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This study aims to examine the effects of electronic games on students' academic achievement. The study was conducted on a sample of parents in the city of Al Ain, United Arab Emirates. A questionnaire was used for data collection, with a sample of 76 parents randomly chosen, comprising 64 females (84.2%) and 12 males (15.8%). The study findings revealed that most students who preferred adventure games used electronic games on weekends for entertainment. However, excessive usage of these games had a negative impact on their academic achievement. Games tend to consume students' time, which in turn, affects their achievement. Based on the study results, the researchers recommended raising awareness among families regarding the risks of electronic games for children and their effects on their academic achievement through workshops, lectures, and seminars. Further research studies should be conducted to highlight the effects of electronic games on students' academic achievement from the perspectives of students themselves and their teachers.

Abstract Prostate cancer (PC) is a frequent neoplasm among men. This study aimed to determine the awareness level of Lebanese men on PC in terms of knowledge, attitude, and practice (KAP). This was a cross-sectional online based survey, conducted on Lebanese men between April and December 2021. We collected data regarding socio-demographic characteristics, habits, and patient/family history of PC, and assessed the level of knowledge (27 items), attitudes (6 items) toward PC, and the level of practice related to the prostate exam and PSA test. We evaluated 844 responses. Only 4.6% of our participants demonstrated an adequate Knowledge level about PC. A greater score was achieved with participants of higher educational levels (p

Abstract Background Premenstrual syndrome (PMS) is a commonly underestimated disorder that negatively impacts a woman’s life. Medical workers, who live a more stressful life, may report an increased rate of PMS. Studies on the relationship between PMS and work-related quality of life for medical professionals are scarce, particularly in the Arab world. This study aimed to compare the frequency of PMS among medical versus non-medical workers at Zagazig University and to assess the association between PMS and their work-related quality of life. Methods A comparative cross-sectional study was conducted. The sample population consisted of 48 medical and 48 non-medical female workers aged 18–45 years from Zagazig University. The two groups filled out a questionnaire with 3 parts: sociodemographic and occupational data, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality of Life Scale (WRQL). Results Severe PMS was reported in 45.8% of medical workers versus 20.8% of non-medical workers with a statistically significant difference between both groups (p = 0.009). Binary logistic regression showed that being a medical worker, clinical specialty, ≥ 8 years of work, ≥ 24 working hours per week, and having a non-set hourly schedule were predictors for severe PMS. PMS was found to be a statistically significant predictor of poor WRQL (p

Abstract Background Since the onset of the coronavirus (COVID-19) pandemic crisis, the supplement market has consistently grown. Therefore, we conducted this survey during the fourth wave of the COVID-19 pandemic to study the frequency and context of dietary supplement (DS) consumption (vitamins and mineral intake) and explore the consumer’s pharmaceutical buying behaviour; and (3) to study its determinants as regards the demographics, Fatigue Severity Scale (FSS), and healthy eating pyramids. Methods We conducted a cross-sectional web-based survey on 1333 Arabic adults aged 18 years or more residing in six Arabic-speaking countries in May 2022, using a validated self-administrated questionnaire. The survey-involved questions about sociodemographic characteristics, physical activity, FSS, healthy eating pyramid, DS consumption, and consumers’ pharmaceutical purchasing behaviour. Results Most participants were aged 20 to less than 35 years, and 64.6% used dietary supplements. There was a statistically significant difference between supplement users and nonusers as regards consumers’ pharmaceutical buying behaviour in terms of advertising quality, safety rules, pharmaceutical forms, and packet quality. Arabic adults consumed the following dietary supplements: 63.5% vitamin C, 60.1% vitamin D, 47.1% iron, and 44.4% zinc. Authorised products (76.0%), natural contents (75.0%), and safety rules (68%), were the most common factors influencing Arabic consumers’ pharmaceutical purchasing behavior. Multi-logistic regression analysis showed that being female, having a history of COVID-19, having a positive attitude about the benefits, and being recommended for supplement use were predictors of dietary supplement use. Conclusion The dietary consumption of supplements is prevalent, mainly including vitamin C, vitamin D, iron, zinc, vitamin B, and magnesium. In addition, Arabic adults are poorly adherent to healthy eating pyramids. Given the ongoing COVID-19 pandemic, Arabic health authorities should prioritize this issue to minimize the potential for misusing dietary supplements.

Objectives: To perform a budget impact analysis (BIA) of the adoption of baricitinib for the management of alopecia areata (AA) by a Saudi public sector payer. Methods: A BIA model was developed to calculate the expected financial impact under two scenarios: the baseline scenario, which reflects the current mix of treatments without baricitinib, and the projected scenario, in which baricitinib is adopted. The model assumed that patients with severe AA and those with mild-to-moderate AA who did not respond to other treatments were eligible for baricitinib treatment. The model input was based on published evidence, expert opinions, and the Saudi Expert Consensus Statement on the Diagnosis and Management of AA. Results: Assuming a hypothetical total eligible population of 368 patients received different AA treatments over the 12-months study period. The aggregated 5-years cost in the baseline scenario was SR 5,836,616. Upon the introduction of baricitinib as an alternative treatment for severe AA, the projected aggregated budget impact was SR 7,473,138. Sensitivity analysis showed that the results were most sensitive to AA prevalence, percentage of severe AA, and predicted market share for baricitinib over the 5-year time horizon. Conclusion: The addition of baricitinib to formularies is likely to increase the cost impact from a government hospital perspective. However, this addition expands the treatment options for patients with AA and may result in improved outcomes. Future cost-effectiveness analyses are recommended to estimate the cost per incremental improvement in the outcomes.

Solid tumours in the tail of the pancreas may present a diagnostic dilemma if the clinical history, imaging features or cytology is not conclusive. The common differential diagnoses for a pancreatic tail mass are a primary malignancy, neuroendocrine tumour or a retroperitoneal tumour. However a comparison to the adjacent spleen on imaging may help identify aberrant splenic tissue. We present the case of an incidental finding of a solid tumour in the tail of the pancreas, which was resected and a histological diagnosis of an intrapancreatic spleen (IPAS) was made. A suspicion of IPAS when reviewing the imaging may have prevented the resection of a benign tumour.

Abstract Background Evaluating nurses’ professional competence is critical for ensuring high-quality patient care. Therefore, this study aimed to evaluate the nurses’ professional competence level and to identify differences based on demographics in three West Bank hospitals. Methods A cross-sectional design was used, and a convenient sample of 206 nurses participated in the study. The Nurse Professional Competence (NPC) Scale was used to assess the competency level. The investigator distributed the questionnaire and explained the aim of the research. Consent forms were signed before the data collection. Results The average competency level was 79% (SD = 11.5), with 90% being professionally competent nurses. The average “nursing care” competency was 79% (SD = 12.98), and the competency level in providing value-based care was 80% (SD = 13.35). The average competency level in technical and medical care was 78% (SD = 13.45), whereas 79% (SD = 12.85) was the average competence level in “Care Pedagogics” and “Documentation and Administration “. The average competence level in the development and leadership subscale was 78% (SD = 12.22). Nurses who attended three to five workshops had a higher level of Nursing Care Competency, (H = 11.98, p = 0.003), and were more competent in value-based care (H = 9.29, p = 0.01); in pedagogical care and patient education (H = 15.16, P = 0.001); and in providing medical and technical care (H = 12.37, p = 0.002). Nurses attending more than five workshops were more competent in documentation and administration (H = 12.55, p = 0.002), and in development and leadership subscale ( H = 7.96, p = 0.20). Conclusion The study revealed that participants lacked development and leadership skills. Engagement in workshops positively impacted the level of competencies among nurses. Notably, those attending more than five workshops exhibited greater competence in documentation, administration, development, and leadership in nursing care. Implications This study emphasized the role of continuing education in improving nurses’ competencies and highlighted the need to conduct the study at a wider aspect to involve more hospitals with various affiliations to help structure more sensitive professional development and adopt the competencies as an integral part of staff development.

Abstract Background Postpartum depression (PPD) affects around 10% of women, or 1 in 7 women, after giving birth. Undiagnosed PPD was observed among 50% of mothers. PPD has an unfavorable relationship with women’s functioning, marital and personal relationships, the quality of the mother-infant connection, and the social, behavioral, and cognitive development of children. We aim to determine the frequency of PPD and explore associated determinants or predictors (demographic, obstetric, infant-related, and psychosocial factors) and coping strategies from June to August 2023 in six countries. Methods An analytical cross-sectional study included a total of 674 mothers who visited primary health care centers (PHCs) in Egypt, Yemen, Iraq, India, Ghana, and Syria. They were asked to complete self-administered assessments using the Edinburgh Postnatal Depression Scale (EPDS). The data underwent logistic regression analysis using SPSS-IBM 27 to list potential factors that could predict PPD. Results The overall frequency of PPD in the total sample was 92(13.6%). It ranged from 2.3% in Syria to 26% in Ghana. Only 42 (6.2%) were diagnosed. Multiple logistic regression analysis revealed there were significant predictors of PPD. These factors included having unhealthy baby adjusted odds ratio (aOR) of 11.685, 95% CI: 1.405–97.139, p = 0.023), having a precious baby (aOR 7.717, 95% CI: 1.822–32.689, p = 0.006), who don’t receive support (aOR 9.784, 95% CI: 5.373–17.816, p = 0.001), and those who are suffering from PPD. However, being married and comfortable discussing mental health with family relatives are significant protective factors (aOR = 0.141 (95% CI: 0.04–0.494; p = 0.002) and (aOR = 0.369, 95% CI: 0.146–0.933, p = 0.035), respectively. Conclusion The frequency of PPD among the mothers varied significantly across different countries. PPD has many protective and potential factors. We recommend further research and screenings of PPD for all mothers to promote the well-being of the mothers and create a favorable environment for the newborn and all family members.

Abstract Background Earth’s climate changes are progressing at an alarming rate. One of the most severe effects of climate change is extreme heat. This study aimed to assess knowledge and adaptation behavior to heat-related illness (HRI) among solid waste disposal workers in the 10th of Ramadan City, Egypt, and to study the predictors for their knowledge and adaptation behavior. Methods An exploratory cross-sectional study was conducted on 220 solid waste disposal workers. A structured interview questionnaire was used to assess the studied workers’ sociodemographic and occupational characteristics, heat exposure risk, and their knowledge, and adaptation behavior. Results The results showed that 40% and 30% of participants had adequate levels of total knowledge and adaptation behavior, respectively. There was a statistically significant relationship between workers’ knowledge and both age and education. There was a statistically significant relationship between workers’ adaptation behavior and age, duration of employment, working hours, and education. A binary logistic regression for significant predictors of knowledge and adaptation behavior showed that age and education were the most significant predictors. Conclusion Solid waste disposal workers were at high risk of HRI due to their low levels of knowledge and adaptation behavior regarding HRI. Educational health programs that guide workers to follow healthy behaviors and prevent HRI are recommended.

Appendicoliths can drop into the peritoneal cavity during the course of an appendicectomy, or more commonly as a result of perforated appendicitis. We report the case of a patient with a history of recurrent retrohepatic abscesses over 7-year period due to a retained appendicolith and review the literature on perihepatic abscesses caused by retained appendicoliths. The abscess had been drained percutaneously 4 times without retrieval of the appendicolith and eventually the patient needed a laparotomy, drainage of the abscess, and extraction of the appendicolith. Treatment of abscesses secondary to dropped appendicoliths may be percutaneous, laparoscopic, or via conventional open surgery, but it is important to retrieve the appendicolith if recurrent abscess formation is to be avoided.

Rasheed K Ibdah,1 Khaled J Zaitoun,2 Rana B Altawalbeh,2 Saad H Tayyem,2 Ulla A Nazzal,2 Sukaina I Rawashdeh,1 Yousef S Khader,3 Abdel-Hameed W Al-Mistarehi,4 Basheer Y Khassawneh5 1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; 2Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; 3Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; 4School of Medicine, Johns Hopkins Hospital, Baltimore, MD, 21287, USA; 5Department of Internal Medicine, Jordan University of Science and Technology, Irbid, 22110, JordanCorrespondence: Khaled J Zaitoun, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan, Tel +962798652961, Email kjzaitoun20@med.just.eud.joBackground: Obstructive Sleep Apnea (OSA) is a common respiratory disorder that causes intermittent upper airway collapse during sleep and can lead to various acute cardiovascular complications. Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of cardiovascular hospitalization and all-cause mortality. Our study aimed to investigate the prevalence of individuals with AF and those considered at high risk for OSA.Methods: A cross-sectional study was conducted with a population comprising patients who had visited KAUH cardiology clinics between 2017– 2019; subjects were categorized into AF patients and general cardiology patients. Patients were surveyed for OSA using the Berlin Questionnaire to assess the degree of OSA symptoms and to classify patients into high- or low-risk groups based on their responses.Results: Of the 656 patients, 545 met our inclusion criteria, of whom 192 were diagnosed with AF. Comparable demographic characteristics were observed between the AF and non-AF groups, barring higher rates of obesity (p=0.001) and smoking (p=0.042) in the AF group. The prevalence of high-risk OSA was significantly higher in AF patients (68.2%) compared to non-AF patients (29.4%), with an adjusted odds ratio of 2.473 times (95% CI: 1.434 − 4.266, p=0.001) greater for AF. The age, gender, and BMI categories did not differ significantly between the two groups. Binary logistic regression revealed significant associations between OSA and risk factors such as asthma (OR=4.408, 95% CI: 2.634– 7.376, p=0.001).Conclusion: These results serve to display a statistically significant increase in high-risk OSA in existing AF patients, irrespective of the presence of conventional OSA risk factors; this could imply a more immediate and direct relationship between both diseases and calls to include routine screening for OSA in patients diagnosed, newly or otherwise, with AF.Keywords: Berlin questionnaire, polysomnography, cross sectional study

Background and Aims: Decoding pancreatic ductal adenocarcinoma heterogeneity and the consequent therapeutic selection remains a challenge. We aimed to characterize epigenetically regulated pathways involved in pancreatic ductal adenocarcinoma progression. Methods: Global DNA methylation analysis in pancreatic cancer patient tissues and cell lines was performed to identify differentially methylated genes. Targeted bisulfite sequencing and in vitro methylation reporter assays were employed to investigate the direct link between site-specific methylation and transcriptional regulation. A series of in vitro loss-of-function and gain-of function studies and in vivo xenograft and the KPC (LSL-KrasG12D/+; LSL-Trp53R172H/+; Pdx1-Cre) mouse models were used to assess pancreatic cancer cell properties. Gene and protein expression analyses were performed in 3 different cohorts of pancreatic cancer patients and correlated to clinicopathological parameters. Results: We identify Hepatocyte Nuclear Factor 4A (HNF4A) as a novel target of hypermethylation in pancreatic cancer and demonstrate that site-specific proximal promoter methylation drives HNF4A transcriptional repression. Expression analyses in patients indicate the methylation-associated suppression of HNF4A expression in pancreatic cancer tissues. In vitro and in vivo studies reveal that HNF4A is a novel tumor suppressor in pancreatic cancer, regulating cancer growth and aggressiveness. As evidenced in both the KPC mouse model and human pancreatic cancer tissues, HNF4A expression declines significantly in the early stages of the disease. Most importantly, HNF4 loss correlates with poor overall patient survival. Conclusion: HNF4A silencing, mediated by promoter DNA methylation, drives pancreatic cancer development and aggressiveness leading to poor patient survival.

Background: Poor survival outcomes in periampullary cancer highlight the need for improvement in biomarkers and the development of novel therapies. Redox proteins, including the thioredoxin system, play vital roles in cellular antioxidant systems. Methods: In this retrospective study, thioredoxin (Trx), thioredoxin-interacting protein (TxNIP), and thioredoxin reductase (TrxR) protein expression was assessed in 85 patients with pancreatic ductal adenocarcinoma (PDAC) and 145 patients with distal bile duct or ampullary carcinoma using conventional immunohistochemistry. Results: In patients with PDAC, high cytoplasmic TrxR expression was significantly associated with lymph node metastasis (p = 0.033). High cytoplasmic and nuclear Trx expression was significantly associated with better overall survival (p = 0.018 and p = 0.006, respectively), and nuclear Trx expression remained significant in multivariate Cox regression analysis (p < 0.0001). In distal bile duct and ampullary carcinomas, high nuclear TrxR expression was associated with vascular (p = 0.001) and perineural (p = 0.021) invasion, and low cytoplasmic TxNIP expression was associated with perineural invasion (p = 0.025). High cytoplasmic TxNIP expression was significantly associated with better overall survival (p = 0.0002), which remained significant in multivariate Cox regression analysis (p = 0.013). Conclusions: These findings demonstrate the prognostic importance of Trx system protein expression in periampullary cancers.

Olive mill wastewater (OMW) poses a significant environmental challenge and health concern in olive-producing countries, including Jordan. Surfactant micelles are frequently employed as solubilizing agents to enhance the water solubility of chemical compounds. This study aims to leverage the sodium dodecyl sulfate (SDS) micelles in a multi-step process to detoxify OMW for agricultural and industrial uses and reduce its impact. The OMW was treated in multiple steps: screening, coagulation with different chemicals, and distillation with different surfactants. The treatment steps were monitored using LC–MS, GC–MS, ICP–MS, chemical oxygen demand contents, and total phenolic compounds. The detoxification of OMW was evaluated using standard germination assays, MTT assays using tissue culture, and toxicity assays using fluorescence bacteria. Following the treatment, the seed growth rate improved significantly from 0% to 100%. The GC–MS revealed a substantial decrease in pollutants. The concentration of polyphenols was reduced to 2.5%, while the COD level decreased to 35%. The toxicity in bacteria was significantly reduced in a time-dependent manner, and the toxicity in human cells decreased by 95%. Additionally, between 50% and 95% of metals in OMW were removed. The multi-step SDS-based approach successfully detoxified the OMW and enhanced water quality, which would pave the road for its direct application in industry and agriculture.

Abstract Background The prevalence of eosinophilic asthma in Lebanon, one of the most severe phenotypes among severe asthma, is not known. This study aimed at determining the prevalence of the eosinophilic phenotype defined as an eosinophil count ≥ 300 cells/mm3 among severe asthma patients in Lebanon. Methods The Lebanese Chapter of the PREPARE study was a national, multicenter, cross-sectional observational study. Patients aged ≥ 12 years with severe asthma were identified and prospectively enrolled during clinic visits and completed the Global Initiative for Asthma (GINA) assessment of asthma control questionnaire. Patients’ health characteristics were collected from medical records and blood samples were obtained for measurement of serum IgE levels and blood eosinophils count. Results Overall, 101 patients (with mean age of 46.3 ± 17.0 years and 73.27% females) with severe asthma were included and, among them, 37% had eosinophilic phenotype, 67.3% had atopic phenotype with IgE > 100 IU/mL and 25.7% patients had overlapping atopic and eosinophilic phenotypes. Close to 80% had late-onset asthma, beyond 12 years of age, and around 85% had at least one severe exacerbation in the 12 months prior to study enrolment. The majority of participants [64.4%] had uncontrolled asthma, 24.7% had partially controlled symptoms and 10.9% had controlled symptoms. 19.8% of participants were on chronic oral corticosteroids, 78.2% had short course treatment of corticosteroids and all were prescribed a combination of inhaled corticosteroids and long-acting beta-agonist. Conclusions The majority of patients with severe asthma were uncontrolled of which 37% present with an eosinophilic phenotype, which should be taken into consideration for better management of these patients in view of the novel phenotype-specific therapeutic options.

BackgroundThe impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data.MethodsThe researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries.ResultsApproximately 678 responses were received, mainly between 18–25 years (46.7%) and 26–36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students.ConclusionControlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.