball young players were selected in a crossover design. Players were studied in four conditions: DCT; CS; CS+DCT, control. In all conditions, blood pressure, heart-rate, and body composition were measured pre- and post- Wingate test. Players were assessed by the Wingate test in two 30-second phases with a 1-minute break between the phases. Blood [lactate-dehydrogenase (LDH), creatine phosphokinase (CK)] was drawn pre- and immediately post- the Wingate test. In players with CS condition, 60 g of creatine was consumed per day in three consecutive days prior to the study (3 meals of 20 g in morning, noon, and night). The DCT was performed after Wingate test to consider its possible effects for alleviating the muscle injury markers. Data were evaluated using analysis of covariance followed by a post-hoc Bonferoni test., Results: The heart-rate' means in DCT, CS and CS+DCT conditions were lower compared to the control-condition (p.

As part of the strategy to safeguard the indexing of the review «La Tunisie Médicale», and the consolidation of its scientific reputation, in Tunisia, the Maghreb and Africa, the new editorial team reported the lessons of a recent bibliometric audit for the management of manuscripts submitted to the journal «La Tunisie Médicale» during the period 2015-2019. During this five-year study, 2376 papers were received by the journal "La Tunisie Médicale", 87% of which came from Tunisia, particularly Cardiology, Pathological Anatomy and Cytology, and Pneumology. If 17% of the manuscripts persisted as «case reports», only 7% were summaries of the literature. During this five-year period, 923 reviewers were mobilized, and the acceptance rate was 32%. Based on this editorial audit and taking into consideration the difficulties of scientific publishing, the plan to safeguard the indexing of our national journal and its resilience should consist of the following measures: 1. Submission development scientific manuscripts, at a rate of 1000 papers per year, by the year 2025; 2. Ensure representation of all health science disciplines on the editorial team; 3. Prioritize the publication of research articles, having a better chance of citation; 4. Enrich the base of readers by more approved reviewers; 5. Establish a didactic reviewing model, centered on the development of authors' skills and their support.

Objective: To evaluate the effect of six weeks of high intensity interval training (HIIT) and L-Arginine supplementation on interleukin-6 (IL-6) levels and body composition in Iranian adult trained males., Methods: This experimental study was performed as an intervention with a pretest-posttest design in three experimental groups and one control group. Fortyeight young males from Qazvin province (Iran) were selected voluntarily based on convenience sampling. Participants were randomly divided into four groups (12 participants in each group): "HIIT"; "L-Arginine supplementation"; "HIIT + L-Arginine supplementation", and "HIIT + placebo". At 7 a.m., when the level of inflammation was at its lowest, a blood sample was taken from the participants, and body mass index (BMI), body fat percentage (BFP), and lean body mass (LBM) were determined. IL-6 analysis was performed using STATE FAX device and ELISA method. Training sessions were conducted for six consecutive weeks, three sessions a week. Analysis of covariance and Bonferroni post hoc test were used to analyze the data., Results: i) There were no significant differences between groups in BMI, BFP, or LBM. ii) There was a significant difference in IL-6 levels between the groups (p < 0.05), so that the inflammatory levels in the "HIIT + L-Arginine supplementation" and "HIIT + placebo" groups were lesser than the "HIIT" (0.002 and <0.001, respectively) and "L-Arginine supplementation" (<0.001and <0.001, respectively) groups. HIIT "seems" to reduce the level of inflammation., Conclusion: HIIT had no significant effect on body composition indices. Plasma IL-6 levels decreased after six weeks of HIIT and L-Arginine supplementation. The level of IL-6 in the "HIIT + L-Arginine supplementation" and "HIIT + placebo" groups were lower than the control group (i.e.; "HIIT") and supplement control group (i.e.; "L-Arginine supplementation").

Introduction: Several studies examined the effects of creatine monohydrate supplementation on renal function, but no previous study has investigated its effects on kidney stones in humans., Observation: A renal ultrasound in a healthy young athlete (without a known renal morphological anomaly, normal kidney function, normal phospholipid and uric acid data) revealed a kidney stone of 11 mm in the lower right calyx. Extracorporeal shock wave lithotripsy was applied in order to break the down stone. Twentyone days later, a follow-up renal ultrasound showed the absence of stones in the kidney. One week later, the athlete started creatine monohydrate supplementation for two months. Fourteen months after stopping creatine monohydrate supplementation, a third renal ultrasound confirmed the absence of stones in the kidney., Conclusion: Two months of creatine monohydrate supplementation in an athlete with a history of kidney stones could not be associated with kidney stone recurrence in the long run.

The exploitation of prisoners in medical research is an ancient phenomenon. However, the history of the XXth century was marked by major events that reached the peak of horror during the second world war. Although the collective mind has remembered the outrages of the Nazi regime, the truth is that these practices were adopted by the majority of the military powers of that time, and continued after the end of the war. This history note is the first in a series that aims to review the circumstances and implications of these dark moments in the history of medical research in order to pay tribute to the countless victims who paid with their lives for «scientific progress» and to understand the reasons for current ethical considerations in biomedical experimentation on persons deprived of liberty.

As part of the strategy for developing its editorial performance Tunis'Med'2030, based on productivity, quality and visibility, the journal «La Tunisie Medicale» (ISSN: 0041-4131, IeSSN: 2724-7031), focused on the identification of Tunisian champions of scientific medical writing, to invite them to submit editorials, describing the prospects for the development of their specialties, and motivating young researchers from low-income countries to excellence academic. The identification of these leaders in scientific medical research was based on the new edition of the Research.com platform (https://research.com/scientists-rankings/medicine) of December 2021. After contacting these national champions of scientific writing, the journal «La Tunisie Medicale» hopes on the one hand to improve its scientific citation and its international notoriety and on the other hand to provide a framework for partnership between national immigrant skills and young researchers residing in the country, under the teaches the social responsibility of scientific research.

Background: The analysis of the clinical and radiological characteristics of COVID-19 patients around the world observed a rich semiology, different from one country to another, and within the same country., Aim: To analyze the clinical, computed tomography (CT) features, and the outcome of patients suspected of COVID-19 hospitalized in a COVID-19 unit of Oran university hospital (Algeria)., Methods: We collected retrospectively the files of patients suspected of COVID-19 admitted in a COVID-19 unit during July 2020. Data were collected on standardized questionnaire with prior coding of parameters. Patients were admitted according to a triage based on their clinical situation and the chest CT aspects suggestive of COVID-19. Two physicians reviewed the high-resolution CT (HR-CT) images independently, and discrepancies were resolved by consensus with the input of two others experimented physicians., Results: 112 patients (64% males, median age: 68 (18-88) years) were included. The main symptoms were dyspnea (51.7%), cough (34%), fatigue (14%). Almost the half (49.1%) of patients had hypoxemia. The HR-CT findings were typical of COVID-19 in 96% of patients. Although 61% of patients had favorable prognosis, mortality rate was 30%. Mutlivariate analysis of risk factors for death showed that patients aged > 60 years had a 4-fold risk of death (95% confidence interval: [1.27-12.58], p=0.018)., Conclusion: Dyspnea, cough and fatigue were predominant symptoms, moderate and severe COVID-19 characterized our patients. Age > 60 years was a major risk factor for the deaths of our patients.

Medical experimentation on prisoners is one of the most difficult ethical issues because it brings many principles into conflict with the reality of the practice. These ethical principles, which are universal and timeless, are accepted as elementary rights for every human being. However, in a detention setting, these principles are easily lost. Moreover, the scope of this problem goes far beyond the walls of the penitentiary to touch on conflicting issues of scientific publication, social discrimination, and even political decisions sometimes. The present history note, the fifth in a series on medical experimentation on prisoners, intended to discuss the main ethical considerations regarding prisoners, and to highlight the difficulty of their implementation.

Given the long history of abuse of prisoners in medical experimentation, it is understandable that additional safeguards have been established to protect this social category. However, the debate between the detractors and the supporters of the medical experimentation in the prison environment is still going on. The present history note, the fourth in a series on medical experimentation on prisoners, intended to relate the main arguments of both sides: ie; the detractors and supporters of medical experimentation on prisoners.

It is well known that exercise increases the activity of thyroid glands and raises the blood level of melatonin. The increase of melatonin during exercise may be linked to a rise in thyroid-stimulating hormone (TSH). No previous study has investigated the combined effects of melatonin ingestion and acute submaximal exercise on thyroid hormones' responses. The purpose of this pilot study was to explore the effects of daytime ingestion of melatonin on thyroid hormones' responses to acute submaximal exercise. After 50 min of either melatonin (6 mg) or placebo ingestion, eight physical education students (mean ± standard deviation of age: 22 ± 1 years) were asked to run for 45 min at 60% of their maximum aerobic speed. Free thyroxine (fT4) and TSH were measured in plasma samples before and immediately after exercise. After submaximal exercise, TSH increased by 54% in both placebo and melatonin conditions. There was no significant (Condition × Exercise) interaction, and no significant condition effect for TSH. The fT4 remained unchanged before/after submaximal exercise in both placebo [15.2 (1.9) and 15.0 (1.6) pmol/L, respectively, p > .05], and melatonin [16.7 (2.7) and 16.3 (2.7) pmol/L, respectively, p > .05] conditions. There was no significant (Condition × Exercise) interaction, no significant exercise effect, and no significant condition effect for fT4. To conclude, acute melatonin ingestion did not affect thyroid hormones' responses to submaximal exercise.

The SCImago platform had just announced, at the beginning of 2022, the new position of the journal «La Tunisie Médicale» (ISSN: 0041-4131; IeSSN: 2724-7031) in the third quartile (Q3) of journals in the field. Medicine/General Medicine, with an SJR index (2021) of 0.29 and an Impact Score (2 years) of 0.53. As for the Scopus® platform, it reported for the journal «La Tunisie Médicale», a CiteScore 2021 of 0.8 (between 2018-2021: 514 citations and 630 documents) and a position at the 34th percentile. To improve its notoriety indices, the new editorial team of the journal "La Tunisie Médicale" will immediately: 1. Select research manuscripts with a high level of evidence; 2. Invite leaders in scientific biomedical writing to actively participate in its special thematic issues; 3. Mobilize an international team of competent, available and committed reviewers.

Prolonged exercise induces cardiovascular drift, which is characterized by decreasing mean arterial pressure (MAP), stroke volume and heart rate increase. Cardiovascular drift has been debated for a long time. Although the exact mechanisms underlying cardiovascular drift are still unknown, two theories have been proposed. The first is that increased skin blood flow displaces blood volume from central circulation to the periphery, which reduces stroke volume. According to this theory, the rise in heart rate is presumably responding to the drop in stroke volume and MAP. The alternative theory is that an increase in heart rate is due to an increase in sympathetic nervous activity causing reducing time at diastole, and therefore stroke volume. It may be difficult to determine a single robust factor accounting for cardiovascular drift, due to the broad range of circumstances. The primary focus of this review is to elucidate our understanding of cardiovascular drift during prolonged exercise through nitric oxide and force-frequency relationship. We highlight for the very first time that cardiovascular drift (in some conditions and within a specific time period) may be considered as a protective strategy against potential damage that could be induced by the intense and prolonged contraction of the myocardium., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Assessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 )) are observed to be 20%-30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts., Methods: Adult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV 1 /FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV 1 values (mild, moderate, severe, very severe) as per the recommended classifications., Results: From a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%-43%), GOLD (33%-65%), GLI-2012 (18%-75%)). The FVC and FEV 1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X 'moderate' AFL almost matching 'severe' AFL categorisation by GOLD or GLI-2012., Conclusions: Health professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The Islamic Republic of Iran has displayed one of the highest rates of COVID-19 infection in the world and the highest rate of mortality in the Middle East. Iran has used a stringent package of preventive health measures to mitigate the spread of infection, which however has negatively affected individuals' physical and psychological health. This study aimed at examining whether physical-activity (PA) behavior, anxiety, well-being, and sleep-quality changed in response to the COVID-19-related public health restrictions enforced in Iran., Patients and Methods: An online questionnaire was disseminated to adults residing in Iran from November 17, 2020, to February 13, 2021 (~88 days), during Iran's strictest public health restrictions. Main outcome measures included Godin-Shephard Leisure-Time Exercise Questionnaire, General Anxiety Disorder-7, Mental Health Continuum-Short Form, and Pittsburgh Sleep Quality Index., Results: A total of 3,323 adults (mean age 30±11 years, 54.3% female) participated in the survey. Firstly, the restrictions generally reduced PA behavior: (a) among inactive participants (IPs), 60.6% became less active vs. 5.1% who became more active; and (b) among active participants (APs), 49.9% became less active vs. 22.8% who became more active. Secondly, PA behavior was associated with higher well-being and sleep quality during the restrictions: (a) APs reported higher (or lower) levels of well-being and sleep quality (or anxiety) than did IPs; and (b) among IPs as well as among APs, the more active the participants, the greater (or lower) the levels of well-being and sleep quality (or anxiety)., Conclusions: This study showed the beneficial role of PA behavior for well-being, anxiety, and sleep quality during the COVID-19 restrictions, whereas such restrictions appeared to decrease PA participation. Active lifestyle should be then encouraged during the COVID-19 outbreak while taking precautions.